Access
The extent to which services are available for individuals who need care. Ease of access depends on several factors, including availability and location of appropriate care and services, transportation, hours of operation, and cultural factors, including languages and cultural appropriateness. For many populations access also includes insurance coverage.

Access
The extent to which an individual who needs care and services is able to receive them. Access is more than having insurance coverage or the ability to pay for services. It is also determined by the availability of services, acceptability of services, cultural appropriateness, location, hours of operation, transportation needs, and cost.

Accessible services
Services that are affordable, located nearby, and open during evenings and weekends. Staff is sensitive to and incorporates individual and cultural values. Staff is also sensitive to barriers that may keep a person from getting help. For example, an adolescent may be more willing to attend a support group meeting in a church or club near home than to travel to a mental health center. An accessible service can handle consumer demand without placing people on a long waiting list.

Accreditation
An official decision made by a recognized organization that a health care plan, network, or other delivery system complies with applicable standards.

Activity Therapy
Includes art, dance, music, recreational and occupational therapies, and psychodrama.

Acute Care
Medical treatment rendered to individuals whose illnesses or health problems are life- threatening or debilitating, requiring immediate response, and are short-term or episodic in nature. Acute care facilities are those hospitals that predominantly serve persons requiring these kinds of services.

Addiction
A chronic, relapsing disease characterized by compulsive drug-seeking and abuse and by long-lasting chemical changes in the brain.

Addition
The number of persons admitted, readmitted, or transferred to a specified service during the reporting period.

Adjusted Community Rating (ACR)
A community rating impacted by group- specific demographics and the group's prior experience. Also known as prospective rating.

Administrative Costs
Costs not linked directly to the provision of medical care. Includes marketing, claims processing, billing, and medical record keeping, among others.

Administrative Services Only Organization (ASO)
A healthcare organization that provides administrative support services only for a self-funded plan or startup MCO.

Adverse Selection
A tendency for utilization of health services in a population group to be higher than average. From an insurance perspective, adverse selection occurs when persons with poorer-than-average life expectancy or health status apply for, or continue, insurance coverage to a greater extent than do persons with average or better health expectations.

AIDS (Acquired Immune Deficiency Syndrome)
The final and most serious stage of HIV disease, which causes severe damage to the immune system. The Centers for Disease Control has defined AIDS as beginning when a person with HIV infection has a CD4 cell (also called "t-cell", a type of immune cell) count below 200. It is also defined by numerous opportunistic infections and cancers that occur in the presence of HIV infection. AIDS is the fifth leading cause of death among persons between ages 25 and 44 in the United States. About 47 million people worldwide have been infected with HIV since the start of the epidemic. The Human Immunodeficiency Virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life- threatening illnesses and cancers. Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with fully functional immune systems can cause fatal illnesses in people with AIDS. Most individuals infected with HIV will progress to AIDS, if not treated. However, there is a tiny group of patients who develop AIDS very slowly or never at all. These patients are called non-progressors and many seem to have a genetic difference which prevents the virus from attaching to certain immune receptors. The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called "opportunistic infections." Patients with AIDS have had their immune system depleted by HIV and are very susceptible to such opportunistic infections. Common symptoms are fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.

Alcohol
A liquid distilled product of fermented fruits, grains and vegetables. Used as solvent, antiseptic and sedative. Moderate potential for abuse. Also know as booze, juice, brew, vino, and sauce.

Alcohol Abuse During Pregnancy
Alcohol Abuse During Pregnancy is dangerous. Alcohol can have a number of harmful effects on the baby. The baby can be born mentally retarded or with learning and behavioral problems that last a lifetime. We don't know exactly how much alcohol is required to cause these problems. We do know, however, that these alcohol-related birth defects are 100- percent preventable, simply by not drinking alcohol during pregnancy. The safest course for women who are pregnant or trying to become pregnant is not to drink alcohol at all.

Alcohol Dependence
Alcohol Dependence, also known as "alcoholism," is a disease that includes four symptoms: * Craving: A strong need, or compulsion, to drink. * Loss of control: The inability to limit one's drinking on any given occasion. * Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety, occur when alcohol use is stopped after a period of heavy drinking. * Tolerance: The need to drink greater amounts of alcohol in order to "get high." People who are not alcoholic sometimes do not understand why an alcoholic can't just "use a little willpower" to stop drinking. However, alcoholism has little to do with willpower. Alcoholics are in the grip of a powerful "craving," or uncontrollable need, for alcohol that overrides their ability to stop drinking. This need can be as strong as the need for food or water. Although some people are able to recover from alcoholism without help, the majority of alcoholics need assistance. With treatment and support, many individuals are able to stop drinking and rebuild their lives. Many people wonder why some individuals can use alcohol without problems but others cannot. One important reason has to do with genetics. Scientists have found that having an alcoholic family member makes it more likely that if you choose to drink you too may develop alcoholism. Genes, however, are not the whole story. In fact, scientists now believe that certain factors in a person's environment influence whether a person with a genetic risk for alcoholism ever develops the disease. A person's risk for developing alcoholism can increase based on the person's environment, including where and how he or she lives; family, friends, and culture; peer pressure; and even how easy it is to get alcohol.

Alcohol Withdrawal
Usually occurs in adults, but it may happen in adolescents as well. It occurs when a person who uses alcohol excessively suddenly stops the alcohol use. The withdrawal usually occurs within 5-10 hours after the decrease in alcohol intake, but it may occur up to 7- 10 days later. Excessive alcohol use is generally considered the equivalent of 2-6 pints of beer (or 4 oz of "hard" alcohol) per day for one week or habitual use of alcohol that disrupts a person's life and routines. The likelihood of developing alcohol withdrawal symptoms increases as the number and frequency of drinks increase. The likelihood of developing severe withdrawal symptoms also increases if a person has other medical problems.

Alcoholism
See Alcohol Dependence

Alternative Therapy
An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial.

Alzheimer's Disease (AD)
A slowly progressive form of dementia, which is a progressive, acquired impairment of intellectual functions. Memory impairment is a necessary feature for the diagnosis. Change in one of the following areas must also be present for any form of dementia to be diagnosed: language, decision-making ability, judgment, attention, and other related areas of cognitive function and personality. The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course. The cause of Alzheimer's disease (AD) is not known, but it is not a part of normal aging. Prior theories regarding the accumulation of aluminum, lead, mercury, and other substances in the brain have been disproved. A diagnosis of AD is made based on characteristic symptoms and by excluding other causes of dementia. It can be confirmed by microscopic examination of a sample of brain tissue after death. By causing both structural and chemical problems in the brain, AD appears to disconnect areas of the brain that normally work together. There are two types of AD -- early onset and late onset. In early onset AD, symptoms first appear before age 60. Some early onset disease runs in families and involves autosomal dominant, inherited mutations that may be the cause of the disease. So far, three early onset genes have been identified. Early onset AD is less common, resulting in about 5-10% of cases. Late onset AD, the most common form of the disease, develops in people 60 and older and is thought to be less likely to occur in families. Late onset AD may run in some families, but the role of genes is less direct and definitive. These genes may not cause the problem itself, but simply increase the likelihood of formation of plaques and tangles or other AD-related pathologies in the brain. In the early stages, the symptoms may be very subtle. Symptoms may often include: repeating statements frequently, frequently misplacing items, trouble finding names for familiar objects, getting lost on familiar routes, personality changes, becoming passive and losing interest in things previously enjoyed. AD cannot be cured and the impaired functions cannot be restored. Currently, the progression can be slowed but not stopped. Treatment focuses on attempting to slow the progression; managing the behavior problems, confusion, and agitation; modifying the home environment; and most importantly, supporting the family. As the disease progresses, it may take a greater toll on the family than the patient.

