Mental Health ↔ relates to ↔ Substance Use Recovery

who may or may not be related by blood or marriage. The conceptual frameworks developed by family therapists, especially those of family systems theorists, have been applied to a wide range of human behavior, including organisational dynamics and the study of greatness. History and theoretical frameworks Formal interventions with families to help individuals and families experiencing various kinds of problems have been a part of many cultures, probably throughout history. These interventions have sometimes involved formal procedures or rituals, and often included the extended family as well as non-kin members of the community (see, for example, Ho'oponopono). Following the emergence of specialization in various societies, these interventions were often conducted by particular members of a community—for example, a tribal chief, priest, physician, and so on—usually as an ancillary function. Family therapy as a distinct professional practice within Western cultures can be argued to have had its origins in the social work movements of the 19th century in the United Kingdom and the United States. As a branch of psychotherapy, its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movement and marriage counseling. The formal development of family therapy dates from the 1940s and early 1950s with the founding in 1942 of the American Association of Marriage Counselors (the precursor of the AAMFT), and through the work of various independent clinicians and groups—in the United Kingdom (John Bowlby at the Tavistock Clinic), the United States (Donald deAvila Jackson, John Elderkin Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker, Virginia Satir, Ivan Boszormenyi-Nagy), and in Hungary, D.L.P. Liebermann—who began seeing family members together for observation or therapy sessions. There was initially a strong influence from psychoanalysis (most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry, and later from behaviorism and behavior therapy—and significantly, these clinicians began to articulate various theories about the nature and functioning of the family as an entity that was more than a mere aggregation of individuals. The movement received an important boost starting in the early 1950s through the work of anthropologist Gregory Bateson and colleagues—Jay Haley, Donald deAvila Jackson, John Weakland, William Fry, and later, Virginia Satir, Ivan Boszormenyi-Nagy, Paul Watzlawick and others—at Palo Alto in the United States, who introduced ideas from cybernetics and general systems theory into social psychology and psychotherapy, focusing in particular on the role of communication. This approach eschewed the traditional focus on individual psychology and historical factors—that involve so-called linear causation and content—and emphasized instead feedback and homeostatic mechanisms and "rules" in here-and-now interactions—so-called circular causation and process—that were thought to maintain or exacerbate problems, whatever the original cause(s). This group was also influenced significantly by the work of US psychiatrist, hypnotherapist, and brief therapist Milton H. Erickson—especially his innovative use of strategies for change, such as paradoxical directives. The members of the Bateson Project (like the founders of a number of other schools of family therapy, including Carl Whitaker, Murray Bowen, and Ivan Boszormenyi-Nagy) had a particular interest in the possible psychosocial causes and treatment of schizophrenia, especially in terms of the putative "meaning" and "function" of signs and symptoms within the family system. The research of psychiatrists and psychoanalysts Lyman Wynne and Theodore Lidz on communication deviance and roles (e.g., pseudo-mutuality, pseudo-hostility, schism, and skew) in families of people with schizophrenia also became influential with systems-communications-oriented theorists and therapists. A related theme—applying to dysfunction and psychopathology more generally—was that of the "identified patient" or "presenting problem" as a manifestation of or surrogate for the family's (or even society's) problems. By the mid-1960s, a number of distinct schools of family therapy had emerged. From the groups that were most strongly influenced by cybernetics and systems theory there came Mental Research Institute brief therapy, strategic therapy, Salvador Minuchin's structural family therapy and the model proposed by Mara Selvini Palazzoli (i.e., the Milan systems model). Partly in reaction to some aspects of these systemic models came the experiential approaches of Virginia Satir and Carl Whitaker, which downplayed theoretical constructs and emphasized subjective experience and unexpressed feelings (including the subconscious), authentic communication, spontaneity, creativity, total therapist engagement, and often included the extended family. Concurrently, intergenerational therapies by Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, and Norman Paul emerged. They proposed different theories on the intergenerational transmission of health and dysfunction, usually involving three generations in therapy or through "homework" and "journeys home." Psychodynamic family therapy—which, more than any other school of family therapy, deals directly with individual psychology and the unconscious mind in the context of current relationships—continued to develop through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, the British school of object relations theory, and John Bowlby's work on attachment theory. Multiple-family group therapy, a precursor of psychoeducational family intervention, emerged, in part, as a pragmatic alternative form of intervention—especially as an adjunct to the treatment of serious mental illnesses with significant biological underpinnings, such as schizophrenia—and represented something of a conceptual challenge to some of the systemic (and thus potentially "family-blaming") paradigms of pathogenesis that were implicit in many of the dominant models of family therapy. The late 1960s and early 1970s saw the development of network therapy (which bears some resemblance to traditional practices such as Ho'oponopono) by Ross Speck and Carolyn Attneave, and the emergence of behavioral marital therapy (renamed behavioral couples therapy in the 1990s) and behavioral family therapy as models in their own right. By the late 1970s, the weight of clinical experience—especially in the treatment of serious mental disorders—had led to revisions of several of the original models and a moderation of earlier stridency and theoretical purism. There were the beginnings of a general softening of the strict demarcations between schools, with moves toward rapprochement, integration, and eclecticism—although there was, nevertheless, some hardening of positions within some schools. These trends were reflected in and influenced by lively debates within the field and critiques from various sources, including feminism and post-modernism, that reflected in part the cultural and political tenor of the times, and which foreshadowed the emergence (in the 1980s and 1990s) of the various post-systems constructivist and social constructionist approaches. While there was still debate within the field about whether, or to what degree, the systemic-constructivist and medical-biological paradigms were necessarily antithetical to each other (see also anti-psychiatry; biopsychosocial model), there was a growing willingness and tendency on the part of family therapists to work in multi-modal clinical partnerships with other members of the helping and medical professions. From the mid-1980s to the present, the field has been marked by a diversity of approaches that partly reflect the original schools, but which also draw on other theories and methods from individual psychotherapy and elsewhere—these approaches and sources include: brief therapy, structural therapy, constructivist approaches (e.g., Milan systems, post-Milan/collaborative/conversational, and reflective), bringforthist approach (e.g., Karl Tomm's IPscope model and Interventive interviewing), solution focused brief therapy, narrative therapy, a range of cognitive behavioral therapy approaches, psychodynamic and object relations approaches, attachment and emotionally focused therapy, intergenerational approaches, network therapy, and multisystemic therapy (MST). Multicultural, intercultural, and integrative approaches are being developed, with Vincenzo Di Nicola weaving a synthesis of family therapy and transcultural psychiatry in his model of cultural family therapy, A Stranger in The Family: Culture, Families, and Therapy. Many practitioners claim to be eclectic, using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s), and there is a growing movement toward a single "generic" family therapy that seeks to incorporate the best of the accumulated knowledge in the field and which can be adapted to many different contexts. Nonetheless, there are still a significant number of therapists who adhere more or less strictly to a particular, or limited number of, approach(es). The liberation-based healing framework for family therapy offers a complete paradigm shift for working with families while addressing the intersections of race, class, gender identity, sexual orientation, and other socio-political identity markers. This theoretical approach and praxis is informed by critical pedagogy, feminism, critical race theory, and decolonizing theory. It necessitates an understanding of the ways colonization, cisheteronormativity, patriarchy, white supremacy and other systems of domination impact individuals, families and communities and centers the need to disrupt the status quo in how power operates. Traditional Western models of family therapy have historically ignored these dimensions, and when white, male privilege has been critiqued, largely by feminist theory practitioners, it has often been to the benefit of middle-class, white women's experiences. While an understanding of intersectionality is of particular significance in working with families with violence, a liberatory framework examines how power, privilege and oppression operate within and across all relationships. Liberatory practices are based on the principles of critical consciousness, accountability, and empowerment. These principles guide not only the content of therapeutic work with clients but also the supervisory and training processes for therapists.

History and theoretical frameworks Formal interventions with families to help individuals and families experiencing various kinds of problems have been a part of many cultures, probably throughout history. These interventions have sometimes involved formal procedures or rituals, and often included the extended family as well as non-kin members of the community (see, for example, Ho'oponopono). Following the emergence of specialization in various societies, these interventions were often conducted by particular members of a community—for example, a tribal chief, priest, physician, and so on—usually as an ancillary function. Family therapy as a distinct professional practice within Western cultures can be argued to have had its origins in the social work movements of the 19th century in the United Kingdom and the United States. As a branch of psychotherapy, its roots can be traced somewhat later to the early 20th century with the emergence of the child guidance movement and marriage counseling. The formal development of family therapy dates from the 1940s and early 1950s with the founding in 1942 of the American Association of Marriage Counselors (the precursor of the AAMFT), and through the work of various independent clinicians and groups—in the United Kingdom (John Bowlby at the Tavistock Clinic), the United States (Donald deAvila Jackson, John Elderkin Bell, Nathan Ackerman, Christian Midelfort, Theodore Lidz, Lyman Wynne, Murray Bowen, Carl Whitaker, Virginia Satir, Ivan Boszormenyi-Nagy), and in Hungary, D.L.P. Liebermann—who began seeing family members together for observation or therapy sessions. There was initially a strong influence from psychoanalysis (most of the early founders of the field had psychoanalytic backgrounds) and social psychiatry, and later from behaviorism and behavior therapy—and significantly, these clinicians began to articulate various theories about the nature and functioning of the family as an entity that was more than a mere aggregation of individuals. The movement received an important boost starting in the early 1950s through the work of anthropologist Gregory Bateson and colleagues—Jay Haley, Donald deAvila Jackson, John Weakland, William Fry, and later, Virginia Satir, Ivan Boszormenyi-Nagy, Paul Watzlawick and others—at Palo Alto in the United States, who introduced ideas from cybernetics and general systems theory into social psychology and psychotherapy, focusing in particular on the role of communication. This approach eschewed the traditional focus on individual psychology and historical factors—that involve so-called linear causation and content—and emphasized instead feedback and homeostatic mechanisms and "rules" in here-and-now interactions—so-called circular causation and process—that were thought to maintain or exacerbate problems, whatever the original cause(s). This group was also influenced significantly by the work of US psychiatrist, hypnotherapist, and brief therapist Milton H. Erickson—especially his innovative use of strategies for change, such as paradoxical directives. The members of the Bateson Project (like the founders of a number of other schools of family therapy, including Carl Whitaker, Murray Bowen, and Ivan Boszormenyi-Nagy) had a particular interest in the possible psychosocial causes and treatment of schizophrenia, especially in terms of the putative "meaning" and "function" of signs and symptoms within the family system. The research of psychiatrists and psychoanalysts Lyman Wynne and Theodore Lidz on communication deviance and roles (e.g., pseudo-mutuality, pseudo-hostility, schism, and skew) in families of people with schizophrenia also became influential with systems-communications-oriented theorists and therapists. A related theme—applying to dysfunction and psychopathology more generally—was that of the "identified patient" or "presenting problem" as a manifestation of or surrogate for the family's (or even society's) problems. By the mid-1960s, a number of distinct schools of family therapy had emerged. From the groups that were most strongly influenced by cybernetics and systems theory there came Mental Research Institute brief therapy, strategic therapy, Salvador Minuchin's structural family therapy and the model proposed by Mara Selvini Palazzoli (i.e., the Milan systems model). Partly in reaction to some aspects of these systemic models came the experiential approaches of Virginia Satir and Carl Whitaker, which downplayed theoretical constructs and emphasized subjective experience and unexpressed feelings (including the subconscious), authentic communication, spontaneity, creativity, total therapist engagement, and often included the extended family. Concurrently, intergenerational therapies by Murray Bowen, Ivan Boszormenyi-Nagy, James Framo, and Norman Paul emerged. They proposed different theories on the intergenerational transmission of health and dysfunction, usually involving three generations in therapy or through "homework" and "journeys home." Psychodynamic family therapy—which, more than any other school of family therapy, deals directly with individual psychology and the unconscious mind in the context of current relationships—continued to develop through a number of groups that were influenced by the ideas and methods of Nathan Ackerman, the British school of object relations theory, and John Bowlby's work on attachment theory. Multiple-family group therapy, a precursor of psychoeducational family intervention, emerged, in part, as a pragmatic alternative form of intervention—especially as an adjunct to the treatment of serious mental illnesses with significant biological underpinnings, such as schizophrenia—and represented something of a conceptual challenge to some of the systemic (and thus potentially "family-blaming") paradigms of pathogenesis that were implicit in many of the dominant models of family therapy. The late 1960s and early 1970s saw the development of network therapy (which bears some resemblance to traditional practices such as Ho'oponopono) by Ross Speck and Carolyn Attneave, and the emergence of behavioral marital therapy (renamed behavioral couples therapy in the 1990s) and behavioral family therapy as models in their own right. By the late 1970s, the weight of clinical experience—especially in the treatment of serious mental disorders—had led to revisions of several of the original models and a moderation of earlier stridency and theoretical purism. There were the beginnings of a general softening of the strict demarcations between schools, with moves toward rapprochement, integration, and eclecticism—although there was, nevertheless, some hardening of positions within some schools. These trends were reflected in and influenced by lively debates within the field and critiques from various sources, including feminism and post-modernism, that reflected in part the cultural and political tenor of the times, and which foreshadowed the emergence (in the 1980s and 1990s) of the various post-systems constructivist and social constructionist approaches. While there was still debate within the field about whether, or to what degree, the systemic-constructivist and medical-biological paradigms were necessarily antithetical to each other (see also anti-psychiatry; biopsychosocial model), there was a growing willingness and tendency on the part of family therapists to work in multi-modal clinical partnerships with other members of the helping and medical professions. From the mid-1980s to the present, the field has been marked by a diversity of approaches that partly reflect the original schools, but which also draw on other theories and methods from individual psychotherapy and elsewhere—these approaches and sources include: brief therapy, structural therapy, constructivist approaches (e.g., Milan systems, post-Milan/collaborative/conversational, and reflective), bringforthist approach (e.g., Karl Tomm's IPscope model and Interventive interviewing), solution focused brief therapy, narrative therapy, a range of cognitive behavioral therapy approaches, psychodynamic and object relations approaches, attachment and emotionally focused therapy, intergenerational approaches, network therapy, and multisystemic therapy (MST). Multicultural, intercultural, and integrative approaches are being developed, with Vincenzo Di Nicola weaving a synthesis of family therapy and transcultural psychiatry in his model of cultural family therapy, A Stranger in The Family: Culture, Families, and Therapy. Many practitioners claim to be eclectic, using techniques from several areas, depending upon their own inclinations and/or the needs of the client(s), and there is a growing movement toward a single "generic" family therapy that seeks to incorporate the best of the accumulated knowledge in the field and which can be adapted to many different contexts. Nonetheless, there are still a significant number of therapists who adhere more or less strictly to a particular, or limited number of, approach(es). The liberation-based healing framework for family therapy offers a complete paradigm shift for working with families while addressing the intersections of race, class, gender identity, sexual orientation, and other socio-political identity markers. This theoretical approach and praxis is informed by critical pedagogy, feminism, critical race theory, and decolonizing theory. It necessitates an understanding of the ways colonization, cisheteronormativity, patriarchy, white supremacy and other systems of domination impact individuals, families and communities and centers the need to disrupt the status quo in how power operates. Traditional Western models of family therapy have historically ignored these dimensions, and when white, male privilege has been critiqued, largely by feminist theory practitioners, it has often been to the benefit of middle-class, white women's experiences. While an understanding of intersectionality is of particular significance in working with families with violence, a liberatory framework examines how power, privilege and oppression operate within and across all relationships. Liberatory practices are based on the principles of critical consciousness, accountability, and empowerment. These principles guide not only the content of therapeutic work with clients but also the supervisory and training processes for therapists.

Evidence base Family therapy has an evolving evidence base. A summary of current evidence is available via the UK's Association of Family Therapy. Evaluation and outcome studies can also be found on the Family Therapy and Systemic Research Centre website. The website also includes quantitative and qualitative research studies of many aspects of family therapy. According to a 2004 French government study conducted by French Institute of Health and Medical Research, family and couples therapy was the second most effective therapy after Cognitive behavioral therapy. The study used meta-analysis of over a hundred secondary studies to find some level of effectiveness that was either "proven" or "presumed" to exist.

Choice, the ability to provide or evidence a decision. Understanding, the capacity to apprehend the relevant facts pertaining to the decision at issue. Appreciation, the ability of the patient to give informed consent with concern for, and belief in, the impact the relevant facts will have upon oneself. Reasoning, the mental acuity to make the relevant inferences from, and mental manipulations of, the information appreciated and understood to apply to the decision at hand. Impairments to reasoning and judgment that may preclude informed consent include intellectual or emotional immaturity, high levels of stress such as post-traumatic stress disorder or a severe intellectual disability, severe mental disorder, intoxication, severe sleep deprivation, dementia, or coma. Obtaining informed consent is not always required. If an individual is considered unable to give informed consent, another person is generally authorized to give consent on the individual's behalf—for example, the parents or legal guardians of a child (though in this circumstance the child may be required to provide informed assent) and conservators for the mentally disordered. Alternatively, the doctrine of implied consent permits treatment in limited cases, for example when an unconscious person will die without immediate intervention. Cases in which an individual is provided insufficient information to form a reasoned decision raise serious ethical issues. When these issues occur, or are anticipated to occur, in a clinical trial, they are subject to review by an ethics committee or institutional review board. Informed consent is codified in both national and international law. 'Free consent' is a cognate term in the International Covenant on Civil and Political Rights, adopted in 1966 by the United Nations, and intended to be in force by 23 March 1976. Article 7 of the covenant prohibits experiments conducted without the "free consent to medical or scientific experimentation" of the subject.

viewed from the patient's perspective. These standards in medical contexts are formalized in the requirement for decision-making capacity and professional determinations in these contexts have legal authority. This requirement can be summarized in brief to presently include the following conditions, all of which must be met in order for one to qualify as possessing decision-making capacity: Choice, the ability to provide or evidence a decision. Understanding, the capacity to apprehend the relevant facts pertaining to the decision at issue. Appreciation, the ability of the patient to give informed consent with concern for, and belief in, the impact the relevant facts will have upon oneself. Reasoning, the mental acuity to make the relevant inferences from, and mental manipulations of, the information appreciated and understood to apply to the decision at hand. Impairments to reasoning and judgment that may preclude informed consent include intellectual or emotional immaturity, high levels of stress such as post-traumatic stress disorder or a severe intellectual disability, severe mental disorder, intoxication, severe sleep deprivation, dementia, or coma. Obtaining informed consent is not always required. If an individual is considered unable to give informed consent, another person is generally authorized to give consent on the individual's behalf—for example, the parents or legal guardians of a child (though in this circumstance the child may be required to provide informed assent) and conservators for the mentally disordered. Alternatively, the doctrine of implied consent permits treatment in limited cases, for example when an unconscious person will die without immediate intervention. Cases in which an individual is provided insufficient information to form a reasoned decision raise serious ethical issues. When these issues occur, or are anticipated to occur, in a clinical trial, they are subject to review by an ethics committee or institutional review board. Informed consent is codified in both national and international law. 'Free consent' is a cognate term in the International Covenant on Civil and Political Rights, adopted in 1966 by the United Nations, and intended to be in force by 23 March 1976. Article 7 of the covenant prohibits experiments conducted without the "free consent to medical or scientific experimentation" of the subject.

