The Runaway and Homeless Youth and Trafficking Prevention Act - Research Proposal Example

HEALTH POLICY PAPER Lecturer: Contents Introduction to the problem 3 of the proposed Bill 3 Contact and Discussion regarding the selected Bill with a respondent 4 Discussion of proposed Bill 5 Health Status 6 Access to Care 7 Health Disparities 9 Cost of Care and Cost-Effectiveness 10 Position of possible opposition 12 Summary, Recommendations and Conclusions 12 Introduction to the problem The constitution of the United States (US) guarantees equal rights and freedom for all. As far as the health sector is concerned however, Scherl and Macht (2009) wondered if such provisions in the constitution can be claimed to be universal. This is because as far as health care provision is concerned, most Americans are noted to be deprived of basic healthcare (Bassuk et al., 2011). According to Depastino (2013) deprivation of healthcare to the ordinary citizen may come in many different forms. The most ranked forms of healthcare deprivation have however been noted to include limited access, inability to afford, and general disparity in the distribution of healthcare resources (Rochefort, 2014). Coupled with these problems is a trend where a particular group of citizens have been noted to be constantly worse hit when it comes to inequality or deprivation of healthcare. Specific example of such group is the homeless. Homelessness has been part of the US for a very long time but the phenomenon is known to have surged in times following the American Civil War and moments during the 1930s during and after the Great Depression (Feldman, 2013). Even though the phenomenon has been there ever since, one aspect of homelessness that continues to be less discussed and catered for is the provision of quality health care to homeless people. It is part of this that the S.2646 - Runaway and Homeless Youth and Trafficking Prevention Act became necessary in 2013 and now. Description of the proposed Bill The Runaway and Homeless Youth and Trafficking Prevention Act is a US bill still under discussion and yet to be passed into law. It was tabled in motion in 2013 with Sen. Patrick Leahy as its sponsor and having 22 other cosponsors. The actual date of sponsorship and introduction is however known to be July 23, 2014. The bill entered Congress under the code of 113th Congress (2013-2014) and was introduced by law but is yet to become law. As it is now, the Runaway and Homeless Youth and Trafficking Prevention Act is yet to pass Senate, pass House, and get to the President. Several short titles are given to the bill, including “Runaway and Homeless Youth and Trafficking Prevention Act”, “Combat Human Trafficking Act of 2014” and “Justice for Victims of Trafficking Act of 2014”. The official title for the bill is however known to be “A bill to reauthorize the Runaway and Homeless Youth Act, and for other purposes”. Even though generally considered under the subject policy area of Social Welfare, there are several significant bearings of the bill to health. Up to date, there have been 6 actions in all since the bill entered Congress, 2 of which are considered major actions. The first major action was when the committee on the Judiciary under the sponsor presented an unwritten report. The second was the actual introduction in Senate (S.2646). Contact and Discussion regarding the selected Bill with a respondent As a very new bill that has not passed Senate yet, it would be expected that information on the bill is very limited. This creates the need to contact someone or a group of people who can be considered insiders at Congress to help with more information and discussion regarding the Runaway and Homeless Youth Act. In the light of this, the research paper had a primary data collection procedure which involved the need to engage the sponsor or other cosponsors in a discussion. As part of this, a number people were emailed for their approval to be part of an interview. Some of the prominent people to whom emails were sent include ………………….. The primary data collection or discussion was preferred to take place as an interview due to the advantages that interview offers in collecting in-depth information about an issue, which in this case was the Runaway and Homeless Youth and Trafficking Prevention Act. A major advantage with the use of interview is that it offers instant feedback between the interviewer and the interviewee. This is something that cannot be achieved when other forms of data collection approaches such as questionnaires are used. Again, interview allows for interviewers to clarify questions to interviewees whiles interviewees are also offered the chance to clarify their answers well to the interviewer. The data collection and discussion took place through a formal interview. This means that there were specifically selected questions, which were well documented and presented to the respondents. In this instance, the questions presented to the respondents bordered on the health aspects of the Runaway and Homeless Youth and Trafficking Prevention Act. As indicated earlier, there are several components of the bill that focus on health care for the homeless. Below are some of the questions that were presented to them. 1. How does the proposed bill differ from the Runaway and Homeless Youth Act through FY2019? 2. What weaknesses with the Runaway and Homeless Youth Act through FY2019 would you say the current bill comes to address? 3. What has been the overall response of the lawmakers since the bill was introduced? 4. What assurance is there for the homeless that this will not be another law that is least enforced to bring pragmatic changes to their state of livelihood? 5. What key health statuses of the vulnerable groups are captured in the bill? 6. In what ways will the passing of the bill into law help improve access of health care for the homeless? 7. In what ways does the bill address health disparities among Americans? 