Time taken off from work. May be classified separately as employee sick leave,
personal days, mental health days, jury duty, vacation, holidays, family
illness or bereavement, Family and Medical Leave Act, workers compensation
program days, short-term disability, or long-term disability. Substance abuse
program theory should be used to determine which of these types of absenteeism
are appropriate for analysis of the impact of a substance abuse prevention or
early intervention program. Absenteeism does not include telecommuting and
The extent to which services are available for individuals who need care. Ease
of access depends on several factors, including availability and location of
appropriate care and services, transportation, hours of operation, and cultural
factors, including languages and cultural appropriateness. For many populations
access also includes insurance coverage.
The extent to which an individual who needs care and services is able to
receive them. Access is more than having insurance coverage or the ability to
pay for services. It is also determined by the availability of services,
acceptability of services, cultural appropriateness, location, hours of
operation, transportation needs, and cost.
Services that are affordable, located nearby, and open during evenings and
weekends. Staff is sensitive to and incorporates individual and cultural
values. Staff is also sensitive to barriers that may keep a person from getting
help. For example, an adolescent may be more willing to attend a support group
meeting in a church or club near home than to travel to a mental health center.
An accessible service can handle consumer demand without placing people on a
long waiting list.
An official decision made by a recognized organization that a health care plan,
network, or other delivery system complies with applicable standards.
Includes art, dance, music, recreational and occupational therapies, and
Medical treatment rendered to individuals whose illnesses or health problems
are life- threatening or debilitating, requiring immediate response, and are
short-term or episodic in nature. Acute care facilities are those hospitals
that predominantly serve persons requiring these kinds of services.
A chronic, relapsing disease characterized by compulsive drug-seeking and abuse
and by long-lasting chemical changes in the brain.
The number of persons admitted, readmitted, or transferred to a specified
service during the reporting period.
Adjusted Community Rating (ACR)
A community rating impacted by group- specific demographics and the group's
prior experience. Also known as prospective rating.
Costs not linked directly to the provision of medical care. Includes marketing,
claims processing, billing, and medical record keeping, among others.
Administrative Services Only Organization (ASO)
A healthcare organization that provides administrative support services only
for a self-funded plan or startup MCO.
A tendency for utilization of health services in a population group to be
higher than average. From an insurance perspective, adverse selection occurs
when persons with poorer-than-average life expectancy or health status apply
for, or continue, insurance coverage to a greater extent than do persons with
average or better health expectations.
AIDS (Acquired Immune Deficiency Syndrome)
The final and most serious stage of HIV disease, which causes severe damage to
the immune system. The Centers for Disease Control has defined AIDS as
beginning when a person with HIV infection has a CD4 cell (also called
"t-cell", a type of immune cell) count below 200. It is also defined by
numerous opportunistic infections and cancers that occur in the presence of HIV
infection. AIDS is the fifth leading cause of death among persons between ages
25 and 44 in the United States. About 47 million people worldwide have been
infected with HIV since the start of the epidemic. The Human Immunodeficiency
Virus (HIV) causes AIDS. The virus attacks the immune system and leaves the
body vulnerable to a variety of life- threatening illnesses and cancers. Common
bacteria, yeast, parasites, and viruses that ordinarily do not cause serious
disease in people with fully functional immune systems can cause fatal
illnesses in people with AIDS. Most individuals infected with HIV will progress
to AIDS, if not treated. However, there is a tiny group of patients who develop
AIDS very slowly or never at all. These patients are called non-progressors and
many seem to have a genetic difference which prevents the virus from attaching
to certain immune receptors. The symptoms of AIDS are primarily the result of
infections that do not normally develop in individuals with healthy immune
systems. These are called "opportunistic infections." Patients with AIDS have
had their immune system depleted by HIV and are very susceptible to such
opportunistic infections. Common symptoms are fevers, sweats (particularly at
night), swollen glands, chills, weakness, and weight loss.
A liquid distilled product of fermented fruits, grains and vegetables. Used as
solvent, antiseptic and sedative. Moderate potential for abuse. Also know as
booze, juice, brew, vino, and sauce.
Alcohol Abuse During Pregnancy
Alcohol Abuse During Pregnancy is dangerous. Alcohol can have a number of
harmful effects on the baby. The baby can be born mentally retarded or with
learning and behavioral problems that last a lifetime. We don't know exactly
how much alcohol is required to cause these problems. We do know, however, that
these alcohol-related birth defects are 100- percent preventable, simply by not
drinking alcohol during pregnancy. The safest course for women who are pregnant
or trying to become pregnant is not to drink alcohol at all.
Alcohol Dependence, also known as "alcoholism," is a disease that includes four
symptoms: * Craving: A strong need, or compulsion, to drink. * Loss of control:
The inability to limit one's drinking on any given occasion. * Physical
dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and
anxiety, occur when alcohol use is stopped after a period of heavy drinking. *
Tolerance: The need to drink greater amounts of alcohol in order to "get high."
People who are not alcoholic sometimes do not understand why an alcoholic can't
just "use a little willpower" to stop drinking. However, alcoholism has little
to do with willpower. Alcoholics are in the grip of a powerful "craving," or
uncontrollable need, for alcohol that overrides their ability to stop drinking.
This need can be as strong as the need for food or water. Although some people
are able to recover from alcoholism without help, the majority of alcoholics
need assistance. With treatment and support, many individuals are able to stop
drinking and rebuild their lives. Many people wonder why some individuals can
use alcohol without problems but others cannot. One important reason has to do
with genetics. Scientists have found that having an alcoholic family member
makes it more likely that if you choose to drink you too may develop
alcoholism. Genes, however, are not the whole story. In fact, scientists now
believe that certain factors in a person's environment influence whether a
person with a genetic risk for alcoholism ever develops the disease. A person's
risk for developing alcoholism can increase based on the person's environment,
including where and how he or she lives; family, friends, and culture; peer
pressure; and even how easy it is to get alcohol.
Usually occurs in adults, but it may happen in adolescents as well. It occurs
when a person who uses alcohol excessively suddenly stops the alcohol use. The
withdrawal usually occurs within 5-10 hours after the decrease in alcohol
intake, but it may occur up to 7- 10 days later. Excessive alcohol use is
generally considered the equivalent of 2-6 pints of beer (or 4 oz of "hard"
alcohol) per day for one week or habitual use of alcohol that disrupts a
person's life and routines. The likelihood of developing alcohol withdrawal
symptoms increases as the number and frequency of drinks increase. The
likelihood of developing severe withdrawal symptoms also increases if a person
has other medical problems.
See Alcohol Dependence
An alternative approach to mental health care is one that emphasizes the
interrelationship between mind, body, and spirit. Although some alternative
approaches have a long history, many remain controversial.
Alzheimer's Disease (AD)
A slowly progressive form of dementia, which is a progressive, acquired
impairment of intellectual functions. Memory impairment is a necessary feature
for the diagnosis. Change in one of the following areas must also be present
for any form of dementia to be diagnosed: language, decision-making ability,
judgment, attention, and other related areas of cognitive function and
personality. The rate of progression is different for each person. If AD
develops rapidly, it is likely to continue to progress rapidly. If it has been
slow to progress, it will likely continue on a slow course. The cause of
Alzheimer's disease (AD) is not known, but it is not a part of normal aging.
Prior theories regarding the accumulation of aluminum, lead, mercury, and other
substances in the brain have been disproved. A diagnosis of AD is made based on
characteristic symptoms and by excluding other causes of dementia. It can be
confirmed by microscopic examination of a sample of brain tissue after death.
By causing both structural and chemical problems in the brain, AD appears to
disconnect areas of the brain that normally work together. There are two types
of AD -- early onset and late onset. In early onset AD, symptoms first appear
before age 60. Some early onset disease runs in families and involves autosomal
dominant, inherited mutations that may be the cause of the disease. So far,
three early onset genes have been identified. Early onset AD is less common,
resulting in about 5-10% of cases. Late onset AD, the most common form of the
disease, develops in people 60 and older and is thought to be less likely to
occur in families. Late onset AD may run in some families, but the role of
genes is less direct and definitive. These genes may not cause the problem
itself, but simply increase the likelihood of formation of plaques and tangles
or other AD-related pathologies in the brain. In the early stages, the symptoms
may be very subtle. Symptoms may often include: repeating statements
frequently, frequently misplacing items, trouble finding names for familiar
objects, getting lost on familiar routes, personality changes, becoming passive
and losing interest in things previously enjoyed. AD cannot be cured and the
impaired functions cannot be restored. Currently, the progression can be slowed
but not stopped. Treatment focuses on attempting to slow the progression;
managing the behavior problems, confusion, and agitation; modifying the home
environment; and most importantly, supporting the family. As the disease
progresses, it may take a greater toll on the family than the patient.
All types of health services provided on an outpatient basis, in contrast to
services provided in the home or to persons who are inpatients. While many
inpatients may be ambulatory, the term ambulatory care usually implies that the
patient must travel to a location to receive services that do not require an
American Indian or Alaska Native
A person having origins in any of the original peoples of North and South
America (including Central America), and who maintains tribal affiliations or
Stimulant drugs whose effects are very similar to cocaine. Amphetamine,
dextroamphetamine, methamphetamine, and their various salts are collectively
referred to as amphetamines. In fact, their chemical properties and actions are
so similar that even experienced users have difficulty knowing which drug they
have taken. Methamphetamine is the most commonly abused.
A group of medications that reduce pain. Some of these medicines are also used
just before or during an operation to help the anesthetic work better. Codeine
and hydrocodone are also used to relieve coughing. Methadone is also used to
help some people control their dependence on heroin or other narcotics.
Narcotic analgesics may also be used for other conditions as determined by your
doctor. Narcotic analgesics act in the central nervous system (CNS) to relieve
pain. Some of their side effects are also caused by actions in the CNS. These
medicines are available only with your medical doctor's or dentist's
prescription. For some of them, prescriptions cannot be refilled and you must
obtain a new prescription from your medical doctor or dentist each time you
need the medicine. In addition, other rules and regulations may apply when
methadone is used to treat narcotic dependence.
An eating disorder characterized by refusal to maintain a minimally accepted
body weight, intense fear of weight gain, and distorted body image. Inadequate
calorie intake or excessive energy expenditure results in severe weight loss.
The exact cause of this disorder is not known, but social attitudes towards
body appearance and family factors are believed to play a role in its
development. The condition usually occurs in adolescence or young adulthood. It
is more common in women, affecting 1-2% of the female population and only
0.1-0.2% of males. Anorexia is seen mainly in Caucasian women who are high
academic achievers and have a goal-oriented family or personality. However,
this eating disorder is not more common in higher socioeconomic groups. Some
experts have suggested that conflicts within a family may also contribute to
anorexia. It is thoughts that anorexia is a way for a child to draw attention
away from marital problems, for example, and bring the family back together.
Other psychologists have suggested that anorexia may be an attempt by young
women to gain control and separate from their mothers. The causes, however, are
still not well understood. The purpose of treatment is first to restore normal
body weight and eating habits, and then attempt to resolve psychological
issues. Hospitalization may be indicated in some cases (usually when body
weight falls below 30% of expected weight). Supportive care by health care
providers, structured behavioral therapy, psychotherapy, and anti-depressant
drug therapy are some of the methods that are used for treatment. Severe and
life-threatening malnutrition may require intravenous feeding.
Antioxidant vitamins -- E, C and beta carotene (a form of vitamin A) -- have
potential health-promoting properties. Much research has recently focused on
how antioxidant vitamins may reduce cardiovascular disease risk. Oxidation of
low- density lipoprotein (LDL or "bad") cholesterol is important in the
development of fatty buildups in the arteries. This process, called
atherosclerosis can lead to heart attacks and strokes. Increasing evidence
suggests that LDL cholesterol lipoprotein oxidation and its biological effects
can be prevented by using antioxidants-both in the diet and in supplements.
These data are from various sources: basic science, epidemiology, experiments
in animals and clinical investigations, including limited clinical trials. The
strongest evidence for using naturally occurring antioxidants to protect
against the development of cardiovascular disease is for vitamin E. It's
weakest for vitamin C. Data on the role of beta carotene are limited. High
intakes of vitamin E have been associated with a lower risk of coronary artery
disease (CAD) incidence, based on epidemiological studies. Animal studies also
suggest that vitamin E can slow the development of atherosclerosis. Further,
vitamin E inhibits LDL cholesterol oxidation in test tube experiments and in
human studies. Some epidemiological studies suggest that vitamin C, which also
inhibits lipoprotein oxidation, is associated with reduced rates of clinical
CAD. Beta carotene doesn't seem to inhibit LDL cholesterol oxidation, but early
data suggest that it may reduce further clinical events in people who have CAD.
One should not recommend using dietary supplements of antioxidants to prevent
cardiovascular disease until their effect is proved in clinical trials that
directly test their impact on CVD end points. This caution is because the doses
of these antioxidants that inhibited LDL cholesterol oxidation in some studies
are much larger than can be achieved by diet alone. Beneficial effects must be
demonstrated in randomized, placebo-controlled clinical trials before
recommending widespread use to prevent cardiovascular disease.
Anxiety is an emotion that can signal just the right response to a situation.
It can spur you on, for example, to add the finishing touches that transform an
essay, painting, or important work document from good to excellent. However, if
you have an anxiety disorder, exaggerated anxiety can stop you cold and disrupt
your life. Like many other illnesses, anxiety disorders often have an
underlying biological cause and frequently run in families. Anxiety disorders
range from feelings of uneasiness to immobilizing bouts of terror. Symptoms
range from chronic, exaggerated worry, tension, and irritability and appear to
have no cause or are more intense than the situation warrants. Physical signs,
such as restlessness, trouble falling or staying asleep, headaches, trembling,
twitching, muscle tension, or sweating, often accompany these psychological
symptoms. Anxiety is among the most common, most treatable mental disorders.
Effective treatments include cognitive behavioral therapy, relaxation
techniques, and biofeedback to control muscle tension. Medication, most
commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also
may be required in some cases. Some commonly prescribed anti-anxiety
medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine
anti-anxiety medication buspirone can be helpful for some individuals.
Anxiety disorders range from feelings of uneasiness to immobilizing bouts of
terror. Most people experience anxiety at some point in their lives and some
nervousness in anticipation of a real situation. However if a person cannot
shake unwarranted worries, or if the feelings are jarring to the point of
avoiding everyday activities, he or she most likely has an anxiety disorder.
Any willing provider
A requirement that a health plan contract for the delivery of health care
services with any provider in the area who would like to provide such services
to the plan's enrollees.
Designed to meet the specific needs of each individual child and family. For
example, one family may need day treatment, while another may need home-based
services. Appropriate services for one child and family may not be appropriate
for another. Appropriate services usually are provided in the child's
The extent to which a particular procedure, treatment, test, or service is
clearly indicated, not excessive, adequate in quantity, and provided in the
setting best suited to a patient's or member's needs. (See also, medically
A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent including, for example, Cambodia,
China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands,
Thailand, and Vietnam.
Assertive Community Treatment
A multi-disciplinary clinical team approach of providing 24-hour, intensive
community services in the individual's natural setting that help individuals
with serious mental illness live in the community.
A professional review of child and family needs that is done when services are
first sought from a caregiver. The assessment of the child includes a review of
physical and mental health, intelligence, school performance, family situation,
and behavior in the community. The assessment identifies the strengths of the
child and family. Together, the caregiver and family decide what kind of
treatment and supports, if any, are needed.
A situation in which a healthcare organization is vulnerable to providing or
paying for the delivery of more services than are received through premiums or
per capita payments.
Attention Deficit Hyperactivity Disorder(ADD-ADHD)
Attention Deficit Hyperactivity Disorder (ADD-ADHD) is a neurobiological
condition characterized by developmentally inappropriate level of attention,
concentration, activity, distractability, and impulsivity. The symptoms
typically begin by 3 years of age-Attention deficit: does not pay close
attention to details; may make careless mistakes at work, school, or other
activities; failure to complete tasks; has difficulty maintaining attention in
tasks or play activities; does not listen when spoken to directly; has
difficulty organizing tasks; is easily distracted; unable to follow more than
one instruction at a time. Many different methods of treatment have been used
for ADD including psychotropic medications, psychosocial interventions, dietary
management, herbal and homeopathic remedies, biofeedback, meditation, and
perception stimulation/training. Of these treatment strategies, the most
research has been done on stimulant medications and psychosocial interventions.
Overall, these studies suggest stimulants to be superior relative to
psychosocial interventions. However, there is no long term information
comparing the two. The primary medications used to treat attention deficit
disorder include: Dexedrine (dextroamphetamine), Ritalin (methylphenidate),
Cylert (magnesium pemoline), tranquilizers (such as thioridazine),
alpha-adrenergic agonist (clonidine), and others. Psychosocial therapeutic
techniques include: contingency management (e.g., point reward systems, time
out...), cognitive-behavioral treatment (self monitoring, verbal self
instruction, problem solving strategies, self reinforcement), parent
counseling, individual psychotherapy.
Autism, also called autistic disorder, is a complex developmental disability
that appears in early childhood, usually before age 3. Autism prevents children
and adolescents from interacting normally with other people and affects almost
every aspect of their social and psychological development.
The automatic assignment of a person to a health insurance plan (typically done
under Medicaid plans).
Average Length of Stay
This represents the average time a client receives a specified service during a
specified time period. This is generally computed by counting all the days that
clients received the service during the time period and dividing by the number
of clients that received the service during the same period. (Days a person was
on furlough or not receiving are not counted.)
Average Payment Rate
The money that the Center for Medicare and Medicaid Services (CMS) can pay an
Drugs that fall under the depressant category and are used medicinally to
relieve anxiety, irritability, and tension. They have a high potential for
abuse and development of tolerance. Depressants produce a state of intoxication
similar to that of alcohol. When combined with alcohol, the effects are
increased and risks are multiplied. Other drugs that fall under the depressant
category include methaqualone, tranquilizers, chloral hydrate, and
Poor quality methamphetamine; methamphetamine produced in bathtubs
A managed care term that applies to the assessment and treatment of problems
related to mental health and substance abuse. Substance abuse includes abuse of
alcohol and other drugs.
A continuum of services to individuals at risk of or suffering from mental,
addictive, or other behavioral disorders
Behavioral heath care firm
Specialized (for-profit) managed care organizations focusing on mental health
and substance abuse benefits, which they term "behavioral healthcare." These
firms offer employers and public agencies a managed mental health and substance
As the name implies, behavioral therapy focuses on behavior-changing unwanted
behaviors through rewards, reinforcements, and desensitization.
Desensitization, or Exposure Therapy, is a process of confronting something
that arouses anxiety, discomfort, or fear and overcoming the unwanted
responses. Behavioral therapy often involves the cooperation of others,
especially family and close friends, to reinforce a desired behavior.
For a particular indicator or performance goal, the industry (healthcare or
non- healthcare) measure of best performance. The benchmarking process
identifies the best performance in the industry for a particular process or
outcome, determines how that performance is achieved, and applies the lessons
learned to improve performance elsewhere.
A person certified as eligible for health care services. A beneficiary may be a
dependent or a subscriber.
Benefit-cost Ratio (also known as return on investment ratio)
For workplace prevention programs, the inflation-adjusted, discounted benefits
of a program or intervention divided by the inflation-adjusted discounted costs
of providing and consuming the program. Values above 1.0 generally denote
economically attractive programs that provide more than 1 dollar in benefits
for each dollar spent on the program.
The types of healthcare and other services to be provided by an employer to
employees. The employer as primary payor can contract for the healthcare
portion of the services. The contractor arranges for delivery of healthcare
services that can include substance abuse prevention and early intervention
Bicycle Safety-wear a bike helmet. 1 out of 7 children under age 15 suffers a
head injury in a bike crash. Bike helmets can prevent head injuries. Make sure
that your bike and your children's bikes are the right size. Your child should
be able to straddle the bike with both feet on the ground. Young children
should use bikes with coaster brakes- -the kind that brake when you pedal
backwards. Before using hand brakes, a child's hands should be large enough and
strong enough to use the levers. Avoid riding at night if at all possible. Make
sure your bike has reflectors. Obey all traffic laws. Stop at stop signs, check
for traffic before turning, and ride on the same side of the road as the
automobiles do. Be predictable and ride defensively. Try to ride where drivers
of cars can see you. Bicycles are frequently involved in car accidents because
the driver of the car did not even know the bike was there. Often, accidents
occur when drivers don't pay enough attention to bikers. Many accidents have
been avoided because the biker was paying attention to the car. Never ride out
into a street without stopping first. Use the proper hand signals for turning
or stopping. Yield the right of way to pedestrians. Wear brightly colored
clothing so that motorists can easily see you. Use bike paths at all times if
Bike Helmet Safety
Bike Helmet Safety-Kids, especially 11- to 14- year-olds, are sometimes
reluctant to wear helmets. They may insist they're good riders who don't need
helmets anymore, complain that helmets are uncomfortable, or - an old favorite
- point out that none of their friends wear them. Your child may be especially
mature for her age; she may be a particularly skilled rider; or it just might
feel easier to give in. But we urge you to resist that temptation. Requiring
your children to wear a helmet every time, everywhere they go, is the best
thing you can do to protect them. If your child rides a bike, then she probably
also enjoys skateboards, scooters or inline skates! Make sure that whenever she
"wheels" around, she's wearing the right gear. Helmet Tips * Don't negotiate.
It's estimated that 75 percent of bicycle-related deaths among children could
be prevented with a bicycle helmet. * Buy a helmet that meets or exceeds
current safety standards developed by the U.S. Consumer Product Safety
Commission. * Correct fit is essential. Helmets should be comfortable and snug,
but not too tight. They shouldn't rock back and forth or side to side. * Make
sure your child wears her helmet correctly - centered on top of her head and
always with the straps buckled. Children who wear their helmets tipped back
have a 52 percent greater risk of head injury than those who wear their helmets
properly. * If your child is reluctant to wear her helmet, try letting her
choose her own. Helmets come in many colors and styles - allowing children to
choose a helmet that's "cool" may make them less likely to take it off when
you're not around. * Talk to other parents and encourage them to have their
kids wear helmets. Let your children see that you wear a helmet, too. Children
are more likely to wear helmets when riding with others who wear them.
Methamphetamine and coffee
The consumption of five or more alcoholic drinks in a row on at least one
Binge Eating is an eating disorder characterized by eating more than needed to
satisfy hunger. It is a feature of bulimia, a disorder that also includes
abnormal perception of body image, constant craving for food and binge eating,
followed by self- induced vomiting or laxative use.
Biofeedback is learning to control muscle tension and "involuntary" body
functioning, such as heart rate and skin temperature; it can be a path to
mastering one's fears. It is used in combination with, or as an alternative to,
medication to treat disorders such as anxiety, panic, and phobias.
Medication alone, or in combination with psychotherapy, has proven to be an
effective treatment for a number of emotional, behavioral, and mental
disorders. Any treatment involving medicine is a biomedical treatment. The kind
of medication a psychiatrist prescribes varies with the disorder and the
individual being treated.