Deception Research involving deception is controversial given the requirement for informed consent. Deception typically arises in social psychology, when researching a particular psychological process requires that investigators deceive subjects. For example, in the Milgram experiment, researchers wanted to determine the willingness of participants to obey authority figures despite their personal conscientious objections. They had authority figures demand that participants deliver what they thought was an electric shock to another research participant. For the study to succeed, it was necessary to deceive the participants so they believed that the subject was a peer and that their electric shocks caused the peer actual pain. Nonetheless, research involving deception prevents subjects from exercising their basic right of autonomous informed decision-making and conflicts with the ethical principle of respect for persons. The Ethical Principles of Psychologists and Code of Conduct set by the American Psychological Association says that psychologists may conduct research that includes a deceptive compartment only if they can both justify the act by the value and importance of the study's results and show they could not obtain the results by some other way. Moreover, the research should bear no potential harm to the subject as an outcome of deception, either physical pain or emotional distress.

ce of British Columbia. Idaho's state capital and largest city is Boise. With an area of 83,569 square miles (216,440 km2), Idaho is the 14th-largest state by land area. The state has a population of approximately two million people; it ranks as the 13th-least populous and the seventh-least densely populated of the 50 U.S. states. For thousands of years, and prior to European colonization, Idaho had been inhabited by natives. In the early 19th century, Idaho was considered part of the Oregon Country, an area which was disputed between the U.S. and the British Empire. Idaho officially became a U.S. territory with the signing of the Oregon Treaty of 1846, but a separate Idaho Territory was not organized until 1863, instead being included for periods in Oregon Territory and Washington Territory. The state was eventually admitted to the Union on July 3, 1890, becoming the 43rd state. Forming part of the Pacific Northwest (and the associated Cascadia bioregion), Idaho is divided into several distinct geographic and climatic regions. The state's north, the relatively isolated Idaho Panhandle, is closely linked with Eastern Washington, with which it shares the Pacific Time Zone—the rest of the state uses the Mountain Time Zone. The state's south includes the Snake River Plain (which has most of the population and agricultural land), and the southeast incorporates part of the Great Basin. Idaho is quite mountainous and contains several stretches of the Rocky Mountains. The United States Forest Service holds about 38% of Idaho's land, the highest proportion of any state. Industries significant for the state economy include manufacturing, agriculture, mining, forestry, science and technology, and tourism. Idaho has been a predominantly Republican state since statehood, with the Republican Party dominating in both state and national elections; abortion is severely restricted and the state retains the death penalty, including methods like the firing squad. The state contains the Idaho National Laboratory. Idaho's agricultural sector supplies many products, but the state is best known for its potato crop, which comprises around one-third of the nationwide yield.

Idaho's highest point is Borah Peak, 12,662 ft (3,859 m), in the Lost River Range north of Mackay. Idaho's lowest point, 710 ft (216 m), is in Lewiston, where the Clearwater River joins the Snake River and continues into Washington. The Sawtooth Range is often considered Idaho's most famous mountain range. Other mountain ranges in Idaho include the Bitterroot Range, the White Cloud Mountains, the Lost River Range, the Clearwater Mountains, and the Salmon River Mountains. Salmon-Challis National Forest is located in the east central sections of the state, with Salmon National Forest to the north and Challis National Forest to the south. The forest is in an area known as the Idaho Cobalt Belt, which consists of a 34 miles (55 km) long geological formation of sedimentary rock that contains some of the largest cobalt deposits in the U.S. Idaho has two time zones, with the dividing line approximately midway between Canada and Nevada. Southern Idaho, including the Boise metropolitan area, Idaho Falls, Pocatello, and Twin Falls, are in the Mountain Time Zone. A legislative error (15 U.S.C. ch. 6 §264) theoretically placed this region in the Central Time Zone, but this was corrected with a 2007 amendment.

g methods like the firing squad. The state contains the Idaho National Laboratory. Idaho's agricultural sector supplies many products, but the state is best known for its potato crop, which comprises around one-third of the nationwide yield. Its official state nickname is the "Gem State". Etymology In the early 1860s, when the U.S. Congress was considering organizing a new territory around Pikes Peak in the Rocky Mountains, the name "Idaho" was popular among the Congressional committee, as they believed it to be derived from a Shoshone term meaning "gem of the mountains." Realizing in January 1861 the name was quite possibly a fabrication and not Native American at all, the U.S. Congress ultimately decided to name the area Colorado Territory when it was created. But, by the time this decision was made in February 1861, the town of Idaho Springs, Colorado had already been named after their early frontrunner for a name, Idaho. In 1863, the Territory of Idaho was formed, though “Montana” was nearly its name. More than a decade after the name Idaho was first discussed for the eventual Colorado Territory, George M. Willing, a politician, claimed that he had been inspired by a little girl named Ida and that he coined the name in Washington at the time of the Congressional committee when he had been posing as an elected delegate to Congress. The same year Congress created Colorado Territory, a county called Idaho County was created in eastern Washington Territory. The county was named after a steamship named Idaho, which was launched on the Columbia River in 1860. It is unclear whether the steamship was named before or after the legitimacy of the Native American origins of “Idaho” came into question. Regardless, part of Washington Territory, including Idaho County, was used to create Idaho Territory in 1863. Idaho Territory would later change its boundaries to the area that became the U.S.

esses and injuries, some of which may be life-threatening and require immediate attention. In some countries, emergency departments have become important entry points for those without other means of access to medical care. The emergency departments of most hospitals operate 24 hours a day, although staffing levels may be varied in an attempt to reflect patient volume. History Accident services were provided by workmen's compensation plans, railway companies, and municipalities in Europe and the United States by the late mid-nineteenth century, but the world's first specialized trauma care center was opened in 1911 in the United States at the University of Louisville Hospital in Louisville, Kentucky. It was further developed in the 1930s by surgeon Arnold Griswold, who also equipped police and fire vehicles with medical supplies and trained officers to give emergency care while en route to the hospital. Today, a typical hospital has its emergency department in its own section of the ground floor of the grounds, with its own dedicated entrance. As patients can arrive at any time and with any complaint, a key part of the operation of an emergency department is the prioritization of cases based on clinical need. This process is called triage. Triage is normally the first stage the patient passes through, and consists of a brief assessment, including a set of vital signs, and the assignment of a "chief complaint" (e.g. chest pain, abdominal pain, difficulty breathing, etc.). Most emergency departments have a dedicated area for this process to take place and may have staff dedicated to performing nothing but a triage role. In most departments, this role is fulfilled by a triage nurse, although dependent on training levels in the country and area, other health care professionals may perform the triage sorting, including paramedics and physicians. Triage is typically conducted face-to-face when the patient presents, or a form of triage may be conducted via radio with an ambulance crew; in this method, the paramedics will call the hospital's triage center with a short update about an incoming patient, who will then be triaged to the appropriate level of care. Most patients will be initially assessed at triage and then passed to another area of the department, or another area of the hospital, with their waiting time determined by their clinical need. However, some patients may complete their treatment at the triage stage, for instance, if the condition is very minor and can be treated quickly, if only advice is required, or if the emergency department is not a suitable point of care for the patient. Conversely, patients with evidently serious conditions, such as cardiac arrest, will bypass triage altogether and move straight to the appropriate part of the department. The resuscitation area, commonly referred to as "Trauma" or "Resus", is a key area in most departments. The most seriously ill or injured patients will be dealt with in this area, as it contains the equipment and staff required for dealing with immediately life-threatening illnesses and injuries. In such situations, the time in which the patient is treated is crucial. Typical resuscitation staffing involves at least one attending physician, and at least one and usually two nurses with trauma and Advanced Cardiac Life Support training. These personnel may be assigned to the resuscitation area for the entirety of the shift or may be "on call" for resuscitation coverage (i.e. if a critical case presents via walk-in triage or ambulance, the team will be paged to the resuscitation area to deal with the case immediately). Resuscitation cases may also be attended by residents, radiographers, ambulance personnel, respiratory therapists, hospital pharmacists and students of any of these professions depending upon the skill mix needed for any given case and whether or not the hospital provides teaching services. Patients who exhibit signs of being seriously ill but are not in immediate danger of life or limb will be triaged to "acute care" or "majors", where they will be seen by a physician and receive a more thorough assessment and treatment. Examples of "majors" include chest pain, difficulty breathing, abdominal pain and neurological complaints. Advanced diagnostic testing may be conducted at this stage, including laboratory testing of blood and/or urine, ultrasonography, CT or MRI scanning. Medications appropriate to manage the patient's condition will also be given. Patients may be discharged home from this area or admitted to the hospital for further treatment depending on underlying causes of the patient's chief complaint. Patients whose condition is not immediately life-threatening will be sent to an area suitable to deal with them, and these areas might typically be termed a "prompt care" or "minors" area. Such patients may still have been found to have significant problems, including fractures, dislocations, and lacerations requiring suturing. Children can present particular challenges in treatment. Some departments have dedicated pediatrics areas, and some departments employ a play therapist whose job is to put children at ease to reduce the anxiety caused by visiting the emergency department, as well as provide distraction therapy for simple procedures. Many hospitals have a separate area for evaluation of psychiatric problems. These are often staffed by psychiatrists and mental health nurses and social workers. There is typically at least one room for people who are actively a risk to themselves or others (e.g. suicidal). Fast decisions on life-and-death cases are critical in hospital emergency departments. As a result, doctors face great pressures to overtest and overtreat.

Emergency departments in the military benefit from the added support of enlisted personnel who are capable of performing a wide variety of tasks they have been trained for through specialized military schooling. For example, in United States military hospitals, Air Force Aerospace Medical Technicians and Navy Hospital Corpsmen perform tasks that fall under the scope of practice of both doctors (i.e. sutures, staples and incision and drainages) and nurses (i.e. medication administration, foley catheter insertion, and obtaining intravenous access) and also perform splinting of injured extremities, nasogastric tube insertion, intubation, wound cauterizing, eye irrigation, and much more. Often, some civilian education and/or certification will be required, such as an EMT certification, in case of the need to provide care outside the base where the member is stationed.

Type 1 department – major A&E, providing a consultant-led 24 hour service with full resuscitation facilities Type 2 department – single specialty A&E service (e.g. ophthalmology, dentistry) Type 3 department – other A&E/minor injury unit/walk-in centre, treating minor injuries and illnesses Historically, waits for assessment in A&E were very long in some areas of the UK. In October 2002, the Department of Health introduced a four-hour target in emergency departments that required departments in England to assess and treat patients within four hours of arrival, with referral and assessment by other departments if deemed necessary. It was expected that the patients would have physically left the department within the four hours. Present policy is that 95% of all patient cases do not "breach" this four-hour wait. The busiest departments in the UK outside London include University Hospital of Wales in Cardiff, The North Wales Regional Hospital in Wrexham, the Royal Infirmary of Edinburgh and Queen Alexandra Hospital in Portsmouth. In July 2014, the QualityWatch research programme published in-depth analysis which tracked 41 million A&E attendances from 2010 to 2013. This showed that the number of patients in a department at any one time was closely linked to waiting times, and that crowding in A&E had increased as a result of a growing and ageing population, compounded by the freezing or reduction of A&E capacity. Between 2010/11 and 2012/13 crowding increased by 8%, despite a rise of just 3% in A&E visits, and this trend looks set to continue. Other influential factors identified by the report included temperature (with both hotter and colder weather pushing up A&E visits), staffing and inpatient bed numbers. A&E services in the UK are often the focus of a great deal of media and political interest, and data on A&E performance is published weekly. However, this is only one part of a complex urgent and emergency care system. Reducing A&E waiting times therefore requires a comprehensive, coordinated strategy across a range of related services. Many A&E departments are crowded and confusing. Many of those attending are understandably anxious, and some are mentally ill, and especially at night are under the influence of alcohol or other substances. Pearson Lloyd's redesign – 'A Better A&E' – is claimed to have reduced aggression against hospital staff in the departments by 50 per cent. A system of environmental signage provides location-specific information for patients. Screens provide live information about how many cases are being handled and the current status of the A&E department. Waiting times for patients to be seen at A&E were rising in the years leading up to 2020, and were hugely worsened during the COVID-19 pandemic that started in 2020. In response to the year-on-year increasing pressure on A&E units, followed by the unprecedented effects of the COVID-19 pandemic, the NHS in late 2020 proposed a radical change to handling of urgent and emergency care, separating "emergency" and "urgent". Emergencies are life-threatening illnesses or accidents which require immediate, intensive treatment. Services that should be accessed in an emergency include ambulance (via 999) and emergency departments. Urgent requirements are for an illness or injury that requires urgent attention but is not a life-threatening situation. Urgent care services include a phone consultation through the NHS111 Clinical Assessment Service, pharmacy advice, out-of-hours GP appointments, and/or referral to an urgent treatment centre (UTC). As part of the response, walk-in Urgent Treatment Centres (UTC) were created. People potentially needing A&E treatment are recommended to phone the NHS111 line, which will either book an arrival time for A&E, or recommend a more appropriate procedure.

Case management (mental health), a specific approach for the coordination of community mental health services Case management (US health system), a specific term used in the health care system of the United States of America Medical case management, a general term referring to the facilitation of treatment plans to assure the appropriate medical care is provided to disabled, ill or injured individuals Legal case management, a set of management approaches for law firms or courts

Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing.

stable housing. Supportive housing in rehabilitation Supportive housing can be coupled with such social services as job training, life skills training, alcohol and substance use disorder treatment, community support services (e.g., child care, educational programs, coffee klatches), and case management to populations in need of assistance. Supportive housing is intended to be a pragmatic solution that helps people have better lives while reducing, to the extent feasible, the overall cost of care. As community housing, supportive housing can be developed as mixed income, scattered site housing not only through the traditional route of low income and building complexes. Supportive housing has been widely researched in the field of psychiatric disabilities and psychiatric rehabilitation, based in part on housing and support principles from studies of leading community integration organizations nationally. In addition, supportive housing has been tied to national initiatives in supportive living (usually developmental and intellectual disabilities) to cross-disability transfer and to national and international efforts on developing homes of one's own. Supported housing in the field of mental health is considered to be a critical component of a community support system which may involve supported education, supported or transitional employment, case management services, clubhouses, supported recreation and involvement of family and friends often translated into psycho-educational programs. From 2002 to 2007, an estimated 65,000 to 72,000 units of supportive housing were created in the United States. This represents about half the supply of supported housing units. Of the new units added, about half were targeted towards chronically homeless individuals, and one-fifth were for homeless families. According to the United States Department of Housing and Urban Development (HUD), the number of Permanent Supportive Housing beds in the US increased from 188,636 to 353,800 between 2007 and 2017.

Populations served Sponsors of supportive housing projects generally aim to serve a specific population; the characteristics of those served and the housing program range widely: However, supporters of regular housing and support services in the community suggest choice based on other personal, social, and situational factors than specific population basis (e.g., choice of roommates or housemates, neighborhoods they live in). Today, important new populations for supported housing in regular neighborhoods include working families, especially those with high proportional housing costs, older adults who need intensive (enriched) services to avoid nursing home placements, and people who need places to live due to the closure of the old style, institutional psychiatric care. Increasingly, supportive housing may be required as unemployment increases, for newly emerging groups such as newly legalized gay and lesbian partners, multi-generational immigrant groups in the new multicultural world, and for those adolescents aging out of their parents' homes to new community options.

service to the client or patient. Learning shall be applied to planning work as well as to diagnostic work and therapeutic work. Derek Milne defined clinical supervision as: "The formal provision, by approved supervisors, of a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s". The main methods that supervisors use are corrective feedback on the supervisee's performance, teaching, and collaborative goal-setting. It therefore differs from related activities, such as mentoring and coaching, by incorporating an evaluative component. Supervision's objectives are "normative" (e.g. quality control), "restorative" (e.g. encourage emotional processing) and "formative" (e.g. maintaining and facilitating supervisees' competence, capability and general effectiveness). Some practitioners (e.g. art, music and drama therapists, chaplains, psychologists, and mental health occupational therapists) have used this practice for many years. In other disciplines the practice may be a new concept. For NHS nurses, the use of clinical supervision is expected as part of good practice. In a randomly controlled trial in Australia, White and Winstanley looked at the relationships between supervision, quality of nursing care and patient outcomes, and found that supervision had sustainable beneficial effects for supervisors and supervisees. Waskett believes that maintaining the practice of clinical supervision always requires managerial and systemic backing, and has examined the practicalities of introducing and embedding clinical supervision into large organisations such as NHS Trusts (2009, 2010). Clinical supervision has some overlap with managerial activities, mentorship, and preceptorship, though all of these end or become less direct as staff develop into senior and autonomous roles. Key issues around clinical supervision in healthcare raised have included time and financial investment.

cal supervision has some overlap with managerial activities, mentorship, and preceptorship, though all of these end or become less direct as staff develop into senior and autonomous roles. Key issues around clinical supervision in healthcare raised have included time and financial investment.

and other professional issues in a structured way. This is often known as clinical or counselling supervision (consultation differs in being optional advice from someone without a supervisor's formal authority). The purpose is to assist the practitioner to learn from his or her experience and progress in expertise, as well as to ensure good service to the client or patient. Learning shall be applied to planning work as well as to diagnostic work and therapeutic work. Derek Milne defined clinical supervision as: "The formal provision, by approved supervisors, of a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s". The main methods that supervisors use are corrective feedback on the supervisee's performance, teaching, and collaborative goal-setting. It therefore differs from related activities, such as mentoring and coaching, by incorporating an evaluative component. Supervision's objectives are "normative" (e.g. quality control), "restorative" (e.g. encourage emotional processing) and "formative" (e.g. maintaining and facilitating supervisees' competence, capability and general effectiveness). Some practitioners (e.g. art, music and drama therapists, chaplains, psychologists, and mental health occupational therapists) have used this practice for many years. In other disciplines the practice may be a new concept. For NHS nurses, the use of clinical supervision is expected as part of good practice. In a randomly controlled trial in Australia, White and Winstanley looked at the relationships between supervision, quality of nursing care and patient outcomes, and found that supervision had sustainable beneficial effects for supervisors and supervisees. Waskett believes that maintaining the practice of clinical supervision always requires managerial and systemic backing, and has examined the practicalities of introducing and embedding clinical supervision into large organisations such as NHS Trusts (2009, 2010). Clinical supervision has some overlap with managerial activities, mentorship, and preceptorship, though all of these end or become less direct as staff develop into senior and autonomous roles. Key issues around clinical supervision in healthcare raised have included time and financial investment.

and breastfeeding, delivery of vaccinations, promoting ventilation and improved air quality both indoors and outdoors, suicide prevention, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases. There is a significant disparity in access to health care and public health initiatives between developed countries and developing countries, as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained healthcare workers, monetary resources, or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention. A major public health concern in developing countries is poor maternal and child health, exacerbated by malnutrition and poverty and limited implementation of comprehensive public health policies. Developed nations are at greater risk of certain public health crises, including childhood obesity, although overweight populations in low- and middle-income countries are catching up. From the beginnings of human civilization, communities promoted health and fought disease at the population level. In complex, pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders, such as army generals, the clergy or rulers. Great Britain became a leader in the development of public health initiatives, beginning in the 19th century, due to the fact that it was the first modern urban nation worldwide. The public health initiatives that began to emerge initially focused on sanitation (for example, the Liverpool and London sewerage systems), control of infectious diseases (including vaccination and quarantine) and an evolving infrastructure of various sciences, e.g.

tion, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases. There is a significant disparity in access to health care and public health initiatives between developed countries and developing countries, as well as within developing countries. In developing countries, public health infrastructures are still forming. There may not be enough trained healthcare workers, monetary resources, or, in some cases, sufficient knowledge to provide even a basic level of medical care and disease prevention. A major public health concern in developing countries is poor maternal and child health, exacerbated by malnutrition and poverty and limited implementation of comprehensive public health policies. Developed nations are at greater risk of certain public health crises, including childhood obesity, although overweight populations in low- and middle-income countries are catching up. From the beginnings of human civilization, communities promoted health and fought disease at the population level. In complex, pre-industrialized societies, interventions designed to reduce health risks could be the initiative of different stakeholders, such as army generals, the clergy or rulers. Great Britain became a leader in the development of public health initiatives, beginning in the 19th century, due to the fact that it was the first modern urban nation worldwide. The public health initiatives that began to emerge initially focused on sanitation (for example, the Liverpool and London sewerage systems), control of infectious diseases (including vaccination and quarantine) and an evolving infrastructure of various sciences, e.g.

