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The State Auditor's Office reports that the state employee turnover rate Issue #1: Fiscal & Program Barriers to Consumer-Friendly Services for FY 1999 had risen to 17.58 percent. HHS Initiative: The Texas Sunset Commission also challenged HHS agencies to improve their planning processes and increase the significance of coordinated strategic planning processes that include local community Promoting Independence Initiative input and use of local planning forums focused on barriers to improving To many Texans with developmental disabilities and their families, service delivery. Examples of improvements to the service delivery system that require a coordinated effort include coordinated the state's system of services and supports is difficult to negotiate. transportation services, information and referral, eligibility and access They often encounter bureaucratic red tape, financial restrictions, lack to services, communication and collaboration among state and local of planning, policies that make it difficult to obtain medication and, agencies and organizations, and the need for comprehensive sometimes, failure to respond to certain kinds of disabilities. The recent assessment and needs planning. Promoting Independence Initiative, undertaken by the Health and Most of Texas' fourteen HHS agencies either provide direct services Human Services Commission and mandated by a 1999 executive or administer programs that provide services to clients. Three other order from Governor Bush, is addressing those concerns. agencies the Health and Human Services Commission, the Children's With the assistance of an Trust Fund and the Health Care advisory board, the Commission has Information Council have missions Based on the state's budget, HHS agencies given state agencies substantial input not focused on service delivery. comprise the second largest function in the as they develop procedures for Based on the state's budget, HHS state government. They employ approximately identifying people with disabilities in agencies comprise the second largest institutional settings who may want function in the state government. 50, 000 full-time equivalent employees community-based support. The They employ approximately 50, 000 and administer hundreds of federal advisory board also made suggestions full-time equivalent employees to the agencies and the Commission categorical funding streams. and administer hundreds of federal about appropriations requests that categorical funding streams. HHS agencies provide services in four basic functional areas: long-term would allow communities to provide more services to people with disabilities. As part of this initiative, the Texas Department of Human services and supports, family services, health, and rehabilitation and Services and the Texas Department of Mental Health and Mental habilitation services. Retardation requested 0.3 million and .2 million, respectively, The health and human service agencies collectively submitted a for 2002-2003 to reduce the waiting list for community services. document entitled "Texas Health and Human Services Coordinated According to focus group participants, financial relief is critical. Strategic Plan for Fiscal Years 2001-2006" to the Governor, Lieutenant Participants generally said the state could serve more people through Governor, and the Speaker of the House of Representatives on better utilization of Medicaid dollars. And in some cases, because of a September 1, 2000. The strategic plan represented consensus of the lack of community-based supports, parents of young adults in agency chief executive officers, and included priorities to guide the transition from school programs have elected to give up their jobs to planning efforts of the health and human service agencies under the umbrella of the Health and Human Services Commission. The care for their children with disabilities. Waiting lists are the bane of coordinated plan was reviewed in relationship to the key issues outlined many parents, and the situation is only made worse by what they -- in SB 374, that the Legislature requested in the first Biennial Report. Key and professionals -- perceive as poor communication between some HHS initiatives and or related legislation are highlighted in this section. agencies. "Everywhere else I went, they sent me somewhere else.no In addition to reviewing the Coordinated Strategic Plan, five focus one knew the rules, " one parent said See Section 3.1, Appendix page 39 ; . groups were held across the state in 2000 as an evaluative tool in preparing this report. This method allowed researchers to efficiently Issue #2: Progress Toward a Service Delivery System Individualized reach a large number of persons to understand the perceptions of to Each Consumer Based on Functional Needs multiple stakeholders about the status of services and supports for people with disabilities in Texas. HHS Initiatives: A summary of key input from the various focus groups follows. This input is framed around the five issue areas identified in SB 374. Improve transition services for youth and young adults to This summary includes an overview of HHS initiatives identified in the overcome service delivery system fragmentation. Current community HHSC Coordinated Strategic Plan that relate to these issue areas. See based service workgroups are addressing transition of children across Section 3, Appendix, page 38 for a more detailed summary of input programs and into independent living. Interagency agreements have and key initiatives. been formed among various agencies.