A chronic disease affecting over 2 million Americans at some point in their
lives. The American Psychiatric Association's "Diagnostic and Statistical
Manual of Mental Disorders" describes two types of bipolar disorder, type I and
type II. In type I (formerly known as manic depressive disorder), there has
been at least one full manic episode. However, people with this type may also
experience episodes of major depression. In type II disorder, periods of
"hypomania" involve more attenuate (less severe) manic symptoms that alternate
with at least one major depressive episode. When the patients have an acute
exacerbation, they may be in a manic state, depressed state, or mixed state.
People who suffer from bipolar disorder, however, have pathological mood swings
from mania to depression, with a pattern of exacerbation and remission that are
sometimes cyclic. The manic phase is characterized by elevated mood,
hyperactivity, over-involvement in activities, inflated self-esteem, a tendency
to be easily distracted, and little need for sleep. The manic episodes may last
from several days to months. In the depressive phase, there is loss of
self-esteem, withdrawal, sadness, and a risk of suicide. While in either phase,
patients may abuse alcohol or other substances which worsen the symptoms. The
disorder appears between the ages of 15 and 25, and it affects men and women
equally. The exact cause is unknown, but it is a disturbance of areas of the
brain which regulate mood. There is a strong genetic component. The incidence
is higher in relatives of people with bipolar disorder. Hospitalization may be
required during an acute phase to control the symptoms and to ensure safety of
individuals. Medications to alleviate acute symptoms may include: neuroleptics
(antipsychotics), antianxiety agents (such as benzodiazepines), and
antidepressant agents. Mood stabilizers, such as lithium carbonate, and
anticonvulsants (including carbamazepine and valproic acid) are started as
maintenance therapy to relieve symptoms and to prevent relapse.
Marijuana; opium; methamphetamine
Black or African American
A person having origins in any of the black racial groups of Africa. Terms such
as "Haitian" or "Negro" can be used in addition to "Black or African American."
The types of healthcare and other services to be provided by an employer to
employees. The employer as primary payor can contract for the healthcare
portion of the services. The contractor arranges for delivery of healthcare
services that can include substance abuse prevention and early intervention
A process of repeated subsampling, with replacement, from a larger sample,
followed by analysis of each repeated subsample. Analyses with the subsample
are used to estimate variances or standard errors of variables of interest
Borderline Personality Disorder
Symptoms of borderline personality disorder, a serious mental illness, include
pervasive instability in moods, interpersonal relationships, self-image, and
behavior. The instability can affect family and work life, long-term planning,
and the individual's sense of self-identity.
Small, mobile, clandestine labs used to produce methamphetamine
An analysis designed to determine the dollar cost or the value of benefits that
would have to be assigned to make two alternative programs equally attractive
(Warner and Luce, 1982).
Marijuana; heroin; methamphetamine
An illness characterized by uncontrolled episodes of overeating usually
followed by self-induced vomiting or other purging. In bulimia, eating binges
may occur as often as several times a day. Induced vomiting known as purging
allows the eating to continue without the weight gain; it may continue until
interrupted by sleep, abdominal pain, or the presence of another person. The
person is usually aware that their eating pattern is abnormal and may
experience fear or guilt associated with the binge-purge episodes. The behavior
is usually secretive, although clues to this disorder include overactivity,
peculiar eating habits, eating rituals, and frequent weighing. Body weight is
usually normal or low, although the person may perceive themselves as
overweight. The exact cause of bulimia is unknown, but factors thought to
contribute to its development are family problems, maladaptive behavior, self-
identity conflict, and cultural overemphasis on physical appearance. Bulimia
may be associated with depression. The disorder is usually not associated with
any underlying physical problem although the behavior may be associated with
neurological or endocrine diseases. The disorder occurs most often in females
of adolescent or young adult age. The incidence is estimated to be 3% in the
general population; but 20% of college women suffers from it. Treatment focuses
on breaking the binge-purge cycles of behavior since the person is usually
aware that the behavior is abnormal. Outpatient treatment may include behavior
modification techniques and individual, group, or family counseling.
Antidepressant drugs may be indicated for some whether or not they have
Substance that exists naturally in plants. It can also be produced
synthetically and used as an additive in certain food products. It is a central
nervous system stimulant and a diuretic. Caffeine is absorbed and distributed
very quickly. After absorption, it passes into the central nervous system, or
the brain. "Caffeine sensitivity" refers to the amount of caffeine that will
produce negative side effects. This amount will vary from person to person.
Caffeine does not accumulate in the bloodstream nor is it stored in the body.
It is excreted in the urine many hours after it has been consumed. Caffeine
will not reduce the effects of alcohol, although many people still believe a
cup of coffee will "sober up" an intoxicated person. Caffeine may be used as a
treatment for migraine headaches and in relieving, for a short time, fatigue or
drowsiness. Caffeine is widely consumed. It is found naturally in the leaves,
seeds, and fruits of more than 60 plants, including tea leaves, kola nuts,
coffee, and cocoa beans. It is in coffee, tea, chocolate, cocoa and many
carbonated beverages such as colas. Caffeine is frequently added to
over-the-counter medications such as pain relievers, appetite suppressants, and
cold medicines. Caffeine has no flavor and can be removed from a food by a
chemical process called decaffeination. Excessive caffeine intake can lead to a
fast heart rate, diuresis (excessive urination), nausea and vomiting,
restlessness, anxiety, depression, tremors, and difficulty sleeping. Abrupt
withdrawal of caffeine may cause headaches, drowsiness, irritability, nausea,
vomiting, and other symptoms. Reduce caffeine intake gradually to prevent any
symptoms of withdrawal.
The NICHD recommends milk and other dairy products as a primary source of
calcium. In addition, a variety of other foods are excellent sources of calcium
as well. Dark green, leafy vegetables and foods with added calcium can be
healthy ways to get enough calcium. By eating a wide variety of foods with
calcium, you can help make sure to get the calcium you need each day.
A facility set up to handle a large volume of phone calls, often of the
customer service variety. However, call centers can be limited to either
inbound or outbound calls. For example, some sales operations have inbound-
only call centers using 1-800 technology. Call centers can be centralized or
distributed. The European Commission has supported distributed, local call
centers in order to facilitate access to work sites. Such sites are ideal for
Camping and Hiking Safety
Camping and Hiking Safety-Always bring a first aid kit when camping. Know how
to use the contents of the kit. Some situations can be made worse by using
first aid supplies incorrectly. Use the buddy-system. It is never a good idea
to camp or hike alone. If you were to become immobile because you broke a leg,
or you were to fall and get stuck, a partner could go for help. Make sure
someone knows where you plan to camp or hike. ( Teach children and remind
adults to pick out landmarks at the campsite, and when on hikes to help
recognize locations.) Be careful when exploring (always take a compass and
map). Take whistles in case you. Whistles can be heard further than your voice
will carry. Use caution when chopping wood or building fires. Dress
appropriately. Wear long-sleeved shirts and long pants to avoid bites from
ticks and other insects. In cold conditions, wear many layers of thin clothing,
along with a hat, boots and gloves. When hiking, consider tucking your pants
into your socks and boots to help protect against ticks. Take a supply of clean
drinking water and drink it. People can become dehydrated very quickly in warm,
dry, or windy conditions. Dehydration can lead to other serious complications
and should be avoided. Don't drink water unless you know it is clean. Avoid
alcoholic beverages which tend to cause dehydration. Don't touch animals out in
the wild. Don't eat wild berries and plants. Don't over-do-it when hiking.
Never leave a campfire unattended. Before leaving a campsite to return home,
make sure all fires are out and the ashes are cold. A single burning ember in a
seemingly smothered fire is enough to initiate another full blown fire.
Chemicals that help control mental and physical processes when produced
naturally by the body and that produce intoxication and other effects when
absorbed from marijuana.
The botanical name for the plant from which marijuana comes.
A method for payment to healthcare providers that is common or targeted in most
managed care arenas. Unlike the older fee-for-service arrangement, in which the
provider is paid per procedure, capitation involves a prepaid amount per month
to the provider per covered member, usually expressed as a PMPM (per member per
month) fee. The provider is then responsible for providing all contracted
services required by members of that group during that month for the fixed fee,
regardless of the actual charges incurred. In such an arrangement, the provider
is now at risk, picking up risk that the payor or employer used to have
exclusively in fee-for-service or idemnity arrangements.
A person who has special training to help people with mental health problems.
Examples include social workers, teachers, psychologists, psychiatrists, and
A strategy for employers to contract with a single provider of managed
healthcare services in which the organization providing general medical
services to employees or enrollees also provides more specialized services,
such as mental health and addiction services, under one predetermined capitated
fee. The term is typically used in reference to behavioral health services
provided by the same MCO that is providing medical services.
A strategy for the employer in contracting or providing managed care services
in which a portion of the benefit (such as a behavioral health benefit) is
separated (carved-out) from the overall medical benefit. A second organization
is contracted under a separate agreement to provide these benefits. The term
"carve-out" usually refers to a managed behavioral healthcare organization;
many HMOs and insurance companies adopt this strategy because they do not have
in-house expertise related to behavioral health. Carve-out vendors may be
specialized units within larger managed care organizations or they may be
The monitoring and coordination of treatment rendered to covered persons with a
specific diagnosis or requiring high-cost or extensive services. The goal is to
achieve optimum patient outcome in the most cost-effective manner.
An individual who organizes and coordinates services and supports for children
with mental health problems and their families. (Alternate terms: service
coordinator, advocate, and facilitator.)
The overall clinical diagnostic profile of a defined population, which
influences intensity, cost, and scope of healthcare services typically
A flat fee paid for a patient's treatment based on the diagnosis and/or
presenting problem. For this fee the provider covers all of the services the
patient requires for a specific period of time. Also referred to as "bundled
rate" or "flat fee-per-case." Very often used as an intervening step prior to
capitation. Diagnostic Related Groups (DRGs) are an example of a case rate.
Data about an event or phenomenon of interest that are unavailable for periods
of time or groups of people. For example, medical expenditures may be
unavailable for persons who switch health plans, or for time periods before or
after employment or some other event of interest, such as the employer changing
the healthcare provider.
Center for Medicare and Medicaid Services (CMS)
The Federal agency that administers the Medicare, Medicaid, and Child Health
Insurance Programs. CMS provides health insurance for more than 74 million
Americans through Medicare, Medicaid, and Child Health. The majority of these
individuals receive their benefits through the fee-for-service delivery system.
However, an increasing number are choosing managed care plans. CMS is working
to maintain and measure quality of care in managed care through HEDIS measures.
Certificate of Need
A certificate of approval issued by a governmental agency to an organization
that proposes to construct or modify a healthcare facility, incur a major
capital expenditure, or offer a new or different health service.
Crack Cocaine; amphetamine; methamphetamine
Child Dental Health
The care of the child's teeth and gums, including hygiene (brushing and
rinsing), examinations by dentists (assessing the current condition of teeth
and gums), and treatments (use of fluoride, extractions, fillings, or
orthodontics). Healthy teeth and gums are essential to overall good health.
Poor dental development, dental disease, and dental trauma can result in poor
nutrition, painful and dangerous infections, problems with speech development,
and problems with self-image. Current recommendations for dental care during
childhood include: Even though newborns and infants do not have teeth, care of
the mouth and gums is important, ask your pediatrician if and when your infant
needs fluoride added to his diet. Use a damp washcloth to wipe your infant's
gums after each meal. Do not put your infant or young child to bed with a
bottle of milk, juice, or sugar water. Use only water for bedtime bottles.
Begin using a soft toothbrush instead of the washcloth to clean your child's
teeth as soon as his first tooth shows (usually between 5-8 months of age).
Your child's first visit to the dentist should be between the time his first
tooth appears (5-8 months) and the time when all his primary teeth are visible
(before 2 1/2 years). Many dentists will recommend a "trial" visit to expose
the child to the sights, sounds, smells, and feel of the office before the
actual examination. Children who are accustomed to having their gums wipes and
teeth brushed will have fewer problems to having the dentist look inside their
mouths. Your child should brush his teeth and gums at least twice each day and
especially before bed. When permanent teeth are established, flossing his teeth
each evening before bed should be encouraged. Additional dental treatments
(such as braces or extractions) may be needed during adolescence to prevent
long-term problems. Prevent tooth damage by teaching your child to use
appropriate protective gear, safe play practices, and actions to take in case
of injuries to teeth, gums, or mouth. Regular visits to your dentist (at least
every 6 months) will ensure early recognition and treatment of problems. Proper
care will give your child healthy teeth and gums for a lifetime. As your child
becomes more active, trauma to his teeth may occur. Lost or damaged teeth
(chips, change in position) or gums should be treated as a medical emergency to
prevent infection, tooth loss, or damage to tooth, root, gums, or mouth. Even
damage to primary (first) teeth should be treated to prevent future problems
with tooth or gum development. If your child loses a GROWN-UP tooth during a
fall or other injury, you should: find the tooth, avoid touching the root, and
carefully rinse the tooth in running water (use stopper or strainer to avoid
losing the tooth down the drain). Place the clean tooth back into its hole in
your child's mouth and have your child hold the tooth in place with his
fingers, if you or your child are unable to do this, place the tooth either in
saliva (under your tongue), cold milk or saline (such as contact lens
solution). Take your child and his tooth for immediate medical or dental
Child protective services
Designed to safeguard the child when abuse, neglect, or abandonment is
suspected, or when there is no family to take care of the child. Examples of
help delivered in the home include financial assistance, vocational training,
homemaker services, and daycare. If in-home supports are insufficient, the
child may be removed from the home on a temporary or permanent basis. Ideally,
the goal is to keep the child with the family whenever possible.
Child Safety-the space between crib bars should be no more than 2 1/2 inches. A
crib or playpen should have no sharp edges. The distance from the mattress to
the top of the rail should be over 2 feet. Use bumper pads on the inside of the
crib. Keep plastic wrap or bags away from children. Keep stuffed animals with
buttons that can be swallowed away from small children. Avoid putting extra
blankets and stuffed animals in a crib with a baby. Child-proof your home: *
Place gates at the top and bottom of each stairway. * Cover unused electrical
sockets. * Keep toxic substances (such as cleaning fluids, bug poisons, and
other chemicals) well out of a child's reach. * Avoid storing toxic substances
in unmarked and inappropriate containers (such as food containers). * Keep
knives out of reach. * Buy medicines with child-resistant caps. Place all
medications out of the reach of children. * Put safety latches on cabinets that
a child should not open. * Keep matches out of reach. * Set the hot water
heater thermostat to no more than 125 degrees F. * When cooking on the stove,
make sure that pot and pan handles are turned to the middle of the stove top.
Handles that hang over the edge of the stove top may be reached by a curious
toddler. * Keep toys with small parts (and other small objects) out of the
reach of toddlers. * In the bathroom, avoid putting dangerous items (such as
razor blades) in a waste basket where a young child might have access. * Keep
toilet lids down. Never leave an infant unattended in the bathtub. Keep
children away from hot beverages and stove tops. Don't leave small children
alone in the kitchen. Establish sensible rules for outdoor play and supervise
young children constantly. When heating a baby bottle in the microwave oven or
on the stove, always test the milk temperature to prevent burning your baby's
Children need to eat a wide variety of foods for good health. Use the Food
Guide Pyramid on page 5 as a starting point for planning family meals and
snacks. The Food Guide Pyramid applies to healthy people age 2 years and older.
The smaller number of servings in the range is for children age 6 years and
under. For 2- to 3-year-old children, the serving size should be smaller, about
two- thirds the size of a regular serving (except for milk). When you help
children build healthy eating habits early, they will approach eating with a
positive attitude-that food is something to enjoy, help them grow, and give
them energy. Give your child a snack or two in addition to his or her three
daily meals. Offer your child a wide variety of foods, such as grains,
vegetables and fruits, low-fat dairy products, and lean meat or beans. Serve
snacks like dried fruit, low-fat yogurt, and air-popped popcorn. Let your child
decide whether and how much to eat. Keep serving new foods even if your child
does not eat them at first. Cook with less fat-bake, roast, or poach foods
instead of frying. Limit the amount of added sugar in your child's diet. Choose
cereals with low or no added sugar. Serve water or low-fat milk more often than
sugar-sweetened sodas and fruit-flavored drinks. Choose and prepare foods with
less salt. Keep the saltshaker off the table. Have fruits and vegetables on
hand for snacks instead of salty snack foods. Involve your child in planning
and preparing meals. Children may be more willing to eat the dishes they help
fix. Have family meals together and serve everyone the same thing. Do not be
too strict. In small amounts, sweets or food from fast-food restaurants can
still have a place in a healthy diet. Make sure your child eats breakfast.
Breakfast provides children with the energy they need to listen and learn in
Children and adolescents at risk for mental health problems
Children are at greater risk for developing mental health problems when certain
factors occur in their lives or environments. Factors include physical abuse,
emotional abuse or neglect, harmful stress, discrimination, poverty, loss of a
loved one, frequent relocation, alcohol and other drug use, trauma, and
exposure to violence.
Children and Exercise
Children should exercise to stay healthy. For children older than 6 years, 20
minutes a day of aerobic exercise at least 3 days a week should be adequate.
Encourage your child to build strength, flexibility and aerobic capacity (for
example, through running).
A soft, waxy substance that is present in all parts of the body including the
nervous system, skin, muscle, liver, intestines, and heart. It is made by the
body and obtained from animal products in the diet. Cholesterol is manufactured
in the liver for normal body functions including the production of hormones,
bile acid, and Vitamin D. It is transported in the blood to be used by all
parts of the body. Dietary cholesterol is present only in foods of animal
origin (not in foods of plant origin). Cholesterol is found in eggs, dairy
products, meat, poultry, fish, and shellfish. Egg yolks and organ meats (liver,
kidney, sweetbread, and brain) are high in dietary cholesterol. Fish generally
contains less cholesterol than other meats, but some shellfish is high in
cholesterol content. Foods of plant origin (vegetables, fruits, grains,
cereals, nuts, and seeds) contain no cholesterol. Fat content is not a good
measurement of cholesterol content. For example, liver and other organ meats
are low in fat but very high in cholesterol. Excessive cholesterol contributes
to atherosclerosis and subsequent heart disease. The risk of developing heart
disease or atherosclerosis increases as the level of blood cholesterol
increases. Approximately 25% of the adult population in the U.S. has elevated
blood cholesterol levels. More than half of the adult population has blood
cholesterol levels that are higher than the "desirable" range, as specified by
the medical community. Elevated cholesterol levels often begin in childhood.
Some children may be at higher risk than others secondary to family history.
The level for total cholesterol has been lowered in the past few years.
Depending on the laboratory levels either less than 200 or 190 milligrams per
deciliter (mg/dl) are considered "desirable" because they carry the least risk
of heart disease. When the level is above 200 mg/dl the risk for coronary heart
disease increases. It is also important to know the levels for High Density
Lipoprotein (HDL, also known as the "good cholesterol") and Low Density
Lipoprotein (LDL, or "bad cholesterol"). You must consult your health care
provider to measure and discuss your cholesterol profile. To lower high
cholesterol levels, eat less than 30% of the total daily calories from fat. Of
that 30%, less than one-third should be from saturated fat and not more than
one-third should be from polyunsaturated fat. At least one-third of the total
fat calories should be from monounsaturated fat. Less than 300 milligrams (mg)
of dietary cholesterol per day should be consumed.
Marijuana; amphetamine; methamphetamine; depressant
Christmas tree meth
Green methamphetamine produced using Drano crystals
The result of chronic liver disease that causes scarring of the liver and liver
dysfunction. This often has many complications, including accumulation of fluid
in the abdomen, bleeding disorders, increased pressure in the blood vessels,
and confusion or a change in the level of consciousness. Common causes of
chronic liver disease in the US include hepatitis C infection and long- term
alcohol abuse. Hepatitis C is now the most common reason for liver
transplantation in the US. Other causes of cirrhosis include hepatitis B,
medications, autoimmune inflammation of the liver, disorders of the drainage
system of the liver (the biliary system), and metabolic disorders of iron and
A request by an individual (or his or her provider) to that individual's
insurance company to pay for services obtained from a health care professional.
A clinical psychologist is a professional with a doctoral degree in psychology
who specializes in therapy.
Clinical Social Worker
Clinical social workers are health professionals trained in client-centered
advocacy that assist clients with information, referral, and direct help in
dealing with local, State, or Federal government agencies. As a result, they
often serve as case managers to help people "navigate the system." Clinical
social workers cannot write prescriptions.
A wide variety of drugs being used by young people at dance clubs, bars, and
all-night dance parties ("trances" or "raves"). These parties are usually held
in a clandestine location with high-volume music, high-tech entertainment, and
easy access to drugs. Club drugs are attractive to today's youth because they
are inexpensive and produce increased stamina and intoxicating highs. Because
many of these drugs are colorless, tasteless, and odorless, they can be
secretly added to beverages by individuals who want to intoxicate or sedate
others. The most widely used club drugs are; ecstasy, rohypnol, ketamine, GHB,
and LSD. Research has shown that club drugs can have long-lasting negative
effects on the brain, especially on memory function and motor skills. When club
drugs are combined with alcohol, the effect is intensified, and they become
even more dangerous and potentially fatal.
A powerfully addictive stimulant that directly affects the brain. Cocaine has
been labeled the drug of the 1980s and '90s, because of its extensive
popularity and use during this period. However, cocaine is not a new drug. In
fact, it is one of the oldest known drugs. The pure chemical, cocaine
hydrochloride, has been an abused substance for more than 100 years, and coca
leaves, the source of cocaine, have been ingested for thousands of years. There
are basically two chemical forms of cocaine: the hydrochloride salt and the
"freebase." The hydrochloride salt, or powdered form of cocaine, dissolves in
water and, when abused, can be taken intravenously (by vein) or intranasally
(in the nose). Freebase refers to a compound that has not been neutralized by
an acid to make the hydrochloride salt. The freebase form of cocaine is
smokable. Cocaine is generally sold on the street as a fine, white, crystalline
powder, known as "coke," "C," "snow," "flake," or "blow." Street dealers
generally dilute it with such inert substances as cornstarch, talcum powder,
and/or sugar, or with such active drugs as procaine (a chemically-related local
anesthetic) or with such other stimulants as amphetamines.
A combination of cognitive and behavioral therapies, this approach helps people
change negative thought patterns, beliefs, and behaviors so they can manage
symptoms and enjoy more productive, less stressful lives.
Cognitive therapy aims to identify and correct distorted thinking patterns that
can lead to feelings and behaviors that may be troublesome, self-defeating, or
even self- destructive. The goal is to replace such thinking with a more
balanced view that, in turn, leads to more fulfilling and productive behavior.