8. What provisions are made in the bill to address the all important subject of cost of care and cost effectiveness? Discussion of proposed Bill Based on available secondary data and what fell out of the interview, some important findings and discussions can be made. These are in the areas of health status addressed by the bill, access to care, health disparities, cost of care or cost effectiveness, and position of possible opposition to the bill. Health Status Ahead of the proposed Runaway and Homeless Youth and Trafficking Prevention Act, there was the Runaway and Homeless Youth Act through FY2019, which had been operational since 2009. Several health critiques however saw limitations with the latter, making it necessary for there to be a more proactive law. Most aspects of critique focus on the definition of health status of beneficiaries. This is because the existing Act only focuses on the overall classification of social welfare needs of the vulnerable without making any clear distinction on health (Nunez, 2011). Meanwhile, Marjorie (2008) noted that people’s vulnerable status such as being runaway and homeless makes them prone to specific health cases, which makes the need for specifications important. The proposed bill seeks to address this limitation on the health status of the vulnerable by giving very clear and distinct definition of some health status of the homeless and runaway. For example in section 103 of the proposed bill, the need for there to be local centers that provide trauma-informed services is clearly stated. Explaining why the issue of trauma may be an important health issue for the homeless, Gabbard et al. (2013) explained that the social deprivation given to the homeless causes mental depression, which makes them prone to psychological trauma. Once such forms of psychological traumas are not controlled through the provision of professional health assistance, it leads to repulsive social acts from these vulnerable people, including suicide, robbery and rape (Depastino, 2013). Another important health status that is focused on by the proposed bill is mental health service, which is captured under section 104. Under section 104, it is required that the Transitional Living Grant (TLG) Program given to long-term residential services will be increased so as to ensure that professional mental health services are offered to homeless people diagnosed to be needing them. In a study by Scherl and Macht (2009), it was discovered that greater percentage of homeless people in the US are people with some degree of mental health problems. In most cases, these people are either rejected by their families or they run away from their families as a way of avoiding possible abuse, including intellectual abuse (Rochefort, 2014). In a related study, Harman (2014) mentioned that most people with mental health problems run away from their homes in order to avoid admission to mental health facilities. But as they become homeless and end up on the streets, their mental health conditions become worsened. It is therefore important and a step in the right direction that the proposed act focuses on the provision of distinctive health service to those with mental health problems. Another important health status under the propose bill is sexual abuse prevention and treatment, which is a form of health issue which cannot be denied for homeless people. This is because greater forms of sexual abuse are performed against the homeless, making incidents of sexually transmitted diseases higher among this vulnerable population (Marjorie, 2008). Access to Care Borus (2001) criticized most laws in the US which are made for the provision of health care to the vulnerable as lacking the modalities needed to make the actual delivery of healthcare possible. It is in the light of this that the proposed bill, which is the Runaway and Homeless Youth and Trafficking Prevention Act seeks to make very clear provisions on ways in which the proposed healthcare opportunities defined for the vulnerable population can be implemented. One of the ways in which the proposed bill addresses this all important issue is by focusing on the access to care for the homeless. Certainly, where there are no provisions made to make healthcare accessible, there is no way that the targeted population which in this case are the homeless can benefit from the bill when it finally becomes law (Feldman, 2013). A typical example of way in which the proposed bill addresses the issue of access to care is by ensuring that the provisions that come under health are taken as close to the vulnerable population as possible. It would be noted that the bill proposes the establishment of social centers where the homeless will be made to reside for different durations of time. It is within these social centers that the provisions of the forms of health care defined earlier are expected to be focused. As the provisions made on healthcare are taken to the social centers, the identified homeless would not have to travel any distance or undergo any special protocols to receive the stipulated forms of healthcare. With this said, there are those who have raised objections as to whether this arrangement alone helps to make healthcare accessible to the homeless. This is because when the social centers are established, it would take only those homeless people who are identified from their homeless places on the streets and taken to the social centers to receive the health benefits. There are therefore those who have already raised objections about the bill and how it addresses access to health. For example Bogard (2011) stated that any form of comprehensive access to healthcare to the homeless must be in such a way that it easily captures the vulnerable people without any intermediate action being made to get the healthcare through. With this said it should be possible to make provisions that ensure that any person who can be identified as being homeless can easily enter a health facility and receive healthcare. Those who support the Runaway and Homeless Youth and Trafficking Prevention Act have