Igure 1. Number of newly identified colonized residents by month, Malgr tous ces efforts, la transDespite these efforts, ongoing Durham Region, Ontario August 2000 to April 2002 mission sest poursuivie dans la transmission has been docuplupart des ESLD touchs, et le mented at most of the involved .igure 1. Nombre de rsidents coloniss nouvellement identifis par mois dans la rgion de Durham, Ontario aot 2000 transfert des rsidents a permis LTC.s and resident transfers avril 2002 la bactrie de se propager dans have introduced the strain to de nouveaux tablissements new facilities .igure 1 ; . 35 figure 1 ; . Entre aot 2000 et Between August 2000 and mars 2002, on a identifi des March 2002, colonized or 30 patients ou rsidents coloniss infected patients and residents ou infects dans 15 ESLD deux have been identified in 15 LTC.s 25 maisons de retraite, un centre de two retirement homes, one 20 sant mentale, un foyer de groupe mental health centre, one group pour enfants handicaps et 11 home for disabled children and 15 maisons de soins infirmiers; 11 nursing homes; 10 facilities 10 tablissements comptaient with more than two cases ; and 10 plus de deux cas ; et six hpitaux six hospital sites four sites with quatre hpitaux comptant plus more than two cases ; . More than 5 de deux cas ; . Plus de 200 person200 individuals have been colo0 nes ont t colonises par la nized with the outbreak strain souche dE. coli productrice de of ESBL E. coli and 24 other BLSE lorigine de lclosion, et individuals have been colonized 24 autres ont t colonises par with other ESBL-producing gram dautres bacilles gram ngatif pronegative bacilli that appear to ducteurs de BLSE, qui semblent have acquired the resistance avoir acquis le plasmide de plasmid from the outbreak strain Month mois rsistance de la souche dE. coli of E. coli. These include strains responsable de lclosion. Les of Citrobacter freundii, autres bacilles gram ngatif sont notamment Citrobacter freundii, Enterobacter Enterobacter cloacae, Klebsiella pneumoniae and K. oxytoca. Although most individuals had asymptomatic rectal colonization, cloacae, Klebsiella pneumoniae et K. oxytoca. Bien que la plupart des personnes aient prsent une colonisation rectale asymptomatique, la culture de un 33 residents had one or more positive clinical cultures. These chantillon clinique ou plus tait positive chez 33 rsidents : la culture include 24 residents with positive urine cultures, and 10, four durine tait positive chez 24 dentre eux et la culture dexpectorations, la and two residents with positive sputum, wound and blood culculture de plaie et lhmoculture taient positives chez 10, quatre et deux tures, respectively ifty-eight deaths occurred within the cohort patients, respectivement. Cinquante-huit rsidents faisant partie de la cohorte of colonized patients over the seventeen months of follow-up. de patients coloniss sont dcds au cours des 17 mois de suivi. Huit des Eight were related to infection with the outbreak strain seven dcs taient lis une infection par la souche lorigine de lclosion sept fatal cases of pneumonia and one fatal bacteremia due to ESBL cas de pneumonie et un cas de bactrimie causes par E. coli producteur E. coli ; . de BLSE. You should not take any medication, including and bactrim without consulting a physician first.
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Armed with determination and the belief that family caregivers should be recognized and supported, they began talking to government representatives and health care organizations to create support groups, education opportunities and to increase awareness of Alzheimer's disease. Much has changed since our organization was in its infancy but our commitment to provide support, inform, educate and increase awareness has not. These are still the essential services of our organization. Coupled with a deep commitment to support Alzheimer research, our organization continues to move forward to achieve our mission of alleviating the personal and social consequences of Alzheimer's disease and related disorders while promoting the search for a cause and a cure. 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The ECVAM Scientific Advisory Committee ESAC ; has endorsed the validation of five alternative tests, which take an important step towards ending the practice of using animals in skin and eye irritancy testing and for skin sensitisation. The EPISKIN method will completely replace the regulatory Draize skin irritation test, a classic test introduced into safety tests for drugs and chemicals 60 years ago and involves applying the product to a rabbit's skin. The EpiDerm model instead is seen as a constituent of a testing strategy. The two alternative testing methods are using artificial human skin, which is able to identify irritant and non-irritant chemicals and both have undergone a full validation study. The two validated organotypic in vitro assays [the Bovine Corneal Opacity and Permeability BCOP ; and the Isolated Chicken Eye ICE ; test methods], will identify severe eye irritants using tissues from slaughter-houses, which would otherwise be discarded. The tests will replace the use of animals to identify severe irritants, though some animal testing will still be required for mild irritants. However, eight other models are currently under evaluation by ECVAM which if successful will completely replace testing on live rabbit's eyes known by toxicologists as the Draize eye irritation test. And finally, following the endorsement of the Local Lymph Node Assay LLNA ; in 2000, a "reduced" version of the LLNA, namely the rLLNA has now scientifically been validated by ESAC. Source: ECVAM : ecvam.jrc.it index.

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