Components Public health is a complex term, composed of many elements and different practices. It is a multi-faceted, interdisciplinary field. For example, epidemiology, biostatistics, social sciences and management of health services are all relevant. Other important sub-fields include environmental health, community health, behavioral health, health economics, public policy, mental health, health education, health politics, occupational safety, disability, gender issues in health, and sexual and reproductive health. Modern public health practice requires multidisciplinary teams of public health workers and professionals. Teams might include epidemiologists, biostatisticians, physician assistants, public health nurses, midwives, medical microbiologists, pharmacists, economists, sociologists, geneticists, data managers, environmental health officers (public health inspectors), bioethicists, gender experts, sexual and reproductive health specialists, physicians, and veterinarians. The elements and priorities of public health have evolved over time, and are continuing to evolve. Common public health initiatives include promotion of hand-washing and breastfeeding, delivery of vaccinations, suicide prevention, smoking cessation, obesity education, increasing healthcare accessibility and distribution of condoms to control the spread of sexually transmitted diseases. Methods Public health aims are achieved through surveillance of cases and the promotion of healthy behaviors, communities and environments. Analyzing the determinants of health of a population and the threats it faces is the basis for public health. Many diseases are preventable through simple, nonmedical methods. For example, research has shown that the simple act of handwashing with soap can prevent the spread of many contagious diseases. In other cases, treating a disease or controlling a pathogen can be vital to preventing its spread to others, either during an outbreak of infectious disease or through contamination of food or water supplies. Public health, together with primary care, secondary care, and tertiary care, is part of a country's overall health care system.

y: are living on the streets (primary homelessness); have no permanent house or place to live safely are moving between temporary shelters, including houses of friends, family, hotels, and emergency accommodation (secondary homelessness) The legal status of homeless people changes from place to place. Homeless enumeration studies conducted by the government of the United States also include people who sleep in a public or private place that is not designed for use as a regular sleeping accommodation for human beings. Homelessness and poverty are interrelated. There is no standardized method for counting homeless individuals and identifying their needs; consequently, most cities only have estimated figures for their homeless populations. In 2025, approximately 330 million people worldwide experience absolute homelessness, lacking any form of shelter. Homeless persons who travel have been termed vagrants in the past; of those, persons looking for work are hobos, whereas those who do not are tramps.

In its Recommendations for the Censuses of Population and Housing, the CES identifies homeless people under two broad groups: Primary homelessness: this category includes persons living in the streets without a shelter that would fall within the scope of living quarters Secondary homelessness: this category may include persons with no place of usual residence who move frequently between various types of accommodations (including dwellings, shelters, and institutions for the homeless or other living quarters). This category includes persons living in private dwellings but reporting 'no usual address' on their census form.

In 2011, there were approximately 2.41 million homeless adults and 179,000 homeless children living in the country. However, one publication estimated that there were one million homeless children in China in 2012. Housing in China is highly regulated by the Hukou system. This gives rise to a large number of migrant workers, numbering 290.77 million in 2019. These migrant workers have rural Hukou, but they move to the cities in order to find better jobs, though due to their rural Hukou they are entitled to fewer privileges than those with urban Hukou. According to Huili et al., these migrant workers "live in overcrowded and unsanitary conditions" and are always at risk of displacement to make way for new real estate developments. In 2017, the government responded to a deadly fire in a crowded building in Beijing by cracking down on dense illegal shared accommodations and evicting the residents, leaving many migrant laborers homeless. This comes in the context of larger attempts by the government to limit the population increase in Beijing, often targeting migrant laborers. However, according to official government statistics, migrant workers in China have an average of 20.4 square metres (220 square feet) of living space per capita, and the vast majority of migrant workers have basic living facilities such as heating, bathing, refrigerators, and washing machines. Several natural disasters have led to homelessness in China. The 2000 Yunnan earthquake left 92,479 homeless and destroyed over 41,000 homes. Homelessness among people with mental health problems is 'much less common' in China than in high-income countries, due to stronger family ties, but is increasing due to migration within families and as a result of the one-child policy. A study in Xiangtan found at least 2439 schizophrenic people that have been homeless on a total population of 2.8 million. It was found that "homelessness was more common in individuals from rural communities (where social support services are limited), among those who wander away from their communities (i.e., those not from Xiangtan municipality), and among those with limited education (who are less able to mobilize social supports). Homelessness was also associated with greater age; [the cause] may be that older patients have 'burned their bridges' with relatives and, thus, end up on the streets." During the Cultural Revolution a large part of child welfare homes were closed down, leaving their inhabitants homeless. By the late 1990s, many new homes were set up to accommodate abandoned children. In 1999, the Ministry of Civil Affairs estimated the number of abandoned children in welfare homes to be 66,000. According to the Ministry of Civil Affairs, China had approximately 2,000 shelters and 20,000 social workers to aid approximately three million homeless people in 2014. From 2017 to 2019, the government of Guangdong Province assisted 5,388 homeless people in reuniting with relatives elsewhere in China. The Guangdong government assisted more than 150,000 people over three years. In 2020, in the wake of the COVID-19 pandemic, the Chinese Ministry of Civil Affairs announced several actions of the Central Committee in response to homelessness, including increasing support services and reuniting homeless people with their families. In Wuhan, the situation for homeless people was particularly bad, as the lockdown made it impossible for homeless migrants to return to other parts of the country.

r mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Some types of psychotherapy are considered evidence-based for treating diagnosed mental disorders; other types have been criticized as pseudoscience. However, at least to some extent, psychotherapies are supported by neuroscience, tend to have longer-lasting effects than pharmacotherapies, and can improve the effects of pharmacotherapies, including those involving psychedelics. There are hundreds of psychotherapy techniques, some being minor variations; others are based on very different conceptions of psychology. Most approaches involve one-to-one sessions, between the client and therapist, but some are conducted with groups, including couples and families. Psychotherapists may be mental health professionals such as psychiatrists, psychologists, mental health nurses, clinical social workers, marriage and family therapists, or licensed professional counselors. Psychotherapists may also come from a variety of other backgrounds, and depending on the jurisdiction may be legally regulated, voluntarily regulated or unregulated (and the term itself may be protected or not). It has shown general efficacy across a range of conditions, although its efficacy varies by individual and condition. While large-scale reviews support its benefits, debates continue over the best methods for evaluating outcomes, including the use of randomized controlled trials versus individualized approaches. A 2022 umbrella review of 102 meta-analyses found that effect sizes for both psychotherapies and medications were generally small, leading researchers to recommend a paradigm shift in mental health research. Although many forms of therapy differ in technique, they often produce similar outcomes, leading to theories that common factors—such as the therapeutic relationship—are key drivers of efficacy. Challenges include high dropout rates, limited understanding of mechanisms of change, potential adverse effects, and concerns about therapist adherence to treatment fidelity.

Definitions The term psychotherapy is derived from Ancient Greek psyche (ψυχή meaning "breath; spirit; soul") and therapeia (θεραπεία "healing; medical treatment"). The Oxford English Dictionary defines it as "The treatment of disorders of the mind or personality by psychological means...", however, in earlier use, it denoted the treatment of disease through hypnotic suggestion. Psychotherapy is often dubbed as a "talking therapy" or "talk therapy", particularly for a general audience, though not all forms of psychotherapy rely on verbal communication. Children or adults who do not engage in verbal communication (or not in the usual way) are not excluded from psychotherapy; indeed some types are designed for such cases. The American Psychological Association adopted a resolution on the effectiveness of psychotherapy in 2012 based on a definition developed by American psychologist John C. Norcross: "Psychotherapy is the informed and intentional application of clinical methods and interpersonal stances derived from established psychological principles for the purpose of assisting people to modify their behaviors, cognitions, emotions, and/or other personal characteristics in directions that the participants deem desirable". Influential editions of a work by psychiatrist Jerome Frank defined psychotherapy as a healing relationship using socially authorized methods in a series of contacts primarily involving words, acts and rituals—which Frank regarded as forms of persuasion and rhetoric. Historically, psychotherapy has sometimes meant "interpretative" (i.e. Freudian) methods, namely psychoanalysis, in contrast with other methods to treat psychiatric disorders such as behavior modification. Some definitions of counseling overlap with psychotherapy (particularly in non-directive client-centered approaches), or counseling may refer to guidance for everyday problems in specific areas, typically for shorter durations with a less medical or "professional" focus. Somatotherapy refers to the use of physical changes as injuries and illnesses, and sociotherapy to the use of a person's social environment to effect therapeutic change.

Europe As of 2015, there are still a lot of variations between different European countries about the regulation and delivery of psychotherapy. Several countries have no regulation of the practice or no protection of the title. Some have a system of voluntary registration, with independent professional organizations, while other countries attempt to restrict the practice of psychotherapy to 'mental health professionals' (psychologists and psychiatrists) with state-certified training. The titles that are protected also vary. The European Association for Psychotherapy (EAP) established the 1990 Strasbourg Declaration on Psychotherapy, which is dedicated to establishing an independent profession of psychotherapy in Europe, with pan-European standards. The EAP has already made significant contacts with the European Union & European Commission towards this end. Given that the European Union has a primary policy about the free movement of labor within Europe, European legislation can overrule national regulations that are, in essence, forms of restrictive practices. In Germany, the practice of psychotherapy for adults is restricted to qualified psychologists and physicians (including psychiatrists) who have completed several years of specialist practical training and certification in psychotherapy. As psychoanalysis, psychodynamic therapy, cognitive behavioral therapy, and systemic therapy meet the requirements of German health insurance companies, mental health professionals regularly opt for one of these four specializations in their postgraduate training. For psychologists, this includes three years of full-time practical training (4,200 hours), encompassing a year-long internship at an accredited psychiatric institution, six months of clinical work at an outpatient facility, 600 hours of supervised psychotherapy in an outpatient setting, and at least 600 hours of theoretical seminars. Social workers may complete the specialist training for child and teenage clients. Similarly in Italy, the practice of psychotherapy is restricted to graduates in psychology or medicine who have completed four years of recognised specialist training. Sweden has a similar restriction on the title "psychotherapist", which may only be used by professionals who have gone through a post-graduate training in psychotherapy and then applied for a licence, issued by the National Board of Health and Welfare. Legislation in France restricts the use of the title "psychotherapist" to professionals on the National Register of Psychotherapists, which requires a training in clinical psychopathology and a period of internship which is only open to physicians or titulars of a master's degree in psychology or psychoanalysis. Austria and Switzerland (2011) have laws that recognize multi-disciplinary functional approaches. In the United Kingdom, the government and Health and Care Professions Council considered mandatory legal registration but decided that it was best left to professional bodies to regulate themselves, so the Professional Standards Authority for Health and Social Care (PSA) launched an Accredited Voluntary Registers scheme. Counseling and psychotherapy are not protected titles in the United Kingdom.

Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing taxpayer-funded health insurance to 85 million low-income and disabled people as of 2022; in 2019, the program paid for half of all U.S. births. In 2023, the total (federal and state) annual cost of Medicaid was $870 billion, with an average cost per enrollee of $7,600 for 2021. 37% of enrollees were children, but they only accounted for 15% of the spending, ($3,000 per person) while seniors and disabled persons accounted for 21% of enrollees and 52% of spending (more than $18,000 per person). In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities. Medicaid also covers long-term services and supports, including both nursing home care and home- and community-based services, for those with low incomes and minimal assets. Of the 7.7 million Americans who used long-term services and supports in 2020, about 5.6 million were covered by Medicaid. Along with Medicare, Tricare, ChampVA, and CHIP, Medicaid is one of the several Federal Government-sponsored medical insurance programs in the United States. Medicaid covers healthcare costs for people with low incomes; Medicare is a universal program providing health coverage for the elderly; and the CHIP program covers uninsured children in families with incomes that are too high to be covered by Medicaid. Medicaid offers elder care benefits not normally covered by Medicare, including nursing home care and personal care services. There are also dual health plans for people who have both Medicaid and Medicare. Research shows that existence of the Medicaid program improves health outcomes, health insurance coverage, access to health care, and recipients' financial security and provides economic benefits to states and health providers.

2025 Medicaid cuts in the second Trump administration In 2025, Republican Congressional leaders John Thune and Mike Johnson announced goals of cutting 1.5 to 2 trillion dollars of the US federal budget, with President Donald Trump stating that cuts to Medicaid would only include "abuse or waste". The 2025 budget resolution, which was passed by the House of Representatives with only Republicans votes, proposed cutting $880 billion from the Standing Committee for Energy and Commerce, which includes many areas, such as Medicaid and Medicare. On July 4, 2025, President Donald Trump signed the One Big Beautiful Bill Act, intended in part to implement this resolution. The act cut Medicaid in a number of ways: while it did not repeal the ACA's Medicaid expansion, it mandated work requirements for able-bodied Medicaid recipients. It also requires Medicaid recipients above the federal poverty line to pay more fees for coverage; adds new verification requirements; increases the number of times states need to check the eligibility of their Medicaid expansion recipients; prohibits Medicaid from funding nonprofits that provide abortion care; makes it harder for illegal immigrants to use Medicaid; bans pharmacy benefit managers from using spread pricing; and puts limits on so-called "provider taxes" that states impose on healthcare providers to fund their portion of Medicaid spending. The non-partisan Congressional Budget Office (CBO) estimated that it will reduce the number of people on Medicaid by several million.; the CBO estimates that the work requirements in particular will lead 11 million to lose their Medicaid coverage, many of whom already work or qualify for exemptions but will not be able to get through the red tape. The bill prompted claims that undocumented immigrants are on Medicaid. Undocumented immigrants are already ineligible for full Medicaid benefits, and many undocumented immigrants access state-funded health programs rather than federal Medicaid. According to a CBO analysis, the bill's provisions could lead some states to cut back those state-funded health programs, potentially causing an estimated 1.4 million people to lose state-level health coverage, including undocumented immigrants. When commenting on the Trump administration's One Big Beautiful Bill Act and the impact of the Medicaid provisions on the economy, USDA Secretary Brooke Rollins stated that 34 million able-bodied adults on Medicaid should be working.

Arizona: AHCCCS California: Medi-Cal Connecticut: HUSKY D Illinois: HealthChoice Illinois Iowa: Hawk-i Healthy and Well-Kids in Iowa Maine: MaineCare Massachusetts: MassHealth New Jersey: NJ FamilyCare Oregon: Oregon Health Plan Oklahoma: Soonercare Tennessee: TennCare Washington: Washington Apple Health Wisconsin: BadgerCare As of January 2012, Medicaid and/or CHIP funds could be obtained to help pay employer health care premiums in Alabama, Alaska, Arizona, Colorado, Florida, and Georgia. Differences by state While states have significant autonomy in implementing the Medicaid program, their flexibility is bounded by federal requirements designed to ensure a baseline of coverage and access. For example, federal law mandates that certain services, such as inpatient and outpatient hospital services, laboratory and X-ray services, and physician services, must be covered by all state Medicaid programs. Additionally, states must adhere to federal guidelines regarding beneficiary protections and quality standards.

Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work practice draws from liberal arts, social science, and interdisciplinary areas such as psychology, sociology, health, political science, community development, law, and economics to engage with systems and policies, conduct assessments, develop interventions, and enhance social functioning and responsibility. The ultimate goals of social work include the improvement of people's lives, alleviation of biopsychosocial concerns, empowerment of individuals and communities, and the achievement of social reform. Social work practice is often divided into three levels. Micro-work involves working directly with individuals and families, such as providing individual counseling/therapy or assisting a family in accessing services. Mezzo-work involves working with groups and communities, such as conducting group therapy or providing services for community agencies. Macro-work involves fostering change on a larger scale through advocacy, social policy, research development, non-profit and public service administration, or working with government agencies. Starting in the 1960s, a few universities began social work management programmes, to prepare students for the management of social and human service organizations, in addition to classical social work education. The social work profession developed in the 19th century, with some of its roots in voluntary philanthropy and in grassroots organizing. However, responses to social needs had existed long before then, primarily from public almshouses, private charities and religious organizations.

Definition Social work is a broad profession that intersects with several disciplines. Social work organizations offer the following definitions: Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences, humanities, and indigenous knowledge, social work engages people and structures to address life challenges and enhance well-being. —International Federation of Social Workers Social work is a profession concerned with helping individuals, families, groups and communities to enhance their individual and collective well-being. It aims to help people develop their skills and their ability to use their resources and those of the community to resolve problems. Social work is concerned with individual and personal problems but also with broader social issues such as poverty, unemployment, and domestic violence. — Canadian Association of Social Workers Social work practice consists of the professional application of social principles, and techniques to one or more of the following ends: helping people obtain tangible services; counseling and psychotherapy with individuals, families, and groups; helping communities or groups provide or improve social and health services, and participating in legislative processes. The practice of social work requires knowledge of human development and behavior; of social and economic, and cultural institutions; and the interaction of all these factors. —[US] National Association of Social Workers Social workers work with individuals and families to help improve outcomes in their lives. This may be helping to protect vulnerable people from harm or abuse or supporting people to live independently. Social workers support people, act as advocates and direct people to the services they may require.

The education of social workers begins with a bachelor's degree (BA, BSc, BSSW, BSW, etc.) or diploma in social work or a Bachelor of Social Services. Some countries offer postgraduate degrees in social work, such as a master's degree (MSW, MSSW, MSS, MSSA, MA, MSc, MRes, MPhil.) or doctoral studies (Ph.D. and DSW (Doctor of Social Work)). Several countries and jurisdictions require registration or license for working as social workers, and there are mandated qualifications. In other places, the professional association sets academic requirements as the qualification for practicing the profession. However, certain types of workers are exempted from needing a registration license. The success of these professionals is based on the recognition of and by the employers that provide social work services.

t programs as it relates to strengthening partnerships with corporations and government agencies, helping to inform and shape the curriculum for degree programs, and generating revenue to support the academic enterprise. Comparable terminology and initiatives Outside the United States and Canada, comparable forms of post-initial education may be described using terms such as adult education, further education, lifelong learning, continuing professional development, upskilling or reskilling. In Ireland, comparable continuing-education and reskilling initiatives include Springboard+, which provides free or subsidised higher-education courses for upskilling and reskilling, and the Human Capital Initiative, a €300 million programme that commenced in 2020 to expand skills-focused higher-education provision in priority areas.