Ambulatory Care
All types of health services provided on an outpatient basis, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services that do not require an overnight stay.

American Indian or Alaska Native
A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliations or community attachment.

Amphetamine
Stimulant drugs whose effects are very similar to cocaine. Amphetamine, dextroamphetamine, methamphetamine, and their various salts are collectively referred to as amphetamines. In fact, their chemical properties and actions are so similar that even experienced users have difficulty knowing which drug they have taken. Methamphetamine is the most commonly abused.

Analgesics
A group of medications that reduce pain. Some of these medicines are also used just before or during an operation to help the anesthetic work better. Codeine and hydrocodone are also used to relieve coughing. Methadone is also used to help some people control their dependence on heroin or other narcotics. Narcotic analgesics may also be used for other conditions as determined by your doctor. Narcotic analgesics act in the central nervous system (CNS) to relieve pain. Some of their side effects are also caused by actions in the CNS. These medicines are available only with your medical doctor's or dentist's prescription. For some of them, prescriptions cannot be refilled and you must obtain a new prescription from your medical doctor or dentist each time you need the medicine. In addition, other rules and regulations may apply when methadone is used to treat narcotic dependence.

Anorexia
An eating disorder characterized by refusal to maintain a minimally accepted body weight, intense fear of weight gain, and distorted body image. Inadequate calorie intake or excessive energy expenditure results in severe weight loss. The exact cause of this disorder is not known, but social attitudes towards body appearance and family factors are believed to play a role in its development. The condition usually occurs in adolescence or young adulthood. It is more common in women, affecting 1-2% of the female population and only 0.1-0.2% of males. Anorexia is seen mainly in Caucasian women who are high academic achievers and have a goal-oriented family or personality. However, this eating disorder is not more common in higher socioeconomic groups. Some experts have suggested that conflicts within a family may also contribute to anorexia. It is thoughts that anorexia is a way for a child to draw attention away from marital problems, for example, and bring the family back together. Other psychologists have suggested that anorexia may be an attempt by young women to gain control and separate from their mothers. The causes, however, are still not well understood. The purpose of treatment is first to restore normal body weight and eating habits, and then attempt to resolve psychological issues. Hospitalization may be indicated in some cases (usually when body weight falls below 30% of expected weight). Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require intravenous feeding.

Antioxidant
Antioxidant vitamins -- E, C and beta carotene (a form of vitamin A) -- have potential health-promoting properties. Much research has recently focused on how antioxidant vitamins may reduce cardiovascular disease risk. Oxidation of low- density lipoprotein (LDL or "bad") cholesterol is important in the development of fatty buildups in the arteries. This process, called atherosclerosis can lead to heart attacks and strokes. Increasing evidence suggests that LDL cholesterol lipoprotein oxidation and its biological effects can be prevented by using antioxidants-both in the diet and in supplements. These data are from various sources: basic science, epidemiology, experiments in animals and clinical investigations, including limited clinical trials. The strongest evidence for using naturally occurring antioxidants to protect against the development of cardiovascular disease is for vitamin E. It's weakest for vitamin C. Data on the role of beta carotene are limited. High intakes of vitamin E have been associated with a lower risk of coronary artery disease (CAD) incidence, based on epidemiological studies. Animal studies also suggest that vitamin E can slow the development of atherosclerosis. Further, vitamin E inhibits LDL cholesterol oxidation in test tube experiments and in human studies. Some epidemiological studies suggest that vitamin C, which also inhibits lipoprotein oxidation, is associated with reduced rates of clinical CAD. Beta carotene doesn't seem to inhibit LDL cholesterol oxidation, but early data suggest that it may reduce further clinical events in people who have CAD. One should not recommend using dietary supplements of antioxidants to prevent cardiovascular disease until their effect is proved in clinical trials that directly test their impact on CVD end points. This caution is because the doses of these antioxidants that inhibited LDL cholesterol oxidation in some studies are much larger than can be achieved by diet alone. Beneficial effects must be demonstrated in randomized, placebo-controlled clinical trials before recommending widespread use to prevent cardiovascular disease.

Anxiety
Anxiety is an emotion that can signal just the right response to a situation. It can spur you on, for example, to add the finishing touches that transform an essay, painting, or important work document from good to excellent. However, if you have an anxiety disorder, exaggerated anxiety can stop you cold and disrupt your life. Like many other illnesses, anxiety disorders often have an underlying biological cause and frequently run in families. Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Symptoms range from chronic, exaggerated worry, tension, and irritability and appear to have no cause or are more intense than the situation warrants. Physical signs, such as restlessness, trouble falling or staying asleep, headaches, trembling, twitching, muscle tension, or sweating, often accompany these psychological symptoms. Anxiety is among the most common, most treatable mental disorders. Effective treatments include cognitive behavioral therapy, relaxation techniques, and biofeedback to control muscle tension. Medication, most commonly anti-anxiety drugs, such as benzodiazepine and its derivatives, also may be required in some cases. Some commonly prescribed anti-anxiety medications are diazepam, alprazolam, and lorazepam. The non-benzodiazepine anti-anxiety medication buspirone can be helpful for some individuals.

Anxiety Disorders
Anxiety disorders range from feelings of uneasiness to immobilizing bouts of terror. Most people experience anxiety at some point in their lives and some nervousness in anticipation of a real situation. However if a person cannot shake unwarranted worries, or if the feelings are jarring to the point of avoiding everyday activities, he or she most likely has an anxiety disorder.

Any willing provider
A requirement that a health plan contract for the delivery of health care services with any provider in the area who would like to provide such services to the plan's enrollees.

Appropriate services
Designed to meet the specific needs of each individual child and family. For example, one family may need day treatment, while another may need home-based services. Appropriate services for one child and family may not be appropriate for another. Appropriate services usually are provided in the child's community.

Appropriateness
The extent to which a particular procedure, treatment, test, or service is clearly indicated, not excessive, adequate in quantity, and provided in the setting best suited to a patient's or member's needs. (See also, medically necessary)

Asian
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Assertive Community Treatment
A multi-disciplinary clinical team approach of providing 24-hour, intensive community services in the individual's natural setting that help individuals with serious mental illness live in the community.

Assessment
A professional review of child and family needs that is done when services are first sought from a caregiver. The assessment of the child includes a review of physical and mental health, intelligence, school performance, family situation, and behavior in the community. The assessment identifies the strengths of the child and family. Together, the caregiver and family decide what kind of treatment and supports, if any, are needed.

At Risk
A situation in which a healthcare organization is vulnerable to providing or paying for the delivery of more services than are received through premiums or per capita payments.