however argued that for the immediately mentioned access to care intervention to work, it would require a nationwide increase and improvement in the number of healthcare facilities. But as this will be difficult to achieve even in the medium term, it only makes sense that a few social centers will first be targeted so that the care for the homeless and other homeless people can be brought ahead of what could wait. Health Disparities Another phenomenon that has been noted to fight against the provision of healthcare to the vulnerable is health disparities. In a study by Bassuk et al. (2011), it was argued that most forms of health disparities are associated with the cost of care. This is because there are healthcare programs that tend to distinguish between the forms of care given to people based on how much they pay. Out of this, there are those who receive premium health care, ordinary care, and disadvantaged healthcare. Very unfortunately, Gabbard et al. (2013) observed that those people who cannot afford premium or advanced care are those within the vulnerable population and other lower socioeconomic status who have the most need of services rendered under premium care. What this means is that those who need the premium services are those who cannot afford these. Rather, those whose socioeconomic status ensures that they live relatively stable health lifestyles and thus require minimal emergency and other premium services are those to whom premium services are given because they can afford these. Under the Runaway and Homeless Youth and Trafficking Prevention Act, health disparities are supposed to be addressed by ensuring that the real issue of funding of healthcare is taken away from the service users who are the vulnerable people and placed on the government. Under section 105 of the Runaway and Homeless Youth and Trafficking Prevention Act, it is expected that federal agencies will coordinate health activities by providing grants for service projects including healthcare. Linking this to the discussion on access to care, it can be deduced that those homeless people who will be in the social centers and thus be receiving accessible care will not be disadvantaged on the subject of how much they are able to personally afford. This is because the real issue of cost which has always created the disparity in the provision of care will be catered for when funding is undertaken by the federal agencies. Also under section 106, there are very specific groups of homeless people who are mentioned to receive healthcare under the Secretary of Health and Human Services (HHS). These include the sexually abused and those under sexually abused prevention programs. This is indeed a step in the right direction when it comes to addressing disparities in health. This is because Nunez (2011) identified cases of disparity in healthcare against the sexually abused in a report where most sexually abused people were said to be withdrawn from their social settings, making them reluctant to seek health support after their ordeal. To most of these people therefore, seeking health care after going through sexual ordeals would amount to exposing themselves to public ridicule. Cost of Care and Cost-Effectiveness Most of the provisions made under the proposed bill to cater for disparity in care seem to be the same that cares for the cost of care. This is because the fundamental provisions for cost of care as defined under section 105 and section 106 ensures that the vulnerable people who are the homeless will not be the people to be responsible for the cost of health care they receive. By so doing, the issue of affordability becomes totally catered for. This is because it no longer becomes the responsibility of vulnerable people to cater for cost of healthcare. This provision has however been met with a number of criticisms. For example there are those who question the sufficiency of proposed cost of care to be allocated to the vulnerable. As realized in the study of Bogard (2011), it is one thing deciding to cater for the cost of health of a person and another thing providing sufficient funds to cover the total health needs of the vulnerable. For example under section 7 of the bill, one of the provisions that the government is expected to put in place to avoid waste by promoting accountability is to ensure that there is a limitation of $20,000 of conference expenditures to the HHS, which of course includes the cost of healthcare. This situation has raised debates as to whether free provision of care should be the best way to approach cost of care and cost effectiveness. There are a number of ways in which the proposed bill seeks to cater for cost effectiveness in healthcare provision to the homeless. As noted by Borus (2001), no amount of funds allocated for the healthcare of the vulnerable will be sufficient when the funds are not effectively managed. In most public portfolios where funds have been given to bodies and agencies to ensure their distribution, instances of fraud, malfeasance and corruption have hampered against the effective utilization of the funds. To fight against such forms of ineffectiveness and inefficiencies, the proposed bill provides that under section 107, accountability will be ensured by having “audits of grant recipients to prevent waste, fraud, and abuse of grant funds”. It is also expected that there will be “disqualification of nonprofit organizations holding money in offshore accounts”, whiles enforcing “a prohibition on use of grant funds for lobbying HHS for the award of grant funding” (S.2646). The rationale behind these provisions is because when the wastes are avoided within the allocated funds there can be enough to provide dedicated health services to the homeless. This is because even though the homeless people as the end users are expected to receive the healthcare for free, their financiers who are the agencies and HHS are actually expected to pay for just as other ordinary people will pay for their healthcare. With this said, unless there is