History In the United Kingdom, Oxford University's Department for Continuing Education was founded in 1878, and the Institute of Continuing Education of Cambridge University dates back to 1873. In the United States, the Chautauqua Institution, originally the Chautauqua Lake Sunday School Assembly, was founded in 1874 "as an educational experiment in out-of-school, vacation learning. It was successful and broadened almost immediately beyond courses for Sunday school teachers to include academic subjects, music, art and physical education." Harvard University traces its origins in continuing education to 1835 when John Lowell Jr. established the Lowell Institute with a mission to provide free public lectures in Boston. In 1909, then-Harvard President A. Lawrence Lowell, who was also a trustee of the Lowell Institute, expanded plans to offer Lowell Institute public courses directly with Harvard. In 1910, Lowell formally established the Havard Extension School, then referred to as the Commission on Extension Courses. The Harvard Extension School now operates under the Faculty of Arts and Sciences and is one of the 13 degree-granting schools that make up Harvard University. The School has remained in continuous operation since 1910. Cornell University was among higher education institutions that began offering university-based continuing education, primarily to teachers, through extension courses in the 1870s. As noted in the Cornell Era of February 16, 1877, the university offered a "Tour of the Great Lakes" program for "teachers and others" under the direction of Professor Theodore B. Comstock, head of Cornell's department of geology. The University of Wisconsin–Madison began its continuing education program in 1907. The New School for Social Research, founded in 1919, was initially devoted to adult education. In 1969, Empire State College, a unit of the State University of New York, was the first institution in the US to exclusively focus on providing higher education to adult learners. In 1976 the University of Florida created its own Division of Continuing Education and most courses were offered on evenings or weekends to accommodate the schedules of working students. The method of delivery of continuing education can include traditional types of classroom lectures and laboratories.

aditional students, non-degree career training, college remediation, workforce training, and formal personal enrichment courses (both on-campus and online). General continuing education is similar to adult education, at least in being intended for adult learners, especially those beyond traditional undergraduate college or university age. Frequently, in the United States and Canada continuing education courses are delivered through a division or school of continuing education of a college or university known sometimes as the university extension or extension school.

as minors, if the instant offense involves child sexual abuse), or with known criminals, particularly co-defendants. Additionally, offenders can be subject to refraining from the use or possession of alcohol and other drugs and may be ordered to submit to alcohol/drug tests or participate in alcohol/drug psychological treatment. Offenders on probation might be fitted with an electronic tag (or monitor), which signals their movement to officials.

icularly co-defendants. Additionally, offenders can be subject to refraining from the use or possession of alcohol and other drugs and may be ordered to submit to alcohol/drug tests or participate in alcohol/drug psychological treatment. Offenders on probation might be fitted with an electronic tag (or monitor), which signals their movement to officials.

When child support nonpayment was criminalized in the early 20th century, probation was the primary punishment levied on nonsupporters. Those in favor of criminalizing nonsupport wanted a penalty that "would maximize deterrence, preserve the family (at least in a financial sense), and lighten the burden on charities and the state to support women and children." When New York authorized probation as a punishment in 1901, the New York City magistrates cited four benefits to probation as opposed to incarceration: "(1) 'Punishment without disgrace, and effective without producing embitterment, resentment or demoralization,' (2) judicial discretion to make the punishment fit the crime, (3) '[p]unishment that is borne solely by the guilty and displacing a system that frequently involved the innocent and helpless,' and (4) punishment attended by increased revenue to the City and by a saving in expense.'" The existence of probation officers in child support cases made it so the state was involved in family life in previously unprecedented ways. Probation officers would often attempt to reconcile separated couples, encourage husbands to drink less alcohol, and teach wives housekeeping skills. Employing probation in nonsupport cases also led to more revenue captured by nonsupporting spouses.

chotherapies. CBT is a "problem-focused" and "action-oriented" form of therapy. The therapist's role is to assist the client in finding and practicing effective cognitive and behavioral strategies to address identified obstacles and alleviate symptoms of the disorder. CBT is based on the belief that thought distortions and maladaptive behaviors play a role in the development and maintenance of many psychological disorders. CBT focuses on challenging and changing these cognitive distortions (thoughts, beliefs, and attitudes) and their associated behaviors to improve emotional regulation and help the individual develop coping strategies to address problems. CBT includes a number of cognitive and behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies. These therapies include, but are not limited to, rational emotive behavior therapy (REBT), cognitive therapy, metacognitive therapy, metacognitive training, reality therapy/choice theory, cognitive processing therapy, eye movement desensitization and reprocessing (EMDR), and multimodal therapy. New forms of CBT specifically influenced by mindfulness approaches include dialectical behavior therapy, mindfulness-based cognitive therapy, acceptance and commitment therapy, and compassion-focused therapy. Though originally designed to treat depression, CBT is often prescribed as an evidence-informed treatment for many mental health and medical conditions. These include obsessive–compulsive disorder, generalized anxiety disorder, substance use disorders, marital problems, attention deficit hyperactivity disorder, and eating disorders. Along with interpersonal psychotherapy (IPT), CBT is recommended in treatment guidelines as a psychosocial treatment of choice. It is recommended by the American Psychiatric Association, the American Psychological Association, and the British National Health Service.

lenging and changing these cognitive distortions (thoughts, beliefs, and attitudes) and their associated behaviors to improve emotional regulation and help the individual develop coping strategies to address problems. CBT includes a number of cognitive and behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies. These therapies include, but are not limited to, rational emotive behavior therapy (REBT), cognitive therapy, metacognitive therapy, metacognitive training, reality therapy/choice theory, cognitive processing therapy, eye movement desensitization and reprocessing (EMDR), and multimodal therapy. New forms of CBT specifically influenced by mindfulness approaches include dialectical behavior therapy, mindfulness-based cognitive therapy, acceptance and commitment therapy, and compassion-focused therapy. Though originally designed to treat depression, CBT is often prescribed as an evidence-informed treatment for many mental health and medical conditions. These include obsessive–compulsive disorder, generalized anxiety disorder, substance use disorders, marital problems, attention deficit hyperactivity disorder, and eating disorders. Along with interpersonal psychotherapy (IPT), CBT is recommended in treatment guidelines as a psychosocial treatment of choice. It is recommended by the American Psychiatric Association, the American Psychological Association, and the British National Health Service.

Groundbreaking work in behaviorism began with John B. Watson and Rosalie Rayner's studies of conditioning in 1920. Behaviorally-centered therapeutic approaches appeared as early as 1924 with Mary Cover Jones' work dedicated to the unlearning of fears in children. These were the antecedents of the development of Joseph Wolpe's behavioral therapy in the 1950s. It was the work of Wolpe and Watson, which was based on Ivan Pavlov's work on learning and conditioning, that influenced Hans Eysenck and Arnold Lazarus to develop new behavioral therapy techniques based on classical conditioning. During the 1950s and 1960s, behavioral therapy became widely used by researchers in the United States, the United Kingdom, and South Africa. Their inspiration was by the behaviorist learning theory of Ivan Pavlov, John B. Watson, and Clark L. Hull. In Britain, Joseph Wolpe, who applied the findings of animal experiments to his method of systematic desensitization, applied behavioral research to the treatment of neurotic disorders. Wolpe's therapeutic efforts were precursors to today's fear reduction techniques. British psychologist Hans Eysenck presented behavior therapy as a constructive alternative. At the same time as Eysenck's work, B. F. Skinner and his associates were beginning to have an impact with their work on operant conditioning. Skinner's work was referred to as radical behaviorism and avoided anything related to cognition. However, Julian Rotter in 1954 and Albert Bandura in 1969 contributed to behavior therapy with their works on social learning theory by demonstrating the effects of cognition on learning and behavior modification. The work of Claire Weekes in dealing with anxiety disorders in the 1960s is also seen as a prototype of behavior therapy. The emphasis on behavioral factors has been described as the "first wave" of CBT. Second wave: cognitive therapy and classical CBT One of the first therapists to address cognition in psychotherapy was Alfred Adler, notably with his idea of basic mistakes and how they contributed to creation of unhealthy behavioral and life goals.Abraham Low believed that someone's thoughts were best changed by changing their actions. Adler and Low influenced the work of Albert Ellis, who developed the earliest cognitive-based psychotherapy called rational emotive behavioral therapy, or REBT. The first version of REBT was announced to the public in 1956. Cognitive therapy was developed by psychoanalyst Aaron Beck in the 1950s. In the late 1950s, Aaron Beck was conducting free association sessions in his psychoanalytic practice. During these sessions, Beck noticed that thoughts were not as unconscious as Freud had previously theorized, and that certain types of thinking may be the culprits of emotional distress. It was from this hypothesis that Beck developed cognitive therapy, and called these thoughts "automatic thoughts". He first published his new methodology in 1967, and his first treatment manual in 1979. Beck has been referred to as "the father of cognitive behavioral therapy". It was these two therapies, rational emotive therapy, and cognitive therapy, that started the "second wave" of CBT, which emphasized cognitive factors and developed into classical CBT in the 1970s. Although the early behavioral approaches were successful in many so-called neurotic disorders, they had little success in treating depression. Behaviorism was also losing popularity due to the cognitive revolution. The therapeutic approaches of Albert Ellis and Aaron T. Beck gained popularity among behavior therapists, despite the earlier behaviorist rejection of mentalistic concepts like thoughts and cognitions.

s and PhD programs in the Colleges of Engineering, Arts & Sciences, and Education; MPA program in the School of Public Service; and the MPH program in the College of Health Sciences. It is classified among "R2: Doctoral Universities – High research activity".

The university also has an honors college. Within the College of Arts and Sciences is the School of the Environment, approved by the Idaho State Board of Education in 2022 and established in 2023. Boise State's fall enrollment in 2016 was 23,886 students, and approximately 76 percent of these students were Idaho residents. More than 90 percent of Boise State's first-year students come directly from high school. In the 2015–16 school year, Boise State awarded diplomas to 3,916 distinct graduates, including 18 doctorates, 10 education specialists, 670 master's and 2,998 bachelor's degrees. The university is classified among "R2: Doctoral Universities – High research spending and doctorate production".

te offers more than 100 graduate programs, including a variety of MBA programs and the MAcc program in the College of Business and Economics; master's and PhD programs in the Colleges of Engineering, Arts & Sciences, and Education; MPA program in the School of Public Service; and the MPH program in the College of Health Sciences. It is classified among "R2: Doctoral Universities – High research activity".

ent, so diagnostic terms such as alcohol use disorder and alcohol dependence are often used instead in a clinical context. Other terms, some slurs and some informal, have been used to refer to people affected by alcoholism such as tippler, sot, drunk, drunkard, dipsomaniac, and souse. Alcohol is addictive, and heavy long-term use results in many negative health and social consequences. It can damage all organ systems, but especially affects the brain, heart, liver, pancreas, and immune system. Heavy usage can result in trouble sleeping, and severe cognitive issues like dementia, brain damage, or Wernicke–Korsakoff syndrome. Physical effects include irregular heartbeat, impaired immune response, cirrhosis, increased cancer risk, and severe withdrawal symptoms if stopped suddenly. These effects can reduce life expectancy by 10 years. Drinking during pregnancy may harm the child's health, and drunk driving increases the risk of traffic accidents. Alcoholism is associated with violent and non-violent crime. While alcoholism directly resulted in 139,000 deaths worldwide in 2013, in 2012, 3.3 million deaths may have been attributable globally to alcohol. The development of alcoholism is attributed to environment and genetics equally. Someone with a parent or sibling with an alcohol use disorder is 3-4 times more likely to develop alcohol use disorder, but only a minority do. Environmental factors include social, cultural and behavioral influences. High stress levels and anxiety, as well as alcohol's low cost and easy accessibility, increase the risk. Medically, alcoholism is considered both a physical and mental illness. Questionnaires are usually used to detect possible alcoholism. Further information is then collected to confirm the diagnosis. Treatment takes several forms. Due to medical problems that can occur during withdrawal, alcohol cessation should often be controlled carefully. Benzodiazepine is used to mitigate withdrawal symptoms, and acamprosate, naltrexone, or disulfiram to reduce cravings and make consumption less rewarding or unpleasant. Mental illness or other addictions may complicate treatment. Individual, group therapy, or support groups are used to attempt to keep a person from returning to alcoholism. Among them is the abstinence-based mutual aid fellowship Alcoholics Anonymous (AA).

Alcoholism is characterized by an increased tolerance to alcohol – which means that an individual can consume more alcohol –and physical dependence on alcohol, which makes it hard for an individual to control their consumption. The physical dependency caused by alcohol can lead to an affected individual having a very strong urge to drink alcohol. These characteristics play a role in decreasing the ability to stop drinking of an individual with an alcohol use disorder. Alcoholism can have adverse effects on mental health, contributing to psychiatric disorders and increasing the risk of suicide.

Psychiatric Long-term misuse of alcohol can cause a wide range of mental health problems. Severe cognitive problems are common; approximately 10% of all dementia cases are related to alcohol consumption, making it the second leading cause of dementia. Excessive alcohol use causes damage to brain function, and psychological health can be increasingly affected over time. Social skills are significantly impaired in people with alcoholism due to the neurotoxic effects of alcohol on the brain, especially the prefrontal cortex area of the brain. The social skills that are impaired by alcohol use disorder include impairments in perceiving facial emotions, prosody, perception problems, and theory of mind deficits; the ability to understand humor is also impaired in people who misuse alcohol. Psychiatric disorders are common in people with alcohol use disorders, with as many as 25% also having severe psychiatric disturbances. The most prevalent psychiatric symptoms are anxiety and depression disorders. Psychiatric symptoms usually initially worsen during alcohol withdrawal, but typically improve or disappear with continued abstinence. Psychosis, confusion, and organic brain syndrome may be caused by alcohol misuse, which can lead to a misdiagnosis such as schizophrenia. Panic disorder can develop or worsen as a direct result of long-term alcohol misuse. The co-occurrence of major depressive disorder and alcoholism is well documented. Among those with comorbid occurrences, a distinction is commonly made between depressive episodes that remit with alcohol abstinence ("substance-induced"), and depressive episodes that are primary and do not remit with abstinence ("independent" episodes). Additional use of other drugs may increase the risk of depression. Psychiatric disorders differ depending on gender. Women who have alcohol-use disorders often have a co-occurring psychiatric diagnosis such as major depression, anxiety, panic disorder, bulimia, post-traumatic stress disorder (PTSD), or borderline personality disorder. Men with alcohol-use disorders more often have a co-occurring diagnosis of narcissistic or antisocial personality disorder, bipolar disorder, schizophrenia, impulse disorders or attention deficit/hyperactivity disorder (ADHD).

t an intervening health care provider." When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telemedicine may bridge the gap and can even improve retention in treatment as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration.

gration. EHealth encompasses a wide range of applications, including but not limited to the following: Two clinicians discussing a case via video conference; Robotic surgery performed through remote access; Physical therapy conducted using digital monitoring instruments, live feed, and application combinations; Diagnostic tests transferred between facilities for interpretation by a higher specialist; Home monitoring through continuous transmission of patient health data; Online consultations between patients and practitioners; Video remote interpretation services for clinical visits.

Telehealth versus telemedicine Telehealth is sometimes discussed interchangeably with telemedicine, the latter being more common than the former. Telehealth has been described as a disruptive innovation in healthcare because it enables medical services to be delivered remotely using communication technologies. The Health Resources and Services Administration distinguishes telehealth from telemedicine in its scope, defining telemedicine only as describing remote clinical services, such as diagnosis and monitoring, while telehealth includes preventative, promotive, and curative care delivery. This includes the above-mentioned non-clinical applications, like administration and provider education. The United States Department of Health and Human Services states that the term telehealth includes "non-clinical services, such as provider training, administrative meetings, and continuing medical education", and that the term telemedicine means "remote clinical services". The World Health Organization uses telemedicine to describe all aspects of health care including preventive care. The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably, although it acknowledges that telehealth is sometimes used more broadly for remote health not involving active clinical treatments. eHealth is another related term, used particularly in the U.K. and Europe, as an umbrella term that includes telehealth, electronic medical records, and other components of health information technology. Methods and modalities Telehealth requires good Internet access by participants, usually in the form of a strong, reliable broadband connection, and broadband mobile communication technology of at least the fourth generation (4G) or long-term evolution (LTE) standard to overcome issues with video stability and bandwidth restrictions. As broadband infrastructure has improved, telehealth usage has become more widely feasible. Healthcare providers often begin telehealth with a needs assessment which assesses hardships that can be improved by telehealth such as travel time, costs or time off work. Collaborators such as technology companies can ease the transition. Delivery can come within four distinct domains: live video (synchronous), store-and-forward (asynchronous), remote patient monitoring, and mobile health. Audio-based telemedicine, primarily through telephone consultations, has been studied as a tool for managing chronic conditions.

tic criteria are met. The ICD-11 divides substance use disorders into two categories: (1) harmful pattern of substance use; and (2) substance dependence. In 2017, globally 271 million people (5.5% of adults) were estimated to have used one or more illicit drugs. Of these, 35 million had a substance use disorder. An additional 237 million men and 46 million women have alcohol use disorder as of 2016. In 2017, substance use disorders from illicit substances directly resulted in 585,000 deaths. Direct deaths from drug use, other than alcohol, have increased over 60 percent from 2000 to 2015.

Substance use disorders (SUDs) are highly prevalent and exact a large toll on individuals' health, well-being, and social functioning. Long-lasting changes in brain networks involved in reward, executive function, stress reactivity, mood, and self-awareness underlie the intense drive to consume substances and the inability to control this urge in a person who suffers from addiction (moderate or severe SUD). Biological (including genetics and developmental life stages) and social (including adverse childhood experiences) determinants of health are recognized factors that contribute to vulnerability to or resilience against developing a SUD. Consequently, prevention strategies that target social risk factors can improve outcomes and, when deployed in childhood and adolescence, can decrease the risk for these disorders. This section divides substance use disorder causes into categories consistent with the biopsychosocial model.

Psychological causal factors include cognitive, affective, and developmental determinants, among others. For example, individuals who begin using alcohol or other drugs in their teens are more likely to have a substance use disorder as adults. Other common risk factors are being male, being under 25, having other mental health problems (with the latter two being related to symptomatic relapse, impaired clinical and psychosocial adjustment, reduced medication adherence, and lower response to treatment), and lack of familial support and supervision. (As mentioned above, some of these causal factors can also be categorized as social or biological).

es typically offered by larger, more comprehensive treatment facilities. A typical IOP program offers group therapy and generally facilitates 9 to 19 hours a week of programming for mental health and addiction treatment. IOP allows patients to participate in their daily affairs, such as work, and in treatment at an appropriate facility in the morning or the end of the day. With an IOP, classes, sessions, meetings, and workshops are scheduled throughout the day, and patients are expected to adhere to the program's structure. Online IOP has also been shown to be effective. Typical IOP programs also encourage active participation in 12-step programs.

An intensive outpatient program (IOP), also known as an intensive outpatient treatment (IOT) program, is a structured non-residential psychological treatment program that addresses mental health disorders and substance use disorders (SUDs) that do not require detoxification through a combination of group-based psychotherapy, individual psychotherapy, family counseling, educational groups, and strategies for encouraging motivation and engagement in treatment. IOP operates on a small scale and does not require the intensive residential or partial day services typically offered by larger, more comprehensive treatment facilities. A typical IOP program offers group therapy and generally facilitates 9 to 19 hours a week of programming for mental health and addiction treatment. IOP allows patients to participate in their daily affairs, such as work, and in treatment at an appropriate facility in the morning or the end of the day. With an IOP, classes, sessions, meetings, and workshops are scheduled throughout the day, and patients are expected to adhere to the program's structure. Online IOP has also been shown to be effective. Typical IOP programs also encourage active participation in 12-step programs.