Attention Deficit Hyperactivity Disorder(ADD-ADHD)
Attention Deficit Hyperactivity Disorder (ADD-ADHD) is a neurobiological condition characterized by developmentally inappropriate level of attention, concentration, activity, distractability, and impulsivity. The symptoms typically begin by 3 years of age-Attention deficit: does not pay close attention to details; may make careless mistakes at work, school, or other activities; failure to complete tasks; has difficulty maintaining attention in tasks or play activities; does not listen when spoken to directly; has difficulty organizing tasks; is easily distracted; unable to follow more than one instruction at a time. Many different methods of treatment have been used for ADD including psychotropic medications, psychosocial interventions, dietary management, herbal and homeopathic remedies, biofeedback, meditation, and perception stimulation/training. Of these treatment strategies, the most research has been done on stimulant medications and psychosocial interventions. Overall, these studies suggest stimulants to be superior relative to psychosocial interventions. However, there is no long term information comparing the two. The primary medications used to treat attention deficit disorder include: Dexedrine (dextroamphetamine), Ritalin (methylphenidate), Cylert (magnesium pemoline), tranquilizers (such as thioridazine), alpha-adrenergic agonist (clonidine), and others. Psychosocial therapeutic techniques include: contingency management (e.g., point reward systems, time out...), cognitive-behavioral treatment (self monitoring, verbal self instruction, problem solving strategies, self reinforcement), parent counseling, individual psychotherapy.

Autism
Autism, also called autistic disorder, is a complex developmental disability that appears in early childhood, usually before age 3. Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development.

Auto-enrollment
The automatic assignment of a person to a health insurance plan (typically done under Medicaid plans).

Average Length of Stay
This represents the average time a client receives a specified service during a specified time period. This is generally computed by counting all the days that clients received the service during the time period and dividing by the number of clients that received the service during the same period. (Days a person was on furlough or not receiving are not counted.)

Average Payment Rate
The money that the Center for Medicare and Medicaid Services (CMS) can pay an HMO.

Barbiturates
Drugs that fall under the depressant category and are used medicinally to relieve anxiety, irritability, and tension. They have a high potential for abuse and development of tolerance. Depressants produce a state of intoxication similar to that of alcohol. When combined with alcohol, the effects are increased and risks are multiplied. Other drugs that fall under the depressant category include methaqualone, tranquilizers, chloral hydrate, and glutethimide.

Bathtub crank
Poor quality methamphetamine; methamphetamine produced in bathtubs

Batu
Smokable methamphetamine

Beannies
Methamphetamine

Behavioral Health
A managed care term that applies to the assessment and treatment of problems related to mental health and substance abuse. Substance abuse includes abuse of alcohol and other drugs.

Behavioral Healthcare
A continuum of services to individuals at risk of or suffering from mental, addictive, or other behavioral disorders

Behavioral heath care firm
Specialized (for-profit) managed care organizations focusing on mental health and substance abuse benefits, which they term "behavioral healthcare." These firms offer employers and public agencies a managed mental health and substance abuse benefit.

Behavioral Therapy
As the name implies, behavioral therapy focuses on behavior-changing unwanted behaviors through rewards, reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior.

Benchmark
For a particular indicator or performance goal, the industry (healthcare or non- healthcare) measure of best performance. The benchmarking process identifies the best performance in the industry for a particular process or outcome, determines how that performance is achieved, and applies the lessons learned to improve performance elsewhere.

Beneficiary
A person certified as eligible for health care services. A beneficiary may be a dependent or a subscriber.

Benefit-cost Ratio (also known as return on investment ratio)
For workplace prevention programs, the inflation-adjusted, discounted benefits of a program or intervention divided by the inflation-adjusted discounted costs of providing and consuming the program. Values above 1.0 generally denote economically attractive programs that provide more than 1 dollar in benefits for each dollar spent on the program.

Benefit Package
The types of healthcare and other services to be provided by an employer to employees. The employer as primary payor can contract for the healthcare portion of the services. The contractor arranges for delivery of healthcare services that can include substance abuse prevention and early intervention programs.

Bicycle Safety
Bicycle Safety-wear a bike helmet. 1 out of 7 children under age 15 suffers a head injury in a bike crash. Bike helmets can prevent head injuries. Make sure that your bike and your children's bikes are the right size. Your child should be able to straddle the bike with both feet on the ground. Young children should use bikes with coaster brakes- -the kind that brake when you pedal backwards. Before using hand brakes, a child's hands should be large enough and strong enough to use the levers. Avoid riding at night if at all possible. Make sure your bike has reflectors. Obey all traffic laws. Stop at stop signs, check for traffic before turning, and ride on the same side of the road as the automobiles do. Be predictable and ride defensively. Try to ride where drivers of cars can see you. Bicycles are frequently involved in car accidents because the driver of the car did not even know the bike was there. Often, accidents occur when drivers don't pay enough attention to bikers. Many accidents have been avoided because the biker was paying attention to the car. Never ride out into a street without stopping first. Use the proper hand signals for turning or stopping. Yield the right of way to pedestrians. Wear brightly colored clothing so that motorists can easily see you. Use bike paths at all times if possible.

Bike Helmet Safety
Bike Helmet Safety-Kids, especially 11- to 14- year-olds, are sometimes reluctant to wear helmets. They may insist they're good riders who don't need helmets anymore, complain that helmets are uncomfortable, or - an old favorite - point out that none of their friends wear them. Your child may be especially mature for her age; she may be a particularly skilled rider; or it just might feel easier to give in. But we urge you to resist that temptation. Requiring your children to wear a helmet every time, everywhere they go, is the best thing you can do to protect them. If your child rides a bike, then she probably also enjoys skateboards, scooters or inline skates! Make sure that whenever she "wheels" around, she's wearing the right gear. Helmet Tips * Don't negotiate. It's estimated that 75 percent of bicycle-related deaths among children could be prevented with a bicycle helmet. * Buy a helmet that meets or exceeds current safety standards developed by the U.S. Consumer Product Safety Commission. * Correct fit is essential. Helmets should be comfortable and snug, but not too tight. They shouldn't rock back and forth or side to side. * Make sure your child wears her helmet correctly - centered on top of her head and always with the straps buckled. Children who wear their helmets tipped back have a 52 percent greater risk of head injury than those who wear their helmets properly. * If your child is reluctant to wear her helmet, try letting her choose her own. Helmets come in many colors and styles - allowing children to choose a helmet that's "cool" may make them less likely to take it off when you're not around. * Talk to other parents and encourage them to have their kids wear helmets. Let your children see that you wear a helmet, too. Children are more likely to wear helmets when riding with others who wear them.

Bikers coffee
Methamphetamine and coffee

Binge Drinking
The consumption of five or more alcoholic drinks in a row on at least one occasion.

Binge Eating
Binge Eating is an eating disorder characterized by eating more than needed to satisfy hunger. It is a feature of bulimia, a disorder that also includes abnormal perception of body image, constant craving for food and binge eating, followed by self- induced vomiting or laxative use.

