At some mental health treatment facilities, children who misbehave risk being tackled, sat upon, and dragged to "seclusion rooms." That's not the case at the Lakeside Treatment and Learning Center, a nonprofit residential treatment facility for emotionally and behaviorally impaired children and About a decade ago, the center's leaders realized that those types of restraint and seclusion techniques not only put their clients at risk of injury or even death but also were counterproductive. To avoid retraumatizing already troubled children, staff faced with problematic behavior these days first try strategies designed to calm clients and de-escalate conflicts. They only resort to seclusion or a restraint technique with great reluctance. Even more important, staff members work to prevent certain behaviors from occurring in the first place. "Our agency is moving away from a Acculturation Increases Risk for Foreign-born youth report lower rates of substance use than U.S.-born youth, but their risk for substance use increases the longer they live in the United States, according to the findings of a new SAMHSA study published in a recent issue of the American Journal of Public Health. The article, "Substance Use Among Foreign-Born Youths in the United States: Does the Length of Residence Matter?" is written by Joseph C. Gfroerer and Lucilla L. Tan of SAMHSA's Office of Applied Studies. The authors discovered that foreign-born youth who had lived in the United States less than 5 years had lower prevalences of substance use than young people who were born in the United States. Yet, prevalence estimates for foreign-born youth who had lived in the United States for 10 years or longer were not significantly different than estimates for U.S.-born youth, except that U.S.-born youth reported substantially higher rates of heavy alcohol use. Odds Ratio 9.809 The study reinforces the results of "A better understanding of these results could be gained by studying how acculturation interacts with known risk and protective factors for substance use," the authors state in the article. "Research in this area should help prevention planners design programs that appropriately consider acculturation to reduce substance use among immigrant youth." Acculturation within U.S. society occurs through interaction with parents and peers, education, and exposure to television, movies, magazines, and other media-each of which may influence a young person's attitudes about substance use. The authors suggest that youth who are more fluent in English may have more access to substances of abuse because they are more familiar with ways to find and obtain substances of abuse in the community. For example, prevalence estimates for Hispanics were higher among those who responded in English than those who answered questions in Spanish. The study was based on a sample of 50,947 young people who participated in SAMHSA'S 1999 and 2000 National Household Survey on Drug Abuse, an ongoing nationally representative survey of the civilian, noninstitutional population age 12 and older. Respondents could answer questions in either English or Spanish. Some 7.1 percent of those in the sample were foreign-born, and of those, 28.4 percent were born in Mexico, 5.1 percent in Germany, 4.6 percent in the Philippines, and 3.0 percent in India, Vietnam, and Korea (North and South). D Ready for HIPAA? SAMHSA Can Help Many Americans have had some personal experience with the Federal Government's Health Insurance Portability and Accountability Act (HIPAA). To ensure privacy, for example, they may have been asked to stand farther away from a customer in line to pick up prescriptions at the pharmacy counter. Or, they've been asked by their physician's office staff to read a "Notice of Privacy Practices" and to sign an acknowledgment of receipt of that information. "While these may be small dayto-day changes, they reflect larger changes taking place behind the scenes that will benefit everyone," says Sarah A. Wattenberg, L.C.S.W.-C, a public health advisor at SAMHSA'S Center for Substance Abuse Treatment (CSAT) and the SAMHSA HIPAA Coordinator. HIPAA can be complex at times, but the U.S. Department of Health and Human Services (HHS) is working hard to develop resources that can help people better understand the requirements, and SAMHSA is contributing to these efforts. Streamlining the System HIPAA was born out of frustration with the inefficiency and spiraling costs-of the Nation's health care system. As a result of the Act, passed in 1996, HHS was required to create regulations for the electronic exchange of certain kinds of health information and for the security and privacy of that information. Some of the regulations, promulgated over several years, include the following: Standards for Electronic Transactions and Code Sets Rule and its Modifications Rule, which had a compliance date of October 16, 2002 (the Administrative Simplification Compliance Act extended this HEALTH Security Rule, with a compliance date of April 21, 2005. (The additional year for small health plans for Transactions and Code Sets and its Modifications ended October 16, 2003.) Three types of "covered entities" are subject to HIPAA: health plans, health care clearinghouses that health care providers and plans can use to