12-step programs. IOP can be more effective than individual therapy for chemical dependency. Some HMOs use IOP as transitional treatment for patients just released from a psychiatric hospital or upon discharge from a residential treatment program. See also Partial hospitalization (PHP) References

ern Oregon to Boise, and is the most populated area in Idaho. Historically, the valley had been known as the Lower Snake River Valley or the Boise River Valley. Pete Olesen, president of the valley's association of local Chambers of Commerce, coined the name "Treasure Valley" in 1959 to reflect the treasure chest of resources and opportunities that the region offered. The valley has a very diverse terrain, from sage flatlands, to mesas, agricultural areas, and urbanized areas.

The Treasure Valley is a valley in the western United States, primarily in southwestern Idaho, where the Payette, Boise, Weiser, Malheur, and Owyhee rivers drain into the Snake River. It includes all the lowland areas from Vale in rural eastern Oregon to Boise, and is the most populated area in Idaho. Historically, the valley had been known as the Lower Snake River Valley or the Boise River Valley. Pete Olesen, president of the valley's association of local Chambers of Commerce, coined the name "Treasure Valley" in 1959 to reflect the treasure chest of resources and opportunities that the region offered. The valley has a very diverse terrain, from sage flatlands, to mesas, agricultural areas, and urbanized areas.

eflect the treasure chest of resources and opportunities that the region offered. The valley has a very diverse terrain, from sage flatlands, to mesas, agricultural areas, and urbanized areas. As the Boise Metropolitan Area grows, more and more undeveloped and agricultural land is being urbanized. History Settling the region The tribes that roamed the area, specifically, were the Northern Paiute and Shoshone. In 1834, Thomas McKay built the original Fort Boise, in the area near present-day Parma, which was run for a time by Francois Payette. It later was moved because of flooding troubles and was abandoned in 1854. The Oregon Trail runs through the Treasure Valley. The valley was settled for the most part by ranchers and farmers, initially to supply the gold and silver mining communities in the higher elevations nearby: Idaho City in the Boise Basin and Silver City in the Owyhees. A new Fort Boise was constructed by the U.S. Army in 1863 in present-day Boise, from which the city grew.

Parole, also known as provisional release, supervised release, or being on paper, is a form of early release of a prison inmate where the prisoner agrees to abide by behavioral conditions, including checking in with their designated parole officers, or else they may be rearrested and returned to prison. Parole is not an additional sentence; rather it is a system that allows inmates to finish their original sentence outside of prison under supervision. In some jurisdictions in the United States, people may shorten their time on parole through earned compliance credits. Originating from the French word parole ('speech, spoken words' but also 'promise'), the term became associated during the Middle Ages with the release of prisoners who gave their word. This differs greatly from pardon, amnesty or commutation of sentence in that parolees are still considered to be serving their sentences, and may be returned to prison if they violate the conditions of their parole.

a system that allows inmates to finish their original sentence outside of prison under supervision. In some jurisdictions in the United States, people may shorten their time on parole through earned compliance credits. Originating from the French word parole ('speech, spoken words' but also 'promise'), the term became associated during the Middle Ages with the release of prisoners who gave their word. This differs greatly from pardon, amnesty or commutation of sentence in that parolees are still considered to be serving their sentences, and may be returned to prison if they violate the conditions of their parole.

their word. This differs greatly from pardon, amnesty or commutation of sentence in that parolees are still considered to be serving their sentences, and may be returned to prison if they violate the conditions of their parole. It is similar to probation, the key difference being that parole is served for the remainder of a prison sentence, while probation can be granted in place of a prison sentence. History The practice of paroling enemy troops began thousands of years ago, at least as early as the time of Carthage. Parole allowed the prisoners' captors to avoid the burdens of having to feed and care for them while still avoiding having the prisoners rejoin their old ranks once released; it could also allow the captors to recover their own men in a prisoner exchange. Hugo Grotius, an early international lawyer, favorably discussed prisoner of war parole. During the American Civil War, both the Dix–Hill Cartel and the Lieber Code set out rules regarding prisoner of war parole. Francis Lieber's thoughts on parole later reappeared in the Declaration of Brussels of 1874, the Hague Convention, and the Geneva Convention Relative to the Treatment of Prisoners of War. Alexander Maconochie, a Scottish geographer and captain in the Royal Navy, introduced the modern idea of parole when, in 1840, he was appointed superintendent of the British penal colonies in Norfolk Island, Australia. He developed a plan to prepare them for eventual return to society that involved three grades. The first two consisted of promotions earned through good behaviour, labour, and study. The third grade in the system involved conditional liberty outside of prison while obeying rules. A violation would return them to prison and they would start all over again through the ranks of the three-grade process. He reformed its ticket of leave system, instituting what many consider to be the world's first parole system. Prisoners served indeterminate sentences from which they could be released early if they showed evidence of rehabilitation through participation in a graded classification system based on a unit of exchange called a mark. Prisoners earned marks through good behavior, lost them through bad behavior, and could spend them on passage to higher classification statuses ultimately conveying freedom.

of cases, there may be involuntary detention or treatment. Prevention programs have been shown to reduce depression. In 2019, common mental disorders around the globe include: major depression, which affects about 264 million people; dementia, which affects about 50 million; bipolar disorder, which affects about 45 million; and schizophrenia and other psychoses, which affect about 20 million people. Neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (autism), and intellectual disability, of which onset occurs early in the developmental period.

eatment. Prevention programs have been shown to reduce depression. In 2019, common mental disorders around the globe include: major depression, which affects about 264 million people; dementia, which affects about 50 million; bipolar disorder, which affects about 45 million; and schizophrenia and other psychoses, which affect about 20 million people. Neurodevelopmental disorders include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (autism), and intellectual disability, of which onset occurs early in the developmental period.

Course The onset of psychiatric disorders usually occurs from childhood to early adulthood. Impulse-control disorders and a few anxiety disorders tend to appear in childhood. Some other anxiety disorders, substance disorders, and mood disorders emerge later in the mid-teens. Symptoms of schizophrenia typically manifest from late adolescence to early twenties. The likely course and outcome of mental disorders vary and are dependent on numerous factors related to the disorder itself, the individual as a whole, and the social environment. Some disorders may last a brief period of time, while others may be long-term in nature. All disorders can have a varied course. Long-term international studies of schizophrenia have found that over a half of individuals recover in terms of symptoms, and around a fifth to a third in terms of symptoms and functioning, with many requiring no medication. While some have serious difficulties and support needs for many years, "late" recovery is still plausible. The World Health Organization (WHO) concluded that the long-term studies' findings converged with others in "relieving patients, carers and clinicians of the chronicity paradigm which dominated thinking throughout much of the 20th century." A follow-up study by Tohen and coworkers revealed that around half of people initially diagnosed with bipolar disorder achieve symptomatic recovery (no longer meeting criteria for the diagnosis) within six weeks, and nearly all achieve it within two years, with nearly half regaining their prior occupational and residential status in that period.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin, and amphetamines.

Types Various types of programs offer help in drug rehabilitation, including residential treatment (in-patient/out-patient), local support groups, extended care centers, recovery or sober houses, addiction counselling, mental health, and medical care. Some rehab centers offer age- and gender-specific programs. In an American survey by three separate institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems and the Society of Psychologists in Addictive Behaviors) measuring treatment responses on the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics Alcoholics Anonymous identified by Ernest Kurtz); the scores were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale (a scale measuring adherence to the disease model or the free-will model addiction). Effective treatment addresses the multiple needs of the patient rather than treating addiction alone. In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction. The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioral therapy, followed by relapse prevention. According to NIDA, effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems. Whatever the methodology, patient motivation is an important factor in treatment success. For individuals addicted to prescription drugs, treatments tend to be similar to those who are addicted to drugs affecting the same brain systems.

Cognitive behavioral therapy, which seeks to help patients to recognize, avoid and cope with situations in which they are most likely to relapse. Multidimensional family therapy, which is designed to support the recovery of the patient by improving family functioning. Motivational interviewing, which is designed to increase patient motivation to change behavior and enter treatment. Motivational incentives, which uses positive reinforcement to encourage abstinence from the addictive substance. EEG Biofeedback augmented treatment improves abstinence rates of 12-step, faith-based, and medically assisted addiction for cocaine, methamphetamine, alcohol use disorder, and opioid addictions. Treatment can be a long process and the duration is dependent upon the patient's needs and history of substance use.

The Boise, Idaho Metropolitan Statistical Area (MSA) (commonly known as the Boise Metropolitan Area or the Treasure Valley) is an area that encompasses Ada, Boise, Canyon, Gem, and Owyhee counties in southwestern Idaho, anchored by the cities of Boise and Nampa. It is the main component of the wider Boise–Mountain Home–Ontario, ID–OR Combined Statistical Area, which adds Elmore and Payette counties in Idaho and Malheur County, Oregon. It is the state's largest officially designated metropolitan area and includes Idaho's three largest cities: Boise, Nampa, and Meridian.

Four-year colleges and universities Northwest Nazarene University (NNU), Nampa, Idaho The College of Idaho (C of I), Caldwell, Idaho University of Idaho (U of I), Boise; Extension Campus Idaho State University (ISU), Meridian, Idaho; Extension Campus Community colleges and trade schools College of Western Idaho, Nampa, Idaho (CWI) Nampa; Main Campus, Aspen Classroom Bldg., Canyon County Extension Boise; Ada County Campus Treasure Valley Community College, Caldwell, Idaho (TVCC) Ontario, Oregon; Main Campus Caldwell, Idaho; Caldwell Campus Northwest Lineman College (NLC), Kuna, Idaho Heavy Equipment Operator School of Idaho, Boise Carrington College, Boise Broadview University, Meridian, Idaho University of Phoenix Meridian; Main Campus Boise Bible College, Boise

tistical Area, which adds Elmore and Payette counties in Idaho and Malheur County, Oregon. It is the state's largest officially designated metropolitan area and includes Idaho's three largest cities: Boise, Nampa, and Meridian. Nearly 40 percent of Idaho's total population lives in the area. As of the 2021 estimate, the Boise–Nampa, Idaho Metropolitan Statistical Area (MSA) had a population of 795,268, while the larger Boise City–Mountain Home–Ontario, ID–OR Combined Statistical Area (CSA) had a population of 850,341. The metro area is currently the third largest in the U.S.

ion, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder. Risk factors include a history of opioid misuse, current opioid misuse, young age, socioeconomic status, race, untreated psychiatric disorders, and environments that promote misuse (social, family, professional, etc.). Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems meeting social or professional responsibilities. Diagnosis may be based on criteria by the American Psychiatric Association in the DSM-5. Opioids include substances such as heroin, morphine, fentanyl, codeine, dihydrocodeine, oxycodone, hydrocodone, and tramadol. A useful standard for the relative strength of different opioids is morphine milligram equivalents (MME). It is recommended for clinicians to refer to daily MMEs when prescribing opioids to decrease the risk of misuse and adverse effects. Long-term opioid use occurs in about 4% of people following their use for trauma or surgery-related pain. In the United States, most heroin users begin by using prescription opioids that may also be bought illegally. People with opioid use disorder are often treated with opioid replacement therapy using methadone or buprenorphine. Such treatment reduces the risk of death. Additionally, they may benefit from cognitive behavioral therapy, other forms of support from mental health professionals such as individual or group therapy, twelve-step programs, and other peer support programs. The medication naltrexone may also be useful to prevent relapse. Naloxone is useful for treating an opioid overdose and giving those at risk naloxone to take home is beneficial. This disorder is much more prevalent than first realized. In 2020, the CDC estimated that nearly 3 million people in the U.S. were living with OUD and more than 65,000 people died by opioid overdose, of whom more than 15,000 overdosed on heroin. In 2022, the U.S. reported 81,806 deaths caused by opioid-related overdoses.

Cause Opioid use disorder can develop for many reasons, including systemic failures such as pervasive marketing strategies, over-prescribing, and self-medication. Scoring systems have been derived to assess the likelihood of opiate addiction in chronic pain patients. Healthcare practitioners have long been aware that despite the effective use of opioids for managing pain, empirical evidence supporting long-term opioid use is minimal. Many studies of patients with chronic pain have failed to show any sustained improvement in their pain or ability to function with long-term opioid use. A 2024 literature review suggests that adverse childhood experiences (ACEs) are significantly associated with opioid use disorder later in life.

Addiction Addiction is a chronic brain disorder characterized by compulsive drug use despite adverse consequences. Addiction involves the overstimulation of the brain's mesocorticolimbic reward circuit (reward system), essential for motivating behaviors linked to survival and reproductive fitness, like seeking food and sex. This reward system encourages associative learning and goal-directed behavior. In addiction, substances overactivate this circuit, causing compulsive behavior due to changes in brain synapses. In the brain's mesolimbic region, Nucleus Accumbens (NAc) accepts releases of dopamine triggered by the neurotransmitters. The brain reward circuitry is rooted in these networks, interacting between the mesolimbic and prefrontal cortex; these systems link motivation, anti-stress, incentive salience, and wellbeing. The incentive-sensitization theory differentiates between "wanting" (driven by dopamine in the reward circuit) and "liking" (related to brain pleasure centers). This explains the addictive potential of non-pleasurable substances and the persistence of opioid addiction despite tolerance to their euphoric effects. Addiction surpasses mere avoidance of withdrawal, involving cues and stress that reactivate reward-driven behaviors.

the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness (e.g. psychosis, schizophrenia) and substance use disorder (e.g. cannabis use), or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness. Those with co-occurring disorders face complex challenges.

Differentiating pre-existing and substance induced The identification of substance-induced versus independent psychiatric symptoms or disorders has important treatment implications and often constitutes a challenge in daily clinical practice. Similar patterns of comorbidity and risk factors in individuals with substance induced disorder and those with independent non-substance induced psychiatric symptoms suggest that the two conditions may share underlying etiologic factors. Substance use disorders, including those of alcohol and prescription medications, can induce a set of symptoms which resembles mental illness, which can make it difficult to differentiate between substance induced psychiatric syndromes and pre-existing mental health problems. More often than not psychiatric disorders among people who use alcohol or illicit substances disappear with prolonged abstinence. Substance induced psychiatric symptoms can occur both in the intoxicated state and also during the withdrawal state. In some cases, these substance induced psychiatric disorders can persist long after detoxification, such as prolonged psychosis or depression after amphetamine or cocaine use. Use of hallucinogens can trigger delusional and other psychotic phenomena long after cessation of use and cannabis may trigger panic attacks during intoxication and with use it may cause a state similar to dysthymia. Severe anxiety and depression are commonly induced by sustained alcohol use which in most cases abates with prolonged abstinence. Even moderate sustained use of alcohol may increase anxiety and depression levels in some individuals. In most cases these drug induced psychiatric disorders fade away with prolonged abstinence. A protracted withdrawal syndrome can also occur with psychiatric and other symptoms persisting for months after cessation of use. Among the currently prevalent medications, benzodiazepines are the most notable drug for inducing prolonged withdrawal effects with symptoms sometimes persisting for years after cessation of use. Prospective epidemiological studies do not support the hypotheses that comorbidity of substance use disorders with other psychiatric illnesses is primarily a consequence of substance use or dependence or that increasing comorbidity is largely attributable to increasing use of substances. Yet emphasis is often on the effects of substances on the brain creating the impression that dual disorders are a natural consequence of these substances. However, addictive drugs or exposure to gambling will not lead to addictive behaviors or drug dependence in most individuals but only in vulnerable ones, although, according to some researchers, neuroadaptation or regulation of neuronal plasticity, and molecular changes, may alter gene expression in some cases and subsequently lead to substance use disorders. Research instruments are also often insufficiently sensitive to discriminate between independent, true dual pathology, and substance-induced symptoms. Structured instruments, as Global Appraisal of Individual Needs - Short Screener-GAIN-SS and Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV-PRISM, have been developed to increase the diagnostic validity.

Prevalence Comorbidity of addictive disorders and other psychiatric disorders, i.e., dual disorders, is very common and a large body of literature has accumulated demonstrating that mental disorders are strongly associated with substance use disorders. Adolescents and young adults are particularly at risk for dual diagnosis, as early substance use can interfere with brain development and exacerbate emerging mental health conditions. The 2011 USA National Survey on Drug Use and Health found that 17.5% of adults with a mental illness had a co-occurring substance use disorder; this works out to 7.98 million people. Estimates of co-occurring disorders in Canada are even higher, with an estimated 40-60% of adults with a severe and persistent mental illness experiencing a substance use disorder in their lifetime. A study by Kessler et al. in the United States attempting to assess the prevalence of dual diagnosis found that 47% of clients with schizophrenia had a substance misuse disorder at some time in their life, and the chances of developing a substance misuse disorder was significantly higher among patients with a psychotic illness than in those without a psychotic illness. Another study looked at the extent of substance misuse in a group of 187 chronically mentally ill patients living in the community. According to the clinician's ratings, around a third of the sample used alcohol, street drugs, or both during the six months before evaluation. Further UK studies have shown slightly more moderate rates of substance misuse among mentally ill individuals. One study found that individuals with schizophrenia showed just a 7% prevalence of problematic drug use in the year prior to being interviewed and 21% reported problematic use some time before that. Wright and colleagues identified individuals with psychotic illnesses who had been in contact with services in the London borough of Croydon over the previous 6 months. Cases of alcohol or substance misuse and dependence were identified through standardized interviews with clients and keyworkers. Results showed that prevalence rates of dual diagnosis were 33% for the use of any substance, 20% for alcohol misuse only and 5% for drug misuse only.

rom harm and their rights are respected. This includes providing a safe environment for children to grow and develop, protecting them from physical, emotional and sexual abuse, and ensuring they have access to education, healthcare, and resources to fulfill their basic needs. Child protection systems are a set of services, usually government-run, designed to protect children and young people who are underage and to encourage family stability. UNICEF defines a 'child protection system' as: "The set of laws, policies, regulations and services needed across all social sectors – especially social welfare, education, health, security and justice – to support prevention and response to protection-related risks. These systems are part of social protection, and extend beyond it. At the level of prevention, their aim includes supporting and strengthening families to reduce social exclusion, and to lower the risk of separation, violence and exploitation. Responsibilities are often spread across government agencies, with services delivered by local authorities, non-State providers, and community groups, making coordination between sectors and levels, including routine referral systems etc.., a necessary component of effective child protection systems."Under Article 19 of the UN Convention on the Rights of the Child, a 'child protection system' provides for the protection of children in and out of the home. One of the ways this can be enabled is through the provision of quality education, the fourth of the United Nations Sustainable Development Goals, in addition to other child protection systems.

Challenges Child protection systems, particularly in Africa and other less developed regions, face significant structural and systemic challenges that prevent effective implementation. These include poverty, disease, conflict, weak institutional capacity, external influences, cultural norms, and emerging threats. Poverty and Economic Constraints Poverty is a major barrier to child protection, affecting both prevention programs and response mechanisms. Financial instability limits access to education, healthcare, and basic needs, often forcing kids into exploitative situations such as child labor, street life, and early marriage. In extreme cases, children engage in "survival sex" for food or money.