Biofeedback
Biofeedback is learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin temperature; it can be a path to mastering one's fears. It is used in combination with, or as an alternative to, medication to treat disorders such as anxiety, panic, and phobias.

Biomedical Treatment
Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of emotional, behavioral, and mental disorders. Any treatment involving medicine is a biomedical treatment. The kind of medication a psychiatrist prescribes varies with the disorder and the individual being treated.

Bipolar Disorder
A chronic disease affecting over 2 million Americans at some point in their lives. The American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders" describes two types of bipolar disorder, type I and type II. In type I (formerly known as manic depressive disorder), there has been at least one full manic episode. However, people with this type may also experience episodes of major depression. In type II disorder, periods of "hypomania" involve more attenuate (less severe) manic symptoms that alternate with at least one major depressive episode. When the patients have an acute exacerbation, they may be in a manic state, depressed state, or mixed state. People who suffer from bipolar disorder, however, have pathological mood swings from mania to depression, with a pattern of exacerbation and remission that are sometimes cyclic. The manic phase is characterized by elevated mood, hyperactivity, over-involvement in activities, inflated self-esteem, a tendency to be easily distracted, and little need for sleep. The manic episodes may last from several days to months. In the depressive phase, there is loss of self-esteem, withdrawal, sadness, and a risk of suicide. While in either phase, patients may abuse alcohol or other substances which worsen the symptoms. The disorder appears between the ages of 15 and 25, and it affects men and women equally. The exact cause is unknown, but it is a disturbance of areas of the brain which regulate mood. There is a strong genetic component. The incidence is higher in relatives of people with bipolar disorder. Hospitalization may be required during an acute phase to control the symptoms and to ensure safety of individuals. Medications to alleviate acute symptoms may include: neuroleptics (antipsychotics), antianxiety agents (such as benzodiazepines), and antidepressant agents. Mood stabilizers, such as lithium carbonate, and anticonvulsants (including carbamazepine and valproic acid) are started as maintenance therapy to relieve symptoms and to prevent relapse.

Black
Marijuana; opium; methamphetamine

Black beauty
Methamphetamine

Black or African American
A person having origins in any of the black racial groups of Africa. Terms such as "Haitian" or "Negro" can be used in addition to "Black or African American."

Blade
Crystal methamphetamine

Blind Sample
The types of healthcare and other services to be provided by an employer to employees. The employer as primary payor can contract for the healthcare portion of the services. The contractor arranges for delivery of healthcare services that can include substance abuse prevention and early intervention programs.

Bling bling
Methamphetamine

Blue devils
Methamphetamine

Blue meth
Methamphetamine

Boo
Marijuana; methamphetamine

Bootstrapping
A process of repeated subsampling, with replacement, from a larger sample, followed by analysis of each repeated subsample. Analyses with the subsample are used to estimate variances or standard errors of variables of interest (Vogt, 1993).

Borderline Personality Disorder
Symptoms of borderline personality disorder, a serious mental illness, include pervasive instability in moods, interpersonal relationships, self-image, and behavior. The instability can affect family and work life, long-term planning, and the individual's sense of self-identity.

Box labs
Small, mobile, clandestine labs used to produce methamphetamine

Break-even Analysis
An analysis designed to determine the dollar cost or the value of benefits that would have to be assigned to make two alternative programs equally attractive (Warner and Luce, 1982).

Brown
Marijuana; heroin; methamphetamine

Bulimia
An illness characterized by uncontrolled episodes of overeating usually followed by self-induced vomiting or other purging. In bulimia, eating binges may occur as often as several times a day. Induced vomiting known as purging allows the eating to continue without the weight gain; it may continue until interrupted by sleep, abdominal pain, or the presence of another person. The person is usually aware that their eating pattern is abnormal and may experience fear or guilt associated with the binge-purge episodes. The behavior is usually secretive, although clues to this disorder include overactivity, peculiar eating habits, eating rituals, and frequent weighing. Body weight is usually normal or low, although the person may perceive themselves as overweight. The exact cause of bulimia is unknown, but factors thought to contribute to its development are family problems, maladaptive behavior, self- identity conflict, and cultural overemphasis on physical appearance. Bulimia may be associated with depression. The disorder is usually not associated with any underlying physical problem although the behavior may be associated with neurological or endocrine diseases. The disorder occurs most often in females of adolescent or young adult age. The incidence is estimated to be 3% in the general population; but 20% of college women suffers from it. Treatment focuses on breaking the binge-purge cycles of behavior since the person is usually aware that the behavior is abnormal. Outpatient treatment may include behavior modification techniques and individual, group, or family counseling. Antidepressant drugs may be indicated for some whether or not they have coincident depression.

Caffeine
Substance that exists naturally in plants. It can also be produced synthetically and used as an additive in certain food products. It is a central nervous system stimulant and a diuretic. Caffeine is absorbed and distributed very quickly. After absorption, it passes into the central nervous system, or the brain. "Caffeine sensitivity" refers to the amount of caffeine that will produce negative side effects. This amount will vary from person to person. Caffeine does not accumulate in the bloodstream nor is it stored in the body. It is excreted in the urine many hours after it has been consumed. Caffeine will not reduce the effects of alcohol, although many people still believe a cup of coffee will "sober up" an intoxicated person. Caffeine may be used as a treatment for migraine headaches and in relieving, for a short time, fatigue or drowsiness. Caffeine is widely consumed. It is found naturally in the leaves, seeds, and fruits of more than 60 plants, including tea leaves, kola nuts, coffee, and cocoa beans. It is in coffee, tea, chocolate, cocoa and many carbonated beverages such as colas. Caffeine is frequently added to over-the-counter medications such as pain relievers, appetite suppressants, and cold medicines. Caffeine has no flavor and can be removed from a food by a chemical process called decaffeination. Excessive caffeine intake can lead to a fast heart rate, diuresis (excessive urination), nausea and vomiting, restlessness, anxiety, depression, tremors, and difficulty sleeping. Abrupt withdrawal of caffeine may cause headaches, drowsiness, irritability, nausea, vomiting, and other symptoms. Reduce caffeine intake gradually to prevent any symptoms of withdrawal.

Calcium
The NICHD recommends milk and other dairy products as a primary source of calcium. In addition, a variety of other foods are excellent sources of calcium as well. Dark green, leafy vegetables and foods with added calcium can be healthy ways to get enough calcium. By eating a wide variety of foods with calcium, you can help make sure to get the calcium you need each day.

Call Center
A facility set up to handle a large volume of phone calls, often of the customer service variety. However, call centers can be limited to either inbound or outbound calls. For example, some sales operations have inbound- only call centers using 1-800 technology. Call centers can be centralized or distributed. The European Commission has supported distributed, local call centers in order to facilitate access to work sites. Such sites are ideal for telework.