Cold Sores or Herpes labialis is an infection caused by the herpes simplex
virus, characterized by an eruption of small and usually painful blisters on
the skin of the lips, mouth, gums or the skin around the mouth. These blisters
are commonly called cold sores or fever blisters. Most Americans are infected
with the type 1 virus by the age of 20. The initial infection may cause no
symptoms or mouth ulcers. The virus remains in the nerve tissue of the face. In
some people, the virus reactivates and produces recurrent cold sores that are
usually in the same area, but are not serious. Herpes virus type 2 usually
causes genital herpes and infection of babies at birth but can also cause
herpes labialis. Herpes viruses are contagious. Contact can occur directly, or
through contact with infected razors, towels, dishes, etc. Occasionally,
oral/genital contact can spread oral herpes to the genitals (and vice versa),
so people with active herpes lesions on or around their mouths or on their
genitals should avoid oral sex. The first symptoms usually appear within 1 or 2
weeks, and as late as 3 weeks, after contact with an infected person. The
lesions of herpes labialis usually last for 7 to 10 days, then begin to
resolve. The virus may become latent, residing in the nerve cells, with
recurrence at or near the original site. Recurrence is usually milder. It may
be triggered by menstruation, sun exposure, illness with fever, stress, or
other unknown causes. Warning symptoms of itching, burning, increased
sensitivity, or tingling sensation may occur about 2 days before lesions
appear. They include: Skin lesion/rash located around the lips, mouth, and
gums; Small blisters (vesicles), filled with clear yellowish fluid, blisters
appear on a raised, red, painful skin area. Blisters form, break, and ooze,
yellow crusts slough to reveal pink, healing skin, several smaller blisters may
merge to form a larger blister, and a mild fever (may occur). Untreated, the
symptoms will generally subside in 1 to 2 weeks. Antiviral medications may be
given by mouth to may shorten the course of the symptoms and decrease pain.
Wash blisters gently with soap and water to minimize the spread of the virus to
other areas of skin. An antiseptic soap may be recommended. Applying ice or
warmth to the area may reduce pain. Take precautions to avoid infecting others.
Prevention methods include avoid direct contact with cold sores or other herpes
lesions. Minimize the risk of indirect spread by thoroughly washing items in
hot (preferably boiling) water before re-use. Do not share items with an
infected person, especially when herpes lesions are active. Avoid precipitating
causes (especially sun exposure) if prone to oral herpes. Avoid performing oral
sex when you have active herpes lesions on or near your mouth and avoid passive
oral sex with someone who has active oral or genital herpes lesions. Condoms
can help reduce, but do not entirely eliminate, the risk of transmission via
oral or genital sex with an infected person. Unfortunately, both oral and
genital herpes viruses can sometimes be transmitted even when the person does
not have active lesions.
Services that include contacts with significant others involved in the
client's/patient's life for the purpose of discussing the client's/patient's
emotional or behavioral problems or the collateral's relationship with the
Services that are provided in a community setting. Community services refer to
all services not provided in an inpatient setting.
Children with conduct disorder repeatedly violate the personal or property
rights of others and the basic expectations of society. A diagnosis of conduct
disorder is likely when these symptoms continue for 6 months or longer. Conduct
disorder is known as a "disruptive behavior disorder" because of its impact on
children and their families, neighbors, and schools.
Consolidated Omnibus Budget Reconciliation Act (COBRA)
An act that allows workers and their families to continue their
employer-sponsored health insurance for a certain amount of time after
terminating employment. COBRA imposes different restrictions on individuals who
leave their jobs voluntarily versus involuntarily.
Any individual who does or could receive health care or services. Includes
other more specialized terms, such as beneficiary, client, customer, eligible
member, recipient, or patient.
Consumer Run Services
Mental health treatment or support services that are provided by current or
former mental health consumers. Includes social clubs, peer- support groups,
and other peer-organized or consumer-run activities.
Continuous quality improvement (CQI)
An approach to health care quality management borrowed from the manufacturing
sector. It builds on traditional quality assurance methods by putting in place
a management structure that continuously gathers and assesses data that are
then used to improve performance and design more efficient systems of care.
Also known as total quality management (TQM).
Continuum of care
A term that implies a progression of services that a child moves through,
usually one service at a time. More recently, it has come to mean comprehensive
services. Also see system of care and wraparound services.
Drug manufacturer; mix heroin with water; heating heroin to prepare it for
To inject a drug; person who manufactures methamphetamine
Child-serving organizations talk with the family and agree upon a plan of care
that meets the child's needs. These organizations can include mental health,
education, juvenile justice, and child welfare. Case management is necessary to
coordinate services. Also see family-centered services and wraparound services.
The portion of the covered healthcare cost for which the person insured has the
responsibility to pay, usually as a fixed fee for a specific service type
(e.g., $10 per doctor visit).
Corporate Health Management Programs
Health promotion and disease prevention/wellness programs that use health
education techniques to promote employee health. These programs usually include
components such as exercise regimens, health- risk appraisals, weight control,
nutrition information, stress management, disease screening, and smoking
Method of reimbursement in which third parties pay providers for services
provided based upon the documented costs of providing that service.
Cost-benefit Analysis (CBA)
A systematic method for valuing over time the monetary costs and consequences
of producing and consuming substance abuse program services. Results from a CBA
are often provided in terms of a net present value figure, which shows the
difference in inflation-adjusted, discounted costs and benefits of the program
in today's dollars or in the dollars of a base year of interest. Results may
also be shown in terms of an internal rate of return or a benefit-cost ratio.
The data is used in determining the content of a benefit package.
Cost-effectiveness Analysis (CEA)
A systematic method for valuing over time the monetary costs and non-monetary
consequences of producing and consuming substance abuse program services.
Results from a CEA are often shown in terms of total costs and total levels of
effectiveness (e.g., total quality adjusted life-years saved or total numbers
of substance abuse cases avoided), or in terms of cost per unit of
effectiveness. This data is used by employers to determine contents of a
Health insurance practice that requires the insured person to pay some portion
of covered expenses (e.g., deductibles, coinsurance, and copayments) in an
attempt to control utilization.
Charging one group of patients more in order to make up for underpayment by
others. Most commonly, charging some privately insured patients more in order
to make up for underpayment by Medicaid or Medicare.
Couples Counseling and Family Therapy
These two similar approaches to therapy involve discussions and problem-solving
sessions facilitated by a therapist-sometimes with the couple or entire family
group, sometimes with individuals. Such therapy can help couples and family
members improve their understanding of, and the way they respond to, one
another. This type of therapy can resolve patterns of behavior that might lead
to more severe mental illness. Family therapy can help educate the individuals
about the nature of mental disorders and teach them skills to cope better with
the effects of having a family member with a mental illness- such as how to
deal with feelings of anger or guilt.
Maximum number of days for which an insurer will reimburse for services
rendered. Days may be limited per episode of illness, per year, per lifetime,
or per length of policy.
Individuals having health insurance coverage under a particular contract,
payer, or provider group. In the private sector, this refers to employees and
The street name given to the freebase form of cocaine that has been processed
from the powdered cocaine hydrochloride form to a smokable substance. The term
"crack" refers to the crackling sound heard when the mixture is smoked. Crack
cocaine is processed with ammonia or sodium bicarbonate (baking soda) and
water, and heated to remove the hydrochloride. Because crack is smoked, the
user experiences a high in less than 10 seconds. This rather immediate and
euphoric effect is one of the reasons that crack became enormously popular in
the mid 1980s. Another reason is that crack is inexpensive both to produce and
Crack Cocaine; heroin; amphetamine; methamphetamine; methcathinone
Someone who uses or manufatures methamphetamine
The process of reviewing a practitioner's credentials, i.e., training,
experience, or demonstrated ability, for the purpose of determining if criteria
for clinical privileging are met.
Any prior health insurance coverage that a person has received. Creditable
coverage is used to decrease exclusion periods for pre- existing conditions
when an individual switches insurance plans. Insurers cannot exclude coverage
of pre-existing conditions, but may impose an exclusion period (no more than 12
months) before covering such conditions. (See also, Health Insurance
Portability and Accountability Act)
Crisis residential treatment services
Short-term, round-the-clock help provided in a nonhospital setting during a
crisis. For example, when a child becomes aggressive and uncontrollable,
despite in-home supports, a parent can temporarily place the child in a crisis
residential treatment service. The purposes of this care are to avoid inpatient
hospitalization, help stabilize the child, and determine the next appropriate
Crack mixed with methamphetamine; methamphetamine
Crush and rush
Method of methamphetamine production in which starch is not filtered out of the
ephedrine or pseudoephedrine tablets.
Cocaine; amphetamine; methamphetamine;PCP
Crystal shards of methamphetamine
Actions that indicate an awareness and acceptance of the importance of
addressing cultural factors while providing care; ability to meet the needs of
clients and patients from diverse backgrounds.
Help that is sensitive and responsive to cultural differences. Caregivers are
aware of the impact of culture and possess skills to help provide services that
respond appropriately to a person's unique cultural differences, including race
and ethnicity, national origin, religion, age, gender, sexual orientation, or
physical disability. They also adapt their skills to fit a family's values and
A component of a computer-based patient record that accepts, files, and stores
clinical data over time from a variety of intervention systems for the purposes
of developing population-based practice guidelines, outcomes management, and
Date Rape Drug
Day treatment includes special education, counseling, parent training,
vocational training, skill building, crisis intervention, and recreational
therapy. It lasts at least 4 hours a day. Day treatment programs work in
conjunction with mental health, recreation, and education organizations and may
even be provided by them.
The minimum threshold payment that must be made by a health plan enrollee each
year before the plan begins to make payments on a shared or total basis.
(Source: Rognehaugh R, The Managed Care Dictionary)
The amount an individual must pay for health care expenses before insurance (or
a self- insured company) begins to pay its contract share. Often insurance
plans are based on yearly deductible amounts.
Delusions are bizarre thoughts that have no basis in reality.
Use of employer-provided health education, wellness, and client empowerment
programs to assist members to make cost-effective healthcare decisions, thereby
decreasing unnecessary utilization and costs. These programs may be part of a
Refers to a group of symptoms involving progressive impairment of all aspects
of brain function. Disorders that cause dementia include conditions that impair
the vascular (blood vessels) or neurologic (nerve) structures of the brain. A
minority of causes of dementia are treatable. These include normal pressure
hydrocephalus, brain tumors, and dementia due to metabolic causes and
infections. Unfortunately, most of the disorders associated with dementia are
progressive, irreversible, degenerative conditions. The two major degenerative
causes of dementia are Alzheimer's disease, which is a progressive loss of
nerve cells without a known cause or cure and vascular dementia, which is loss
of brain function due to a series of small strokes. Dementia may be diagnosed
when there is impairment of two or more brain functions, including language,
memory, visual-spatial perception, emotional behavior or personality, and
cognitive skills (such as calculation, abstract thinking, or judgment).
Dementia usually appears first as forgetfulness. Other symptoms may be apparent
only on neurologic examination or cognitive testing. Loss of functioning
progresses slowly from decreased problem solving and language skills to
difficulty with ordinary daily activities to severe memory loss and complete
disorientation with withdrawal from social interaction.
Drugs used medicinally to relieve anxiety, irritability, and tension. They have
a high potential for abuse and development of tolerance. Depressants produce a
state of intoxication similar to that of alcohol. When combined with alcohol,
the effects are increased and risks are multiplied. Drugs that fall under the
depressant category include barbiturates, methaqualone, tranquilizers, chloral
hydrate, and glutethimide.
A term that people commonly use to refer to states involving sadness,
dejection, lack of self-esteem, and lack of energy. Feelings of depression are
synonymous with feeling sad, blue, down in the dumps, unhappy, and miserable.
Most feelings of depression are a reaction to an unhappy event. It is natural
to have some feelings of sadness after a loss such as the death of a relative,
or after a major disappointment at home or at work. Depression is more
prevalent in women than men and is especially common among adolescents. Mild
depression comes and goes and is characterized by downheartedness, sadness, and
dejection. Short-term episodes of depression or other mood changes can occur
with hormone changes, including those that accompany pregnancy or premenstrual
syndrome (PMS), and those occurring shortly after the birth of a baby
(postpartum "blues"). Sleep disruption and lack of sunlight during the winter
months are other biological factors that can precipitate depressive symptoms.
Distorted thought patterns, characterized by feelings of worthlessness,
helplessness, and hopelessness are part of the "cognitive triad of depression,"
and can be a risk factor for depression. It appears that a tendency toward
depression is often genetic, but that stressful life circumstances usually play
a major role in bringing on depressive episodes. Problems with depression
usually begin in adolescence, and are about twice as common in women as in men.
Noticeably disturbed thought processes, poor communication and socialization,
and sensory dysfunction indicate moderate depression. People with severe
depression are withdrawn, indifferent toward their surroundings, and may show
signs of delusional thinking and limited physical activity.
Diabetes is a life-long disease marked by elevated levels of sugar in the
blood. It can be caused by too little insulin (a chemical produced by the
pancreas to regulate blood sugar), resistance to insulin, or both. People with
diabetes have high blood glucose. This is because their pancreas does not make
enough insulin or their muscle, fat, and liver cells do not respond to insulin
normally, or both. There are three major types of diabetes: * Type 1 diabetes
is usually diagnosed in childhood. The body makes little or no insulin, and
daily injections of insulin are required to sustain life. Without proper daily
management, medical emergencies can arise. * Type 2 diabetes is far more common
than type 1 and makes up about 90% of all cases of diabetes. It usually occurs
in adulthood. Here, the pancreas does not make enough insulin to keep blood
glucose levels normal, often because the body does not respond well to the
insulin. Many people with type 2 diabetes do not know they have it, although it
is a serious condition. Type 2 diabetes is becoming more common due to the
growing number of older Americans, increasing obesity levels, and widespread
failure to exercise. * Gestational diabetes is high blood glucose that develops
at any time during pregnancy in a person who does not have diabetes. High blood
levels of glucose can cause several problems, including frequent urination,
excessive thirst, hunger, fatigue, weight loss and blurry vision. However,
because type 2 diabetes develops slowly, some people with high blood sugar
experience no symptoms at all. About 40% of type 2 diabetics have no symptoms
of the condition.
The aims of a general psychiatric evaluation are 1) to establish a psychiatric
diagnosis, 2) to collect data sufficient to permit a case formulation, and 3)
to develop an initial treatment plan, with particular consideration of any
immediate interventions that may be needed to ensure the patient's safety, or,
if the evaluation is a reassessment of a patient in long-term treatment, to
revise the plan of treatment in accord with new perspectives gained from the
Diagnostic Related Groups (DRGs)
A payment system that reimburses healthcare providers a fixed amount for all
care in connection with a standard diagnostic category. The DRG system was
instituted by Medicare and is now used by many insurance companies. It is a
form of case rate payment system.
Dietary fiber is found in plant foods and humans cannot digest it. It has no
calories because the body cannot absorb it. Dietary fiber provides a feeling of
fullness and adds bulk in the diet. This assists digestion and elimination.
Including fiber in your daily diet helps prevent many problems and brings many
benefits. It may be helpful in controlling weight by making you feel full
sooner. It helps prevent constipation. It may be helpful in the prevention or
treatment of diverticulosis, diabetes, and heart disease (ask your health care
provider or registered dietician about recommendations for these conditions).
There are two forms of fiber: soluble and insoluble. Soluble fiber attracts
water and turns to gel during digestion. This slows digestion and the rate of
nutrient absorption from the stomach and intestine. It is found in oat bran,
barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables.
Insoluble fiber is found in foods such as wheat bran, vegetables and whole
grains. It appears to speed the passage of foods through the stomach and
intestines and adds bulk to the stool. The recommendation for older children,
adolescents and adults is 20 to 35 grams per day. Younger children will not be
able to eat enough calories to achieve this, but introducing whole grains,
fresh fruits and other high fiber foods is suggested. To ensure an adequate
fiber intake, eat a variety of foods, including more fruits, vegetables, whole
grains, cereals, and dried beans and peas.
A discharge is the formal termination of service, generally when treatment has
been completed or through administrative authority.
The rate at which future dollars or future units of effectiveness are devalued,
relative to current dollars or units of effectiveness.
The process of devaluing future dollars or units of effectiveness to reflect
preferences for dollars or goods or services now, versus in the future.
Disease Management Programs
Comprehensive, integrated programs for managing patients' disease conditions.
These programs usually target specific disease conditions for which there are
effective, evidence-based practice guidelines, and are designed for diseases
such as depression, diabetes, arthritis, hypertension, and heart disease.
A brain chemical, classified as a neurotransmitter, found in regions of the
brain that regulate movement, emotion, motivation, and pleasure.
A social club offering peer support and flexible schedule of activities: may
operate on evenings and/ weekends.
Wrapping methamphetamine in bread and then consuming it
A chemical compound or substance that can alter the structure and function of
the body. Psychoactive drugs affect the function of the brain, and some of
these may be illegal to use and possess.
The use of illegal drugs or the inappropriate use of legal drugs. The repeated
use of drugs to produce pleasure, to alleviate stress, or to alter or avoid
reality (or all three).
The list of prescription drugs for which a particular employer or State
Medicaid program will pay. Formularies are either "closed," including only
certain drugs or "open," including all drugs. Both types of formularies
typically impose a cost scale requiring consumers to pay more for certain
brands or types of drugs.
Drug Free Workplace Act
The 1988 Federal act that laid the groundwork for subsequent regulation of
workplace drug testing.
DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth
An official manual of mental health problems developed by the American
Psychiatric Association. Psychiatrists, psychologists, social workers, and
other health and mental health care providers use this reference book to
understand and diagnose mental health problems. Insurance companies and health
care providers also use the terms and explanations in this book when discussing
mental health problems.
Identification of dual diseases, disorders, or injuries, commonly used to
describe individuals diagnosed with both mental disorders and addictive
A reading disability resulting from a defect in the ability to process graphic
symbols. There are about 2 to 8% of elementary-age children that have some
degree of reading disability. Developmental reading disorder (DRD) or dyslexia
is not attributable to eye problems but instead is a defect of higher cortical
(brain) processing of symbols. Children with DRD may have trouble rhyming and
separating the sounds in spoken words. These abilities appear critical in the
process of learning to read. Initial reading skills are based on word
recognition. More developed reading skills require the linking of words into a
coherent sentence (thought). DRD children may be unable to form images from the
meanings of the words or to process the words into an idea which is
understandable. At this level, reading may fail at its primary function, which
is to convey information. Dyslexia or developmental reading disorder may appear
in combination with developmental writing disorder and developmental arithmetic
disorder. All of these processes involve the manipulation of symbols and the
conveyance of information by their manipulation. These conditions may appear
singly or in any combination. Other causes of learning disability and, in
particular, reading disability, must be ruled out before a diagnosis of DRD can
be made. Cultural and educational shortfalls, emotional problems, mental
retardation, and diseases of the brain (for example AIDS) can all cause
learning disabilities. Remedial instruction has remained the best approach to
this type of reading disorder.
electronic mail, or written messages that people exchange via computer in
ordinary language. It is created, sent, delivered and read using a specific
software product that must be bought by the user and loaded onto his or her
computer. Microsoft Outlook, Lotus Mail, and Eudora are all e-mail products. E-
mail sent from one person to another on the same LAN or WAN is delivered by the
network itself. E-mail from one network or computer system to another is
delivered via the internet by an INTERNET SERVICE PROVIDER.
Refers to identifying persons at high risk prior to their having a serious
consequence, or persons at high risk who have had limited serious consequences
related to substance use on the job, or having a significant personal,
economic, legal, or health/mental health consequence, and providing these
persons at high risk with appropriate counseling, treatment, education, or
Aa stimulant that combines the effects of amphetamines and hallucinogens. MDMA
is a synthetic, psychoactive drug with both stimulant (amphetamine-like) and
hallucinogenic (LSD-like) properties. Street names for MDMA include Ecstasy,
Adam, XTC, hug, beans, and love drug. Its chemical structure (3-4
methylenedioxymethamphetamine, "MDMA") is similar to methamphetamine,
methylenedioxyamphetamine (MDA), and mescaline - other synthetic drugs known to
cause brain damage. MDMA also is neurotoxic. In addition, in high doses it can
cause a sharp increase in body temperature (malignant hyperthermia) leading to
muscle breakdown and kidney and cardiovascular system failure.
Education Services link
Locating or providing a full range of educational services from basic literacy
through the General Equivalency Diploma and college courses. Includes special
education at the pre-primary, primary, secondary, and adult levels.
The magnitude of a relationship between the dependent and independent variables
in the population, or the degree of departure from the null hypothesis. Typical
measures of effect size include d, eta, and r.
One pound of methamphetamine
Also known as ECT, this highly controversial technique uses low voltage
electrical stimulation of the brain to treat some forms of major depression,
acute mania, and some forms of schizophrenia. This potentially life- saving
technique is considered only when other therapies have failed, when a person is
seriously medically ill and/or unable to take medication, or when a person is
very likely to commit suicide. Substantial improvements in the equipment,
dosing guidelines, and anesthesia have significantly reduced the possibility of
An employee who qualifies to receive health benefits through his/her employer.
A planned program to provide psychiatric care in emergency situations with
staff specifically assigned for this purpose. Includes crisis intervention,
which enables the individual, family members and friends to cope with the
emergency while maintaining the individual's status as a functioning community
member to the greatest extent possible.
Emergency and crisis services
A group of services that is available 24 hours a day, 7 days a week, to help
during a mental health emergency. Examples include telephone crisis hotlines,
suicide hotlines, crisis counseling, crisis residential treatment services,
crisis outreach teams, and crisis respite care.
Emergency Medical Treatment and Labor Act (EMTALA)
EMTALA, also referred to as the Federal Anti- patient Dumping Law link An act
pertaining to emergency medical situations. EMTALA requires hospitals to
provide emergency treatment to individuals, regardless of insurance status and
ability to pay (EMTALA, 2002).
This is a broad category of employment that includes competitive, supported,
and sheltered employment.
Employee Assistance Program (EAP)
Programs to assist employees, their family members, and employers in finding
solutions for workplace and personal problems. The EAP may be provided directly
by the employer or be part of the healthcare contract with a managed care
organization or managed behavioral healthcare organization. Components of An
EAP program may include some or all of the following components: employee
education, supervisor training, drug testing, needs assessments, wellness
programs, support for parents, health fairs, peer-to-peer counseling,
interactive Web sites, health risk appraisals, newsletters, and employee
seminars and information campaigns.
Employee Retirement Income Security Act of 1974 (ERISA)
Also called the Pension Reform Act, this act regulates the majority of private
pension and welfare group benefit plans in the United States. It sets forth
requirements governing, among many areas, participation, crediting of service,
vesting, communication and disclosure, funding, and fiduciary conduct.
Employment/Vocational Rehabilitation Services
A broad range of services designed to address skills necessary for
participation in job- related activities.
Something produced by the brain or body.
A person eligible for services from a managed care plan.
The total number of covered persons (employees and their dependents) enrolled
in a health plan. Also refers to the process by which a health plan signs up
groups and individuals for membership, or to the number of enrollees who sign
up in any one group.
Ethyl Alcohol or ethanol is the member of the alcohol series of chemicals which
is used in alcoholic beverages. It is less toxic than other members of this
series, but it is a central nervous system depressant and has a high abuse
Exclusive Provider Organization
A plan in which the patient must remain in the network to receive benefits
(out-of- network costs are paid by the patient); a plan regulated under State
insurance statute that provides coverage only for contracted providers and does
not extend to non- preferred-provider services.
Time spent at the employer's offices interacting with colleagues, supervisors,
etc. Many employers require regular face time to ensure the teleworker's
integration into company culture and practices.
Help designed to meet the specific needs of each individual child and family.
Children and families should not be expected to fit into services that do not
meet their needs. Also see appropriate services, coordinated services,
wraparound services, and cultural competence.
A broad range of living arrangements that simulate a family situation. This
includes foster care and small group homes.
Family support services
Help designed to keep the family together, while coping with mental health
problems that affect them. These services may include consumer information
workshops, in-home supports, family therapy, parenting training, crisis
services, and respite care.
