 |
 |
 |
 |
 |
 |
 |
|
Statement of The American
Psychological Association
The American Psychological Association (APA) is the world’s largest scientific and professional organization representing psychology. APA's membership includes more 159,000 researchers, educators, clinicians, consultants, and students. APA's mission is to advance psychology as a science, as a profession, and as a means of promoting human welfare. APA's members participate in a range of programs covered in the Fiscal Year 2001 appropriations bill, ranging from behavioral research funded by the National Institutes of Health to the provision of services through programs in the Substance Abuse and Mental Health Services Administration to the training of health professionals by the Health Resources and Services Administration. In particular, we are concerned about the disproportionate rates of disease, morbidity, and mortality experienced by ethnic minorities in this country. Their reduced access to quality, affordable, timely, and culturally competent health and mental health services, together with their socioeconomic status, significantly compromises their overall health status. These disparities cannot be eliminated without recognizing the critical role of behavioral and social science research. Research on health and behavior helps to determine how attributes of habit, personality, and social environment contribute to the development and course of disease, and to establish practical behavioral strategies to reduce disease risk and to assist in preventing, improving, and managing illness. Six of the ten leading causes of death are behaviorally based, i.e., diet, substance abuse, HIV/AIDS, smoking, violence, and accidents. In addition, many behavioral factors are now known to increase individuals' risk for disease, physical disability, and early death. These factors include physical inactivity; obesity; anxiety, traits of anger or hostility; depression; and diverse social or environmental variables (e.g., low socioeconomic status, inadequate social support, and life stress). Abundant research shows that tobacco and alcohol consumption, obesity, inadequate physical activity, unprotected sex, and poor nutrition place individuals at risk for many diseases, including cancer and heart disease, diabetes, stroke, disease of the liver and lung, and AIDS. NATIONAL INSTITUTES OF HEALTH (NIH) APA is pleased that the Administration has proposed a 5.6 percent increase for NIH for Fiscal Year 2001, but we encourage Congress to continue on the path to doubling NIH’s budget by 2003. As a member of the Ad Hoc Group for Biomedical Research Funding and the Coalition for Health Funding, APA supports a 15% increase for NIH. We are pleased that research to help eliminate health disparities in minority populations is one of NIH’s top four priorities for Fiscal Year 2001. Below are some specific examples of the contributions of NIH-funded behavioral research toward reducing health disparities, and the challenges that additional funds will allow NIH to address. Dietary intervention research at the National Cancer Institute (NCI)--The Native Nutrition Circles project is a four-year program based at the Center for American Indian Research and Education (CAIRE). The goal of the project is to develop a culturally appropriate nutrition education intervention that is designed to strengthen positive food habits and modify nutritionally harmful ones, with the long range goal of reducing the risk of cancer and other diseases in the American Indian populations. A second project targets pre-adolescents in schools serving predominantly low income Hispanic families. It seeks to address the crucial question of whether an overall intervention can have an impact on pre-adolescent obesity. The comparatively higher prevalence of obesity among Hispanic Americans coupled with diets that are relatively higher in fat and lower in fiber may place Hispanic Americans at increased risk of cancer. The students in the study will receive interventions during both their fourth and fifth grade years. Behavioral research has demonstrated that while difficult, it is certainly possible to influence and change diet in high risk groups, but many factors influence the extent to which these changes are integrated and reinforced in the community. These two NCI projects will refine that knowledge in two important subpopulations. Reducing Risk of Sudden Infant Death Syndrome-- In the five years since the National Institute for Child Health and Human Development launched the national Back to Sleep campaign, which urges caretakers to place infants on their backs to sleep, deaths due to Sudden Infant Death Syndrome (SIDS) have dropped by 38 percent. Despite this significant success, challenges remain. Both the SIDS rate and the rate of stomach sleeping among African-Americans infants are more than double those rates for white infants. To address this marked disparity, the NICHD joined hands with leaders from a number of national African-American organizations to develop and implement strategies for reducing SIDS in