Camping and Hiking Safety
Camping and Hiking Safety-Always bring a first aid kit when camping. Know how to use the contents of the kit. Some situations can be made worse by using first aid supplies incorrectly. Use the buddy-system. It is never a good idea to camp or hike alone. If you were to become immobile because you broke a leg, or you were to fall and get stuck, a partner could go for help. Make sure someone knows where you plan to camp or hike. ( Teach children and remind adults to pick out landmarks at the campsite, and when on hikes to help recognize locations.) Be careful when exploring (always take a compass and map). Take whistles in case you. Whistles can be heard further than your voice will carry. Use caution when chopping wood or building fires. Dress appropriately. Wear long-sleeved shirts and long pants to avoid bites from ticks and other insects. In cold conditions, wear many layers of thin clothing, along with a hat, boots and gloves. When hiking, consider tucking your pants into your socks and boots to help protect against ticks. Take a supply of clean drinking water and drink it. People can become dehydrated very quickly in warm, dry, or windy conditions. Dehydration can lead to other serious complications and should be avoided. Don't drink water unless you know it is clean. Avoid alcoholic beverages which tend to cause dehydration. Don't touch animals out in the wild. Don't eat wild berries and plants. Don't over-do-it when hiking. Never leave a campfire unattended. Before leaving a campsite to return home, make sure all fires are out and the ashes are cold. A single burning ember in a seemingly smothered fire is enough to initiate another full blown fire.

Cannabinoids
Chemicals that help control mental and physical processes when produced naturally by the body and that produce intoxication and other effects when absorbed from marijuana.

Cannabis
The botanical name for the plant from which marijuana comes.

Capitation
A method for payment to healthcare providers that is common or targeted in most managed care arenas. Unlike the older fee-for-service arrangement, in which the provider is paid per procedure, capitation involves a prepaid amount per month to the provider per covered member, usually expressed as a PMPM (per member per month) fee. The provider is then responsible for providing all contracted services required by members of that group during that month for the fixed fee, regardless of the actual charges incurred. In such an arrangement, the provider is now at risk, picking up risk that the payor or employer used to have exclusively in fee-for-service or idemnity arrangements.

Caregiver
A person who has special training to help people with mental health problems. Examples include social workers, teachers, psychologists, psychiatrists, and mentors.

Carve-In
A strategy for employers to contract with a single provider of managed healthcare services in which the organization providing general medical services to employees or enrollees also provides more specialized services, such as mental health and addiction services, under one predetermined capitated fee. The term is typically used in reference to behavioral health services provided by the same MCO that is providing medical services.

Carve-Out
A strategy for the employer in contracting or providing managed care services in which a portion of the benefit (such as a behavioral health benefit) is separated (carved-out) from the overall medical benefit. A second organization is contracted under a separate agreement to provide these benefits. The term "carve-out" usually refers to a managed behavioral healthcare organization; many HMOs and insurance companies adopt this strategy because they do not have in-house expertise related to behavioral health. Carve-out vendors may be specialized units within larger managed care organizations or they may be independent companies.

Case Management
The monitoring and coordination of treatment rendered to covered persons with a specific diagnosis or requiring high-cost or extensive services. The goal is to achieve optimum patient outcome in the most cost-effective manner.

Case manager
An individual who organizes and coordinates services and supports for children with mental health problems and their families. (Alternate terms: service coordinator, advocate, and facilitator.)

Case Mix
The overall clinical diagnostic profile of a defined population, which influences intensity, cost, and scope of healthcare services typically provided.

Case Rate
A flat fee paid for a patient's treatment based on the diagnosis and/or presenting problem. For this fee the provider covers all of the services the patient requires for a specific period of time. Also referred to as "bundled rate" or "flat fee-per-case." Very often used as an intervening step prior to capitation. Diagnostic Related Groups (DRGs) are an example of a case rate.

Censored Data
Data about an event or phenomenon of interest that are unavailable for periods of time or groups of people. For example, medical expenditures may be unavailable for persons who switch health plans, or for time periods before or after employment or some other event of interest, such as the employer changing the healthcare provider.

Center for Medicare and Medicaid Services (CMS)
The Federal agency that administers the Medicare, Medicaid, and Child Health Insurance Programs. CMS provides health insurance for more than 74 million Americans through Medicare, Medicaid, and Child Health. The majority of these individuals receive their benefits through the fee-for-service delivery system. However, an increasing number are choosing managed care plans. CMS is working to maintain and measure quality of care in managed care through HEDIS measures.

Certificate of Need
A certificate of approval issued by a governmental agency to an organization that proposes to construct or modify a healthcare facility, incur a major capital expenditure, or offer a new or different health service.

Chalk
Crack Cocaine; amphetamine; methamphetamine

Chicken Feed
Methamphetamine

Child Dental Health
The care of the child's teeth and gums, including hygiene (brushing and rinsing), examinations by dentists (assessing the current condition of teeth and gums), and treatments (use of fluoride, extractions, fillings, or orthodontics). Healthy teeth and gums are essential to overall good health. Poor dental development, dental disease, and dental trauma can result in poor nutrition, painful and dangerous infections, problems with speech development, and problems with self-image. Current recommendations for dental care during childhood include: Even though newborns and infants do not have teeth, care of the mouth and gums is important, ask your pediatrician if and when your infant needs fluoride added to his diet. Use a damp washcloth to wipe your infant's gums after each meal. Do not put your infant or young child to bed with a bottle of milk, juice, or sugar water. Use only water for bedtime bottles. Begin using a soft toothbrush instead of the washcloth to clean your child's teeth as soon as his first tooth shows (usually between 5-8 months of age). Your child's first visit to the dentist should be between the time his first tooth appears (5-8 months) and the time when all his primary teeth are visible (before 2 1/2 years). Many dentists will recommend a "trial" visit to expose the child to the sights, sounds, smells, and feel of the office before the actual examination. Children who are accustomed to having their gums wipes and teeth brushed will have fewer problems to having the dentist look inside their mouths. Your child should brush his teeth and gums at least twice each day and especially before bed. When permanent teeth are established, flossing his teeth each evening before bed should be encouraged. Additional dental treatments (such as braces or extractions) may be needed during adolescence to prevent long-term problems. Prevent tooth damage by teaching your child to use appropriate protective gear, safe play practices, and actions to take in case of injuries to teeth, gums, or mouth. Regular visits to your dentist (at least every 6 months) will ensure early recognition and treatment of problems. Proper care will give your child healthy teeth and gums for a lifetime. As your child becomes more active, trauma to his teeth may occur. Lost or damaged teeth (chips, change in position) or gums should be treated as a medical emergency to prevent infection, tooth loss, or damage to tooth, root, gums, or mouth. Even damage to primary (first) teeth should be treated to prevent future problems with tooth or gum development. If your child loses a GROWN-UP tooth during a fall or other injury, you should: find the tooth, avoid touching the root, and carefully rinse the tooth in running water (use stopper or strainer to avoid losing the tooth down the drain). Place the clean tooth back into its hole in your child's mouth and have your child hold the tooth in place with his fingers, if you or your child are unable to do this, place the tooth either in saliva (under your tongue), cold milk or saline (such as contact lens solution). Take your child and his tooth for immediate medical or dental assistance.

Child protective services
Designed to safeguard the child when abuse, neglect, or abandonment is suspected, or when there is no family to take care of the child. Examples of help delivered in the home include financial assistance, vocational training, homemaker services, and daycare. If in-home supports are insufficient, the child may be removed from the home on a temporary or permanent basis. Ideally, the goal is to keep the child with the family whenever possible.