Fee for Service
A type of health care plan under which health care providers are paid for
individual medical services rendered.
Fetal Alcohol Syndrome
The manifestation of specific growth, mental, and physical birth defects
associated with the mother's high levels of alcohol use during pregnancy.
Alcohol use or abuse by the pregnant woman subjects her to the same range of
risks that alcohol has in the general population. However, it poses extreme and
unique risks to the fetus and is associated with fetal alcohol syndrome (FAS).
Timing of alcohol use during pregnancy is also of importance. Alcohol use
during the first trimester is more damaging than during the second trimester,
which is, in turn, more damaging than use in the third trimester. Alcohol
ingested by a pregnant woman easily passes across the placental barrier to the
fetus. Because of this, drinking alcohol can adversely affect the development
of the baby. A pregnant woman who drinks any amount of alcohol is at risk,
since a "safe" level of alcohol ingestion during pregnancy has not been
established. However, larger amounts appear to cause increased problems.
Multiple birth defects associated with "classical" fetal alcohol syndrome are
more commonly associated with heavy alcohol use or alcoholism. Fetal alcohol
syndrome consists of the following abnormalities: * Intrauterine growth
retardation: growth deficiency in the fetus and newborn in all parameters --
head circumference, weight, height) * Delayed development with decreased mental
functioning (mild to severe) * Facial abnormalities including small head; small
upper jaw; short, up-turned nose; groove in upper lip; smooth and thin upper
lip; and narrow, small, and unusual-appearing eyes with prominent epicanthal
folds * Heart defects * Limb abnormalities of joints, hands, feet, fingers, and
Crack and methamphetamine; to inject a drug
Fire Safety-In the event of a fire, remember time is the biggest enemy and
every second counts! Escape first, then call for help. Develop a home fire
escape plan and designate a meeting place outside. Make sure everyone in the
family knows two ways to escape from every room. Practice feeling your way out
with your eyes closed. Never stand up in a fire, always crawl low under the
smoke and try to keep your mouth covered. Never return to a burning building
for any reason; it may cost you your life. Finally, having a working smoke
alarm dramatically increases your chances of surviving a fire. And remember to
practice a home escape plan frequently with your family. In less than 30
seconds a small flame can get completely out of control and turn into a major
fire. It only takes minutes for thick black smoke to fill a house. In minutes,
a house can be engulfed in flames. Most fires occur in the home when people are
asleep. If you wake up to a fire, you won't have time to grab valuables because
fire spreads too quickly and the smoke is too thick. There is only time to
escape. A fire's heat alone can kill. Room temperatures in a fire can be 100
degrees at floor level and rise to 600 degrees at eye level. Inhaling this
super hot air will scorch your lungs. This heat can melt clothes to your skin.
In five minutes a room can get so hot that everything in it ignites at once:
this is called flashover. Fire starts bright, but quickly produces black smoke
and complete darkness. If you wake up to a fire you may be blinded, disoriented
and unable to find your way around the home you've lived in for years. Fire
uses up the oxygen you need and produces smoke and poisonous gases that kill.
Breathing even small amounts of smoke and toxic gases can make you drowsy,
disoriented and short of breath. The odorless, colorless fumes can lull you
into a deep sleep before the flames reach your door. You may not wake up in
time to escape.
a secure way of setting up a computer network so that users 'outside' the
firewall cannot gain access. For example ABC Company may have an internal
information system (sometimes called an intranet) that everyone in the company
can use to communicate, but no one outside the company can access it because of
the ABC's firewall.
First Aid-Know CPR and/or first aid techniques. Post emergency numbers near the
telephone. Know how and when to call 911 or other emergency numbers. Keep a
first aid kit available.
Combines snorting of heroin, cocaine, methamphetamine, ground up flunitrazepam
pills, and drinking alcohol
The five way
Heroin plus cocaine plus methamphetamine plus Rohypnol (flunitrazepam) plus
Denotes a range of working practices defined by employers and documented in
employment policies. Flexible work policies give employees latitude as to how
work will get done. Examples are flexible hours (the policy states a minimum
number of hours to be worked and parameters for when those hours can be);
flexible work location (various permissible work locations are defined); and
flexible work contracts (for example the employee's role may vary within
Folic Acid is a water-soluble vitamin of the B-complex group (B9). Folic acid
acts as a coenzyme (with vitamin B-12 and vitamin C) in the breakdown
(metabolism) of proteins and in the synthesis of new proteins. It is necessary
for the production of red blood cells and the synthesis of DNA (which controls
heredity), as well as tissue growth and cell function. It also increases the
appetite and stimulates the formation of digestive acids. Synthetic folic acid
supplements may be used in the treatment of disorders associated with folic
acid deficiency, and may also be part of the recommended treatment for certain
menstrual problems and leg ulcers. Food sources of folic acid include: beans
and legumes, citrus fruits and juices, wheat bran and other whole grains, dark
green leafy vegetables, poultry, pork, shellfish, and liver.
Refers to the conditions and practices that preserve the quality of food to
prevent contamination and food-borne illnesses. Proper handling and preparation
of food greatly reduces the risks of getting foodborne illnesses. Food can be
contaminated in many different ways -- during the packaging process, by
inadequate cooking or storage. Different food products may already have
different microorganisms such as bacteria or parasites which may be allowed to
multiply and cause disease if food is not appropriately handled. Higher risk
foods include red meats and poultry; eggs; cheese and dairy products; raw
sprouts; and raw fish or shellfish. The main consequence of improper handling
and inadequate food safety is infection (foodborne illness) which may be severe
and life-threatening especially in young children, older adults, pregnant
women, and persons with weakened immune systems. To safetly handle food wash
your hands thoroughly before and after handling any food, and after using the
bathroom, changing diapers or after coming into contact with animals; Wash all
cutting boards and utensils with hot water and soap after preparing each food
item and prior to moving on to the next food item. Wear gloves or avoid
preparation if your hands have any cuts or sores; Avoid cross-contaminating
food items -- separate meat, poultry and seafood from other food and always
wash hands, utensils and boards after coming into contact with these products;
Cook to proper temperatures. Cook eggs until both the white and yolk are firm.
Fish should be opaque and flake easily. Red meats and poultry should reach an
internal temperature of 160 and 180 degrees, respectively. Leftovers must be
reheated thoroughly to at least 165 degrees Fahrenheit; Refrigerate promptly --
some items such as meat and poultry must be frozen if not to be used within 1-2
days. Leftovers should be refrigerated within two hours. Keep frozen foods in
the freezer until they are ready to be thawed and cooked; Foods can also be
contaminated before they are purchased. Watch for and do not use outdated food,
packaged food with the seal broken, and cans that have a bulge. Do not use
foods that have an unusual odor or a spoiled taste; Prepare home- canned foods
in nearly sterile conditions and with extreme caution. Home-canned food is the
most common cause of botulism.
Provision of a living arrangement in a household other than that of the
Full Service Employee Assistance Program (EAP)
A comprehensive EAP with a human resource management consultation orientation;
typically well-funded and well-staffed; most are offered internally.
Gamma Hydroxy Butyrate (GHB)
In the 1980s, GHB was widely available over the counter in health food stores,
and bodybuilders used it to lose fat and build muscle. GHB has been given
nicknames such as Grievous Bodily Harm, G, Liquid Ecstasy, and Georgia Home
Boy. In 1990, the Food and Drug Administration banned the use of GHB except
under the supervision of a physician because of reports of severe side effects,
including euphoric and sedative effects similar to the effects experienced
after taking Rohypnol (the "date rape" drug.) GHB also has been associated with
sexual assaults in cities throughout the United States (NIDA, Infofax.) Despite
the ban on use, GHB is created in clandestine laboratories, in a variety of
forms, including clear liquid, white powder and tablet. Increasing use rates
are being reported. In 1998, the Denver Poison Control Center received 33 calls
involving GHB, and almost half of these cases were considered life-
threatening. (NIDA Infofax-Club Drugs, 2000.) Because it clears from the body
relatively quickly, it is often difficult to detect when patients go to
emergency rooms and other treatment facilities.
Marijuana; person who uses or manufactures methamphetamine
Primary care physician or local agency responsible for coordinating and
managing the health care needs of members. Generally, in order for specialty
services such as mental health and hospital care to be covered, the gatekeeper
must first approve the referral.
A situation in which a primary care provider, the "gatekeeper," serves as the
consumer's contact for healthcare and referrals. Also called closed access or
A hospital that provides mental health services in at least one separate
psychiatric unit with specially allocated staff and space for the treatment of
persons with mental illness.
Includes transportation, childcare, homemaker services, day care, and other
general services for clients/patients.
To snort methamphetamine
Heroin; amphetamine; hypodermic needle; methamphetamine
Methcathinone; crank; methamphetamine
A sexually transmitted disease (commonly known as "the clap") caused by the
bacterium Neisseria gonorrhea. Gonorrhea is one of the most common infectious
bacterial diseases and is most frequently transmitted during sexual activity,
including vaginal intercourse and both oral and anal sex. Gonorrhea is a
reportable disease and all state governments require that cases of diagnosed
gonorrhea be reported to the health authorities (State Board of Health). This
allows for adequate follow-up and testing of sexual contacts. Gonorrhea is
easily transmitted during oral, vaginal, or anal sex. The bacteria can infect
the throat, producing a severe sore throat (gonococcal pharyngitis). It can
infect the vagina, causing irritation with drainage (vaginitis), or the anus
and rectum, producing a condition called proctitis. In addition, the organisms
may spread up the female reproductive tract, through the cervix and uterus,
into the fallopian tubes (the tubes that carry the egg from the ovaries to the
uterus). On rare occasions gonorrhea can spread through non-sexual contact. An
infected woman may transmit the infection to her newborn during childbirth.
Infection of the newborn's eyes is called ophthalmia neonatorum (gonococcal
conjunctivitis). Young girls who contract gonorrhea either from sexual abuse or
intimate contact with recently contaminated objects (such as a damp towel)
develop a severe infection called vulvovaginitis. Symptoms in women include:
vaginal discharge, pain or burning on urination, urinary hesitancy, sore
throat, painful sexual intercourse, and/or mouth sores. Symptoms in men
include: increased irinary frequency or urgency, incontinence, urethral
dischard, pain on urination, red or sowllen opening of penis, and/or tender
testicles. There are two important steps to treating a sexually transmitted
disease, especially one as easily spread as gonorrhea. The first is to cure the
infected person. The second is to locate and test all of the person's other
sexual contacts and to treat them to prevent further spread of the disease.
That is why mandatory reporting has been instituted and has, until recently,
held the number of cases of gonorrhea at a low level. However, the incidence is
once again rising. Even though penicillin is effective against gonorrhea, there
have been increasing numbers of strains that are resistant to penicillin (they
don't respond to penicillin treatment). Because of this, gonorrhea is now
treated by a large number of new and very potent antibiotics.
Group Model HMO
A healthcare model involving contracts with physicians organized as a
partnership, professional corporation, or other association. The health plan
compensates the medical group for contracted services at a negotiated rate, and
that group is responsible for compensating its physicians and contracting with
hospitals for care of their patients.
This form of therapy involves groups of usually 4 to 12 people who have similar
problems and who meet regularly with a therapist. The therapist uses the
emotional interactions of the group's members to help them get relief from
distress and possibly modify their behavior.
Gum Disease or Periodintis is a dental disorder that results from progression
of gingivitis, involving inflammation and infection of the ligaments and bones
that support the teeth. Periodontitis is caused when inflammation or infection
of the gums (gingivitis) is untreated or treatment is delayed. Infection and
inflammation spreads from the gums (gingiva) to the ligaments and bone that
support the teeth. Loss of support causes the teeth to become loose and
eventually fall out. Periodontitis is the primary cause of tooth loss in
adults. This disorder is uncommon in childhood but increases during
adolescence. Plaque and tartar (calculus) accumulate at the base of the teeth.
Inflammation causes a pocket to develop between the gums and the teeth, which
fills with plaque and tartar. Soft tissue swelling traps the plaque in the
pocket. Continued inflammation eventually causes destruction of the tissues and
bone surrounding the tooth. Because plaque contains bacteria, infection is
likely and a tooth abscess may also develop, which increases the rate of bone
destruction. Symptoms include: swollen gums, gums appear bright red or
red-purple, gums appear shiny, gums bleed easily, gums may be tender when
touched but are painless otherwise, breath odor and/or loose teeth. The goal of
treatment is to reduce inflammation, and to correct causative conditions.
Dental irritants such as rough surfaces of teeth or dental appliances should be
repaired. It is important to have the teeth cleaned thoroughly. This may
involve use of various instruments or devices to loosen and remove deposits
from the teeth (scaling). Meticulous home oral hygiene is necessary after
professional tooth cleaning to limit further destruction. The dentist or
hygienist will demonstrate brushing and flossing techniques. With
periodontitis, professional tooth cleaning is often recommended more frequently
than the standard twice a year.
1/2 pound of methamphetamine
Hallucinations are experiences of sensations that have no source. Some examples
of hallucinations include hearing nonexistent voices, seeing nonexistent
things, and experiencing burning or pain sensations with no physical cause.
Drugs that cause hallucinations - profound distortions in a person's
perceptions of reality. Under the influence of hallucinogens, people see
images, hear sounds, and feel sensations that seem real but do not exist. Some
hallucinogens also produce rapid, intense emotional swings. Hallucinogens cause
their effects by disrupting the interaction of nerve cells and the
neurotransmitter serotonin. Distributed throughout the brain and spinal cord,
the serotonin system is involved in the control of behavioral, perceptual, and
regulatory systems, including mood, hunger, body temperature, sexual behavior,
muscle control, and sensory perception. LSD (an abbreviation of the German
words for "lysergic acid diethylamide") is the drug most commonly identified
with the term "hallucinogen" and the most widely used in this class of drugs.
It is considered the typical hallucinogen, and the characteristics of its
action and effects described in this Research Report apply to the other
hallucinogens, including mescaline, psilocybin, and ibogaine.
Health Insurance Organization (HIO)
HIOs act as fiscal intermediaries between State Medicaid agencies and
healthcare providers. They receive a per capita payment from a Medicaid agency
to finance the care of Medicaid enrollees. As with HMOs, they assume the risk
of a loss if the payment is inadequate to cover a beneficiary's healthcare
expenses. Unlike HMOs, however, HIOs typically do not deliver care. Since 1985,
Congress has subjected HIOs engaged in full-risk contracting to the same
regulatory standards as HMOs. HIOs that do not offer a comprehensive set of
services, however, face fewer regulatory requirements. States contracting with
HIOs for a less-than- comprehensive set of services must only address such
issues as the term of the capitation arrangement, renegotiation, and
distribution of shared savings.
Health Insurance Portability and Accountability Act (HIPAA)
This 1996 act provides protections for consumers in group health insurance
plans. HIPAA prevents health plans from excluding health coverage of
pre-existing conditions and discriminating on the basis of health status.
Health Maintenance Organization (HMO)
An organized system of healthcare that provides a comprehensive range of
healthcare services to a voluntarily enrolled population in a geographic area
on a primarily prepaid and fixed periodic basis. An HMO contracts with
healthcare providers, e.g, physicians, hospitals, and other health
professionals. Plan members are required to use participating providers for all
health services. Model types include staff, group practice, network, and IPA.
Under the Federal HMO Act, an entity must have three characteristics in order
to call itself an HMO: 1. An organized system for providing people healthcare
services, 2. An agreed-upon set of basic supplemental health and treatment
services, and 3. A voluntarily enrolled group of people.
Health Plan Employer Data and Information Set (HEDIS)
A set of performance measures designed to standardize the way health plans
report data to payers. HEDIS currently measures five major areas of health plan
performance: quality, access and patient satisfaction, membership utilization,
finance, and descriptive information on health plan management. HEDIS
guidelines are published by CMS, which oversees federally funded healthcare.
Health Promotion Program
In the worksite, a program designed to improve employee health and productivity
and to save the company money.
Someone who reports having five or more drinks on five or more occasions in the
past 30 days. A form of alcohol abuse.
Inflammation of the liver. Hepatitis can be caused by infections with various
organisms, including bacteria, viruses (Hepatitis A, B, C, etc.), or parasites.
Chemical toxins such as alcohol, drugs, or poisonous mushrooms can also damage
the liver and cause it to become inflamed. A rare but extremely dangerous cause
of hepatitis results from overdose of acetaminophen (Tylenol), which can be
deadly. In addition, immune cells in the body may attack the liver and cause
autoimmune hepatitis. Hepatitis may resolve quickly (acute hepatitis), or cause
long-term disease (chronic hepatitis). In some instances, progressive liver
damage or liver failure may result. The incidence and severity of hepatitis
vary depending on many factors, including the cause of the liver damage and any
underlying illnesses in a patient. Common risk factors include intravenous drug
use, Tylenol overdose (the dose needed to cause damage is quite close to the
effective dose so be sure to be careful to take Tylenol only as directed),
risky sexual behaviors,
A highly addictive drug, and its use is a serious problem in America. Recent
studies suggest a shift from injecting heroin to snorting or smoking because of
increased purity and the misconception that these forms of use will not lead to
addiction. Heroin is processed from morphine, a naturally occurring substance
extracted from the seedpod of the Asian poppy plant. Heroin usually appears as
a white or brown powder. Street names for heroin include "smack," "H," "skag,"
and "junk." Other names may refer to types of heroin produced in a specific
geographical area, such as "Mexican black tar."
HHS Certified Laboratory
The term used to describe a laboratory that is certified by the Department of
Health and Human Services and that participates in the National Laboratory
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race. The term, "Spanish origin," can
be used in addition to "Hispanic or Latino."
HIV infection is a viral infection caused by the human immunodeficiency virus
(HIV) that gradually destroys the immune system, resulting in infections that
are hard for the body to fight. Acute HIV infection may be associated with
symptoms resembling mononucleosis or the flu within 2 to 4 weeks of exposure.
HIV seroconversion (converting from HIV negative to HIV positive) usually
occurs within 3 months of exposure. People who become infected with HIV may
have no symptoms for up to 10 years, but they can still transmit the infection
to others. Meanwhile, their immune system gradually weakens until they are
diagnosed with AIDS. Acute HIV infection progresses over time to asymptomatic
HIV infection and then to early symptomatic HIV infection and later, to AIDS
(advanced HIV infection): HIV Infection (acute HIV infection) -->early
asymptomatic HIV infection -->early symptomatic HIV infection -->AIDS.
Most individuals infected with HIV will progress to AIDS if not treated.
However, there is a tiny subset of patients who develop AIDS very slowly, or
never at all. These patients are called non- progressors. HIV has spread
throughout the United States. Higher concentrations of the disease are found in
inner city areas. Any symptoms of illness may occur, since infections can occur
throughout the body. Special symptoms relating to HIV infection include: sore
throat, mouth sores, including candidal infection, muscular stiffness or
aching, headache, diarrhea, swollen lymph glands, fever, fatigue, rash of
various types, including seborrheic dermatitis, and/or frequent vaginal yeast
infections. Drug therapy is often recommended for patients who are committed to
taking all their medications and have a CD4 count less than 500 (indicating
immune system suppression) or a high viral load (amount of HIV virus in the
bloodstream). It is extremely important that patients take all doses of their
medications, otherwise the virus will rapidly become resistant to the
medications. Therapy is always given with a combination of antiviral drugs.
People with HIV infection need to receive education about the disease and
treatment so that they can be active partners in decision making with their
health care provider.
Green methamphetamine produced using Drano crystals
Help provided in a family's home either for a defined period of time or for as
long as it takes to deal with a mental health problem. Examples include parent
training, counseling, and working with family members to identify, find, or
provide other necessary help. The goal is to prevent the child from being
placed outside of the home. (Alternate term: in-home supports.)
A person who lives on the street or in a shelter for the homeless.
When local health plans (or local hospitals) merge. This practice was popular
in the late 1990s and was used to expand regional business presence.
Merging of two or more firms at the same level of production in some formal,
legal relationship. In hospital networks, this may refer to the grouping of
several hospitals, the grouping of outpatient clinics within the hospital, or a
geographic network of various healthcare services. Integrated systems seek to
integrate vertically with some organizations and horizontally with others.
Liquefying methamphetamine in an eye dropper and then inhaling it
To heat methamphetamine and inhale the vapor through nose using a plastic tube
Household Safety-wear protective footwear and eye wear when mowing the lawn,
operating power tools, working with a chisel and hammer or hammering metal on
metal. Don't allow children to handle tools until they are old enough to
understand and obey instructions regarding their proper use. All stairways
should have a sturdy hand rail. All entryways should have lighting that is
bright enough to read by. Don't leave objects on stairways and make sure that
carpet on stairways is securely fastened. Unplug appliances (such as heating
pads and electric blankets) when they are not in use. In the bathroom, use
floor mats that don't slip. Put non-slip appliques on the bathtub. Don't use
any electrical appliances when you are wet or in the bathtub, shower or pool.
Make sure that each fireplace has a fire screen. Keep a fire extinguisher in
the kitchen and at least one on every level. Know how to use the extinguishers.
Keep the kitchen floor clean from spills that might cause someone to slip and
fall. Position pot and pan handles toward the back of the stove or counter.
Keep any guns in a locked cabinet and make sure they are unloaded. Firearms and
ammunition should be stored separately.
Assistance to clients/patients in finding and maintaining appropriate housing
HPV (human papilloma virus)
HPV (human papilloma virus) or genital warts is a viral skin disease
characterized by a soft wart-like growth on the genitals. In adults, the
disorder is considered a sexually- transmitted disease. Genital warts are
caused by the human papilloma virus (HPV). Papilloma viruses cause small
growths (warts) on the skin and mucous membranes. Infection of the genital and
anal regions with HPV can cause warts (anogenital condyloma) on the penis,
vulva, urethra, vagina, cervix, and around the anus (perianal). More than 70
different types of HPV have been classified. Several types, including 6, 11,
and 42, are associated with raised, rough, easily visible genital warts
(especially in women). Other types are associated with flat warts. More
importantly, several types are associated with pre-malignant and malignant
changes in the cervix (abnormal Pap smears). These include types 16, 18, 31,
33, 35, 39, 45, 51, and 52. Research also shows that the presence of both HPV
and herpes virus together is a good predictor of cervical cancer. Lesions on
the external genitalia are easily recognized. On the penis, genital warts tend
to be drier and more limited than on the female genitalia or around the anus of
either sex. They grow best in the moist genital area. They are raised, rough,
flesh-colored "warty" appearing tumors that may occur singly or in clusters.
Left untreated, warts around the anus and vulva may rapidly enlarge, taking on
a "cauliflower-like" appearance. Keeping the infected area dry may be a problem
because the warts are usually damp. In women, HPV can invade the vagina and
cervix. These warts are flat and not easily visible without special procedures.
Because HPV can lead to premalignant changes in the cervix (cervical
dysplasia), it is important that this condition be diagnosed and treated.