enough savings made on the dedicated amount, it will be difficult providing quality care. Position of possible opposition Like most other bills that have gone through Congress, there is the possibility that some opposition will be raised against key areas of the bill. It is therefore important that right at the onset, some of these possible oppositions will be identified and rightly catered for. One position that possible opponents may take with the issue of healthcare for the homeless under the Runaway and Homeless Youth and Trafficking Prevention Act is the quality of care. It would be noticed that through the various sections of the Runaway and Homeless Youth and Trafficking Prevention Act, proponents of the bill seem to focus more on accessibility and cost. Meanwhile, in a study by Harman (2014), it was emphasized that quality of healthcare is an important outcome of healthcare delivery which nullifies all other components of care when it is lacking. What this means is that even when healthcare is made accessible and provided at the cheapest cost available but it is not quality, healthcare users cannot be assured of the expected outcome of healthcare provision, which is improved health. As very clear provisions are made on how to capture the different health needs of the homeless people, improve accessibility of care to them, and ensure affordability, it is also important that there will be specifications on the level of provisions of care which guarantees quality healthcare to these vulnerable people. Summary, Recommendations and Conclusions The Runaway and Homeless Youth and Trafficking Prevention Act has been noted to be an advanced bill which has been proposed and introduced in Congress to reauthorize the existing the Runaway and Homeless Youth Act through FY2019. As reauthorization, it is generally expected that the new proposal will find areas of inadequacies with the existing law and try to address the inadequacies. As far as the discussions so far are concerned, it can be said that enough provisions have been put in place to ensure that the most inadequacies are addressed. For example, the proposed bill highlights on health status of the homeless, where three major health issues are identified to be peculiar with this population. The health issues are psychological trauma, mental health problems and sexual health problems. Again, the proposed bill highlights on the issue of accessibility of healthcare to the homeless. One way in which the proposed bill seeks to address accessibility is by ensuring that healthcare services will be given right at the social centers where the homeless are expected to be lodged over a period of time. It must be stated however that there are those who have criticized this approach to addressing accessibility, saying it is not all homeless people who will make their way to the social centers. Last but not least, the bill has provisions made for cost of care and cost effectiveness, where agencies are expected to be funded to provide free healthcare to the homeless. From the major findings made from the discussions and the research paper, there are a number of recommendations that can be made. First, it will be recommended that if the accessibility to care will be focused on the provision of healthcare at the social centers, it will be important to expand programs that put as many homeless people as possible at the social centers. Until this is done, it will be better to have a policy amendment that ensures that homeless people who are not admitted to the social centers can also access healthcare freely. The second suggestion made is for the argument on quality of healthcare to be centered round the philosophies of healthcare provision. What this means is that service providers such as doctors and nurses must be made to appreciate the provision of quality healthcare to the vulnerable as a social responsibility. Once this philosophy is developed, health service providers will be more determined to deliver quality healthcare without primarily focusing on how much they get in return for this as far as monetary reward is concerned. To conclude, it would be said that the Runaway and Homeless Youth and Trafficking Prevention Act is a step in the right direction, as far as the promotion of health of the homeless is concerned. It will therefore be important that the bill goes through all stages of law making successfully to become a law in the US. References Bassuk, E.L., et al. (2011) Americas Youngest Outcasts: 2010 Needham, MA: The National Center on Family Homelessness Bogard, C. J. (2011). Advocacy and Enumeration: Counting Homeless People in a Suburban Community. American Behavioral Scientist September, 45(1), 1 105-120. Borus J. F. (2001). Sounding Board. De-institutionalization of the chronically mentally ill. N. Engl. J. Med. 305 (6): 339–342. Depastino, T. (2013). Citizen Hobo: How a Century of Homelessness Shaped America. Chicago : University of Chicago Press Feldman S (2013). Out of the hospital, onto the streets: the overselling of benevolence. Hastings Cent Rep 33 (3): 5–7. Gabbard, W. J. et al. (2013). Methodological Issues in Enumerating Homeless Individuals. Journal of Social Distress and the Homeless, 16(2), 90-103 Harman, D. (2014). Read all about it: street papers flourish across the US. The Christian Science Monitor, 116(3), 67–79 Marjorie K. M. (2008). Controlling Misbehavior in England,1370–1600. London: Cambridge University Press. Nunez, R. (2011). Family Homelessness in New York City: A Case Study. Political Science Quarterly, 116(3), 367–379 Rochefort D. A. (2014). Origins of the "Third psychiatric revolution: the Community Mental Health Centers Act of 1963. J Health Polit Policy Law, 9 (1): 1–30. S.2646. (2014). Runaway and Homeless Youth and Trafficking Prevention Act. Retrieved November 21, 2014 from https://www.congress.gov/bill/113th-congress/senate-bill/2646 Scherl D.J. and Macht L. B. (2009). Deinstitutionalization in the absence of consensus. Hosp Community Psychiatry 30 (9), 599–604 Read More