Child Safety
Child Safety-the space between crib bars should be no more than 2 1/2 inches. A crib or playpen should have no sharp edges. The distance from the mattress to the top of the rail should be over 2 feet. Use bumper pads on the inside of the crib. Keep plastic wrap or bags away from children. Keep stuffed animals with buttons that can be swallowed away from small children. Avoid putting extra blankets and stuffed animals in a crib with a baby. Child-proof your home: * Place gates at the top and bottom of each stairway. * Cover unused electrical sockets. * Keep toxic substances (such as cleaning fluids, bug poisons, and other chemicals) well out of a child's reach. * Avoid storing toxic substances in unmarked and inappropriate containers (such as food containers). * Keep knives out of reach. * Buy medicines with child-resistant caps. Place all medications out of the reach of children. * Put safety latches on cabinets that a child should not open. * Keep matches out of reach. * Set the hot water heater thermostat to no more than 125 degrees F. * When cooking on the stove, make sure that pot and pan handles are turned to the middle of the stove top. Handles that hang over the edge of the stove top may be reached by a curious toddler. * Keep toys with small parts (and other small objects) out of the reach of toddlers. * In the bathroom, avoid putting dangerous items (such as razor blades) in a waste basket where a young child might have access. * Keep toilet lids down. Never leave an infant unattended in the bathtub. Keep children away from hot beverages and stove tops. Don't leave small children alone in the kitchen. Establish sensible rules for outdoor play and supervise young children constantly. When heating a baby bottle in the microwave oven or on the stove, always test the milk temperature to prevent burning your baby's mouth.

Children
Children need to eat a wide variety of foods for good health. Use the Food Guide Pyramid on page 5 as a starting point for planning family meals and snacks. The Food Guide Pyramid applies to healthy people age 2 years and older. The smaller number of servings in the range is for children age 6 years and under. For 2- to 3-year-old children, the serving size should be smaller, about two- thirds the size of a regular serving (except for milk). When you help children build healthy eating habits early, they will approach eating with a positive attitude-that food is something to enjoy, help them grow, and give them energy. Give your child a snack or two in addition to his or her three daily meals. Offer your child a wide variety of foods, such as grains, vegetables and fruits, low-fat dairy products, and lean meat or beans. Serve snacks like dried fruit, low-fat yogurt, and air-popped popcorn. Let your child decide whether and how much to eat. Keep serving new foods even if your child does not eat them at first. Cook with less fat-bake, roast, or poach foods instead of frying. Limit the amount of added sugar in your child's diet. Choose cereals with low or no added sugar. Serve water or low-fat milk more often than sugar-sweetened sodas and fruit-flavored drinks. Choose and prepare foods with less salt. Keep the saltshaker off the table. Have fruits and vegetables on hand for snacks instead of salty snack foods. Involve your child in planning and preparing meals. Children may be more willing to eat the dishes they help fix. Have family meals together and serve everyone the same thing. Do not be too strict. In small amounts, sweets or food from fast-food restaurants can still have a place in a healthy diet. Make sure your child eats breakfast. Breakfast provides children with the energy they need to listen and learn in school.

Children and adolescents at risk for mental health problems
Children are at greater risk for developing mental health problems when certain factors occur in their lives or environments. Factors include physical abuse, emotional abuse or neglect, harmful stress, discrimination, poverty, loss of a loved one, frequent relocation, alcohol and other drug use, trauma, and exposure to violence.

Children and Exercise
Children should exercise to stay healthy. For children older than 6 years, 20 minutes a day of aerobic exercise at least 3 days a week should be adequate. Encourage your child to build strength, flexibility and aerobic capacity (for example, through running).

Cholesterol
A soft, waxy substance that is present in all parts of the body including the nervous system, skin, muscle, liver, intestines, and heart. It is made by the body and obtained from animal products in the diet. Cholesterol is manufactured in the liver for normal body functions including the production of hormones, bile acid, and Vitamin D. It is transported in the blood to be used by all parts of the body. Dietary cholesterol is present only in foods of animal origin (not in foods of plant origin). Cholesterol is found in eggs, dairy products, meat, poultry, fish, and shellfish. Egg yolks and organ meats (liver, kidney, sweetbread, and brain) are high in dietary cholesterol. Fish generally contains less cholesterol than other meats, but some shellfish is high in cholesterol content. Foods of plant origin (vegetables, fruits, grains, cereals, nuts, and seeds) contain no cholesterol. Fat content is not a good measurement of cholesterol content. For example, liver and other organ meats are low in fat but very high in cholesterol. Excessive cholesterol contributes to atherosclerosis and subsequent heart disease. The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases. Approximately 25% of the adult population in the U.S. has elevated blood cholesterol levels. More than half of the adult population has blood cholesterol levels that are higher than the "desirable" range, as specified by the medical community. Elevated cholesterol levels often begin in childhood. Some children may be at higher risk than others secondary to family history. The level for total cholesterol has been lowered in the past few years. Depending on the laboratory levels either less than 200 or 190 milligrams per deciliter (mg/dl) are considered "desirable" because they carry the least risk of heart disease. When the level is above 200 mg/dl the risk for coronary heart disease increases. It is also important to know the levels for High Density Lipoprotein (HDL, also known as the "good cholesterol") and Low Density Lipoprotein (LDL, or "bad cholesterol"). You must consult your health care provider to measure and discuss your cholesterol profile. To lower high cholesterol levels, eat less than 30% of the total daily calories from fat. Of that 30%, less than one-third should be from saturated fat and not more than one-third should be from polyunsaturated fat. At least one-third of the total fat calories should be from monounsaturated fat. Less than 300 milligrams (mg) of dietary cholesterol per day should be consumed.

Christmas tree
Marijuana; amphetamine; methamphetamine; depressant

Christmas tree meth
Green methamphetamine produced using Drano crystals

Cinnamon
Methamphetamine

Cirrhosis
The result of chronic liver disease that causes scarring of the liver and liver dysfunction. This often has many complications, including accumulation of fluid in the abdomen, bleeding disorders, increased pressure in the blood vessels, and confusion or a change in the level of consciousness. Common causes of chronic liver disease in the US include hepatitis C infection and long- term alcohol abuse. Hepatitis C is now the most common reason for liver transplantation in the US. Other causes of cirrhosis include hepatitis B, medications, autoimmune inflammation of the liver, disorders of the drainage system of the liver (the biliary system), and metabolic disorders of iron and copper.

Claim
A request by an individual (or his or her provider) to that individual's insurance company to pay for services obtained from a health care professional.

Clear
Methamphetamine

Clinical Psychologist
A clinical psychologist is a professional with a doctoral degree in psychology who specializes in therapy.

Clinical Social Worker
Clinical social workers are health professionals trained in client-centered advocacy that assist clients with information, referral, and direct help in dealing with local, State, or Federal government agencies. As a result, they often serve as case managers to help people "navigate the system." Clinical social workers cannot write prescriptions.