Emerging Threats New challenges, such as climate-induced disasters, digital exploitation, and the COVID-19 pandemic, have intensified risks for children. School closures during the pandemic led to spikes in child marriage and gender-based violence, while economic collapse pushed more children into street situations. Online abuse and trafficking have also risen with increased internet access. These intersecting challenges create a complex environment where child protection systems struggle to function effectively, often leaving vulnerable children without adequate safeguards. History Provincial or state governments' child protection legislation empowers the government department or agency to provide services in the area and to intervene in families where child abuse or other problems are suspected. The agency that manages these services has various names in different provinces and states, e.g., Department of Children's Services, Children's Aid, Department of Child and Family Services.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy–Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President Bill Clinton on August 21, 1996. It aimed to alter the transfer of healthcare information and stipulated guidelines by which personally identifiable information maintained by the healthcare and healthcare insurance industries should be protected from fraud and theft, and addressed some limitations on healthcare insurance coverage. It generally prohibits healthcare providers and businesses called covered entities from disclosing protected information to anyone other than a patient and the patient's authorized representatives without their consent. The law does not restrict patients from accessing their own information, except in limited cases.

Effects on clinical care The complexity of HIPAA, combined with potentially stiff penalties for violators, can lead physicians and medical centers to withhold information from those who may have a right to it. A review of the implementation of the HIPAA Privacy Rule by the U.S. Government Accountability Office found that health care providers were "uncertain about their legal privacy responsibilities and often responded with an overly guarded approach to disclosing information ... than necessary to ensure compliance with the Privacy rule". Reports of this uncertainty continue. Standardizing the handling and sharing of health information under HIPAA has contributed to a decrease in medical errors. Accurate and timely access to patient information ensures that healthcare providers make informed decisions, reducing the risk of errors related to incomplete or incorrect data. This standardization supports safer clinical practices and better patient outcomes. Furthermore, HIPAA grants patients the right to access their own health information, request amendments to their records, and obtain an accounting of disclosures.

Education and training Education and training of healthcare providers is a requirement for correct implementation of both the HIPAA Privacy Rule and Security Rule. Healthcare providers must receive initial training on HIPAA policies and procedures, including the Privacy Rule and the Security Rule. This training covers how to handle protected health information (PHI), patient rights, and the minimum necessary standard. Providers learn about the types of information that are protected under HIPAA, such as medical records, billing information and any other health information. They are also taught about patients' rights under HIPAA, such as the right to access their health records and request correction. Regular fresher training is recommended to keep healthcare providers up to date with any changes in HIPAA regulations and best practices. This includes updates on new policies, procedures, and any material changes to existing practices. Misspelling as HIPPA Although the acronym HIPAA matches the title of the 1996 Public Law 104-191, Health Insurance Portability and Accountability Act, HIPAA is sometimes incorrectly referred to as HIPPA, variously said to refer to the "Health Information Privacy and Portability Act", "Health Information Privacy Protection Act", or "Health Insurance Privacy and Protection Act".

inistration for a Healthy America. During the second Trump administration, the CDC faced major disruptions, including orders to halt cooperation with the World Health Organization, remove or restrict access to public health information, and pause agency communications, including a temporary suspension of the Morbidity and Mortality Weekly Report. The administration also imposed content restrictions on scientific research, carried out large-scale layoffs and program cuts, and oversaw repeated leadership changes. Public health experts and medical organizations warned that these actions undermined scientific independence, public health capacity, and institutional stability. In February 2026, Scientific American wrote that trust in the CDC has "plummeted under" HHS secretary Robert F. Kennedy Jr.

sociation of National Public Health Institutes. As part of the announced 2025 HHS reorganization, the CDC is planned to be reoriented towards infectious disease programs. It is planned to absorb the Administration for Strategic Preparedness and Response, while the National Institute for Occupational Safety and Health is planned to move into the new Administration for a Healthy America. During the second Trump administration, the CDC faced major disruptions, including orders to halt cooperation with the World Health Organization, remove or restrict access to public health information, and pause agency communications, including a temporary suspension of the Morbidity and Mortality Weekly Report. The administration also imposed content restrictions on scientific research, carried out large-scale layoffs and program cuts, and oversaw repeated leadership changes. Public health experts and medical organizations warned that these actions undermined scientific independence, public health capacity, and institutional stability. In February 2026, Scientific American wrote that trust in the CDC has "plummeted under" HHS secretary Robert F. Kennedy Jr.

disease programs. It is planned to absorb the Administration for Strategic Preparedness and Response, while the National Institute for Occupational Safety and Health is planned to move into the new Administration for a Healthy America. During the second Trump administration, the CDC faced major disruptions, including orders to halt cooperation with the World Health Organization, remove or restrict access to public health information, and pause agency communications, including a temporary suspension of the Morbidity and Mortality Weekly Report. The administration also imposed content restrictions on scientific research, carried out large-scale layoffs and program cuts, and oversaw repeated leadership changes. Public health experts and medical organizations warned that these actions undermined scientific independence, public health capacity, and institutional stability. In February 2026, Scientific American wrote that trust in the CDC has "plummeted under" HHS secretary Robert F. Kennedy Jr.

Idaho Department of Health and Welfare is a public health agency in the state of Idaho. History The department was founded in 1972. Functions The department provides healthcare services, records management, children and family services, food assistance programs, and healthcare services.

l authority to pass judgements for crimes committed by children who have not attained the age of majority. In most modern legal systems, children who commit a crime are treated differently from legal adults who have committed the same offense. Juveniles have a lack of capacity for understanding their criminal acts, meaning they also have diminished criminal responsibility compared to their adult counterparts. In some states like California and Georgia, juvenile courts also have jurisdiction over dependency proceedings which involve determining whether a child has been abused or neglected by their parent or legal guardian and needs state intervention to protect them from further harm. Industrialized countries differ in whether juveniles should be charged as adults for serious crimes or considered separately. Since the 1970s, minors have been increasingly tried as adults in response to "increases in violent juvenile crime". Young offenders may still not be charged as adults. Serious offenses, such as murder or rape, can be prosecuted through adult court in England. However, as of 2007, no United States data reported any exact numbers of juvenile offenders prosecuted as adults. In contrast, countries such as Australia and Japan are in the early stages of developing and implementing youth-focused justice initiatives positive youth justice as a deferment from adult court. Globally, the United Nations has encouraged nations to reform their systems to fit with a model in which "entire society [must] ensure the harmonious development of adolescence" despite the delinquent behavior that may be causing issues. The hope was to create a more "child-friendly justice". Despite all the changes made by the United Nations, the rules in practice are less clear cut. Changes in a broad context cause issues of implementation locally, and international crimes committed by youth are causing additional questions regarding the benefit of separate proceedings for juveniles. Issues of juvenile justice have gained global prominence in various cultural contexts. As globalization has progressed in recent centuries, questions about justice, particularly concerning the protection of children's rights within juvenile courts, have come to the forefront.

legal adults who have committed the same offense. Juveniles have a lack of capacity for understanding their criminal acts, meaning they also have diminished criminal responsibility compared to their adult counterparts. In some states like California and Georgia, juvenile courts also have jurisdiction over dependency proceedings which involve determining whether a child has been abused or neglected by their parent or legal guardian and needs state intervention to protect them from further harm. Industrialized countries differ in whether juveniles should be charged as adults for serious crimes or considered separately. Since the 1970s, minors have been increasingly tried as adults in response to "increases in violent juvenile crime". Young offenders may still not be charged as adults. Serious offenses, such as murder or rape, can be prosecuted through adult court in England. However, as of 2007, no United States data reported any exact numbers of juvenile offenders prosecuted as adults. In contrast, countries such as Australia and Japan are in the early stages of developing and implementing youth-focused justice initiatives positive youth justice as a deferment from adult court. Globally, the United Nations has encouraged nations to reform their systems to fit with a model in which "entire society [must] ensure the harmonious development of adolescence" despite the delinquent behavior that may be causing issues. The hope was to create a more "child-friendly justice". Despite all the changes made by the United Nations, the rules in practice are less clear cut. Changes in a broad context cause issues of implementation locally, and international crimes committed by youth are causing additional questions regarding the benefit of separate proceedings for juveniles. Issues of juvenile justice have gained global prominence in various cultural contexts. As globalization has progressed in recent centuries, questions about justice, particularly concerning the protection of children's rights within juvenile courts, have come to the forefront.

as been abused or neglected by their parent or legal guardian and needs state intervention to protect them from further harm. Industrialized countries differ in whether juveniles should be charged as adults for serious crimes or considered separately. Since the 1970s, minors have been increasingly tried as adults in response to "increases in violent juvenile crime". Young offenders may still not be charged as adults. Serious offenses, such as murder or rape, can be prosecuted through adult court in England. However, as of 2007, no United States data reported any exact numbers of juvenile offenders prosecuted as adults. In contrast, countries such as Australia and Japan are in the early stages of developing and implementing youth-focused justice initiatives positive youth justice as a deferment from adult court. Globally, the United Nations has encouraged nations to reform their systems to fit with a model in which "entire society [must] ensure the harmonious development of adolescence" despite the delinquent behavior that may be causing issues. The hope was to create a more "child-friendly justice". Despite all the changes made by the United Nations, the rules in practice are less clear cut. Changes in a broad context cause issues of implementation locally, and international crimes committed by youth are causing additional questions regarding the benefit of separate proceedings for juveniles. Issues of juvenile justice have gained global prominence in various cultural contexts. As globalization has progressed in recent centuries, questions about justice, particularly concerning the protection of children's rights within juvenile courts, have come to the forefront.

ogical assessment, diagnosis, clinical formulation, and psychotherapy; although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession. The field is generally considered to have begun in 1896 with the opening of the first psychological clinic at the University of Pennsylvania by Lightner Witmer. In the first half of the 20th century, clinical psychology was focused on psychological assessment, with little attention given to treatment. This changed after the 1940s when World War II resulted in the need for a large increase in the number of trained clinicians. Since that time, three main educational models have developed in the US—the PhD Clinical Science model (heavily focused on research), the PhD science-practitioner model (integrating scientific research and practice), and the PsyD practitioner-scholar model (focusing on clinical theory and practice). In the UK and Ireland, the Clinical Psychology Doctorate falls between the latter two of these models, whilst in much of mainland Europe, the training is at the master's level and predominantly psychotherapeutic. Clinical psychologists are expert in providing psychotherapy, and generally train within four primary theoretical orientations—psychodynamic, humanistic, cognitive behavioral therapy (CBT), and systems or family therapy. Clinical psychology is different from psychiatry. Although practitioners in both fields are experts in mental health, clinical psychologists are experts in psychological assessment, including neuropsychological and psychometric assessment, and they treat mental disorders primarily through psychotherapy. Currently, eight US states (Louisiana, New Mexico, Illinois, Iowa, Idaho, Colorado, Utah and, most recently, Vermont) allow clinical psychologists with advanced specialty training to prescribe psychotropic medications. Psychiatrists are medical doctors who specialize in the treatment of mental disorders via a variety of methods, including diagnostic assessment, psychotherapy, psychoactive medications, and medical procedures such as electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS).

World War II and the integration of treatment When World War II broke out, the military once again called upon clinical psychologists. As soldiers began to return from combat, psychologists started to notice symptoms of psychological trauma labeled "shell shock" (eventually to be termed post-traumatic stress disorder) that were best treated as soon as possible. Because physicians (including psychiatrists) were over-extended in treating bodily injuries, psychologists were called to help treat this condition. At the same time, female psychologists (who were excluded from the war effort) formed the National Council of Women Psychologists with the purpose of helping communities deal with the stresses of war and giving young mothers advice on child rearing. After the war, the Veterans Administration in the US made an enormous investment to set up programs to train doctoral-level clinical psychologists to help treat the thousands of veterans needing care. As a consequence, the US went from having no formal university programs in clinical psychology in 1946 to over half of all PhDs in psychology in 1950 being awarded in clinical psychology. WWII helped bring dramatic changes to clinical psychology, not just in America but internationally as well. Graduate education in psychology began adding psychotherapy to the science and research focus based on the 1947 scientist-practitioner model, known today as the Boulder Model, for PhD programs in clinical psychology.

Clinical psychologists engage in a wide range of activities. Some focus solely on research into the assessment, treatment, or cause of mental illness and related conditions. Some teach, whether in a medical school or hospital setting, or in an academic department (e.g., psychology department) at an institution of higher education. The majority of clinical psychologists engage in some form of clinical practice, with professional services including psychological assessment, provision of psychotherapy, development and administration of clinical programs, and forensics (e.g., providing expert testimony in a legal proceeding). In clinical practice, clinical psychologists may work with individuals, couples, families, or groups in a variety of settings, including private practices, hospitals, mental health organizations, schools, businesses, and non-profit agencies. Clinical psychologists who provide clinical services may also choose to specialize. Some specializations are codified and credentialed by regulatory agencies within the country of practice.

health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001. CMS actively inspects and reports on every nursing home in the United States.

External links Official website Centers for Medicare and Medicaid Services in the Federal Register Centers for Medicare & Medicaid Services in the Code of Federal Regulations Centers for Medicare & Medicaid Services reports and recommendations from the Government Accountability Office Grants to States for Medicaid account on USAspending.gov Centers for Medicare and Medicaid Innovation account on USAspending.gov State Grants and Demonstration account on USAspending.gov Cente

The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities (more commonly referred to as nursing homes) through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001. CMS actively inspects and reports on every nursing home in the United States.

n the United States, the Department of Health and Human Services defines a health care provider as any "person or organization who furnishes, bills, or is paid for health care in the normal course of business." Individual providers In the United States, the law defines a healthcare provider as a "doctor of medicine or osteopathy who is authorized to practice medicine or surgery" by the state, or anyone else designated by the United States Secretary of Labor as being able to provide health care services.

A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices.

Individual providers In the United States, the law defines a healthcare provider as a "doctor of medicine or osteopathy who is authorized to practice medicine or surgery" by the state, or anyone else designated by the United States Secretary of Labor as being able to provide health care services.

l restructuring, management changes, and shifts in ownership and control. As a financial product, a private-equity fund is private capital for financing a long-term investment strategy in an illiquid business enterprise.

An Investment manager (the private equity investor) raises money from institutional investors (e.g., hedge funds, pension funds, university endowments, and ultra-high-net-worth individuals) to pursue a particular investment strategy. The fund's raised proceeds are placed into an investment fund, of which the investment manager acts as a general partner (GP) and the institutional investors act as limited partners (LPs). The investment manager then purchases equity ownership stakes in companies by using a combination of equity and debt financing, with the goal of generating returns on the equity invested, including any subsequent equity investments into the target companies, over a target horizon based on the particular investment fund and strategy (typically 4–7 years). From a financial modeling perspective, the primary levers available to private equity investors to drive returns are: Revenue growth Margin expansion (typically an EBITDA margin) Free cash flow generation / debt paydown Valuation multiple expansion (typically an Enterprise Value / EBITDA multiple) Value creation strategies can vary widely by private equity fund. For example, some investors may target increasing sales in new or existing markets (driving revenue growth), and others may look to reduce costs through headcount reduction (expanding margins). Many strategies incorporate some amount of corporate governance restructuring, for example, setting up a board of directors or updating the target's managerial reporting structure. The use of debt financing in acquiring companies increases an investment's return on equity by reducing the amount of initial equity required to purchase the target. Moreover, the interest payments are tax-deductible, so the debt financing reduces corporate taxes and thus increases total after-tax cash flows generated by the business. Following a series of high-profile bankruptcies, aggressive leverage usage by private equity funds has declined in recent decades. In 2005, approximately 70% of the average private equity acquisition represented debt, but it was closer to 50% in 2020. Firms that assume large operational risks (e.g., "turnarounds") will usually apply far lower leverage levels to acquired companies in order to provide management with more financial flexibility; firms taking fewer operational risks will often try to maximize available leverage and focus on investments that generate strong, stable cash flows needed to service the higher debt balances. Over time, "private equity" has come to refer to many different investment strategies, including leveraged buyout, distressed securities, venture capital, growth capital, and mezzanine capital.

Strategies The strategies private-equity firms may use are as follows, leveraged buyout being the most common. Leveraged buyout Leveraged buyout (LBO) refers to a strategy of making equity investments as part of a transaction in which a company, business unit, or business asset is acquired from the current shareholders typically with the use of financial leverage. The companies involved in these transactions are typically mature and generate operating cash flows. Private-equity firms view target companies as either Platform companies, which have sufficient scale and a successful business model to act as a stand-alone entity, or as add-on / tuck-in / bolt-on acquisitions, which would include companies with insufficient scale or other deficits. Leveraged buyouts involve a financial sponsor agreeing to an acquisition without itself committing all the capital required for the acquisition. To do this, the financial sponsor will raise acquisition debt, which looks to the cash flows of the acquisition target to make interest and principal payments. Acquisition debt in an LBO is often non-recourse to the financial sponsor and has no claim on other investments managed by the financial sponsor. Therefore, an LBO transaction's financial structure is particularly attractive to a fund's limited partners, allowing them the benefits of leverage, but limiting the degree of recourse of that leverage. This kind of financing structure leverage benefits an LBO's financial sponsor in two ways: (1) the investor only needs to provide a fraction of the capital for the acquisition, and (2) the returns to the investor will be enhanced, as long as the return on assets exceeds the cost of the debt. As a percentage of the purchase price for a leverage buyout target, the amount of debt used to finance a transaction varies according to the financial condition and history of the acquisition target, market conditions, the willingness of lenders to extend credit (both to the LBO's financial sponsors and the company to be acquired) and the interest costs and the ability of the company to cover those costs. Historically the debt portion of a LBO will range from 60 to 90% of the purchase price.

Southwestern Idaho is a geographical term for the area along the U.S. state of Idaho's borders with Oregon and Nevada.

wyhee, Payette, Valley, and Washington are included in the region. Demographics In the 2020 Census, the ten county area had a combined population of 845,395 people; 45.9% of the state's population. Ada and Canyon are the two most populous counties in Idaho, and both have (respectively) experienced a 36.6% and 31.2% growth in population since 2010, making them among the fastest growing counties in terms of population in the state. The largest city in Southwestern Idaho, and in the state, is Boise, with a population of 235,684.

History Southwestern Idaho was originally inhabited by three main Native American tribes: the Shoshone-Bannock, the Nez Perce, and the Northern Paiute. These people were among the first inhabitants in Idaho, first living in the area as early as 12,000 years ago. The Native Americans tribes were nomadic, adopting a hunter-gatherer lifestyle, and had an annual rendezvous in the Boise Valley, which also included catching salmon. Spanish explorers in the late 1500s explored parts of the American West, including southwestern Idaho, and introduced the Native Americans of the area to pigs, horses, domestic fowl, corn, tomatoes, and garlic. After the Lewis and Clark Expedition through Idaho, French-Canadian fur trappers further explored the area. Mountain men, including Spaniards and Mexicans, lived off the land in Southwestern Idaho, trading with the Native Americans in the area. However, it wasn't until further development in Oregon, the mass exodus of settlers to the West on the Oregon, Californian, and Mormon trails, the establishment of Fort Boise, and the Idaho Gold Rush in the 1850s and 60s that settling of Southwestern Idaho began to increase. In order to support mining towns, such as Idaho City, Booneville, Ruby City, and Silver City, numerous ranching and agriculture businesses were set up in the area. One of the biggest ranching operations in 1869 was in Owyhee County, where an original 1,400 head of cattle was driven around the county, forging the area's cattle industry that persists today.

Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis. Cross-national approaches Across different countries, crisis intervention following mass trauma events such as natural disasters relies on trained professionals who provide immediate support, coping strategies, and resource coordination to help individuals navigate psychological distress. Intervention process often begins with an assessment. In countries such as the Czech Republic, crisis intervention is an individual therapy, usually lasting four to six weeks, and includes assistance with housing, food, and legal matters. Long waiting times for resident psychotherapists and in Germany, explicit exclusions of couples therapy and other therapies complicate implementation. In the United States, licensed professional counselors (LPCs) provide mental health care to those in need.

Crisis and Intervention A crisis can have physical or psychological effects. Usually significant and more widespread, the latter lacks the former's obvious signs, complicating diagnosis. It is defined as a breakdown of psychological equilibrium, and being unable to benefit from normal methods of coping. Three factors define crisis: negative events, feelings of hopelessness, and unpredictable events. People who experience a crisis perceive it as a negative event that generate physical emotion, pain, or both. They also feel helpless, powerless, trapped, and a loss of control over their lives. Crisis events tend to occur suddenly and without warning, leaving little time to respond and resulting in trauma. In intervention for individuals facing personal or societal crises, there are five universal principles to guide the process. Prompt intervention is essential as victims are initially at high risk for maladaptive coping or immobilization, such as displaying distress behaviours that carry varying levels of risk. Stabilization involves mobilizing resources to help victims regain a sense of order and normalcy, promoting independent functioning. Comprehension of the traumatic event is facilitated to aid the individual in understanding and expressing their feelings about the experience. Problem-solving is a crucial aspect where counselors assist victims in resolving issues within their unique circumstances, promoting self-efficacy and self-reliance. Lastly, the goal is to help individuals return to normalcy by actively facilitating problem-solving, supporting the development of appropriate coping strategies, and assisting in their implementation.

Critical incident debriefing Critical incident debriefing is a widespread approach to support those who experienced crisis. This technique is done in a group setting 24–72 hours after the event occurred, and is typically a one-time meeting that lasts 3–4 hours, but can be done over numerous sessions if needed. Debriefing is a process by which facilitators describe various symptoms related PTSD and other anxiety disorders that individuals are likely to experience due to exposure to a trauma. The group setting allows participants to process negative emotions surrounding the traumatic event collectively in a safe environment. Facilitators also guide participants through techniques that involve active cognitive engagement while introducing attentional tasks that may serve to distract and ground individuals as they recount distressing experiences, allowing for less stressful emotional processing. However, critical incident debriefing has been the subject of substantial academic criticism regarding its effectiveness in reducing the impact of harm from crisis situations. Some studies show that individuals exposed to debriefing are actually more likely to exhibit symptoms of PTSD at a 13-month follow-up than those who received no intervention. Most recipients of debriefing reported that they found the intervention helpful.

The Substance Abuse and Mental Health Services Administration (SAMHSA; pronounced ) is a branch of the U.S. Department of Health and Human Services (HHS). SAMHSA is charged with improving the quality and availability of treatment and rehabilitative services in order to reduce illness, death, disability, and the cost to society resulting from substance abuse and mental illnesses. The Administrator of SAMHSA reports directly to the secretary of the U.S. Department of Health and Human Services.

Health and Human Services. SAMHSA's headquarters building is located outside of Rockville, Maryland. As part of the announced 2025 HHS reorganization, SAMHSA is planned to be integrated into the new Administration for a Healthy America. History SAMHSA was established in 1992 by Congress as part of a reorganization stemming from the abolition of Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). ADAMHA had been established in 1973, combining the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH). The 1992 ADAMHA Reorganization Act consolidated the treatment functions that were previously scattered amongst the NIMH, NIAAA, and NIDA into SAMHSA, established as an agency of the Public Health Service (PHS). NIMH, NIAAA, and NIDA continued with their research functions as agencies within the National Institutes of Health. Congress directed SAMHSA to target effectively substance abuse and mental health services to the people most in need and to translate research in these areas more effectively and rapidly into the general health care system. Charles Curie was SAMHSA's Director until his resignation in May 2006. In December 2006 Terry Cline was appointed as SAMHSA's Director. Dr. Cline served through August 2008. Rear Admiral Eric Broderick served as the Acting Director upon Dr. Cline's departure, until the arrival of the succeeding Administrator, Pamela S. Hyde, J.D. in November 2009. She resigned in August 2015 and Kana Enomoto, M.A. served as Acting Director of SAMHSA until Dr. Elinore F. McCance-Katz was appointed as the inaugural Assistant Secretary for Mental Health and Substance Abuse.

o the new Administration for a Healthy America. History SAMHSA was established in 1992 by Congress as part of a reorganization stemming from the abolition of Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). ADAMHA had been established in 1973, combining the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH). The 1992 ADAMHA Reorganization Act consolidated the treatment functions that were previously scattered amongst the NIMH, NIAAA, and NIDA into SAMHSA, established as an agency of the Public Health Service (PHS). NIMH, NIAAA, and NIDA continued with their research functions as agencies within the National Institutes of Health. Congress directed SAMHSA to target effectively substance abuse and mental health services to the people most in need and to translate research in these areas more effectively and rapidly into the general health care system. Charles Curie was SAMHSA's Director until his resignation in May 2006. In December 2006 Terry Cline was appointed as SAMHSA's Director. Dr. Cline served through August 2008. Rear Admiral Eric Broderick served as the Acting Director upon Dr. Cline's departure, until the arrival of the succeeding Administrator, Pamela S. Hyde, J.D. in November 2009. She resigned in August 2015 and Kana Enomoto, M.A. served as Acting Director of SAMHSA until Dr. Elinore F. McCance-Katz was appointed as the inaugural Assistant Secretary for Mental Health and Substance Abuse.

Boise (locally also ) is the capital and most populous city in the U.S. state of Idaho. It is the county seat of Ada County. The population of the city was 235,685 at the 2020 census. The Boise metropolitan area, located in the Treasure Valley, includes five counties of Idaho with an estimated population of 846,000, the most populous metropolitan area in Idaho and 95th-most populous in the United States. Located on the Boise River in southwestern Idaho, it is 41 miles (66 km) east of the Oregon border and 110 miles (177 km) north of the Nevada border. Downtown Boise's elevation is 2,704 feet (824 m) above sea level. Boise is home to major employers in the technology, manufacturing, and service sectors, including companies such as Micron Technology and Hewlett-Packard.

an area in Idaho and 95th-most populous in the United States. Located on the Boise River in southwestern Idaho, it is 41 miles (66 km) east of the Oregon border and 110 miles (177 km) north of the Nevada border. Downtown Boise's elevation is 2,704 feet (824 m) above sea level. Boise is home to major employers in the technology, manufacturing, and service sectors, including companies such as Micron Technology and Hewlett-Packard.

...that the military should continue killing Indians 'until the last Indian in the Territories was either on his reservation or enriched the sagebrush with his decaying carcass.' ...if the Indians refused to move there, 'they will be killed or put on the reservation by force, and certainly shot if they don't stay there.' Furthermore, the editor continues, 'The idea that the Indians have any right to the soil is ridiculous. ...They have no more rights to the soil of the Territories of the United States than wolves or coyotes...' This would be our plan of establishing friendship upon an eternal basis with our Indians: Let all the hostile bands of Idaho Territory be called in (they will not be caught in any other manner) to attend a grand treaty; plenty of blankets and nice little trinkets distributed among them; plenty of grub on hand; have a real jolly time with them; then just before the big feast put strychnine in their meat and poison to death the last mother's son of them. At the same time, native warriors around the valley, under the leadership of Howluck also known as "Bigfoot" among white settlers, among others, waged an escalating and intensified guerrilla campaign of harassment of passerby caravans along the Oregon Trail. The United States Army also escalated and intensified "punitive expeditions" against formations of warriors and against civilian communities as well. This marked the start of the "unofficial" Snake War in 1866. This war lasted until 1868, and is statistically the deadliest of the Indian Wars in the West in terms of casualties. In the end, 1,762 men were counted as the casualties of this war from both sides. In 1868, Fort Hall Indian Reservation was established in Southeastern Idaho, about 220 miles upstream, according to the terms of Fort Bridger Treaty. The Boise Valley Shoshone and Bannock Tribes were not party to this treaty. Nevertheless, in April 1869, the United States Military embarked on a campaign of "Removal, rounding up of natives in the region including in and around Boise, and expelling them with cavalry escort to Fort Hall Indian Reservation. This period is known among the Shoshone and Bannock people as Idaho's Trail of Tears. Some of the natives managed to escape, and they ran to either Duck Valley or Fort McDermitt in Nevada. Incorporation and growth Boise's early growth was significantly driven by its role in supplying the nearby gold towns that sprung up in the 1860s northeast and then southwest of the town. Miners sometimes wintered in Boise and a number of early prominent businessmen were miners who settled in town in the years after the gold rush waned. By 1864 substantial agricultural production was underway on easily irrigated lands near the river and three canal companies had been incorporated. Early transportation improvements were largely a result of toll road franchises awarded by the territorial legislature starting in the 1860s. These first ran from Fort Boise to the mining centers in the Boise Basin and east to Rocky Bar and to Rattlesnake Station where they connected to the Oregon Trail. Territorial census records from a special 1864 enumeration list the population of Boise as 1,658, and an act of December 12, 1864, was the first attempt by the Idaho Territorial Legislature to incorporate the city. This was rejected by voters the following March. Two more unsuccessful attempts were made to organize a city administration by election before the 1866 version of the city charter was approved by voters on January 6, 1868. The growing number of homes and businesses, for which owners wanted proper legal title, may have contributed to the eventual success of incorporation. All of these rejected efforts to incorporate the city came after Boise had been controversially made the state capital in 1864 over strong opposition from northern Idaho interests. This decision reflected the rapid shift of population growth from north to south after the discovery of gold in southern Idaho. By 1868 Boise had over 400 permanent buildings with a wide range of commercial services. 1868 also marked the formal beginning of a long advocacy for railroad connections to other Idaho communities and, just as importantly, to other growing cities in the west such as Portland, Oregon. Competing railroad and western state government interests frustrated these efforts for many years. Designed by Alfred B. Mullett, the U.S. Assay Office at 210 Main Street was built in 1871 and today is a National Historic Landmark. It first began accepting gold and silver for purchase on March 2, 1872, largely eliminating the need to transport ore to the mint in San Francisco. A territorial penitentiary, now known as the Old Idaho State Penitentiary, opened the same month several miles east of town. Mining continued to be important to Boise's economic growth and periodic booms contributed to population growth as well, though production of gold and silver probably peaked in the 1860s. 1882's gold and silver production of $3,500,000 declined to $1,488,315 (including lead) by 1899. Boise began to earn its City of Trees nickname in this period with a popular focus on a range of tree planting projects. Thomas J. Davis planted several thousand fruit trees in 1864 and several other early businessmen either founded nurseries or orchards of their own. In the 1870s tree planting began in earnest in downtown Boise led by prominent hotels as well as businessmen and residents. In 1907 Davis donated 43 acres of his orchard property to the city for use as a park in the name of his wife Julia. Commercial agriculture continued to expand, but was slowed by the lack of reliable rail links to regional and national markets and by a lack of large scale irrigation projects, which themselves were often tied to hoped-for railroad projects for financing. A.D. Foote, a successful mining engineer, drew up plans to irrigate up to 500,000 acres immediately south of Boise in 1882, but progress was halting and smaller farms were the norm until after the turn of the century with most located near to the river bottom where soil was productive and irrigation more easily achieved. Fruit orchards proliferated and sugar beets, still an important agricultural industry in Idaho, began to be widely cultivated in the 1890s. Cattle and sheep farming became increasingly important as the century closed. With the exception of dairy, most livestock products were exported from Idaho, unlike other agricultural products which were still largely scaled to support local markets. The timber industry also increasingly thrived in the Boise market in the 1880s and 1890s. Large quantities of timber were exported from elsewhere in Idaho, but a growing Boise supported the expansion of Alexander Rossi's sawmill, first established in 1865. Prominent early Boisean William Ridenbaugh had inherited control of the canal now bearing his name from his uncle William Morris in 1878 and later partnered with Rossi to expand the sawmill capacity under the name Rossi and Ridenbaugh Lumber Company. Their materials supported bridge building and the rapid expansion of Boise in the 1890s. As with many early infrastructure ventures, electrification succeeded only after at least one false start. July 4, 1887, marked the start of electrical transmission from a plant located on the Bench. William Ridenbaugh provided expertise and manpower for the water supply and several months were spent rigging poles and lines from the Bench to the service area across the river. Additional electrical supplies allowed the building of an electric streetcar line in 1891. This ran without interruption until buses replaced the lines in 1927, tracking—and sometimes driving—the development of Boise and nearby communities. This system expanded over several decades, reaching into the North End, South Boise and across the river on Front St. A loop line, completed in 1912, ran as far as Caldwell and Nampa, providing transport throughout the valley. Three early trolley companies merged in 1912 to form the Idaho Traction Company with a depot at 7th and Bannock Streets downtown. Additional services and urban amenities arrived in the 1890s as Boise grew. Exploratory drilling for hot water was successful in 1890 and by the end of the decade many homes along Warm Springs avenue were being heated by this source. A natatorium was built in 1892 close to the source of the hot water near the Idaho State Penitentiary. Churches serving several denominations, a Jewish synagogue, a major hardware store and department store, a Masonic hall, the Columbia Theater, Saint Alphonsus' Hospital, a number of parochial and secular schools, a City Hall and a new Union Pacific passenger station, constructed when service was finally extended to downtown, were all built during the 1890s. Falk's Department Store sponsored a semi-professional baseball team representing Boise from at least 1892 and the city supported other organized sports as they became popular.

pa ( ) is the most populous city in Canyon County, Idaho, United States. The population was 100,200 at the 2020 census. It is Idaho's third-most populous city. Nampa is about 20 miles (32 km) west of Boise along Interstate 84, and 6 miles (9.7 km) west of Meridian. It is the second principal city of the Boise metropolitan area. The name "Nampa" may have come from a Shoshoni word meaning 'moccasin' or 'footprint'. According to toponymist William O. Bright, the name comes from the Shoshoni word /nampai/, meaning "foot".

History Nampa had its beginnings in the early 1880s when the Oregon Short Line Railroad built a line from Granger, Wyoming, to Huntington, Oregon, that passed through Nampa. In Nampa there is a history museum that marks the railroad's significance. More railroad lines sprang up through Nampa, making it an important railroad town. Alexander and Hannah Duffes established one of the town's first homesteads, eventually forming the Nampa Land and Improvement Company with the help of their friend and co-founder, James McGee. Despite the name, many early settlers called the town "New Jerusalem" because of its citizens' strong religious focus. After only a year the town grew from 15 homes to 50. As amenities were added, Nampa continued to grow, and it was incorporated in 1891. Downtown Nampa's street grid is oriented with the railroad tracks, which run northwest–southeast; this was done intentionally by Alexander Duffes to prevent accidents like one that occurred earlier in a town he had platted near Toronto, where a woman and her two children were killed by a train when their buggy wheel got stuck as they crossed the tracks. As the Oregon Short Line railroad originally bypassed Boise, Nampa has the fanciest of many railroad depots built in the area. Nampa gained attention in 1889 due to a purported archaeological discovery known as the Nampa figurine. George Frederick Wright wrote up details that year for the Boston Society of Natural History. The first elementary school was built in the 1890s. Lakeview School was on a hill on 6th Street and 12th Avenue North, with a view of Lake Ethel. Just after the school's centennial celebration, it was condemned as a school and sold to the First Mennonite Church. In 2008 the building was refurbished, and it is now used by the Idaho Arts Charter School. Lake Ethel, an irrigation reservoir, had long been the site of community picnics, and many citizens fished, swam, boated, and even hunted on it and its surrounding property. But the hunting didn't last long, as O. F. Persons, owner of the adjoining homestead, took offense when local hunters started shooting his pet ducks. The city later auctioned off the lake. E. H. Dewey (a former Nampa mayor) was the only bidder. But occasional flooding led to a series of lawsuits from neighbors. Dewey eventually drained Lake Ethel. Not long after, the city council became interested in buying back the Fritz Miller property as well as the Dewey home. Pressure had been building for more than four years. Nampa citizens wanted another park. On August 7, 1924, the city council passed an ordinance to purchase the Miller property and name it Lakeview Park. A bandstand was completed in 1928, and the municipal swimming pool opened on August 13, 1934. It is Nampa's largest park and many community celebrations are held there. Colonel William H. Dewey, a man who made a fortune mining in Silver City, built the Dewey Palace Hotel in 1902 for $250,000. He died in his hotel in 1903, leaving his son $1 million. The hotel survived the great fire of 1909, which burned several blocks of downtown Nampa, but was razed in 1963 after redevelopment plans failed. Relics from the hotel such as the chandelier and the hotel safe can be found at the Canyon County Historical Museum, which is in the old train depot on Front Street and Nampa City Hall. After demolition the location on First Street between 11th and 12th Ave. South was sold to private enterprise, including a bank and tire store, replacing this building with modern structures. A public-use postage stamp sized park was later placed across the street from the old palace property as a collaboration between the Downtown Alliance of Nampa (the local business council) and an Eagle Scout Project for the Boy Scouts of America. The park includes a large mural/wall sculpture of running horses commissioned for the project. A Carnegie library was built downtown in 1908; it burned down after the library moved in 1966. Nampa Public Library was then on the corner of 1st Street and 11th Avenue South in the old bank building. A new library, on 12th Avenue South, opened in 2015. Deer Flat Reservoir, an offstream irrigation storage reservoir, was constructed by the United States Bureau of Reclamation between 1906 and 1911. Known locally as Lake Lowell, it is surrounded by the Deer Flat National Wildlife Refuge, established in 1909 by President Theodore Roosevelt. The refuge is administered by the U.S. Fish and Wildlife Service. Lake Lowell is filled by the concrete New York Canal; the water is diverted from the Boise River a few miles below Lucky Peak Dam. In 1910, the Idaho State School and Hospital was built northwest of Nampa for the state's developmentally challenged population. It opened in 1918. The institution was largely self-sufficient, with a large farm staffed by the residents. The higher-functioning residents also cared for residents who could not care for themselves. The land for the farm was sold and is now golf courses (Centennial and Ridgecrest), and the residents no longer give primary care to other residents. The institution is modernized and remains in operation, though a few of the oldest buildings now house juvenile offenders. Nampa held an annual harvest festival and farmers' market from about 1908, a time of celebration and community fun. From this festival emerged the Snake River Stampede Rodeo in 1937, which continues to this day. It is one of the top 12 rodeos in the pro rodeo circuits. In 1913, a local congregation of the Church of the Nazarene built a small elementary school, which became to Northwest Nazarene College in 1915 and finally Northwest Nazarene University. As of 2025, the university has approximately 1,800 undergraduate and graduate students. Karcher Mall opened in 1965, the first enclosed shopping mall in the Treasure Valley. It was "the place to gather" for several decades until the Boise Towne Square mall was built in Boise in 1988, drawing business away. Karcher Mall was renamed District 208 in 2022. The Idaho Press-Tribune is the local newspaper for the Canyon County area.