Regular Pap smears are important for detecting HPV. Infection with HPV is very
common, although the majority of people have no symptoms (asymptomatic). In
several studies done on college women, nearly half were positive for HPV;
although only 1 to 2% had visible warts and less than 10% had ever had any
visible genital warts. The incidence of genital warts appears to be increasing
rapidly, although this may be a result of increased diagnostic ability and
awareness. Risk factors for genital warts include multiple sexual partners,
unknown partners, early onset of sexual activity, tobacco use, nutritional
status, hormonal conditions, age, stress and concurrent viral infections (such
as flu, HIV, Epstein-Barr and herpes). Symptoms include: raised "warty"
appearing tumors on the genitals; raised, flesh colored lesions; genital
lesions; cauliflower-like appearing growths around the anus or female
genitalia; increased dampness or moisture in the area of the growths; itching
of the penis, scrotum, anal area, or a vulvar itch; increased vaginal
discharge; and/or abnormal vaginal bleeding (not associated with a menstrual
period) after sexual intercourse (postcoital).
Hugs and Kisses
Combination of methamphetamine and methylenedioxymethamphetamine (MDMA)
Amphetamine; high quality methamphetamine; marijuana;
methylenedioxymethamphetamine (MDMA); marijuana grown in water (hydroponic)
Hypoglycemia occurs when your body's blood sugar, or glucose, is abnormally
low. The term insulin shock is used to describe severe hypoglycemia that
results in unconsciousness. Hypoglycemia results when your body's glucose is
used up too rapidly, when glucose is released into the bloodstream more slowly
than is needed by your body, or when excessive insulin is released into the
bloodstream. Insulin is a hormone produced by the pancreas in response to
increased glucose levels in the blood, which then reduces blood glucose.
Hypoglycemia is relatively common in diabetics. It occurs when too much insulin
or oral antidiabetic medication is taken, not enough food is eaten, or from a
sudden increase in the amount of exercise without an increase in food intake.
Relative hypoglycemia, where a newborn's blood glucose is low, is a fairly
common occurrence. Severe hypoglycemia may occur in an infant born to a
gestational diabetic or a diabetic mother. In these cases the child is referred
to as an IDM for "infant of diabetic mother." If, during the pregnancy, the
mother's blood sugar is persistently high, the fetus' pancreas assists in
controlling the excess blood sugar by producing extra insulin. When the infant
is born, it no longer gets the mother's glucose, but still produces increased
insulin, and the increased insulin drives the infant's blood sugar down to
dangerous levels. This is a medical emergency that may result in seizures and
damage to the baby's nervous system if not treated. Sometimes the cause of
hypoglycemia is unknown, or idiopathic. In this case, people who are not
diabetic and who do not have another known causes of hypoglycemia experience
these symptoms. Hypoglycemia can occur because of an insulin-secreting tumor of
the pancreas, liver disease, or as a response to the ingestion of alcohol. It
can occur in adults, infants, and children. The incidence is approximately 1
out of 1000 people. Symptoms include: fatigue, general discomfort, uneasiness,
or ill feeling (malaise), nervousness, Irritability, or even aggression,
trembling, headache, hunger, cold sweats, rapid heart rate, blurry or double
vision, confusion, convulsions and/or coma.
Cocaine; crack cocaine; smokable methamphetamine; methamphetamine;
methylenedioxymethamphetamine (MDMA); phencyclidine (PCP)
The inability to achieve and maintain penile erection sufficient to complete
satisfactory intercourse. Between 2 and 30 million men in the United States are
affected by impotence problems, according to recent estimates. About 52% of men
between 40 and 70 years-old have some degree of erectile dysfunction (ED).
Approximately 90% of ED is caused by physical, not psychological, problems.
Risk factors for ED include: hypertension (high blood pressure), hyperlipidemia
(high cholesterol), diabetes, coronary artery disease, peripheral vascular
disease, anemia, medications, smoking, alcohol abuse, surgical procedures
(vascular surgeries, abdomino- perineal resection, radical prostatectomy, other
pelvic surgeries, etc.), neurological conditions, depression, endocrine
disorgers (low testosterone, thyroid disease, hyperprolactinemia, etc.), and/or
trauma. Impotence can be classified as primary or secondary. A man with primary
impotence has never had an erection sufficient for intercourse. This is rare.
The more common condition, secondary impotence, is the loss of erectile
function after a period of normal function. Except for impotence caused by
injury or sudden illness, secondary impotence usually comes on gradually.
Treatment of secondary impotence is usually more successful than that for
primary impotence because it is easier to restore function that has been lost
than it is to discover why function has never occurred in the first place.
The process of replacing missing data. May be done logically (based on other
existing data) or with statistical techniques based on variables that are
correlated with the variable and the missing data.
In Home Family Services
Mental health treatment and support services offered to children and
adolescents with mental illness and to their family members in their own homes
Incremental Cost-Effectiveness Ratio
The difference in the inflation-adjusted, discounted average costs of two
programs, divided by the difference in discounted average levels of
effectiveness of the two programs.
Incremental Net Benefit Value
The difference in the inflation-adjusted, discounted average benefits and costs
of two alternative programs.
Indemnity insurance plans are an alternative to managed care plans. These plans
charge consumers a set amount for coverage and reimburse (fully or partially)
consumers for most medical services.
Independent living services
Support for a young person living on his or her own. These services include
therapeutic group homes, supervised apartment living, and job placement.
Services teach youth how to handle financial, medical, housing, transportation,
and other daily living needs, as well as how to get along with others.
A strategy designed for persons who are identified as having minimal but
detectable signs or symptoms or precursors of some illness or condition, but
whose condition is below the threshold of a formal diagnosis of the condition.
A defined, measurable variable used to monitor the quality or appropriateness
of an important aspect of patient care. Indicators can be activities, events,
occurrences, or outcomes for which data can be collected to allow comparison
with a threshold, a benchmark, or prior performance.
Individual Practice Association (IPA) Model HMO
A healthcare model that contracts with an entity, which in turn contracts with
physicians to provide healthcare services in return for a negotiated fee.
Physicians continue in their existing individual or group practices and are
compensated on a per capita, fee schedule, or fee-for-service basis.
Therapy tailored for a patient/client that is administered one-on-one.
Services designed to meet the unique needs of each child and family. Services
are individualized when the caregivers pay attention to the needs and
strengths, ages, and stages of development of the child and individual family
members. Also see appropriate services and family-centered services.
Information and Referral Services
Information services are those designed to impart information on the
availability of clinical resources and how to access them. Referral services
are those that direct, guide, or a client/patient with appropriate services
provided outside of your organization.
Breathable chemical vapors that produce psychoactive (mind-altering) effects.
Although people are exposed to volatile solvents and other inhalants in the
home and in the workplace, many do not think of inhalable substances as drugs
because most of them were never meant to be used in that way. Young people are
likely to abuse inhalants, in part because inhalants are readily available and
inexpensive. Sometimes children unintentionally misuse inhalant products that
are found in household products. Parents should see that these substances are
monitored closely so that they are not inhaled by young children. Inhalants
fall into the following categories: Solvents: Industrial or household solvents
or solvent-containing products, including paint thinners or solvents,
degreasers (dry- cleaning fluids), gasoline, and glues Art or office supply
solvents, including correction fluids, felt-tip-marker fluid, and electronic
contact cleaners Gases - Gases used in household or commercial products,
including butane lighters and propane tanks, whipping cream aerosols or
dispensers (whippets), and refrigerant gases - Household aerosol propellants
and as sociated solvents in items such as spray paints, hair or deodorant
sprays, and fabric protector sprays - Medical anesthetic gases, such as ether,
chloroform, halothane, and nitrous oxide (laughing gas) Nitrites - aliphatic
nitrites, including cyclohexyl nitrite, which is available to the general
public; amyl nitrite, which is available only by prescription; and butyl
nitrite, which is now an illegal substance.
The act of administering a drug or combination of drugs by nasal or oral
respiration. Also, the act of drawing air or other substances into the lungs.
Nicotine in tobacco smoke enters the body by inhalation. 
A method of administering a substance such as a drug into the skin,
subcutaneous tissue, muscle, blood vessels, or body cavities, usually by means
of a needle.
Mental health treatment provided in a hospital setting 24 hours a day.
Inpatient hospitalization provides: (1) short-term treatment in cases where a
child is in crisis and possibly a danger to his/herself or others, and (2)
diagnosis and treatment when the patient cannot be evaluated or treated
appropriately in an outpatient setting.
Services designed to briefly assess the type and degree of a client's/patient's
mental health condition to determine whether services are needed and to link
him/her to the most appropriate and available service. Services may include
interviews, psychological testing, physical examinations including
speech/hearing, and laboratory studies.
Integrated Delivery System
A system of providers and diverse organizations working collaboratively to
coordinate a full range of care and services within a community.
Integrated Health Plan
A single entity serving as an integrated delivery network that is fully
responsible for obtaining and managing payer contracts, assuming healthcare
risk, collecting revenue, and asset control by lease or ownership.
Integrated Service Delivery (ISD)
A generic term referring to a joint effort of physician/hospital integration
for a variety of purposes.
A concept describing how previously separate organizations, functions, and/or
caregivers are blending their services and operations to function more
efficiently and effectively in offering a seamless system of care within which
consumers can easily move.
Intensive case management
Intensive community services for individuals with severe and persistent mental
illness that are designed to improve planning for their service needs. Services
include outreach, evaluation, and support.
Intensive Residential Services
Intensively staffed housing arrangements for clients/patients. May include
medical, psychosocial, vocational, recreational or other support services.
An evaluation design in which analyses are conducted upon the basis of a
treatment or comparison group assigned or chosen at baseline, regardless of how
long observations remained in that group.
Internal Rate of Return
The discount rate associated with a net present value figure of $0. Programs
with higher internal rates of return are more economically attractive.
Refers to the ability to make statements about causal relationships between
variables. Internal validity threats may diminish the truthfulness of those
The International Classification of Diseases, Ninth Revision (ICD- 9)
The ICD-9 system is a classification system that groups related disease
entities and procedures for the reporting of statistical information.
Responsibility for maintenance of the classification system is shared between
the National Center for Health Statistics (NCHS), which handles diagnosis
classification, and the Center for Medicare and Medicaid Services (CMS), which
handles procedure classification.
The worldwide networking of separate computer systems and networks into one
"information superhighway". To get around, "browse," or "surf" this complex
interconnection of networks, special software and hardware are needed. The cost
of such equipment would be prohibitive for individuals, or even most companies.
However, a user can gain access to the internet via an Internet Service
Provider(ISP). One cannot get onto the internet simply by buying a computer,
but must also contract with an ISP, usually for a monthly fee. Compuserve, AOL,
Worldnet, MSN, and Mindspring are just a few of the hundreds of ISP's
Through one-on-one conversations, this approach focuses on the patient's
current life and relationships within the family, social, and work
environments. The goal is to identify and resolve problems with insight, as
well as build on strengths.
PCP; methamphetamine; methamphetamine combined with PCP (phencyclidine)
a central nervous system depressant that produces a rapid-acting dissociative
effect. It was developed in the 1970s as a medical anesthetic for both humans
and animals. Ketamine is often mistaken for cocaine or crystal methamphetamine
because of a similarity in appearance (NCADI, 2000). Also known as K, Special
K, Vitamin K, Kit Kat, Keller, Super Acid, and Super C, Ketamine is available
in tablet, powder, and liquid form. So powerful is the drug that, when
injected, there is a risk of losing motor control before the injection is
completed. In powder form, the drug can be snorted or sprinkled on tobacco or
marijuana and smoked (Partnership for a Drug-Free America, 2000). The effects
of Ketamine last from 1 to 6 hours, and it is usually 24-48 hours before the
user feels completely "normal" again.
LAN (Local Area Network)
A group of computers hooked up to operate as a network within a specific
building or on a floor of a building. The largest LAN's can operate among a few
An inflammation of the larynx generally associated with hoarseness or loss of
voice. The voice box (larynx) is located at the top of the airway to the lungs
(windpipe, trachea) and contains the vocal cords. When they become inflamed or
infected, they swell. This can cause hoarseness, and may occasionally cause
obstruction of the airway. The most common form of laryngitis is an infectious
illness usually caused by a virus which results in hoarseness. It may also be
part of a bacterial infection or part of a common cold, bronchitis, flu, or
pneumonia. Laryngitis often follows or occurs during an upper respiratory
infection and is a self- limiting condition. Common laryngitis is not normally
associated with any breathing difficulty (respiratory distress). Several forms
of laryngitis occur in children and can lead to significant or fatal
respiratory obstruction. These are croup and epiglottitis (discussed under
their respective headings). Other causes of laryngitis include laryngeal
polyps, laryngeal paralysis (such as Horner syndrome), premalignant changes of
the vocal mucosa, malignant tumors, allergies, and trauma. Symptoms include:
recent or current upper respiratory infection, hoarseness, fever, swollen lymph
nodes or glands in the neck and/or drooping eyelid on one side (Horner
syndrome). Since most common laryngitis is viral, treatment with antibiotics is
generally not indicated. Your health care provider will make this decision.
Voice rest helps both the voice and to reduce inflammation of the vocal cords.
A humidifier may provide comfort for the scratchy feeling sometimes associated
with laryngitis. Decongestants and analgesics may provide some symptomatic
relief from the accompanying upper respiratory infection.
Legal services provided to ensure the protection and maintenance of a
Methamphetamine with a dull yellow tint
Length of Stay
The duration of an episode of care for a covered person. The number of days an
individual stays in a hospital or inpatient facility.
Better grade methamphetamine
Open scabs and skin lesions due to methamphetamine abuse
A client who lives in a private residence and requires no assistance in
activities of daily living.
Load of Laundry
Local Mental Health Authority
Local organizational entity (usually with some statutory authority) that
centrally maintains administrative, clinical, and fiscal authority for a
geographically specific and organized system of health care.
Long-term Disability Expenditures
Includes salary continuation payments for those covered by insured,
self-administered, or trust plans (Source: U.S. Chamber of Commerce definition,
Lysergic Acid Diethylamide (LSD)
An hallucinogenic drug that acts on the serotonin receptor. LSD was discovered
in 1938 and is one of the most potent mood- changing chemicals. It is
manufactured from lysergic acid, which is found in ergot, a fungus that grows
on rye and other grains. LSD, commonly referred to as "acid," is sold on the
street in tablets, capsules, and, occasionally, liquid form. It is odorless,
colorless, and has a slightly bitter taste and is usually taken by mouth. Often
LSD is added to absorbent paper, such as blotter paper, and divided into small
decorated squares, with each square representing one dose. The Drug Enforcement
Administration reports that the strength of LSD samples obtained currently from
illicit sources ranges from 20 to 80 micrograms of LSD per dose. This is
considerably less than the levels reported during the 1960s and early 1970s,
when the dosage ranged from 100 to 200 micrograms, or higher, per unit.
Managed Behavioral Healthcare
Any of a variety of strategies to control behavioral health (i.e., mental
health and substance abuse) costs while ensuring quality care and appropriate
utilization. Cost-containment and quality assurance methods include the
formation of preferred provider networks, gatekeeping (or precertification),
case management, relapse prevention, retrospective review, claims payment, and
others. In many employer-negotiated health plans, behavioral healthcare is
separated from care available in the rest of the health plan for the separate
management of costs and quality of care.
Managed Behavioral Healthcare Organizations (MBHO)
An organized system of behavioral healthcare delivery, usually to defined
population or members of HMOs, PPOs, and other managed care structures; also
known as a behavioral health carve-out.
For Workplace Managed Care definitional purposes, managed care includes the
following four characteristics: (1) a network of healthcare providers operating
within some degree of management control; (2) assumption of financial risk by
the provider network or health benefit intermediary; (3) management of service
utilization through guidelines, protocols, and case management techniques; and
(4) provision of preventive care.
Managed Care Organization (MCO)
A generic term applied to a managed care plan; may be in the form of an HMO,
PHO, PPO, EPO, or other structure.
Managed Healthcare Plan
A healthcare plan that integrates financing and management with the delivery of
healthcare services to an enrolled population; employs or contracts with an
organized provider network that delivers services and which (as a network or
individual provider) either shares financial risk or has some incentive to
deliver quality, cost-effective services; and uses an information system
capable of monitoring and evaluating patterns of covered persons' use of
healthcare services and the cost of those services.
Management Services Organization (MSO)
An organization that provides practice management, administration, and support
services to individual physicians or group practices. MSOs are typically owned
by hospital(s) or investors.
In drug testing, the term used to refer to the Mandatory Guidelines for Federal
Workplace Drug Testing Programs initially published in the Federal Register on
April 11, 1988, and revised on June 9, 1994, to establish the scientific and
technical guidelines for Federal drug testing programs.
A green, brown, or gray mixture of dried, shredded leaves, stems, seeds, and
flowers of a plant. You may hear marijuana called by street names such as pot,
herb, weed, grass, boom, Mary Jane, gangster, or chronic. There are more than
200 slang terms for marijuana. Sinsemilla (sin-seh-me-yah; it's a Spanish
word), hashish ("hash" for short), and hash oil are stronger forms of
marijuana. All forms of marijuana are mind-altering. In other words, they
change how the brain works. They all contain THC (delta-9-
tetrahydrocannabinol), the main active chemical in marijuana. They also contain
more than 400 other chemicals. Marijuana's effects on the user depend on the
strength or potency of the THC it contains. THC potency of marijuana has
increased since the 1970s but has been about the same since the mid-1980s.
Maternal and Child Health Programs (MCHP)
A State service organization to assist children under 21 years of age who have
conditions leading to health problems
A term that describes a third variable's relationship to a dependent and an
independent variable, in which the third variable represents the generative
mechanism through which the independent variable is able to influence the
dependent variable of interest. A variable functions as a mediator when it
meets the following criteria: (1) variations in the levels of the independent
variable significantly account for variations in the presumed mediator; (2)
variations in the mediator significantly account for variations in the
dependent variable; and (3) a previously significant relationship between the
independent and the dependent variable is lost or greatly attenuated when the
variance accounted for by the independent/mediator relationship is removed.
Medicaid is a health insurance assistance program funded by Federal, State, and
local monies. It is run by State guidelines and assists low-income persons by
paying for most medical expenses.
Mental health clients to whom some services were reimbursable through Medicaid.
Medical group practice
A number of physicians working in a systematic association with the joint use
of equipment and technical personnel and with centralized administration and
The evaluation of healthcare services to determine if they are medically
appropriate and necessary to meet basic health needs, consistent with the
diagnosis or condition and rendered in a cost-effective manner, and consistent
with national medical practice guidelines regarding type, frequency, and
duration of treatment.
Medical review criteria
Screening criteria used by third-party payers and review organizations as the
underlying basis for reviewing the quality and appropriateness of care provided
to selected cases.
Medical Review Officer
In drug testing, a licensed medical doctor specially trained in substance abuse
who is responsible for receiving, interpreting, and evaluating drug test
Health insurers often specify that, in order to be covered, a treatment or drug
must be medically necessary for the consumer. Anything that falls outside of
the realm of medical necessity is usually not covered. The plan will use prior
authorization and utilization management procedures to determine whether or not
the term "medically necessary" is applicable.
Medicare is a Federal insurance program serving the disabled and persons over
the age of 65. Most costs are paid via trust funds that beneficiaries have paid
into throughout the courses of their lives; small deductibles and some
co-payments are required.
A drug that is used to treat an illness or disease according to established
Prescription, administration, assessment of drug effectiveness, and monitoring
of potential side effects of psycho-tropic medications.
MediGap plans are supplements to Medicare insurance. MediGap plans vary from
State to State; standardized MediGap plans also may be known as Medicare Select
Used synonymously with the terms enrollee and insured. A member is any
individual or dependent who is enrolled in and covered by a managed health care
Member Assistance Program
A human risk management program that focuses on lowering behavioral and
healthcare costs by proactively reducing demand for treatment. Also known as
"demand reduction" or "demand management program."
Memorandum for Record (MFR)
In drug testing, a statement prepared by an individual that provides or
corrects information on any documents associated with a drug test.
Another term used for mental health problems.
Refers to how a person thinks, feels, and acts when faced with life's
situations. It is how people look at themselves, their lives, and the other
people in their lives; evaluate the challenges and the problems; and explore
choices. This includes handling stress, relating to other people, and making
How a person thinks, feels, and acts when faced with life's situations. Mental
health is how people look at themselves, their lives, and the other people in
their lives; evaluate their challenges and problems; and explore choices. This
includes handling stress, relating to other people, and making decisions.
Mental Health Parity (Act)
Mental health parity refers to providing the same insurance coverage for mental
health treatment as that offered for medical and surgical treatments. The
Mental Health Parity Act was passed in 1996 and established parity in lifetime
benefit limits and annual limits.
Mental health problems
Mental health problems are real. They affect one's thoughts, body, feelings,
and behavior. Mental health problems are not just a passing phase. They can be
severe, seriously interfere with a person's life, and even cause a person to
become disabled. Mental health problems include depression, bipolar disorder
(manic-depressive illness), attention-deficit/ hyperactivity disorder, anxiety
disorders, eating disorders, schizophrenia, and conduct disorder.
This term is usually used to refer to severe mental health problems in adults.
Methamphetamine regular user
One who has a violent reaction to methamphetamine
Meth speed ball
Methamphetamine combined with heroin
A powerfully addictive stimulant that dramatically affects the central nervous
system. The drug is made easily in clandestine laboratories with relatively
inexpensive over-the-counter ingredients. These factors combine to make
methamphetamine a drug with high potential for widespread abuse.
Methamphetamine is commonly known as "speed," "meth," and "chalk." In its
smoked form, it is often referred to as "ice," "crystal," "crank," and "glass."
It is a white, odorless, bitter-tasting crystalline powder that easily
dissolves in water or alcohol. The drug was developed early in this century
from its parent drug, amphetamine, and was used originally in nasal
decongestants and bronchial inhalers. Methamphetamine's chemical structure is
similar to that of amphetamine, but it has more pronounced effects on the
central nervous system. Like amphetamine, it causes increased activity,
decreased appetite, and a general sense of well-being. The effects of
methamphetamine can last 6 to 8 hours. After the initial "rush," there is
typically a state of high agitation that in some individuals can lead to
Methamphetamine with the appearance of crack; methamphetamine
Crack and methamphetamine
Activities related to the planning, organization, management, funding, and
oversight of direct services.
MHA Data collection/reporting
These are activities to obtain, analyze, and report data for planning,
management or evaluation purposes.
MHA Other Activities
Other specific non-direct service activities of State MHAs that further the
provision of mental health services in the State.
MHA Planning Council Activities
All activities that comply with the mandate of State MHAs to form and operate a
planning council to support the development of a strategic plan for mental
health services and assess ongoing operations.
MHA Technical Assistance
Provision or sponsorship of training, education, or technical support in the
planning, operation or management of public mental health programs in the
MI and MR/DD services
Services designed to address the needs of people with both psychiatric illness
and mental retardation or developmental disabilities.
Mobile Treatment Team
Provides assertive outreach, crisis intervention, and independent-living
assistance with linkage to necessary support services in the client's/patient's
own environment. This includes PACT, CTTP, or other continuous treatment team
A device that allows a computer to communicate with another computer by dialing
over telephone lines. Modems may be built into compUters or added onto them as
separate equipment. To get onto the INTERNET, one's computer must dial an ISP's
computer using a modem
A term that describes a third variable's relationship to a dependent and an
independent variable, in which the third variable partitions the independent
variable into subgroups that establish its domains of maximal effectiveness in
regard to the dependent variable. The moderator may be qualitative or
quantitative, and it affects the direction and/or strength of the relation
between the independent and the dependent variable. Within an ANOVA framework,
the moderator effect can be represented as an interaction between an
independent variable and a factor that specifies particular conditions for its
An actuarial determination of the incidence and severity of sicknesses and
accidents in a well-defined class or classes of persons.