Club Drugs
A wide variety of drugs being used by young people at dance clubs, bars, and all-night dance parties ("trances" or "raves"). These parties are usually held in a clandestine location with high-volume music, high-tech entertainment, and easy access to drugs. Club drugs are attractive to today's youth because they are inexpensive and produce increased stamina and intoxicating highs. Because many of these drugs are colorless, tasteless, and odorless, they can be secretly added to beverages by individuals who want to intoxicate or sedate others. The most widely used club drugs are; ecstasy, rohypnol, ketamine, GHB, and LSD. Research has shown that club drugs can have long-lasting negative effects on the brain, especially on memory function and motor skills. When club drugs are combined with alcohol, the effect is intensified, and they become even more dangerous and potentially fatal.

Cocaine
A powerfully addictive stimulant that directly affects the brain. Cocaine has been labeled the drug of the 1980s and '90s, because of its extensive popularity and use during this period. However, cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years. There are basically two chemical forms of cocaine: the hydrochloride salt and the "freebase." The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable. Cocaine is generally sold on the street as a fine, white, crystalline powder, known as "coke," "C," "snow," "flake," or "blow." Street dealers generally dilute it with such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically-related local anesthetic) or with such other stimulants as amphetamines.

Cognitive/Behavioral Therapy
A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.

Cognitive Therapy
Cognitive therapy aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or even self- destructive. The goal is to replace such thinking with a more balanced view that, in turn, leads to more fulfilling and productive behavior.

Cold Sores
Cold Sores or Herpes labialis is an infection caused by the herpes simplex virus, characterized by an eruption of small and usually painful blisters on the skin of the lips, mouth, gums or the skin around the mouth. These blisters are commonly called cold sores or fever blisters. Most Americans are infected with the type 1 virus by the age of 20. The initial infection may cause no symptoms or mouth ulcers. The virus remains in the nerve tissue of the face. In some people, the virus reactivates and produces recurrent cold sores that are usually in the same area, but are not serious. Herpes virus type 2 usually causes genital herpes and infection of babies at birth but can also cause herpes labialis. Herpes viruses are contagious. Contact can occur directly, or through contact with infected razors, towels, dishes, etc. Occasionally, oral/genital contact can spread oral herpes to the genitals (and vice versa), so people with active herpes lesions on or around their mouths or on their genitals should avoid oral sex. The first symptoms usually appear within 1 or 2 weeks, and as late as 3 weeks, after contact with an infected person. The lesions of herpes labialis usually last for 7 to 10 days, then begin to resolve. The virus may become latent, residing in the nerve cells, with recurrence at or near the original site. Recurrence is usually milder. It may be triggered by menstruation, sun exposure, illness with fever, stress, or other unknown causes. Warning symptoms of itching, burning, increased sensitivity, or tingling sensation may occur about 2 days before lesions appear. They include: Skin lesion/rash located around the lips, mouth, and gums; Small blisters (vesicles), filled with clear yellowish fluid, blisters appear on a raised, red, painful skin area. Blisters form, break, and ooze, yellow crusts slough to reveal pink, healing skin, several smaller blisters may merge to form a larger blister, and a mild fever (may occur). Untreated, the symptoms will generally subside in 1 to 2 weeks. Antiviral medications may be given by mouth to may shorten the course of the symptoms and decrease pain. Wash blisters gently with soap and water to minimize the spread of the virus to other areas of skin. An antiseptic soap may be recommended. Applying ice or warmth to the area may reduce pain. Take precautions to avoid infecting others. Prevention methods include avoid direct contact with cold sores or other herpes lesions. Minimize the risk of indirect spread by thoroughly washing items in hot (preferably boiling) water before re-use. Do not share items with an infected person, especially when herpes lesions are active. Avoid precipitating causes (especially sun exposure) if prone to oral herpes. Avoid performing oral sex when you have active herpes lesions on or near your mouth and avoid passive oral sex with someone who has active oral or genital herpes lesions. Condoms can help reduce, but do not entirely eliminate, the risk of transmission via oral or genital sex with an infected person. Unfortunately, both oral and genital herpes viruses can sometimes be transmitted even when the person does not have active lesions.

Collateral Services
Services that include contacts with significant others involved in the client's/patient's life for the purpose of discussing the client's/patient's emotional or behavioral problems or the collateral's relationship with the client/patient.

Community Services
Services that are provided in a community setting. Community services refer to all services not provided in an inpatient setting.

Conduct Disorders
Children with conduct disorder repeatedly violate the personal or property rights of others and the basic expectations of society. A diagnosis of conduct disorder is likely when these symptoms continue for 6 months or longer. Conduct disorder is known as a "disruptive behavior disorder" because of its impact on children and their families, neighbors, and schools.

Consolidated Omnibus Budget Reconciliation Act (COBRA)
An act that allows workers and their families to continue their employer-sponsored health insurance for a certain amount of time after terminating employment. COBRA imposes different restrictions on individuals who leave their jobs voluntarily versus involuntarily.

Consumer
Any individual who does or could receive health care or services. Includes other more specialized terms, such as beneficiary, client, customer, eligible member, recipient, or patient.

Consumer Run Services
Mental health treatment or support services that are provided by current or former mental health consumers. Includes social clubs, peer- support groups, and other peer-organized or consumer-run activities.

Continuous quality improvement (CQI)
An approach to health care quality management borrowed from the manufacturing sector. It builds on traditional quality assurance methods by putting in place a management structure that continuously gathers and assesses data that are then used to improve performance and design more efficient systems of care. Also known as total quality management (TQM).

Continuum of care
A term that implies a progression of services that a child moves through, usually one service at a time. More recently, it has come to mean comprehensive services. Also see system of care and wraparound services.

Cook
Drug manufacturer; mix heroin with water; heating heroin to prepare it for injection

Cooker
To inject a drug; person who manufactures methamphetamine

Coordinated services
Child-serving organizations talk with the family and agree upon a plan of care that meets the child's needs. These organizations can include mental health, education, juvenile justice, and child welfare. Case management is necessary to coordinate services. Also see family-centered services and wraparound services.

Copayment
The portion of the covered healthcare cost for which the person insured has the responsibility to pay, usually as a fixed fee for a specific service type (e.g., $10 per doctor visit).

Corporate Health Management Programs
Health promotion and disease prevention/wellness programs that use health education techniques to promote employee health. These programs usually include components such as exercise regimens, health- risk appraisals, weight control, nutrition information, stress management, disease screening, and smoking cessation.

Cost-based Reimbursement
Method of reimbursement in which third parties pay providers for services provided based upon the documented costs of providing that service.

Cost-benefit Analysis (CBA)
A systematic method for valuing over time the monetary costs and consequences of producing and consuming substance abuse program services. Results from a CBA are often provided in terms of a net present value figure, which shows the difference in inflation-adjusted, discounted costs and benefits of the program in today's dollars or in the dollars of a base year of interest. Results may also be shown in terms of an internal rate of return or a benefit-cost ratio. The data is used in determining the content of a benefit package.

Cost-effectiveness Analysis (CEA)
A systematic method for valuing over time the monetary costs and non-monetary consequences of producing and consuming substance abuse program services. Results from a CEA are often shown in terms of total costs and total levels of effectiveness (e.g., total quality adjusted life-years saved or total numbers of substance abuse cases avoided), or in terms of cost per unit of effectiveness. This data is used by employers to determine contents of a benefits package.