African-Americans. Their goal is to eliminate the racial disparity in infant back sleeping position within three years. Reducing the Risk of HIV Transmission-- The HIV/AIDS epidemic in the United States continues to evolve. While the incidence of new AIDS cases has declined, HIV infection rates are continuing to climb in a number of population subgroups such as women, racial and ethnic minorities, young homosexual men, people older than 50 years of age, and individuals with addictive disorders. African Americans and Hispanics accounted for 45 percent and 20 percent, respectively, of all newly diagnosed AIDS cases in 1998. Research has shown that behavioral change can successfully prevent or reduce the spread of HIV/AIDS. A better understanding, however, is needed of how to actually change behavior prior to HIV transmission, including how to maintain protective behaviors once they are adopted. We are far from realizing the full potential of prevention research on a global scale. Projects funded by the National Institute of Mental Health (NIMH), NIDA and other institutes are focusing on these issues. Office of Behavioral and Social Sciences Research—Thanks to the leadership of this committee, OBSSR has grown steadily in its five years of existence. We thank you recognizing the important work of the Office to seed trans-NIH initiatives that move forward important areas of behavioral and social science research. The OBSSR’s current budget is $19.86 million. The President’s request for FY 2001 provides no increase for the Office’s budget. APA supports an appropriation of $21.84 million for OBSSR in FY 2001, an increase of 10 percent. A 10 percent increase would enhance the OBSSR’s ability to coordinate research and training programs across the NIH institutes. Such an increase would allow the Office to augment its efforts to enhance NIH’s portfolio of this needed research, including an initiative on the links between socioeconomic status and health. One of OBSSR’s most important areas of concentration has been behavioral intervention research. An additional 10 percent for its budget would allow the OBSSR to support research toward the development of effective interventions for maintaining a healthy diet, getting an adequate amount of exercise, abstaining from tobacco and alcohol use, and other risky behaviors Additional funds would make it possible for OBSSR to focus on the other end of the research continuum: on basic behavioral and social sciences research in areas such as memory, emotions, or animal models of stress. By its nature, basic research generates knowledge that may be applied in any number of areas. This research is funded by several NIH institutes, as is appropriate. There may be areas of focus that could benefit from trans-NIH initiatives. Center for Research on Minority Health--While APA supports the elevation of the National Institutes of Health Office of Research on Minority Health to Center status, it is critical that the new Center be adequately funded to carry out the full scope of its mission and to collaborate with the Office of Behavioral and Social Sciences Research. Therefore, APA supports an additional $50 million above the President's request for the Center for Research on Minority Health. Women and their families, particularly those of color, living with HIV/AIDS experience significant challenges accessing health and mental health care. APA supports increased funds to the Department of Health and Human Services’ (HHS) Office of Women's Health to support activities and programs to develop tools and services, including behavioral and psychosocial, to assist women in navigating complex health care delivery systems to link them to various entry points for care. These activities will address and incorporate geographic differences, racial and ethnic disparities, and linguistic competency, among other factors. APA supports the recommendations of the Institute of Medicine's 1999 report on "Lesbian Health: Current Assessment and Directions for the Future." We urge the Committee to support the development of an agenda by the Public Health Service's Office of Women's Health and NIH's Office of Research on Women's Health for expanding opportunities for research on lesbian health, particularly at NIH and the CDC, including within existing programs. CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) Youth Violence Prevention. CDC plays a critical role in the development of culturally responsive interventions and programs through evaluation research and demonstrations to address the disparities in morbidity among racial and ethnic minorities attributable to violence. APA recognizes the importance of CDC’s ongoing initiative to carry out a multi-site demonstration project involving the most effective culturally sensitive school- and family-based interventions to prevent youth violence. Additional funding is needed to expand opportunities for participation in the interventions and to carry out a full-scale evaluation by expanding the number of schools involved in the project. APA also recognizes the need for national surveillance