More Than One Race
A category of racial grouping for a person who reports multiple racial origins.
An actuarial determination of the death rate at each age as determined from
Motor Vehicle-more than 41,000 people lose their lives in motor vehicle crashes
each year and over two million more suffer disabling injuries, according to the
National Safety Council. The triple threat of high speeds, impaired or careless
driving and not using occupant restraints threatens every driver -- regardless
of how careful or how skilled. Driving defensively means not only taking
responsibility for yourself and your actions but also keeping an eye on "the
other guy." The National Safety Council suggests the following guidelines to
help reduce your risks on the road: Don't start the engine without securing
each passenger in the car, including children and pets. Safety belts save
thousands of lives each year! Lock all doors. Remember that driving too fast or
too slow can increase the likelihood of collisions. Don't kid yourself. If you
plan to drink, designate a driver who won't drink. Alcohol is a factor in
almost half of all fatal motor vehicle crashes. Be alert! If you notice that a
car is straddling the center line, weaving, making wide turns, stopping
abruptly or responding slowly to traffic signals, the driver may be impaired.
Avoid an impaired driver by turning right at the nearest corner or exiting at
the nearest exit. If it appears that an oncoming car is crossing into your
lane, pull over to the roadside, sound the horn and flash your lights. Notify
the police immediately after seeing a motorist who is driving suspiciously.
Follow the rules of the road. Don't contest the "right of way" or try to race
another car during a merge. Be respectful of other motorists. While driving, be
cautious, aware and responsible.
National Committee for Quality Assurance (NCQA)
A national organization founded in 1979 and composed of 14 directors
representing consumers, purchasers, and providers of managed healthcare. It
accredits quality assurance programs in prepaid managed healthcare
organizations, and develops and coordinates programs for assessing the quality
of care and service in the managed care industry.
Native Hawaiian or Other Pacific Islander
A person having origins in any of the original peoples of Hawaii, Guam, Samoa,
or other Pacific Islands.
Net Present Value
The inflation-adjusted, discounted benefits of a program or intervention, minus
the inflation-adjusted, discounted costs of producing and consuming it,
expressed in today's dollars or the dollars of a base year of interest.
The rules of behavior for the Internet and e- mail communications.
The system of participating providers and institutions in a managed care plan.
Many States have laws defining network adequacy, the number and distribution of
health care providers required to operate a health plan. Also known as provider
adequacy of a network.
Network Model HMO
An HMO type in which the HMO contracts with more than one physician group, and
may contract with single- and multi-specialty groups. The physician works out
of his/her own office. The physician works out of share in utilization savings,
but does not necessarily provide care exclusively for HMO members.
New Generation Medications
Anti-psychotic medications which are new and atypical.
One of the most heavily used addictive drugs in the United States. Cigarette
smoking has been the most popular method of taking nicotine since the beginning
of the 20th century. In 1998, 60 million Americans were current cigarette
smokers (28 percent of all Americans aged 12 and older), and 4.1 million were
between the ages of 12 and 17 (18 percent of youth in this age bracket). In
1989, the U.S. Surgeon General issued a report that concluded that cigarettes
and other forms of tobacco, such as cigars, pipe tobacco, and chewing tobacco,
are addictive and that nicotine is the drug in tobacco that causes addiction.
In addition, the report determined that smoking was a major cause of stroke and
the third leading cause of death in the United States.
A facility that provides mental health services, but not on a residential
basis, other than an inpatient facility or nursing home.
Services other than those funded by Medicaid.
Nurse Practitioner (NP)
A nurse practitioner is a registered nurse who works in an expanded role and
manages patients' medical conditions.
An establishment that provides living quarters and care for the elderly and the
chronically ill. This includes assisted living outside a nursing home.
Nutrition for Seniors
Nutrition for Seniors-As you grow older, you may need less energy from what you
eat. But, you still need just as many of the nutrients in food. Nutrition
experts can recommend what the average older person needs to eat, but you
should also check with your doctor or a registered dietitian, a specialist
trained in nutrition. This is especially true if you have a health problem that
limits what you should eat. They can help you plan meals that will include the
healthy foods you need without the foods you should avoid. Choose many
different healthy foods. Pick those that are lower in fat, especially saturated
fat (mostly in foods that come from animals), and cholesterol. Eat or drink
only small amounts of sugary or salty foods, and alcoholic drinks, if you drink
them at all. Avoid "empty calories" as much as you can. These are foods like
sodas, potato chips, and cookies that have a lot of calories, but not many
nutrients. The U.S. Department of Agriculture (USDA) has developed the Food
Guide Pyramid to help you make healthy food choices. There are five major food
groups. Every day you should try to eat the suggested number of servings from
each group. If you can't do that, at least try to eat something from each group
each day. Lower fat choices are best. Make sure you eat vegetables, fruits, and
Obesity is defined as a BMI (body mass index) over 30 kg/m2. Patients with a
BMI between 25 and 29.9 are considered overweight, but not obese. An individual
is considered obese when weight is 20% (25% in women) or more over the maximum
desirable for their height. When an adult is more than 100 pounds overweight,
it is considered morbid obesity. More than half of the U.S. population is
overweight. But being obese is different from being overweight. Obesity
increases a person's risk of illness and death due to diabetes, stroke,
coronary artery disease, hypertension, high cholesterol, and kidney and
gallbladder disorders. Obesity may increase the risk for some types of cancer.
It is also a risk factor for the development of osteoarthritis and sleep apnea.
Genetic factors play some part in the development of obesity -- children of
obese parents are 10 times more likely to be obese than children with parents
of normal weight. To help prevent an increase in weight: Avoid excess alcohol
consumption; Stress; Depression; Boredom and frustration; Poor eating habits;
and avoid a sedentary lifestyle. Perform aerobic exercise for at least 30
minutes a day, 3 times a week and try to increase physical activity in general
by walking rather than driving, and climbing stairs rather than using an
elevator or escalator. In addition reduce consumption of food that is high in
fat and sugar.
In drug testing, the individual who watches the donor urinate into a collection
container or specimen bottle when a direct-observed collection is required.
Obsessive-Compulsive Disorder (OCD)
One of the anxiety disorders, OCD is a potentially disabling condition that can
persist throughout a person's life. The individual who suffers from OCD becomes
trapped in a pattern of repetitive thoughts and behaviors that are senseless
and distressing but extremely difficult to overcome. OCD occurs in a spectrum
from mild to severe, but if severe and left untreated, can destroy a person's
capacity to function at work, at school, or even in the home. Obsessions are
unwanted ideas or impulses that repeatedly well up in the mind of the person
with OCD. Persistent fears that harm may come to self or a loved one, an
unreasonable concern with becoming contaminated, or an excessive need to do
things correctly or perfectly, are common. Again and again, the individual
experiences a disturbing thought, such as, "My hands may be contaminated--I
must wash them"; "I may have left the gas on"; or "I am going to injure my
child." These thoughts are intrusive, unpleasant, and produce a high degree of
anxiety. Sometimes the obsessions are of a violent or a sexual nature, or
concern illness. In response to their obsessions, most people with OCD resort
to repetitive behaviors called compulsions. The most common of these are
washing and checking. Other compulsive behaviors include counting (often while
performing another compulsive action such as hand washing), repeating,
hoarding, and endlessly rearranging objects in an effort to keep them in
precise alignment with each other. Mental problems, such as mentally repeating
phrases, listmaking, or checking are also common. These behaviors generally are
intended to ward off harm to the person with OCD or others. Some people with
OCD have regimented rituals while others have rituals that are complex and
changing. Performing rituals may give the person with OCD some relief from
anxiety, but it is only temporary. People with OCD show a range of insight into
the senselessness of their obsessions. Often, especially when they are not
actually having an obsession, they can recognize that their obsessions and
compulsions are unrealistic. At other times they may be unsure about their
fears or even believe strongly in their validity. OCD is sometimes accompanied
by depression, eating disorders, substance abuse disorder, a personality
disorder, attention deficit disorder, or another of the anxiety disorders.
Co-existing disorders can make OCD more difficult both to diagnose and to
Occupational illness is any abnormal condition or disorder, other than one
resulting from an occupational injury, caused by exposure to factors associated
with employment. It includes acute and chronic illnesses or disease which may
be caused by inhalation, absorption, ingestion, or direct contact.
Occupational injury is any injury such as a cut, fracture, sprain, amputation,
etc., which results from a work-related event or from a single instantaneous
exposure in the work environment.
Also known as "narcotic analgesics". Concern about the abuse of prescription
painkillers has risen dramatically in the U.S. Of particular concern is the
abuse of pain medications containing opiates, marketed under such brand names
as Vicodin, OxyContin, Percocet, Demerol, and Darvon. According to the Drug
Abuse Warning Network (DAWN), the incidence of emergency department (ED) visits
related to narcotic analgesic abuse has been increasing in the U.S. since the
mid-1990s, and more than doubled between 1994 and 2001.
The value of resources used to produce or consume goods or services in their
next best alternative use.
Organized Delivery Systems
Proposed networks of providers and payors that would provide care and compete
with other systems for enrollees in their region. Systems could include any
providers and/or sites that offer a full range of preventive and treatment
Information on outbreaks of concern to international travelers.
Assessments that gauge the effect or results of services provided to a defined
population. Outcomes measures include the consumers' perception of restoration
of function, quality of life, and functional status, as well as objective
measures of mortality, morbidity, and health status.
The results of a specific health care service or benefit package.
Studies that measure the effects of care or services.
Extremely high or low values of a variable of interest.
P and P
Methamphetamine used in combination with MDMA (methylenedioxymethamphetamine)
Panic Disorder is when people experience white-knuckled, heart-pounding terror
that strikes suddenly and without warning. Since they cannot predict when a
panic attack will seize them, many people live in persistent worry that another
one could overcome them at any moment. Most panic attacks last only a few
minutes, but they occasionally go on for ten minutes, and, in rare cases, have
been known to last for as long as an hour. They can occur at any time, even
during sleep. The good news is that proper treatment helps 70 to 90 percent of
people with panic disorder, usually within six to eight weeks. Symptoms include
pounding heart, chest pains, lightheadedness or dizziness, nausea, shortness of
breath, shaking or trembling, choking, fear of dying, sweating, feelings of
unreality, numbness or tingling, hot flashes or chills, and a feeling of going
out of control or going crazy. Cognitive behavioral therapy and medications
such as high-potency anti-anxiety drugs like alprazolam can be used to treat
panic disorders. Several classes of antidepressants (such as paroxetine, one of
the newer selective serotonin reuptake inhibitors) and the older tricyclics and
monoamine oxidase inhibitors (MAO inhibitors) are considered "gold standards"
for treating panic disorder. Sometimes a combination of therapy and medication
is the most effective approach to helping people manage their symptoms.
A dosage unit of heroin; one-tenth of a gram or less of the drug ice or
Party and play
Methamphetamine used in combination with MDMA (methylenedioxymethamphetamine)
The exposure of non-smoking subjects to side- stream smoke from active smokers,
thereby raising the possibility that a non-user may test positive.
A code known only to a specific user, thanks to which he or she can access a
computer network, program, system or file. Usually a word or phrase.
Pastoral counselors are counselors working within traditional faith communities
to incorporate psychotherapy, and/or medication, with prayer and spirituality
to effectively help some people with mental disorders. Some people prefer to
seek help for mental health problems from their pastor, rabbi, or priest,
rather than from therapists who are not affiliated with a religious community.
The party, including employers, government agencies, and insurance companies,
that purchases the health services provided to consumers.
Methamphetamine; PCP mixed with peanut butter
The desired level of achievement of standards of care or service. These may be
expressed as desired minimum performance levels (thresholds), industry best
performance (benchmarks), or the permitted variance from the standard.
Performance goals usually are not static but change as performance improves
and/or the standard of care is refined.
Methods or instruments to estimate or monitor the extent to which the actions
of a healthcare practitioner or provider conform to practice guidelines,
medical review criteria, or standards of quality.
Pharmacy Benefit Manager (PBM)
PBMs are third party administrators of prescription drug benefits.
Also known as "angel dust" and is a hallucinogen. It is difficult to estimate
the current use of phencyclidine in the United States because many individuals
do not recognize that they have taken it. PCP is frequently laced with other
illicit substances (such as marijuana) and the buyer not made aware of its
presence. PCP use in the U.S. dates back to 1967 when it was sold as the "Peace
Pill" in the Haight-Ashbury district of San Francisco. Its use never became
very popular because it had a reputation for causing "bad trips." PCP use grew
during the mid-1970s primarily because of different packaging (sprinkling on
leaves that are smoked) and marketing strategies. During the 1980s it was
established as the most commonly used hallucinogen, with the majority of users
15 to 25 years old. Although phencyclidine was initially developed by a
pharmaceutical company searching for a new anesthetic, it was not suitable for
human use because of its psychotropic side effects. PCP is no longer
manufactured for legitimate, legal purposes. Unfortunately it can be made
rather easily and without great expense by anyone with a basic knowledge of
organic chemistry, making it a prime drug for the illicit drug industry. It is
available illegally as a white, crystalline powder that can be dissolved in
either alcohol or water.
Irrational fears that lead people to altogether avoid specific things or
situations that trigger intense anxiety. Phobias occur in several forms.
Specific phobia is an unfounded fear of a particular object or situation-such
as being afraid of dogs, yet loving to ride horses, or avoiding highway
driving, yet being able to drive on city and country roads. Virtually an
unlimited number of objects or situations- such as being afraid of flying,
heights, or spiders-can be the target of a specific phobia. Agoraphobia is the
fear of being in any situation that might trigger a panic attack and from which
escape might be difficult. Many people who have agoraphobia become housebound.
Others avoid open spaces, standing in line, or being in a crowd. Many of the
physical symptoms that accompany panic attacks - such as sweating, racing
heart, and trembling - also occur with phobias. Social phobia is a fear of
being extremely embarrassed in front of other people. The most common social
phobia is fear of public speaking. Cognitive behavioral therapy has the best
track record for helping people overcome most phobic disorders. The goals of
this therapy are to desensitize a person to feared situations or to teach a
person how to recognize, relax, and cope with anxious thoughts and feelings.
Medications, such as anti-anxiety agents or antidepressants, can also help
relieve symptoms. Sometimes therapy and medication are combined to treat
Physical activity is defined as the state of being active, or as energetic
action or movement. Physical activity can increase the basal metabolic rate by
approximately 10%. This increase can last for up to 48 hours after the
completion of the activity. Physical activity helps in the utilization of
calories. The number of calories used is dependent on the type and intensity of
the activity, and on the body weight of the person performing the physical
activity. Physical activity assists in reducing the appetite. For the purpose
of weight loss, physical activity can reduce body fat and is more beneficial in
combination with reduced intake of calories. Physical activity also helps in
the maintenance and control of weight. Physical activity contributes to health
by reducing the heart rate, decreasing the risk for cardiovascular disease, and
reducing the amount of bone loss that is associated with age and osteoporosis.
Physical activity also helps the body use calories more efficiently, thereby
helping in weight loss and maintenance. It can increase basal metabolic rate,
reduces appetite, and helps in the reduction of body fat.
An adaptive physiological state that occurs with regular drug use and results
in a withdrawal syndrome when drug use is stopped; usually occurs with
A physician assistant is a trained professional who provides health care
services under the supervision of a licensed physician.
Physician-Hospital Community Organization
Similar to a physician-hospital organization, with the addition of community
Physician-Hospital Organization (PHO)
An IPA (individual practice association) associated with and often initiated by
a hospital which provides management services; features a contracting mechanism
for obtaining "covered lives," generally with 50:50 physician and hospital
control and hospital financing.
Plan of care
A treatment plan especially designed for each child and family, based on
individual strengths and needs. The caregiver(s) develop(s) the plan with input
from the family. The plan establishes goals and details appropriate treatment
and services to meet the special needs of the child and family.
Geared toward young children, play therapy uses a variety of activities-such as
painting, puppets, and dioramas-to establish communication with the therapist
and resolve problems. Play allows the child to express emotions and problems
that would be too difficult to discuss with another person.
Stands for "per member per month," a fixed rate paid per enrolled member under
a managed care contract for the provision of healthcare. This is the form that
a capitated payment usually takes.
A type of healthcare benefit plan in which the insured person can choose to use
a nonparticipating provider at a reduced coverage level and with more
out-of-pocket cost. Such POS plans combine HMO-like systems with indemnity
systems. Often known as open- ended HMOs or PPOs, these plans permit the
insured to choose providers outside the plan, yet are designed to encourage the
use of network providers. One of the most popular plans with consumers and
employers, POS services represent the area of greatest HMO growth.
Poor man's coke
Isobutyl nitrite; amyl nitrite; methamphetamine
Post-Traumatic Stress Disorder (PTSD)
Post-Traumatic Stress Disorder (PTSD) affects people of all ages if they have
experienced, witnessed, or participated in a traumatic occurrence-especially if
the event was life threatening. PTSD can result from terrifying experiences
such as rape, kidnapping, natural disasters, or war or serious accidents such
as airplane crashes. The psychological damage such incidents cause can
interfere with a person's ability to hold a job or to develop intimate
relationships with others. The symptoms of PTSD can range from constantly
reliving the event to a general emotional numbing. Persistent anxiety,
exaggerated startle reactions, difficulty concentrating, nightmares, and
insomnia are common. In addition, people with PTSD typically avoid situations
that remind them of the traumatic event, because they provoke intense distress
or even panic attacks. A rape victim with PTSD, for example, might avoid all
contact with men and refuse to go out alone at night. Many people with PTSD
also develop depression and may, at times, abuse alcohol or other drugs as
"self-medication" to dull their emotional pain and to forget about the trauma.
Psychotherapy can help people who have PTSD regain a sense of control over
their lives. Many people who have this disorder need to confront what has
happened to them and, by repeating this confrontation, learn to accept the
trauma as part of their past. They also may need cognitive behavior therapy to
change painful and intrusive patterns of behavior and thought and to learn
relaxation techniques. Another focus of psychotherapy is to help people who
have PTSD resolve any conflicts that may have occurred as a result of the
difference between their personal values and how behaviors and experiences
during the traumatic event violated them. Support from family and friends can
help speed recovery and healing. Medications, such as antidepressants and anti-
anxiety agents to reduce anxiety, can ease the symptoms of depression and sleep
problems. Treatment for PTSD often includes both psychotherapy and medication.
Posttraumatic Stress Disorder (PTSD)
Posttraumatic Stress Disorder is an anxiety disorder that develops as a result
of witnessing or experiencing a traumatic occurrence, especially life
threatening events. PTSD can cause can interfere with a person's ability to
hold a job or to develop intimate relationships with others.
In statistics, the probability of rejecting the null hypothesis. In a
statistical comparison of two groups, the power of a statistical test is the
probability of correctly identifying a difference between the groups, given
that the difference does in fact exist. Power = 1-beta, where beta is type II
A result or value of sufficient magnitude that it is important to program
providers, clients, employers, policy makers, or other stakeholders.
Systematically developed statements on healthcare practice that assist
healthcare providers and consumers in making decisions about appropriate
healthcare for specific situations or conditions. Managed care organizations
frequently use these guidelines to evaluate appropriateness and medical
necessity of care.
A congenital (present from birth) disease characterized by obesity, decreased
muscle tone, decreased mental capacity, and hypogonadism. Prader-Willi is
caused by the deletion of a gene on chromosome 15. For unkown reasons, only the
copy of this gene on chromosome 15 that is received from the father is active.
The maternal copy of this gene is turned off in all people. When there is a
deletion of this gene on the copy received from the father, the disease occurs.
This is because the patient is left with only the maternal copy -- which is
inactive in all people. Signs of Prader-Willi may be seen at birth. New infants
with the condition are often small and very floppy (hypotonic). Male infants
may have undescended testicles. The growing child exhibits slow mental and
delayed motor development, increasing obesity, and characteristically small
hands and feet. Rapid weight gain may occur during the first few years because
the patient develops uncontrollable hunger which leads to morbid obesity.
Mental development is slow, and the IQ seldom exceeds 80. However, children
with Prader-Willi generally are very happy, smile frequently, and are pleasant
to be around. Affected children have an intense craving for food and will do
almost anything to get it. This results in uncontrollable weight gain. Morbid
obesity (the degree of obesity that seriously affects health) may lead to
respiratory failure with hypoxia (low blood oxygen levels), cor pulmonale
(right- sided heart failure), and death.
A medical condition that is excluded from coverage by an insurance company
because the condition was believed to exist prior to the individual obtaining a
policy from the insurance company. Many insurance companies now impose waiting
periods for coverage of pre-existing conditions. Insurers will cover the
condition after the waiting period (of no more than 12 months) has expired.
(See also, HIPAA)
Preferred Provider Organization (PPO)
A network discount, fee-for-service provider arrangement with incentives to
stay inside the network; allows healthcare services outside of the PPO network
at an increased copayment and/or deductible; has structured quality and
Make complex surgery possible, relieve pain for millions of people, and enable
many individuals with chronic medical conditions to control their symptoms and
lead productive lives. Most people who take prescription medications use them
responsibly. However, the non-medical use of prescription drugs is a serious
public health concern. Nonmedical use of prescription drugs like opioids,
central nervous system (CNS) depressants, and stimulants can lead to abuse and
addiction, characterized by compulsive drug seeking and use. Addiction rarely
occurs among people who use a pain reliever, CNS depressant, or stimulant as
prescribed; however, inappropriate use of prescription drugs can lead to
addiction in some cases. Patients, healthcare professionals, and pharmacists
all have roles in preventing misuse and addiction. For example, if a doctor
prescribes a pain medication, CNS depressant, or stimulant, the patient should
follow the directions for use carefully, and also learn what effects the drug
could have and potential interactions with other drugs by reading all
information provided by the pharmacist. Physicians and other health care
providers should screen for any type of substance abuse during routine
history-taking with questions about what prescriptions and over-the-counter
medicines the patient is taking and why.
The public health model of prevention includes primary, secondary, and tertiary
prevention (defined elsewhere in this glossary). An Institute of Medicine (IOM)
committee (1994) set forth another definition in which prevention refers to
those interventions that take place before the onset of a disorder. IOM
classifies preventive interventions as: -Universal preventive interventions:
-Target the general public or an entire population not identified on the basis
of individual risk -Selective preventive interventions: -Target populations
whose risk of a disorder is significantly higher than average at present or
over a lifetime -Indicated preventive interventions: -Target high risk
individuals who have minimal but detectable signs or symptoms which may lead to
a mental disorder.
The U.S. Public Health Service definition defines prevention research as
research designed to show results directly applicable to interventions to
prevent occurrences of disease or disability.
Comprehensive healthcare emphasizing priorities for prevention, early
detection, and early treatment of conditions, generally including risk
assessment appraisals, routine physical examinations, immunizations, and
Basic or general healthcare, traditionally provided by family practice,
pediatrics, and internal medicine.