process and submit their transaction data in a HIPAA-approved manner, and health care providers who electronically exchange health information for which HIPAA has adopted a particular standard. Covered entities must comply with all HIPAA standards, not just one or two. In addition, business associates of covered entities who have contact with a patient's health information are required to sign contracts agreeing to protect that information. Business associates could identify an individual, whether the Electronic Until now, every health care organization had its own codes for billing and other types of transactions. The result was babel, with health insurers and providers unable to use the same language to "talk to each other." To create a common language, HIPAA's electronic transaction regulations require covered entities to use a standardized content and format when transmitting certain health care information electronically. Standards have been adopted so far for the exchange of information related to plan eligibility, health plan enrollment and disenrollment, premium payments, referral certification and authorization, claims and encounter information, claim status, payment and remittance advice, and benefit coordination. A National Code Standard code sets for diagnosis and treatment have not existed up to this point. States have typically used "home-grown" codes for treatment procedures. Now, HIPAA requires that national, uniform codes be used. Certain code sets have been adopted by the HHS Secretary as national standards: the International Classification of Diseases, continued on page 4 19 473 AA M61 1078 Either way, Dr. Manderscheid's advice is the same: caveat emptor (buyer beware). "The burden of proof concerning the accuracy of the data ultimately lies with the provider or plan,” he explains. Providers who go the software route should consult SAMHSA's handbooks for each of the eight electronic transactions to ensure that they're meeting the standards. (See "Resources," p. 4.) Protecting Privacy "Before HIPAA, patients were very concerned about how the general health care system was handling information about them," says Ms. Wattenberg. "In fact, in 1999, the California HealthCare Foundation conducted a survey and found that one out of seven Americans reported evasive actions to avoid inappropriate use of their health care information. For example, someone wouldn't tell the truth to their primary care physician about a chronic physical condition for fear the information might get back to their employer," says Ms. Wattenberg. "That's a pretty upsetting statistic. It means that patients may not be giving their doctors important health information that's needed for appropriate and effective treatment," she added. For this reason, HIPAA requires that covered entities obtain authorization from patients before they use or disclose information. This applies unless otherwise allowed by the Privacy Rule, such as, for While some providers may be able to adapt existing systems to comply with HIPAA's electronic transactions provision, most will need outside help. example, information can be shared without authorization for treatment (so that your physician can discuss your x-rays with another provider, like a radiologist); for payment (e.g., so that information can be used to process claims); or for operations (e.g., so that information can be used or disclosed to oversee the quality of the health care you are receiving). Among other requirements, covered entities also need to establish privacy policies, put privacy safeguards in place, train staff, designate a privacy officer, and establish a grievance process. Consumers of health care services also have new rights under HIPAA and they need to be informed of these rights. For example, patients can review their medical records, make a copy of the records, and request changes. "Mental health and substance abuse treatment providers should not have a hard Before HIPAA, patients were very concerned about how the general health care system was handling information about them. time complying with HIPAA's privacy rule," says Ms. Wattenberg. "For mental health providers, state laws and professional ethics have always dictated high standards for protecting the sensitive information treatment providers create or receive about their clients." "For substance abuse providers, most treatment programs have been required for decades to comply with the Federal Confidentiality of Alcohol and Drug Abuse Patient Records regulation, 42 C.F.R. Part 2," says senior program management officer Captain Ann G. Mahony, M.P.H., of CSAT's Division of Systems Improvement. "Covered entities should read both laws together," she advises. When HIPAA conflicts with the "Part 2" regulations or with state laws, the more stringent rule applies. Patients will enjoy even more protection when HIPAA's security standard goes into effect. The standard will require covered entities to assign a security officer who will be responsible for conducting risk assessments and other measures to assure the integrity, confidentiality, and availability of identifiable health information that covered entities store, maintain, or transmit. For more information on HIPAA, visit SAMHSA's Web site at www.hipaa .samhsa.gov. -By Rebecca A. Clay |