efforts for uniform data collection and monitoring of injuries, deaths, and behavioral risk factors associated with youth and school violence and firearm-related violence. APA encourages the Committee to include funding for extramural research to promote the development of expertise from under-represented racial and ethnic populations in violence prevention research at universities throughout the nation. To carry out these critically needed youth violence prevention efforts, APA recommends an increase of $40 million for CDC. Suicide Prevention. Suicide is the eighth-leading cause of death overall and the third leading cause of death among young people, ages 10 to 24. APA is pleased that the CDC continues to participate with the Surgeon General to develop and implement the National Strategy for the Prevention of Suicide. APA urges CDC to evaluate the efficacy of suicide prevention programs and to establish regional resource centers to provide technical assistance to states, schools, community organizations, and the health professions to identify and implement effective programs for those at significant risk for suicide, including African American males, American Indians/Alaska Natives, young adolescents and the elderly. APA recommends an additional $40 million for these CDC suicide prevention efforts. Preventing Violence against Women. APA lauds CDC for its efforts to enhance services for women who are victims of violence and to begin to change social norms that contribute to this problem. APA recommends that CDC receive the $5 million increase requested in the President’s budget to bring a focus on prevention and early intervention of violence against women through demonstration projects, to evaluate programs that address violence against women, and to provide information on effective interventions to service providers. Preventing Child Maltreatment. APA urges the Committee to support
$10 million in increased funding for CDC’s child maltreatment
prevention initiatives to begin to improve information on child
maltreatment through mechanisms such as state-based surveillance, the
development of uniform definitions, and survey information from victims
and perpetrators. This additional funding would also help to support the
evaluation and dissemination of effective interventions and include
funds for the development and distribution of an evaluation primer, a
resource guide for evaluating child maltreatment interventions, and
educational materials on child maltreatment prevention. SAMHSA has provided innovative federal leadership in the prevention, early intervention, treatment, and rehabilitation of mental disorders and substance abuse. APA urges the Committee to support the following initiatives within the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Prevention (CSAP). Children’s Mental Health Services. The increasing number of young children diagnosed with mental disorders, the rising teen suicide rate, and the recent incidents of school violence are all indicators that our nation’s children and youth have serious unmet mental health needs. There are three excellent vehicles for addressing these needs within SAMHSA: the Children’s Mental Health programs, Targeted Capacity Expansion, and the Safe Schools/Healthy Students initiative. APA recommends that the Committee provide $100 million for the Comprehensive Community Mental Health Services for Children and their Families so that it may continue to develop and evaluate mental health services for children and youth. The additional funding would allow for the expansion of the program into new states and localities. APA applauds the Committee’s foresight in creating the Safe Schools/Healthy Students initiative as part of the federal response to the crisis of school-based violence. APA recommends that the Committee provide $250 million to the Departments of Health and Human Services, Justice, and Education so that they can continue working together to develop empirically supported programs to prevent youth violence and to intervene with families, schools, and communities where violence has already occurred. APA also recommends that the Committee provide $30 million for Targeted Capacity Expansion activities to develop and implement empirically based models for prevention and early intervention for mental health problems. APA recognizes that such services can prevent or reduce the need for more intensive services in certain individuals. Minority Fellowship Program (MFP). The Surgeon General’s Report on Mental Health acknowledged the shortage of minority mental health professionals and specifically recommended increased training funds to expand the pool of qualified professionals. SAMHSA’s Minority Fellowship Program (MFP) attempts to address this need. The MFP is the only program designed to train ethnic minority mental health professionals in the areas of psychology, psychiatry, nursing, and social work. Research clearly demonstrates a direct relationship between increased numbers of ethnic minority mental health professionals hired and increased service utilization by ethnic