Primary Care Case Management (PCCM)
Case management that requires a gatekeeper to coordinate and manage primary
care services, referrals, pre-admission certification, and other medical or
rehabilitative services. The primary advantage of PCCM for Medicaid eligibles
is increased access to PCP while reducing use of hospital outpatient
departments and emergency rooms. (There is encouragement within Medicare
Choices to provide PCP coordination for patients being treated by a wide
variety of specialists but who no longer have a PCP for oversight.)
Primary Care Provider (PCP)
A term used to denote the health care provider who typically delivers health
care services to the patient, such as a family practitioner, general internist,
pediatrician, and sometimes an ob/gyn. Generally, under managed care, a PCP
supervises, coordinates, and provides initial ambulatory medical care, acting
as a "gatekeeper" for the initiation of all referrals for non-urgent specialty
Strategies designed to decrease the number of new cases of a disorder or
The approval a provider must obtain from an insurer or other entity before
furnishing certain health services, particularly inpatient hospital care, in
order for the service to be covered under the plan.
Defined generally by economists as the amount of output of a good or service
produced per unit of input needed to produce it. May be measured more easily in
manufacturing processes in terms of goods or units produced per staff member or
machine. More difficult to measure for services, because the boundaries that
define services may be less well understood or the quality of services produced
may be more difficult to measure. Factors related to productivity, such as
various forms of absenteeism, restricted activity days, employee morale,
production delays, job tenure, etc.
In the context of performing adjustments for selection bias, the propensity
score is the predicted probability that each client participates in a substance
Proteins are complex organic compounds. The basic structure of protein is a
chain of amino acids that contain carbon, hydrogen, oxygen, and nitrogen. The
presence of nitrogen differentiates protein from carbohydrate and fat. Protein
is the main component of muscles, organs, and glands. Every living cell and all
body fluids, except bile and urine, contain protein. The cells of muscles,
tendons, and ligaments are maintained with protein. Children and adolescents
require protein for growth and development. Proteins are described as essential
and nonessential proteins or amino acids. The human body requires approximately
20 amino acids for the synthesis of its proteins. The body can make only 13 of
the amino acids -- these are known as the nonessential amino acids. They are
called non- essential because the body can make them and does not need to get
them from the diet. There are 9 essential amino acids that are obtained only
from food, and not made in the body. If the protein in a food supplies enough
of the essential amino acids, it is called a complete protein. If the protein
of a food does not supply all the essential amino acids, it is called an
incomplete protein. All meat and other animal products are sources of complete
proteins. These include beef, lamb, pork, poultry, fish, shellfish, eggs, milk,
and milk products. Protein in foods (such as grains, fruits, and vegetables)
are either low, incomplete protein or lack one of the essential amino acids.
These food sources are considered incomplete proteins. Plant proteins can be
combined to include all of the essential amino acids and form a complete
protein. Examples of combined, complete plant proteins are rice and beans, milk
and wheat cereal, and corn and beans.
Provider (Participating Provider)
Individuals and/or organizations that directly deliver prevention, treatment,
and maintenance services to consumers within the defined plan. Depending upon
the arrangement, usually involves contracts.
Providers Service Organization/Provider Sponsored Network (PSN)
A formal affiliation of healthcare providers organized and operated to provide
a full range of healthcare services; a term used in draft language of the 1996
budget discussions of House and Senate proposals that would allow Medicare to
contract directly with PSNs on a full-risk capitated basis in a way that would
"cut some HMOs out of the middle" depending on the ultimate language. The
degree to which PSNs must be subject to licensing, financing, and insurance
considerations, as regulated by State insurance commissioners, will determine
the number of providers to qualify, as compared to the more rigid HMO standards
under which provider networks must currently qualify.
A drug that distorts perception, thought, and feeling. This term is typically
used to refer to drugs with actions like those of LSD.
Psychiatric Emergency Walk- in
A planned program to provide psychiatric care in emergency situations with
staff specifically assigned for this purpose. Includes crisis intervention,
which enables the individual, family members and friends to cope with the
emergency while maintaining the individual's status as a functioning community
member to the greatest extent possible and is open for a patient to walk-in.
A psychiatrist is a professional who completed both medical school and training
in psychiatry and is a specialist in diagnosing and treating mental illness.
A drug that changes the way the brain works.
Psychoanalysis focuses on past conflicts as the underpinnings to current
emotional and behavioral problems. In this long-term and intensive therapy, an
individual meets with a psychoanalyst three to five times a week, using "free
association" to explore unconscious motivations and earlier, unproductive
patterns of resolving issues.
Based on the principles of psychoanalysis, this therapy is less intense, tends
to occur once or twice a week, and spans a shorter time. It is based on the
premise that human behavior is determined by one's past experiences, genetic
factors, and current situation. This approach recognizes the significant
influence that emotions and unconscious motivation can have on human behavior.
Therapeutic activities or interventions provided individually or in groups that
may include development and maintenance of daily and community-living skills,
self-care, skills training includes grooming, bodily care, feeding, social
skills training, and development of basic language skills.
Quality-Adjusted Life- Year
Measurement unit to define health outcomes that result from medical or surgical
care, expressed in terms of the number of years of life in a less-desirable
health condition as compared to years of full health; if the quality of life
for a bedridden patient is 50 percent with a life expectancy of 10 years, the
measurement would be 5 quality-adjusted life-years. As the U.S. system of
medicine becomes more focused on how to allocate limited healthcare resources,
more attention will be given to this and other measures of intervention
Quality Assurance (QA)
A formal set of measures, requirements, and tasks to monitor the level of care
being provided. Such programs include peer or utilization review components to
identify and remedy deficiencies in quality. The program must have a mechanism
for assessing effectiveness and may measure care against preestablished
Quality of Care
The degree to which health services for individuals and populations increase
the likelihood of desired health outcomes and are consistent with current
Cocaine; heroin; methamphetamine
A process of repeated testing used to eliminate P-values for statistical tests
with small samples.
A large molecule that recognizes specific chemicals (normally
neurotransmitters, hormones, and similar endogenous substances) and transmits
the message carried by the chemical into the cell on which the receptor
Under the influence of drugs; methamphetamine
Registered Nurse (RN)
A registered nurse is a trained professional with a nursing degree who provides
patient care and administers medicine.
In drug abuse, relapse is the resumption of drug use after trying to stop
taking drugs. Relapse is a common occurrence in many chronic disorders,
including addiction, that require behavioral adjustments to treat effectively.
A term generally used from the management point of view, meaning workers who
are based at a location or locations different from management's location. For
example a plant in Singapore might have remote Purchasing employees in Hong
Kong. This is often the case when the remote employees serve more than one
organizational unit. The Hong Kong Purchasing group might service all of an
American company's Far East operation.
An accounting of the quality of services, compared among providers over time.
The report card grades providers on predetermined, measurable quality and
outcome indicators. Generally, consumers use report cards to choose a health
plan or provider, while policy makers may use report card results to determine
overall program effectiveness, efficiency, and financial stability.
Report Card on Healthcare
An emerging tool that can be used by policymakers and healthcare purchasers
such as employers, government bodies, employer coalitions, and consumers to
compare and understand the actual performance of health plans. The tool
provides health plan performance data in major areas of accountability, such as
healthcare quality and utilization, consumer satisfaction, administrative
efficiencies and financial stability, and cost control.
Reproductive Health is the many factors can contribute to producing healthy
children. It is well known that the health of an unborn child can suffer if a
woman fails to eat right, smokes, or drinks alcohol during pregnancy. It is not
well known, however, that a man's exposure to substances in the workplace can
affect his ability to have healthy children. Radiation, many chemicals, drugs
(legal and illegal), cigarettes, and heat are examples of reproductive hazards.
Services provided over a 24-hour period or any portion of the day which a
patient resided, on an on-going basis, in a State facility or other facility
and received treatment.
Residential treatment centers
Facilities that provide treatment 24 hours a day and can usually serve more
than 12 young people at a time. Children with serious emotional disturbances
receive constant supervision and care. Treatment may include individual, group,
and family therapy; behavior therapy; special education; recreation therapy;
and medical services. Residential treatment is usually more long- term than
inpatient hospitalization. Centers are also known as therapeutic group homes.
A service that provides a break for parents who have a child with a serious
emotional disturbance. Trained parents or counselors take care of the child for
a brief period of time to give families relief from the strain of caring for
the child. This type of care can be provided in the home or in another
location. Some parents may need this help every week.
Respite Residential Services
Provision of periodic relief to the usual family members and friends who care
for the clients/patients.
Clients who are of legal age, stopped working and have withdrawn from one's
The process by which neurotransmitters are removed from the synapse by being
"pumped" through transporters back into the axon terminals that first released
The process that reinforces behavior. It is mediated at least in part by the
release of dopamine into the nucleus accumbens. Human subjects report that
reward is associated with feelings of pleasure.
Possibility that revenues of the insurer will not be sufficient to cover
expenditures incurred in the delivery of contractual services. A managed care
provider is at risk if actual expenses exceed the payment amount.
The adjustment of premiums to compensate health plans for the risks associated
with individuals who are more likely to require costly treatment. Risk
adjustment takes into account the health status and risk profile of patients.
The process of evaluating expected healthcare costs for a prospective group and
determining what product, benefit level, and price to offer in order to best
meet the needs of the group and the carrier.
The distribution of financial risk among parties furnishing a service. For
example, if a hospital and a group of physicians from a corporation provide
healthcare at a fixed price, a risk-sharing arrangement would entail both the
hospital and the physician group being held liable if expenses exceed revenues.
Trade name for flunitrazepam, has been a concern for the last few years because
of its abuse as a "date rape" drug. People may unknowingly be given the drug
which, when mixed with alcohol, can incapacitate a victim and prevent them from
resisting sexual assault. Also, Rohypnol may be lethal when mixed with alcohol
and/or other depressants. Rohypnol produces sedative-hypnotic effects including
muscle relaxation and amnesia; it can also produce physical and psychological
dependence. In Miami, one of the first sites of Rohypnol abuse, poison control
centers report an increase in withdrawal seizures among people addicted to
Rohypnol. Rohypnol is not approved for use in the United States and its
importation is banned. Illicit use of Rohypnol began in Europe in the 1970s and
started appearing in the United States in the early 1990s, where it became
known as "rophies," "roofies," "roach," "rope," and the "date rape" drug.
Another very similar drug is now being sold as "roofies" in Miami, Minnesota,
and Texas. This is clonazepam, marketed in the U.S. as Klonopin and in Mexico
as Rivotril. It is sometimes abused to enhance the effects of heroin and other
opiates. Based on emergency room admission information, Boston, San Francisco,
Phoenix, and Seattle appear to have the highest use rates of clonazepam.
Route of administration
The way a drug is put into the body. Drugs can enter the body by eating,
drinking, inhaling, injecting, snorting, smoking, or absorbing a drug through
A serious brain disorder. It is a disease that makes it difficult for a person
to tell the difference between real and unreal experiences, to think logically,
to have normal emotional responses to others, and to behave normally in social
situations. Schizophrenia is a complex and puzzling illness. Even the experts
in the field are not exactly sure what causes it. Some doctors think that the
brain may not be able to process information correctly. Genetic factors appear
to play a role, as people who have family members with schizophrenia may be
more likely to get the disease themselves. Some researchers believe that events
in a person's environment may trigger schizophrenia. For example, problems
during intrauterine development (infection) and birth may increase the risk for
developing schizophrenia later in life. Psychological and social factors may
also play some role in its development. However, the level of social and
familial support appears to influence the course of illness and may be
protective against relapse. There are five recognized types of schizophrenia:
catatonic, paranoid, disorganized, undifferentiated, and residual. Features of
schizophrenia include its typical onset before the age of 45, continuous
presence of symptoms for six months or more, and deterioration from a prior
level of social and occupational functioning. People with schizophrenia can
have a variety of symptoms. Usually the illness develops slowly over months or
even years. At first, the symptoms may not be noticed. For example, people may
feel tense, may have trouble sleeping, or have trouble concentrating. They
become isolated and withdrawn, and they do not make or keep friends. No single
characteristic is present in all types of schizophrenia. The risk factors
include a family history of schizophrenia. Schizophrenia is thought to affect
about 1% of the population worldwide. Schizophrenia appears to occur in equal
rates among men and women, but women have a later onset. For this reason, males
tend to account for more than half of clients in services with high proportions
of young adults. Although the onset of schizophrenia is typically in young
adulthood, cases of the disorder with a late onset (over 45 years) are known.
Childhood- onset schizophrenia begins after five years of age and, in most
cases, after relatively normal development. Childhood schizophrenia is rare and
can be difficult to differentiate from other pervasive developmental disorders
of childhood, such as autism.
Physical presence of a child in a school setting during scheduled class hours.
"Regular" school attendance is attendance at least 75% of scheduled hours.
School Based Services
School-based treatment and support interventions designed to identify emotional
disturbances and/or assist parents, teachers, and counselors in developing
comprehensive strategies for addressing these disturbances. School-based
services also include counseling or other school-based programs for emotionally
disturbed children, adolescents, and their families within the school, home and
Seasonal affective disorder (SAD)
Seasonal affective disorder (SAD) is a form of depression that appears related
to fluctuations in the exposure to natural light. It usually strikes during
autumn and often continues through the winter when natural light is reduced.
Researchers have found that people who have SAD can be helped with the symptoms
of their illness if they spend blocks of time bathed in light from a special
full-spectrum light source, called a "light box."
Prevention strategies designed to lower the rate of established cases of a
disorder or illness in the population (prevalence).
Section 1115 Waiver
A statutory provision that allows a State to operate its system of care for
Medicaid enrollees in a manner different from that proscribed by the Centers
for Medicare and Medicaid Services (CMS), in an attempt to demonstrate the
efficacy and cost- effectiveness of an alternative delivery system through
research and evaluation.
Section 1915(b) Waiver
A statutory provision that allows a State to partially limit the choice of
providers for Medicaid enrollees; for example, under the waiver, a State can
limit the number of times per year that enrollees can choose to drop out of an
A bias in the estimate of a program effect that arises from the inability to
separate the impact of the program on an outcome of interest from the impact of
other factors that are correlated with program participation and outcome
measures. Such bias often occurs in nonrandomized or poorly randomized
settings, resulting in treatment and comparison groups that differ on
measurable and unmeasurable factors. For example, self-referral to (or
self-selection into) a substance abuse program may result in substantial
differences between substance abusers who participate in the program and those
who do not. These differences, along with participation status, may influence
Strategy designed for individuals who are members of population subgroups whose
risk of developing an imminent or lifetime disease or disability is
significantly above average.
Self-help generally refers to groups or meetings that: involve people who have
similar needs; are facilitated by a consumer, survivor, or other layperson;
assist people to deal with a "life-disrupting" event, such as a death, abuse,
serious accident, addiction, or diagnosis of a physical, emotional, or mental
disability, for oneself or a relative; are operated on an informal,
free-of-charge, and nonprofit basis; provide support and education; and are
voluntary, anonymous, and confidential. Many people with mental illnesses find
that self-help groups are an invaluable resource for recovery and for
In the context of the accuracy of diagnosis coding, sensitivity refers to the
ability to identify persons with a particular disorder using claims data or
survey data among persons who really have that disorder.
A process of repeating the CBA or CEA several times, each time varying one or
more assumptions necessary to carry out the analysis, to see how robust the
results are to these changing assumptions.
Serious emotional disturbances
Diagnosable disorders in children and adolescents that severely disrupt their
daily functioning in the home, school, or community. Serious emotional
disturbances affect one in 10 young people. These disorders include depression,
attention- deficit/hyperactivity, anxiety disorders, conduct disorder, and
eating disorders. Pursuant to section 1912(c) of the Public Health Service Act
"children with a serious emotional disturbance" are persons: (1) from birth up
to age 18 and (2) who currently have, or at any time during the last year, had
a diagnosable mental, behavioral, or emotional disorder of sufficient duration
to meet diagnostic criteria specified within DSM- III-R. Federal Register
Volume 58 No. 96 published Thursday May 20, 1993 pages 29422 through 29425.
Serious Mental Illness
Pursuant to section 1912(c) of the Public Health Service Act, adults with
serious mental illness SMI are persons: (1) age 18 and over and (2) who
currently have, or at any time during the past year had a diagnosable mental
behavioral or emotional disorder of sufficient duration to meet diagnostic
criteria specified within DSM-IV or their ICD-9-CM equivalent (and subsequent
revisions) with the exception of DSM-IV "V" codes, substance use disorders, and
developmental disorders, which are excluded, unless they co-occur with another
diagnosable serious mental illness. (3) That has resulted in functional
impairment, which substantially interferes with or limits one or more major
life activities. Federal Register Volume 58 No. 96 published Thursday May 20,
1993 pages 29422 through 29425.
A type of support or clinical intervention designed to address the specific
mental health needs of a child and his or her family. A service could be
provided only one time or repeated over a course of time, as determined by the
child, family, and service provider.
A description, usually statistical, of the level, frequency, and necessity of
services actually used by consumers. Generally aggregated into population
measures, rather than individual consumer measures.
Sexually transmitted diseases (STDs)
Sexually transmitted diseases (STDs), once called venereal diseases, are among
the most common infectious diseases in the U.S. today. More than 20 STDs have
now been identified and they affect more than 13 million men and women in this
country each year. The annual comprehensive cost of STDs in the United States
is estimated to be well in excess of $10 billion. STDs affect men and women of
all backgrounds and economic levels. They are most prevalent among teenagers
and young adults. Nearly two-thirds of all STDs occur in people younger than 25
years of age. The incidence of STDs is rising, in part because in the last few
decades, young people have become sexually active earlier yet are marrying
later. In addition, divorce is more common. The net result is that sexually
active people today are more likely to have multiple sex partners during their
lives and are potentially at risk for developing STDs. Most of the time, STDs
cause no symptoms, particularly in women. When and if symptoms develop, they
may be confused with those of other diseases not transmitted through sexual
contact. Even when an STD causes no symptoms, however, a person who is infected
may be able to pass the disease on to a sex partner. That is why many doctors
recommend periodic testing or screening for people who have more than one sex
partner. Health problems caused by STDs tend to be more severe and more
frequent for women than for men, in part because the frequency of asymptomatic
infection means that many women do not seek care until serious problems have
developed. * Some STDs can spread into the uterus (womb) and fallopian tubes to
cause pelvic inflammatory disease (PID), which in turn is a major cause of both
infertility and ectopic (tubal) pregnancy. The latter can be fatal. * STDs in
women also may be associated with cervical cancer. One STD, human
papillomavirus infection (HPV), causes genital warts and cervical and other
genital cancers. * STDs can be passed from a mother to her baby before, during,
or immediately after birth; some of these infections of the newborn can be
cured easily, but others may cause a baby to be permanently disabled or even
die. When diagnosed and treated early, many STDs can be treated effectively.
Some infections have become resistant to the drugs used to treat them and now
require newer types of antibiotics. Experts believe that having STDs other than
AIDS increases one's risk for becoming infected with the AIDS virus.
Combination of powder cocaine and methamphetamine; crack cocaine;
methamphetamine; methylenedioxymethamphetamine (MDMA)
Short-term Disability Expenditures
Includes company payments for sickness and accident benefits beyond any sick
leave or other days not included in the short-term disability program. For
example, many companies do not pay for the first five consecutive absence days
under a short-term disability program.
The consolidation of multiple sources of funding into a single stream. This is
a key approach used in progressive mental health systems to ensure that "funds
Like cigarettes, comes from the tobacco plant. Unfortunately, most of the
publicity focused only on the health hazards associated with cigarette smoking.
While the number of cigarette smokers in the United States has continually
decreased over recent years, the number of smokeless tobacco users has steadily
increased. Since the 1970s, a 15-fold increase in smokeless tobacco has been
noted in adolescents aged 17 to 19. This has most likely been related to the
emphasis on smoke- free environments; availability of tobacco products;
increased advertising of smokeless products; macho, athletic role models who
use and advertise for smokeless products; and the false belief that smokeless
tobacco is a safe alternative for those convinced they should stop smoking but
who still want (are addicted to) the nicotine effects of tobacco.
Means to quit or stop smoking. Some tips to help people quit smoking include:
-Enroll in a smoking cessation program (hospitals, health departments,
community centers, and work sites frequently offer programs). -Ask your health
care provider for help, including whether prescription medications (such as
Zyban) might help. -Find out about nicotine patches, gum, and sprays. -Hypnosis
may help some people. -Ask your family, friends, and people you work with for
help. -Avoid smoke-filled settings and situations in which you are more likely
to smoke. -Start reducing your cigarette use, including decreasing the number
and strength of the cigarettes. -Set a quit date. -Quit completely--cold
turkey. -Exercise to relieve urges to smoke. -Get rid of all your cigarettes.
-Make a plan about what you will do instead of smoking when you are stressed
Smoking During Pregnancy
Can lead to increased fetal death, premature labor, low birthweight infants,
and SIDS (sudden infant death syndrome), which are all specific health risks
associated with tobacco use.
Gamma hydroxybutyrate (GHB); crack cocaine; methamphetamine
Methamphetamine with a pinkish tint
Social Health Maintenance Organization
Federally funded Medicare demonstration project for the elderly; provides
comprehensive health and long-term care benefits to Medicare beneficiaries.
Unlike other Medicare-enrolling HMOs, care in a social HMO is reimbursed at 100
Methamphetamine that has a somewhat shiny appearance
In the context of the accuracy of diagnosis coding, specificity refers to the
ability to identify those who do not have a disorder of interest using claims
data or survey data among those who really do not have that disorder.
In drug testing, urine that has been provided by a donor for a drug test. The
entire sample is contained in a single specimen bottle.
Crack Cocaine; amphetamine; methamphetamine
Habitual user of methamphetamine
To shoot up or smoke a mixture of cocaine and heroin; ecstasy mixed with
ketamine; the simultaneous use of a stimulant with a depressant
In drug testing, a single specimen that is split into two separate specimen
bottles. Split specimens are never collected from two different voids by the
Sports injuries like Raoul's may be inevitable, but there are some things you
can do to help prevent them: Enroll your child in organized sports through
schools, community clubs, and recreation areas where there may be adults who
are certified athletic trainers (ATC). An ATC is also trained in the
prevention, recognition and immediate care of athletic injuries. Make sure your
child uses the proper protective gear for a particular sport. This may lessen
the chances of being injured. Warmup exercises, such as stretching and light
jogging, can help minimize the chance of muscle strain or other soft tissue
injury during sports. Warmup exercises make the body's tissues warmer and more
flexible. Cooling down exercises loosen the body's muscles that have tightened
during exercise. Make warmups and cool downs part of your child's routine
before and after sports participation. And don't forget to include sunscreen
and a hat (where possible) to reduce the chance of sunburn, which is actually
an injury to the skin. Sun protection may also decrease the chances of
malignant melanoma--a potentially deadly skin cancer--or other skin cancers
that can occur later in life. It is also very important that your child has
access to water or a sports drink to stay properly hydrated while playing.