Idaho Hispanic Community Center (IH2C) In 2003, the Hispanic Cultural Center of Idaho (HCCI) opened thanks to community support. It has recently transitioned back to the City of Nampa and was renamed the Idaho Hispanic Community Center (IH2C) and is home to the Idaho Hispanic Foundation. It hosts events, classes, and festivals, including Día de los Muertos, Hispanic Heritage Month, and Día Internacional de la Mujer. It serves as a meeting place for associations and groups. Displays of cultural history are available to the public. Nampa Train Depot Museum The Nampa Train Depot Museum is a historical depot with displays and archives of the area's railroad and cultural history. The Canyon County Historical Society saved the depot from demolition in 1972. Annual Festival of the Arts Nampa's Festival of the Arts, which began in 1987, is held in Lakeview Park every year and includes local art, music, dance, and food.

Ada County is located in the southwestern part of Idaho, United States. As of the 2020 census, the county had a population of 494,967, which by 2025 was estimated to have risen to 546,141. Ada County is by far the state's most populous county; it is home to 26.8% of the state's population. The county seat and largest city is Boise, which is also the state capital. Ada County is included in the Boise metropolitan area. The Ada County Highway District has jurisdiction over all the local county and city streets, except for private roads and state roads.

populous county; it is home to 26.8% of the state's population. The county seat and largest city is Boise, which is also the state capital. Ada County is included in the Boise metropolitan area. The Ada County Highway District has jurisdiction over all the local county and city streets, except for private roads and state roads.

ea. The Ada County Highway District has jurisdiction over all the local county and city streets, except for private roads and state roads. In the interior Pacific Northwest east of the Cascade Range, Ada County ranks second in population, behind Spokane County, Washington. History Ada County was created by the Idaho Territory legislature on December 22, 1864, partitioned from Boise County. It is named for Ada Riggs, the daughter of H. C. Riggs, a member of the legislature; he established the county and was a co-founder of Boise.

105, which by 2025 was estimated to have risen to 275,123, making it the second-most populous county in Idaho. The county seat is Caldwell, and its largest city is Nampa. Canyon County is part of the Boise metropolitan area. History Hudson's Bay Company established Fort Boise in 1834 near what is now Parma, but abandoned it in 1855. Emigrants traveled through Canyon County on the Oregon Trail. Discovery of gold in the Boise Basin in 1862 brought settlement to the region again. The lower Boise River was fully contained within Boise County from 1863 until the formation of Ada County in 1864. Settlement of the lower Boise River west of Boise City was limited prior to the completion of the Oregon Short Line Railroad. Middleton was the first European settlement of Canyon County, starting in 1863. The 1870 Census for Ada County listed 76 residents of the Boise Valley, excluding Boise City and the 1880 Census listed 44 residents at Middleton. The arrival of the railroad at Caldwell led to the establishment of a town there as of August 1883. Businessmen James A. McGee and Alexander Duffes filed the plat for nearby Nampa in 1886. Parma was settled around the same time, with the Old Fort Boise post office being moved to the town's location; it was incorporated in 1904. Ada County established precincts for each of the settlements with a combined 1890 Census population of 2,311. Significant settlement of Greenleaf and Notus started around 1904 with the two settlements listed as precincts at the 1910 census. Notus was incorporated in 1921 while Greenleaf was incorporated prior to 1980. Melba was incorporated in 1912 while Wilder was incorporated in 1919. The City of Star annexed a portion of territory in northeast Canyon County prior to 2007, becoming the county's ninth incorporated city. The majority of Star is located within Ada County. The Idaho Legislature created Canyon County from Ada County in an act approved March 7, 1891, effective at the November 26, 1892, election. Caldwell was established as the county seat. The county originally contained all of Canyon and Payette counties and part of Gem; Gem County formed in 1915 and Payette County in 1917.

History Hudson's Bay Company established Fort Boise in 1834 near what is now Parma, but abandoned it in 1855. Emigrants traveled through Canyon County on the Oregon Trail. Discovery of gold in the Boise Basin in 1862 brought settlement to the region again. The lower Boise River was fully contained within Boise County from 1863 until the formation of Ada County in 1864. Settlement of the lower Boise River west of Boise City was limited prior to the completion of the Oregon Short Line Railroad. Middleton was the first European settlement of Canyon County, starting in 1863. The 1870 Census for Ada County listed 76 residents of the Boise Valley, excluding Boise City and the 1880 Census listed 44 residents at Middleton. The arrival of the railroad at Caldwell led to the establishment of a town there as of August 1883. Businessmen James A. McGee and Alexander Duffes filed the plat for nearby Nampa in 1886. Parma was settled around the same time, with the Old Fort Boise post office being moved to the town's location; it was incorporated in 1904. Ada County established precincts for each of the settlements with a combined 1890 Census population of 2,311. Significant settlement of Greenleaf and Notus started around 1904 with the two settlements listed as precincts at the 1910 census. Notus was incorporated in 1921 while Greenleaf was incorporated prior to 1980. Melba was incorporated in 1912 while Wilder was incorporated in 1919. The City of Star annexed a portion of territory in northeast Canyon County prior to 2007, becoming the county's ninth incorporated city. The majority of Star is located within Ada County. The Idaho Legislature created Canyon County from Ada County in an act approved March 7, 1891, effective at the November 26, 1892, election. Caldwell was established as the county seat. The county originally contained all of Canyon and Payette counties and part of Gem; Gem County formed in 1915 and Payette County in 1917.

2000 census As of the 2000 census, there were 131,441 people, 45,018 households and 33,943 families living in the county. The population density was 223 people per square mile (86 people/km2). There were 47,965 housing units at an average density of 81 units per square mile (31 units/km2). The racial makeup of the county was 83.10% White, 0.32% Black or African American, 0.85% Native American, 0.80% Asian, 0.13% Pacific Islander, 12.17% from other races, and 2.62% from two or more races. Hispanic or Latino of any race were 18.61% of the population. 15.9% were of German, 12.7% English, 10.3% American and 7.6% Irish ancestry. There were 45,018 households, of which 39.80% had children under the age of 18 living with them, 60.70% were married couples living together, 10.10% had a female householder with no husband present, and 24.60% were non-families. 19.80% of all households were made up of individuals, and 8.40% had someone living alone who was 65 years of age or older. The average household size was 2.85 and the average family size was 3.28. 30.90% of the population were under the age of 18, 10.70% from 18 to 24, 28.30% from 25 to 44, 19.10% from 45 to 64, and 11.00% who were 65 years of age or older. The median age was 30 years. For every 100 females, there were 98.70 males. For every 100 females age 18 and over, there were 96.30 males. The median household income was $35,884 and the median family income was $40,377. Males had a median income of $29,418 compared with $22,044 for females. The per capita income for the county was $15,155. About 8.70% of families and 12.00% of the population were below the poverty line, including 14.50% of those under age 18 and 10.70% of those age 65 or over. Communities Cities Unincorporated communities Bowmont Huston Roswell Sunnyslope Walters Ferry, Idaho Politics Like the majority of Idaho, Canyon County is reliably Republican by comfortable margins. The last time a Democratic candidate carried the county was in 1936 by Franklin D. Roosevelt.

Meridian is a city located in Ada County, Idaho, United States. The population was 117,635 at the 2020 census, making it the second most populous city in the county and Idaho, after Boise, the state capital.

Rail transportation (1908–28) Following the raising of $4,000 to lay the Interurban rail line from Onweiler (Meridian and Ustick Roads), the tracks were completed into the village center. Turning east on Broadway and ending at East Second, the last car would spend the night in Meridian before returning to Boise early the next morning with passengers and freight. The interurban Station and Generator building (west one-third of the old library at Meridian and Idaho Streets) was built in 1912, and the line continued on to Nampa via Meridian. The tracks down Broadway were not used after 1912. The Interurban Company entered into receivership and closed in 1928 after 20 years of providing continuous transportation to neighboring towns. It was Meridian's main connection to the area outside the local community. The Union Pacific Railroad spur opened in 1900 and is currently operated by the Boise Valley Railroad. Many industrial customers continue to ship forest, agricultural, and chemical products along this corridor. Creamery (1929–70) The city's official website describes the history of the Ada County Dairymen's cooperative creamery as follows:The lowest days of the Great Depression brightened for area dairymen when the Ada County Dairymen's cooperative creamery began operation in 1929. It provided milk checks to those who were members of the cooperative, enabling them to pay their taxes and provide food for their families. Other community members hauled milk to the creamery and were employed by the creamery, whose product was Challenge Butter. The creamery ran seven days a week for 40 years. Additions and improvements were made while the plant was in full operation. Later years saw the Wyeth Laboratories affiliate with the creamery to manufacture SMA baby formula.

Creamery (1929–70) The city's official website describes the history of the Ada County Dairymen's cooperative creamery as follows:The lowest days of the Great Depression brightened for area dairymen when the Ada County Dairymen's cooperative creamery began operation in 1929. It provided milk checks to those who were members of the cooperative, enabling them to pay their taxes and provide food for their families. Other community members hauled milk to the creamery and were employed by the creamery, whose product was Challenge Butter. The creamery ran seven days a week for 40 years. Additions and improvements were made while the plant was in full operation. Later years saw the Wyeth Laboratories affiliate with the creamery to manufacture SMA baby formula.

city in Idaho. As of the 2020 census, Caldwell had a population of 59,996. Caldwell is considered part of the Boise metropolitan area, and is the location of the College of Idaho. The city is located approximately 24 miles (39 km) west of Boise, and approximately 17 miles (27 km) east of the Oregon border. History The present-day location of Caldwell is along a natural passageway to the Inland and Pacific Northwest. Native American tribes from the west coast, north Idaho and as far away as Colorado came to the banks of the Boise River for annual trading fairs, or rendezvous. European and some Hawaiian explorers and traders soon followed the paths left by Native Americans and hopeful emigrants later forged the Oregon Trail and followed those paths to seek a better life in the Oregon Territory. Pioneers of the Trail traveled along the Boise River to Canyon Hill and forded the river close to the Silver Bridge on Plymouth Street. During the Civil War, the discovery of gold in Idaho's mountains brought a variety of new settlers into the area. Many never made it to the mines but settled along the Boise River and run ferries, stage stations, and freighting businesses. These early entrepreneurs created small ranches and farms in the river valleys. Caldwell's inception occurred largely as a result of the construction of the Oregon Short Line Railroad, which connected Wyoming to Oregon through Idaho. Robert E. Strahorn came to the Boise River Valley in 1883 to select a route for the railroad. He rejected the grade into Boise City as too steep and chose a site 30 miles to the west. He drove a stake into an alkali flat of sagebrush and greasewood and the City of Caldwell was platted. Caldwell was named after one of Strahorn's business partners, Alexander Caldwell, a former senator from Kansas. When Caldwell was platted in August 1883, its founder, the Idaho and Oregon Land Improvement Company, started persuading settlers and businessmen to move to the area. Within four months, Caldwell had 600 residents living in 150 dwellings, 40 businesses, a school, a telephone exchange, and two newspapers. On January 15, 1890, the Board of Commissioners of Ada County issued a handwritten order incorporating the City of Caldwell. The College of Idaho was founded in Caldwell in 1891. In 1892, Canyon County was established from a portion of Ada County, and Caldwell was named the county seat. Irrigation canals and waterways were constructed throughout Canyon County, providing the foundation for an agricultural economy. The Oregon Short Line Railroad became part of the larger Union Pacific Railroad network and in 1906 the Caldwell freight and passenger depot was constructed. Caldwell experienced moderate growth as an agricultural processing, commercial retail and educational center during the 20th century. In 2009, the City of Caldwell completed a revitalization project to restore Indian Creek, which runs through downtown Caldwell, but had been used for sewage disposal by local industries and been covered over.

History The present-day location of Caldwell is along a natural passageway to the Inland and Pacific Northwest. Native American tribes from the west coast, north Idaho and as far away as Colorado came to the banks of the Boise River for annual trading fairs, or rendezvous. European and some Hawaiian explorers and traders soon followed the paths left by Native Americans and hopeful emigrants later forged the Oregon Trail and followed those paths to seek a better life in the Oregon Territory. Pioneers of the Trail traveled along the Boise River to Canyon Hill and forded the river close to the Silver Bridge on Plymouth Street. During the Civil War, the discovery of gold in Idaho's mountains brought a variety of new settlers into the area. Many never made it to the mines but settled along the Boise River and run ferries, stage stations, and freighting businesses. These early entrepreneurs created small ranches and farms in the river valleys. Caldwell's inception occurred largely as a result of the construction of the Oregon Short Line Railroad, which connected Wyoming to Oregon through Idaho. Robert E. Strahorn came to the Boise River Valley in 1883 to select a route for the railroad. He rejected the grade into Boise City as too steep and chose a site 30 miles to the west. He drove a stake into an alkali flat of sagebrush and greasewood and the City of Caldwell was platted. Caldwell was named after one of Strahorn's business partners, Alexander Caldwell, a former senator from Kansas. When Caldwell was platted in August 1883, its founder, the Idaho and Oregon Land Improvement Company, started persuading settlers and businessmen to move to the area. Within four months, Caldwell had 600 residents living in 150 dwellings, 40 businesses, a school, a telephone exchange, and two newspapers. On January 15, 1890, the Board of Commissioners of Ada County issued a handwritten order incorporating the City of Caldwell. The College of Idaho was founded in Caldwell in 1891. In 1892, Canyon County was established from a portion of Ada County, and Caldwell was named the county seat. Irrigation canals and waterways were constructed throughout Canyon County, providing the foundation for an agricultural economy. The Oregon Short Line Railroad became part of the larger Union Pacific Railroad network and in 1906 the Caldwell freight and passenger depot was constructed. Caldwell experienced moderate growth as an agricultural processing, commercial retail and educational center during the 20th century. In 2009, the City of Caldwell completed a revitalization project to restore Indian Creek, which runs through downtown Caldwell, but had been used for sewage disposal by local industries and been covered over.

location of the College of Idaho. The city is located approximately 24 miles (39 km) west of Boise, and approximately 17 miles (27 km) east of the Oregon border. History The present-day location of Caldwell is along a natural passageway to the Inland and Pacific Northwest. Native American tribes from the west coast, north Idaho and as far away as Colorado came to the banks of the Boise River for annual trading fairs, or rendezvous. European and some Hawaiian explorers and traders soon followed the paths left by Native Americans and hopeful emigrants later forged the Oregon Trail and followed those paths to seek a better life in the Oregon Territory. Pioneers of the Trail traveled along the Boise River to Canyon Hill and forded the river close to the Silver Bridge on Plymouth Street. During the Civil War, the discovery of gold in Idaho's mountains brought a variety of new settlers into the area. Many never made it to the mines but settled along the Boise River and run ferries, stage stations, and freighting businesses. These early entrepreneurs created small ranches and farms in the river valleys. Caldwell's inception occurred largely as a result of the construction of the Oregon Short Line Railroad, which connected Wyoming to Oregon through Idaho. Robert E. Strahorn came to the Boise River Valley in 1883 to select a route for the railroad. He rejected the grade into Boise City as too steep and chose a site 30 miles to the west. He drove a stake into an alkali flat of sagebrush and greasewood and the City of Caldwell was platted. Caldwell was named after one of Strahorn's business partners, Alexander Caldwell, a former senator from Kansas. When Caldwell was platted in August 1883, its founder, the Idaho and Oregon Land Improvement Company, started persuading settlers and businessmen to move to the area. Within four months, Caldwell had 600 residents living in 150 dwellings, 40 businesses, a school, a telephone exchange, and two newspapers. On January 15, 1890, the Board of Commissioners of Ada County issued a handwritten order incorporating the City of Caldwell. The College of Idaho was founded in Caldwell in 1891. In 1892, Canyon County was established from a portion of Ada County, and Caldwell was named the county seat. Irrigation canals and waterways were constructed throughout Canyon County, providing the foundation for an agricultural economy. The Oregon Short Line Railroad became part of the larger Union Pacific Railroad network and in 1906 the Caldwell freight and passenger depot was constructed. Caldwell experienced moderate growth as an agricultural processing, commercial retail and educational center during the 20th century. In 2009, the City of Caldwell completed a revitalization project to restore Indian Creek, which runs through downtown Caldwell, but had been used for sewage disposal by local industries and been covered over.

on, is a designation earned by a person to assure qualification to perform a job or task. Not all certifications that use post-nominal letters are an acknowledgement of educational achievement, or an agency appointed to safeguard the public interest. Overview A certification is a third-party attestation of an individual's level of knowledge or proficiency in a certain industry or profession. They are granted by authorities in the field, such as professional societies and colleges, or by private certificate-granting agencies. Most certifications are time-limited; some expire after a period of time (e.g., the lifetime of a product that requires certification for use), while others can be renewed indefinitely as long as certain requirements are met. Renewal usually requires ongoing education to remain up-to-date on advancements in the field, evidenced by earning the specified number of continuing education credits (CECs), or continuing education units (CEUs), from approved professional development courses. Certification is different from occupational licensing. In the United States, licenses are typically issued by state agencies, whereas certifications are usually awarded by professional societies or educational institutes. Obtaining a certificate is voluntary in some fields, but in others, certification from a government-accredited agency may be legally required to perform certain jobs or tasks. In other countries, licenses are typically granted by professional societies or universities and require a certificate after about three to five years and so on thereafter. The assessment process for certification may be more comprehensive than that of licensure, though sometimes the assessment process is very similar or even the same, despite differing in terms of legal status. According to The Guide to National Professional Certification Programs (1997) by Phillip Barnhart, "certifications are portable, since they do not depend on one company's definition of a certain job" and they provide potential employers with "an impartial, third-party endorsement of an individual's professional knowledge and experience". Many certification programs are affiliated with professional associations, trade organizations, or private vendors interested in raising industry standards. Certification programs are often created or endorsed by professional associations, but are typically completely independent from membership organizations.

A certification is a third-party attestation of an individual's level of knowledge or proficiency in a certain industry or profession. They are granted by authorities in the field, such as professional societies and colleges, or by private certificate-granting agencies. Most certifications are time-limited; some expire after a period of time (e.g., the lifetime of a product that requires certification for use), while others can be renewed indefinitely as long as certain requirements are met. Renewal usually requires ongoing education to remain up-to-date on advancements in the field, evidenced by earning the specified number of continuing education credits (CECs), or continuing education units (CEUs), from approved professional development courses. Certification is different from occupational licensing. In the United States, licenses are typically issued by state agencies, whereas certifications are usually awarded by professional societies or educational institutes. Obtaining a certificate is voluntary in some fields, but in others, certification from a government-accredited agency may be legally required to perform certain jobs or tasks. In other countries, licenses are typically granted by professional societies or universities and require a certificate after about three to five years and so on thereafter. The assessment process for certification may be more comprehensive than that of licensure, though sometimes the assessment process is very similar or even the same, despite differing in terms of legal status. According to The Guide to National Professional Certification Programs (1997) by Phillip Barnhart, "certifications are portable, since they do not depend on one company's definition of a certain job" and they provide potential employers with "an impartial, third-party endorsement of an individual's professional knowledge and experience". Many certification programs are affiliated with professional associations, trade organizations, or private vendors interested in raising industry standards. Certification programs are often created or endorsed by professional associations, but are typically completely independent from membership organizations.

Data management Business Intelligence and Data Analyst (BIDA) by Corporate Finance Institute (CFI). Certified Data Management Professional (CDMP) by DAMA International. Dentistry Electronics In the United States, several electronics certifications are provided by the Electronics Technicians Association. Emergency management The Federal Emergency Management Agency's EMI offers credentials and training opportunities for United States citizens.