minorities. APA strongly urges the Committee to allocate $5 million to train minority mental health professionals. HIV/AIDS Mental Health Services Demonstration Projects. Although over $1 billion is directed in the federal budget to combating HIV/AIDS, no new funding is currently targeted for critically needed mental health services. Accordingly, APA urges the Committee to reinstate the $1 million in funding for CMHS to enhance outreach efforts and to address the mental health needs of increasingly at-risk populations for HIV/AIDS. Center for Substance Abuse and Prevention (CSAP). CSAP’s primary responsibility is to reduce substance abuse by supporting programs designed to prevent substance abuse and bridge the gap between research and practice. The United States has an estimated 5.7 million hard-core users of heroin, crack, cocaine, and methamphetamine. Only 2.1 million people receive treatment, which means that 3.6 million people never receive services. Since FY1997, funding for CSAP’s KDA and Targeted Capacity Expansion (TCE) program has been cut by $21 million. APA urges the Committee to reinstate the $21 million cut from CSAP since FY 1997. INDIAN HEALTH SERVICE (IHS) --Although suicide claims more lives than homicide, our nation has failed to adopt a national strategy to combat this crisis. The Surgeon General in 1999 took a significant step in addressing this issue by releasing his "Call to Action to Prevent Suicide." For the past 15 years, suicide has been the second leading cause of death for 15- to 24-year-old American Indians and Alaska Natives. The suicide rate for this age group is 31.7 per 100,000, as compared to a rate of 13.0 per 100,000 for persons in this age group for all races in the U.S. population. A number of suicide prevention programs, such as the Zuni Life-Skills program, have been implemented and shown to be effective. APA recommends appropriating $5 million for the establishment of a
National Suicide Prevention Center funded by IHS, SAMHSA, CDC and NIMH. The
goal of the Center would be to develop community partnerships, provide
grants, support developing knowledge, conduct analysis of
state-of-the-art- practices, and disseminate and transfer information
related to suicide prevention. Social Services Block Grant--Children, people with disabilities, and older Americans are among the most vulnerable members of our society. The Social Services Block Grant provides a flexible funding stream enabling states to serve these vulnerable groups in a way that is most appropriate for each jurisdiction. APA urges the Committee to fund the Social Services Block Grant at its authorized level of $2.38 billion. ADMINISTRATION ON AGING--Suicide, depression, and Alzheimer’s disease are among the most devastating problems older Americans face. APA requests that the Committee provide $10 million to the Administration on Aging to address this concern through the State and Local Innovations and Projects of National Significance. The funding is to support projects to improve assessment and referral of older persons for mental health services and to improve the capacity of the mental health system to provide appropriate, accessible, and quality mental health services for older Americans. AGENCY FOR HEALTH CARE RESEARCH AND QUALITY-- APA endorses the Friends of AHRQ recommendation of $300M for the Agency for Healthcare Research and Quality (AHRQ) in FY 01, an increase of $50M over the President’s request. Recent reports from both the Institute of Medicine (IoM) and the Quality Interagency Coordination (QuIC) Task Force have identified a critical role for human factors research in improving patient safety. AHRQ has been designated the coordinating agency for this ambitious research agenda through the formation of a Center for Quality Improvement and Patient Safety. APA recognizes that government efforts to improve safety will require building new partnerships with human factors researchers and adopting new human factors methods. However, we also recognize that these areas of expertise are outside the realm of most medical and healthcare organizations. Therefore, APA recommends that AHRQ direct $1 million for a contract with the National Academy of Sciences (NAS) Committee on Human Factors to conduct a study to advise AHRQ on how to integrate human factors techniques, activities and expertise into their research strategy, planning, and evaluation. The NAS study should consider different models for integrating human factors into federal and state agencies' responses to the patient safety crisis. Such a study should include examples of both the successful and unsuccessful integration of human factors in federally funded research, development, acquisition and application programs. Again, we appreciate the opportunity to submit this statement for the record. Please contact APA's Public Policy Office with any questions or concerns about this statement.
|
750 First Street, NE, Washington, DC 20002-4242
Telephone: 800-374-2721; 202-336-5500. TDD/TTY: 202-336-6123
PsychNET® | Contact | Terms of Use | Privacy Policy | Security | Advertise with us