Treat Injuries With "RICE" If your child receives a soft tissue injury,
commonly known as a sprain or a strain, or a bone injury, the best immediate
treatment is easy to remember. "RICE" (Rest, Ice, Compression, and Elevation)
the injury. Get professional treatment if any injury is severe. A severe injury
means having an obvious fracture or dislocation of a joint, prolonged swelling,
or prolonged or severe pain. RICE: * Rest: Reduce or stop using the injured
area for 48 hours. If you have a leg injury, you may need to stay off of it
completely. * Ice: Put an ice pack on the injured area for 20 minutes at a
time, 4 to 8 times per day. Use a cold pack, ice bag, or a plastic bag filled
with crushed ice that has been wrapped in a towel. * Compression: Compression
of an injured ankle, knee, or wrist may help reduce the swelling. These include
bandages such as elastic wraps, special boots, air casts and splints. Ask your
doctor which one is best. * Elevation: Keep the injured area elevated above the
level of the heart. Use a pillow to help elevate an injured limb.
Staff Model HMO
A healthcare model that employs physicians to provide healthcare to its
members. All premiums and other revenues accrue to the HMO, which compensates
physicians by salary and incentive programs.
Persons or groups who have strong interest about the design, function, or
outcomes of a healthcare program or intervention.
State Children's Health Insurance Plan (SCHIP)
Under Title XXI of the Balanced Budget Act of 1997, the availability of health
insurance for children with no insurance or for children from low-income
families was expanded by the creation of SCHIP. SCHIPs operate as part of a
State's Medicaid program (Centers for Medicare and Medicaid Services, 2002).
The total unduplicated count of mental health patients/clients served through
State programs, exclusive of Medicaid and Other Coverage.
A publicly funded inpatient facility for persons with mental illness.
State Mental Health Authority or Agency
State government agency charged with administering and funding its State's
public mental health services.
The ability to accurately detect differences between groups or relationships
A class of drugs that elevates mood, increases feelings of well-being, and
increases energy and alertness. These drugs produce euphoria and are powerfully
rewarding. Stimulants include cocaine, methamphetamine, and methylphenidate
Crystal methamphetamine; methamphetamine
Defined as a feeling of tension that can be both emotional and physical.
Emotional stress usually occurs when situations are considered difficult or
unmanageable. Therefore, different people consider different situations as
stressful. Physical stress refers to a physiological reaction of the body to
various triggers. The pain experienced after surgery is an example of physical
stress. Physical stress often leads to emotional stress, and emotional stress
is frequently experienced as physical discomfort (e.g., stomach cramps). Stress
management refers to various efforts used to control and reduce the tension
that occurs in these situations. The attitude of an individual can influence
whether a situation or emotion is stressful or not. Negative attitude can be a
predictor of stress, because this type of person will often report more stress
than a person with a more positive attitude. Stress is not a disease and is a
normal part of everyone's life. Stress in small quantities is good: it makes us
more productive. For example, the fear of a bad grade can make the a student
study more attentively. However, too much stress is unhealthy and
counterproductive. The same student, if he was recently mugged and or is
getting over the sudden death of a friend will not be able to study as well.
Persistent and unrelenting stress is called anxiety.
An arrangement whereby a capitated health plan pays its contracted providers on
a capitated basis.
Employment group or individual that contracts with an insurer for medical
Refers to the abuse of alcohol and/or drugs. There are many definitions. The
DSM-IV definition is: The maladaptive pattern of substance use leading to
clinically significant impairment or distress, as manifested by one or more of
the following occurring within a 12-month period: * recurrent substance use
resulting in a failure to fulfill major role obligations; * recurrent substance
use in situations in which it is physically hazardous; * recurrent
substance-related legal problems; and * substance use despite having persistent
or recurrent social or interpersonal problems caused by or exacerbated by the
effects of the substance.
Substance Abuse Prevention and Early Intervention Program (components of)
here are six key components: (1) Written company/managed care policy that
includes prevention and early intervention; (2) Substance abuse education for
covered lives; (3) A clearly identified locus (e.g., managed care corporation,
personnel, human resources, EAP, etc.) for prevention and early intervention
activities; (4) Program with all covered lives having access to
prevention/early intervention programs and activities; (5) Capacity for
prevention and early intervention; and (6) Trained medical/behavioral
interventionists for prevention and early intervention.
A successful or unsuccessful attempt to intentionally kill oneself. Suicidal
behaviors indicate that a person wishes to, intends to, or actually attempts to
commit suicide. Suicidal behaviors can accompany many emotional disturbances,
including depression, schizophrenia, and other psychotic illnesses. In fact,
more than 90% of all suicides are related to an emotional or psychiatric
illness. Suicidal behaviors occur as a response to a situation that the person
views as overwhelming, such as social isolation, death of a loved one,
emotional trauma, serious physical illness, growing old, unemployment or
financial problems, guilt feelings, drug abuse, and alcohol abuse. In the U.S.,
suicide accounts for about 1% of all deaths each year. The highest rate is
among the elderly, but there has been a steady increase in the rate among young
people (particularly adolescents). Suicide is now the third leading cause of
death for those 15 to 19 years old (after accidents and homicide). The
incidence of reported suicides varies widely from country to country in the
world; however, this may be in part related to reporting (especially in
cultures where suicide is considered sinful or shameful). Suicide attempts
(where the person tries to harm him- or herself but the attempt does not result
in death) far outnumber actual suicides. The method of suicide attempt varies
from relatively nonviolent methods (such as poisoning, overdose, or inhaling
car exhaust) to violent methods (such as shooting or cutting oneself). Males
are more likely to choose violent methods, which probably accounts for the fact
that suicide attempts by males are more likely to be successful. Many
unsuccessful suicide attempts are carried out in a manner or setting that makes
rescue possible. They must be viewed as a cry for help.
Combination of methamphetamine and methylenedioxymethamphetamine (MDMA)
Clandestine laboratories capable of producing 10 pounds of methamphetamine in
Supportive services that include assisting individuals in finding work;
assessing individuals' skills, attitudes, behaviors, and interest relevant to
work; providing vocational rehabilitation and/or other training; and providing
work opportunities. Includes transitional and supported employment services.
Services to assist individuals in finding and maintaining appropriate housing
Supportive Residential Services
Moderately staffed housing arrangements for clients/patients. Includes
supervised apartments, satellite facilities, group homes, halfway houses,
mental health shelter- care facilities, and other facilities.
Suppressor or Masking Variable
A variable that may have a low correlation with a dependent variable, but
which, when entered in a multiple regression analysis, leads to improvement in
the predictive power of another predictor in the equation. The inclusion of the
variable is thought to control for irrelevant variance, that is, variance that
it shares with the predictors but which may not be shared with the dependent
A sexually transmitted or congenital infection caused by the bacterium
Treponema pallidum. Syphilis is an infectious disease caused by the spirochete
Treponema pallidum, which penetrates broken skin or mucous membranes.
Transmission occurs most frequently by sexual contact. Syphilis can also be
transmitted to the fetus during any stage in pregnancy. Syphilis is widespread
in the United States and primarily involves sexually active adults between
20-29 years of age. Syphilis has several stages. In the primary stage, painless
sores, called chancres, appear approximately 2-3 weeks after initial exposure.
Some individuals with primary syphilis may not notice chancres nor have
symptoms associated with them, in particular if the chancres are located in the
rectum or cervix. In about 4 to 6 weeks chancres will usually disappear.
Approximately one-third of untreated individuals will progress to the second
stage: secondary syphilis. This usually occurs at about 2 to 8 weeks after the
appearance of the original chancre in some cases the chancre may still be
present. Secondary syphilis is the stage where the bacteria have spread in the
bloodstream and have reached their highest numbers. The most common symptoms
include: skin rash which can be varied in appearance, yet frequently involves
the palms and soles, in addition to lesions in the mouth, vagina, penis (mucous
patches), swollen lymph nodes, and fever. This stage is the most contagious
stage of syphilis. It usually resolves within weeks to a year. A latent phase
follows, which may last for years and is characterized by the absence of
symptoms. The final stage of syphilis is called tertiary syphilis (syphilis;
tertiary) and is characterized by brain or central nervous system involvement
(neurosyphilis), cardiovascular involvement with inflammation of the aorta
(aortitis or aneurysms), and gummatous syphilis (destructive lesions of the
skin and bones). The symptoms of syphilis depend on the stage of the disease.
In addition, a significant proportion of individuals may remain without
symptoms. Symptoms include: Syphilis; primary: chancres -- (usually single yet
may be multiple) painless sores on genitals, rectum, or mouth and/or enlarged
lymph nodes in the area adjacent to the chancre. Syphilis; secondary: skin rash
-- usually throughout the body with both flat and raised patches which may
involve the palms and soles of the feet; extensive lymph node enlargement;
mucous patches (painless silvery ulcerations of mucous membranes -- seen mostly
in the mouth and on the genitals); condyloma lata: coalescing papules which
form a grey-white plaque frequently in folds such as groin, genital areas,
axilla, and under the breasts; hair loss (alopecia); general symptoms such as
fever, fatigue, loss of appetite, and aches and pains in bones. Syphilis;
tertiary: infiltrative, destructive lesions of skin, bones, or liver (gummatous
syphilis); cardiovascular syphilis, which leads to inflammation of the aorta
(aortitis) and can be associated with aortic aneurysms; central nervous system
disorders with involvement of the meninges, brain, spinal cord, eye, or
System of Care
A system of care is a method of addressing children's mental health needs. It
is developed on the premise that the mental health needs of children,
adolescents, and their families can be met within their home, school, and
community environments. These systems are also developed around the principles
of being child-centered, family- driven, strength-based, and culturally
competent and involving interagency collaboration.
In drug testing, the label that is used to seal a urine specimen bottle. In
addition to sealing the specimen bottle, it also provides an appropriate
specimen number and space for the donor to initial and date the label.
A facility set up for the support of teleworkers; includes both single-company
centers and multi- company facilities. Sometimes set up as a satellite office
by a company, a partnership of companies, or an independent vendor of telework
A meeting held among people at different loca- tions using telecommunications
software that allows meeting attendees to all dial a single number, then talk
A dedicated telephone line that is advertised and may be operated as a crisis
hotline for emergency counseling, or as a referral resource for callers with
mental health problems.
Strategies designed to decrease the amount of disability associated with an
existing disorder or illness.
Delta-9-tetrahydrocannabinol; the main active ingredient in marijuana, which
acts on the brain to produce its effects.
Therapeutic Foster Care
A service which provides treatment for troubled children within private homes
of trained families. The approach combines the normalizing influence of
family-based care with specialized treatment interventions, thereby creating a
therapeutic environment in the context of a nurturant family home.
Third-party Administrator (TPA)
Usually an out-of-house professional firm providing healthcare administrative
services, such as paying claims, collecting premiums, and carrying out other
administrative support services, for employee benefit plans. (Synonyms:
administrative agent, carrier, insurer, underwriter).
Third party payer
A public or private organization that is responsible for the health care
expenses of another entity.
PCP in powder form; methamphetamine
Methamphetamine; crystal methamphetamine; methamphetamine used with Viagra
A plant grown for its leaves, which are smoked, chewed, or sniffed for a
variety of effects. It is considered an addictive substance because it contains
the chemical nicotine. The tobacco plant is believed to have originated in the
Western Hemisphere. The leaves of the plant are prepared for smoking, chewing,
or sniffing. In addition to nicotine, tobacco contains over 19 known
carcinogens (most are collectively known as "tar") and more than 4,000
chemicals. Prior to European influence in the Americas, tobacco was used by the
Indians of Mexico and Peru for ceremonies, medicinal purposes, and to alleviate
hunger pangs during famines. Columbus is credited with introducing tobacco into
Europe. Tobacco use became widely accepted by the Portuguese, Spanish, French,
British, and Scandinavians. Explorers and sailors who became dependent upon
tobacco began planting seeds at their ports of call, introducing the product
into other parts of Europe and Asia. The colonists introduced tobacco on the
American continent in the early 1600s. It became a major crop and trading
commodity of the Jamestown colony. Over the years, tobacco has been claimed as
a cure for a wide range of ailments with varying forms of administration (for
example, used in poultices, pastes, smoked, chewed, sniffed, or placed in any
body cavity). Its social importance also grew over the years, even to the point
of denoting the "modern or liberated woman" during the first part of the
twentieth century. It was not until the 1960s, with the introduction of medical
research related to cigarette smoking, that the adverse health effects of
tobacco became widely publicized.
A condition in which higher doses of a drug are required to produce the same
effect as during initial use; often leads to physical dependence.
Tonsil glands serve as agents against infections. However, in some people,
particularly in children with larger tonsils, these glands can perform less
efficiently and cause frequent throat and ear infections or obstruct breathing.
In these cases, surgery to remove the tonsils is of benefit. Under general
anesthesia, the ear-nose-throat (ENT) surgeon holds the mouth open using a
mouth gag to expose the tonsils. The tonsils are then removed by being cut away
with an instrument or a cautery (burning instrument). Bleeding is controlled,
and the cut heals naturally without stitches. Tonsillectomy is advisable when
tonsillitis attacks are so frequent or severe that they affect a child's
general health or interfere with school, hearing, or breathing. However, some
physicians believe tonsillectomies are done more often than necessary, so a
second opinion should be obtained when there is any doubt. Specifically, the
guidelines for surgery are: * 7 or more episodes of tonsillitis in one year * 5
or more episodes per year over a 2- year period * Severe tonsillitis *
Tonsillitis that is not responding to antibiotics * An abscess in the tonsils *
Grossly asymmetric tonsils Tonsillectomy is advised if the tonsils are enlarged
and obstructing access to the adenoid during an adenoidectomy operation, or the
physician suspects the presence of a tonsil tumor. Tonsillectomy is usually
done on an outpatient basis, with the patient returning home the same day as
the surgery. Only rarely are patients observed overnight in the hospital and
return home the day after the surgery. Complete recovery can take 2 weeks.
Expect some throat and ear pain in the first days following surgery. The use of
ice packs to relieve pain may be used, although sucking on an ice cube or ice
cream may provide adequate comfort. In addition, pain- relief medication may be
prescribed. During recovery, it is recommended to eat soft, easy- to-swallow
food and to drink a lot of cold fluids. The use of humidifier at home can also
bring some comfort. Your child may experience alternating "good and bad" days
for 2 weeks after surgery. It is a good idea to keep your child away from
crowds or ill people for 7 days, since the throat is highly susceptible to
infections during this period.
Includes all permanent separations, whether voluntary or involuntary. Monthly
turnover rates are calculated by employers and collected as part of the Bureau
of National Affairs' Quarterly Employment Survey. BNA then calculates the
monthly median rates and the average of monthly median rates for the year.
Monthly rates are calculated as (number of separations during month / average
number of employees on payroll during the month) * 100. (Source: Bureau of
National Affairs' definition, 1995). SAMHSA grantees may wish to calculate
separate turnover rates for voluntary and involuntary separations if their
programs are more likely to affect one type of turnover than another.
Crack and methamphetamine
Type I Error
The error committed when a true null hypothesis is rejected.
Type II Error
The error committed when a false null hypothesis is accepted.
Unable to Work
This on-line forum was created especially for the nation's jobless and
underemployed workers. This resource is available to help the unemployed learn
more about the unemployment system, to share their experiences and concerns,
and to participate in the national debate over aid to the jobless.
The review of prospective or renewing cases to determine their risk and their
Counting a client/patient and their services uniquely. Unduplicated counts can
exist at different levels: a program, a local system of care, or at the State
Not currently employed. This could include people looking for work, or people
engaged in other activities such as homemakers, students or volunteers.
Prevention designed for everyone in the eligible population, both the general
public and all members of specific eligible groups.
Identified treatment needs of the people that are not being met as well as
those receiving treatment that is inappropriate or not optimal.
The level of use of a particular service over time.
Utilization Management (UM)
The process of evaluating the necessity, appropriateness, and efficiency of
healthcare service. A review coordinator or medical director gathers
information about the proposed hospitalization, service, or procedure from the
patient and/or providers, then determines whether it meets established
guidelines and criteria, which may be written or automated protocols approved
by the organization. A provider or integrated delivery network that proves it
is skilled in UM may negotiate more advantageous pricing, if UM is normally
performed by the HMO but could be more effectively passed downward at a savings
to the HMO.
Utilization Review (UR)
The evaluation of the medical necessity and the efficiency of healthcare
services, either prospectively, concurrently, or retrospectively; contrasted
with utilization management in that UR is more limited to the physician's
diagnosis, treatment, and billing amount, whereas UM addresses the wider
The risk that actual service utilization might differ from utilization
Vegetarian diets excluding all or some animal products. Vegan is a diet that
consists of only foods of plant origin. Lacto-vegetarian is a diet that
consists of plant foods plus some or all dairy products. Lacto- ovovegetarian
is a diet that consists of plant foods, milk, dairy products and eggs. Semi or
Partial Vegetarian is a diet that consists individuals that do not eat red
meat, but may eat chicken or fish with plant foods, dairy products, and eggs.
The diet may be adopted for a variety of reasons, including religious or
political beliefs, economics, or the desire to consume a more healthful diet.
The American Dietetic Association states that a well-planned vegetarian diet
can be consistent with good nutritional intake. Dietary recommendations vary
with the type of vegetarian diet. For children and adolescents these diets
require special planning, because it may be difficult to obtain all the
nutrients required for growth and development. Nutrients that may be lacking in
a vegetarian's diet are Protein, Vitamin B12, Vitamin D, Riboflavin, Calcium,
Zinc, and Iron. Eating protein, which is made up of smaller chemicals called
amino acids, is necessary for good health. You don't have to eat animal
products to get complete proteins in the diet. Integrating the vegetarian style
of eating into a non- vegetarian diet is recommended for individuals wishing to
choose a healthier diet. For example, a person may choose to eat meat once a
day or as little as twice a week.
A practice of selling off health plan subsidiaries or provider activities.
Vertical disintegration was a trend in the late 1990s.
An organization of production whereby one business entity controls or owns all
stages of the production and distribution of goods or services. In healthcare,
vertical integration can take many forms, but generally implies that
physicians, hospitals, and health plans have combined their organizations or
processes in some manner to increase efficiencies, increase competitive
strength, or to improve quality of care. Integrated delivery systems or
healthcare networks are generally vertically integrated.
A meeting held among people at different loca-tions wherein attendees can both
hear and see one another. It involves a set of hardware and software linked
together, including cameras, microphones, scanners, and television screens at
each attendee location.
Workers who belong to separate organizations, and/or operate as independent
contractors, but sometimes work together to accomplish a specific, defined
result. For example, an Environment Engineering firm might create a virtual
orga- nization of engineers, financial analysts, scientists, and information
technologists, all of whom work for other companies or universities, but who
cooperate to deliver specific work to the Environmental Engineering firm on an
as needed basis.
Virtual Team (Distributed Team or Dispsersed Team)
employees from the same or different departments in the same company who work
as a structured team under a designated team leader to accomplish a specific,
defined result. For example, Product Development Managers often pick
individuals from around the company to bring a new idea to market. Those
individuals work on the new product until it is delivered, at which time they
return to their separate department structures, where they have a permanent
The Dietary Supplement Health and Education Act defines dietary supplements as
a: product (other than tobacco) intended to supplement the diet that bears or
contains one or more of the following dietary ingredients: a vitamin, mineral,
amino acid, herb or other botanical; a dietary substance for use to supplement
the diet by increasing the total dietary intake; a concentrate, metabolite,
constituent, extract, or combination of any ingredient described above;
intended for ingestion in the form of a capsule, powder, softgel, or gelcap,
and not represented as a conventional food or as a sole item of a meal or the
diet. Dietary supplements are available widely through many commercial sources
including health food stores, grocery stores, pharmacies, and by mail.
Vocational Rehabilitation Services
Services that include job finding/development, assessment and enhancement of
work-related skills, attitudes, and behaviors as well as provision of job
experience to clients/patients. Includes transitional employment.
A combination of hydrogen and oxygen; it is the basis for the fluids of the
body. Water makes up more than two thirds of the weight of the human body.
Without water, humans would die in a few days. All the cell and organ functions
depend on water for functioning. It serves as a lubricant and forms the base
for saliva and the fluids that surround the joints. Water regulates the body
temperature, as the cooling and heating is distributed through perspiration.
Water helps to alleviate constipation by moving food through the intestinal
tract and thereby eliminating waste. Water is obtained from some of the foods
we eat. These are foods that are 85 to 95% water. Some water is obtained from
the by-products of metabolism. But our main source of water is our drinking
water, which is the best source. Water is also obtained from soup, milk, and
juices. Alcoholic beverages and beverages with caffeine (such as coffee, tea,
and colas) are not the best choices because they have a diuretic
(water-excreting) effect. Six to eight 8-ounce glasses of water, or half of the
body weight in ounces, are recommended on a daily basis. For example, if you
weight 140 lbs, you will need 70 ounces of water. Milk, juice, and soup can not
be substituted for the entire water requirement. Caffeinated and alcoholic
beverages (due to their diuretic effect) would not be appropriate substitutes
at all. Carrying a water bottle and drinking at regular intervals will help you
to obtain the required amount of water your body needs.
Blunts; methamphetamine; PCP; a mixture of marijuana and other substances
within a cigar; Gamma hydroxybutyrate (GHB)
Learn to swim. The best thing anyone can do to stay safe in and around the
water is to learn to swim. Always swim with a buddy; never swim alone. The
American Red Cross has swimming courses for people of any age and swimming
ability. Swim in supervised areas only. Obey all rules and posted signs. Watch
out for the "dangerous too's"--too tired, too cold, too far from safety, too
much sun, too much strenuous activity. Don't mix alcohol and swimming. Alcohol
impairs your judgement, balance, and coordination, affects your swimming and
diving skills, and reduces your body's ability to stay warm. Pay attention to
local weather conditions and forecasts. Stop swimming at the first indication
of bad weather. Know how to prevent, recognize, and respond to emergencies.
Programs, typically oriented toward healthy lifestyle and preventive care, that
may decrease health-care utilization and costs. From an employer perspective
the emphasis is on keeping employees healthy.
Blunts mixed with marijuana and PCP; methamphetamine; marijuana cigarettes
soaked in PCP ("embalming fluid") and dried
A person having origins in any of the original peoples of Europe, the Middle
East, or North Africa.
Symptoms that occur after chronic use of a drug is reduced or stopped.
Workers Compensation Payments
Includes actual disbursements for injuries and illnesses covered under Workers
Compensation program rules.
Working man's cocaine
Workplace Injuries and Illnesses
Nonfatal occupational illnesses or injuries that involve one or more of the
following: loss of consciousness, restriction of work or motion, lost worktime,
transfer to another job, or medical treatment (other than first aid).
Workplace Managed Care (WMC)
In WMC, workplaces integrate their substance- abuse prevention and
early-intervention programs, strategies, and activities for employees and their
families (covered lives). Integrated activities frequently include internal and
external workplace and workplace- related components: employee assistance
programs (EAPs), human resources, security, management, and managed care
organizations and providers (primary and behavioral health care). Services may
be received in various locations and through face-to-face encounters (e.g., at
the workplace, physician's office, health fairs, etc.) or multi-media (e.g.,
video, telephone, Internet, publications, etc.). It is the strategy of
integrating these elements and agents that constitutes the WMC approach to
providing substance abuse prevention and early intervention to employees and
Services that address consumers' total healthcare needs in order to achieve
health or wellness. These services "wrap around" core clinical interventions,
usually medical. Typical examples include such services as financial support,
transportation, housing, job training, specialized treatment, or educational
A pure and powerful form of methamphetamine from Thailand; "crazy drug"