Cost-Sharing
Health insurance practice that requires the insured person to pay some portion of covered expenses (e.g., deductibles, coinsurance, and copayments) in an attempt to control utilization.

Cost-Shifting
Charging one group of patients more in order to make up for underpayment by others. Most commonly, charging some privately insured patients more in order to make up for underpayment by Medicaid or Medicare.

Couples Counseling and Family Therapy
These two similar approaches to therapy involve discussions and problem-solving sessions facilitated by a therapist-sometimes with the couple or entire family group, sometimes with individuals. Such therapy can help couples and family members improve their understanding of, and the way they respond to, one another. This type of therapy can resolve patterns of behavior that might lead to more severe mental illness. Family therapy can help educate the individuals about the nature of mental disorders and teach them skills to cope better with the effects of having a family member with a mental illness- such as how to deal with feelings of anger or guilt.

Covered Days
Maximum number of days for which an insurer will reimburse for services rendered. Days may be limited per episode of illness, per year, per lifetime, or per length of policy.

Covered Lives
Individuals having health insurance coverage under a particular contract, payer, or provider group. In the private sector, this refers to employees and family members.

CR
Methamphetamine

Crack Cocaine
The street name given to the freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. The term "crack" refers to the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride. Because crack is smoked, the user experiences a high in less than 10 seconds. This rather immediate and euphoric effect is one of the reasons that crack became enormously popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy.

Crank
Crack Cocaine; heroin; amphetamine; methamphetamine; methcathinone

Crankster
Someone who uses or manufatures methamphetamine

Credentialing
The process of reviewing a practitioner's credentials, i.e., training, experience, or demonstrated ability, for the purpose of determining if criteria for clinical privileging are met.

Creditable Coverage
Any prior health insurance coverage that a person has received. Creditable coverage is used to decrease exclusion periods for pre- existing conditions when an individual switches insurance plans. Insurers cannot exclude coverage of pre-existing conditions, but may impose an exclusion period (no more than 12 months) before covering such conditions. (See also, Health Insurance Portability and Accountability Act)

Crink
Methamphetamine

Cris
Methamphetamine

Crisis residential treatment services
Short-term, round-the-clock help provided in a nonhospital setting during a crisis. For example, when a child becomes aggressive and uncontrollable, despite in-home supports, a parent can temporarily place the child in a crisis residential treatment service. The purposes of this care are to avoid inpatient hospitalization, help stabilize the child, and determine the next appropriate step.

Cristina (Spanish)
Methamphetamine

Cristy
Smokable methamphetamine

Croak
Crack mixed with methamphetamine; methamphetamine

Crossles
Methamphetamine

Crush and rush
Method of methamphetamine production in which starch is not filtered out of the ephedrine or pseudoephedrine tablets.

Crypto
Methamphetamine

Crystal
Cocaine; amphetamine; methamphetamine;PCP

Crystal glass
Crystal shards of methamphetamine

Crystal meth
Methamphetamine

Cultural Competence
Actions that indicate an awareness and acceptance of the importance of addressing cultural factors while providing care; ability to meet the needs of clients and patients from diverse backgrounds.

Cultural competence
Help that is sensitive and responsive to cultural differences. Caregivers are aware of the impact of culture and possess skills to help provide services that respond appropriately to a person's unique cultural differences, including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability. They also adapt their skills to fit a family's values and customs.

Data Warehouse
A component of a computer-based patient record that accepts, files, and stores clinical data over time from a variety of intervention systems for the purposes of developing population-based practice guidelines, outcomes management, and research.

Date Rape Drug
See Rohypnol

Day treatment
Day treatment includes special education, counseling, parent training, vocational training, skill building, crisis intervention, and recreational therapy. It lasts at least 4 hours a day. Day treatment programs work in conjunction with mental health, recreation, and education organizations and may even be provided by them.

Deductible
The minimum threshold payment that must be made by a health plan enrollee each year before the plan begins to make payments on a shared or total basis. (Source: Rognehaugh R, The Managed Care Dictionary)

Deductible
The amount an individual must pay for health care expenses before insurance (or a self- insured company) begins to pay its contract share. Often insurance plans are based on yearly deductible amounts.

Delusions
Delusions are bizarre thoughts that have no basis in reality.

Demand-side Management
Use of employer-provided health education, wellness, and client empowerment programs to assist members to make cost-effective healthcare decisions, thereby decreasing unnecessary utilization and costs. These programs may be part of a carve-out service.

Dementia
Refers to a group of symptoms involving progressive impairment of all aspects of brain function. Disorders that cause dementia include conditions that impair the vascular (blood vessels) or neurologic (nerve) structures of the brain. A minority of causes of dementia are treatable. These include normal pressure hydrocephalus, brain tumors, and dementia due to metabolic causes and infections. Unfortunately, most of the disorders associated with dementia are progressive, irreversible, degenerative conditions. The two major degenerative causes of dementia are Alzheimer's disease, which is a progressive loss of nerve cells without a known cause or cure and vascular dementia, which is loss of brain function due to a series of small strokes. Dementia may be diagnosed when there is impairment of two or more brain functions, including language, memory, visual-spatial perception, emotional behavior or personality, and cognitive skills (such as calculation, abstract thinking, or judgment). Dementia usually appears first as forgetfulness. Other symptoms may be apparent only on neurologic examination or cognitive testing. Loss of functioning progresses slowly from decreased problem solving and language skills to difficulty with ordinary daily activities to severe memory loss and complete disorientation with withdrawal from social interaction.

Depressants
Drugs used medicinally to relieve anxiety, irritability, and tension. They have a high potential for abuse and development of tolerance. Depressants produce a state of intoxication similar to that of alcohol. When combined with alcohol, the effects are increased and risks are multiplied. Drugs that fall under the depressant category include barbiturates, methaqualone, tranquilizers, chloral hydrate, and glutethimide.

Depression
A term that people commonly use to refer to states involving sadness, dejection, lack of self-esteem, and lack of energy. Feelings of depression are synonymous with feeling sad, blue, down in the dumps, unhappy, and miserable. Most feelings of depression are a reaction to an unhappy event. It is natural to have some feelings of sadness after a loss such as the death of a relative, or after a major disappointment at home or at work. Depression is more prevalent in women than men and is especially common among adolescents. Mild depression comes and goes and is characterized by downheartedness, sadness, and dejection. Short-term episodes of depression or other mood changes can occur with hormone changes, including those that accompany pregnancy or premenstrual syndrome (PMS), and those occurring shortly after the birth of a baby (postpartum "blues"). Sleep disruption and lack of sunlight during the winter months are other biological factors that can precipitate depressive symptoms. Distorted thought patterns, characterized by feelings of worthlessness, helplessness, and hopelessness are part of the "cognitive triad of depression," and can be a risk factor for depression. It appears that a tendency toward depression is often genetic, but that stressful life circumstances usually play a major role in bringing on depressive episodes. Problems with depression usually begin in adolescence, and are about twice as common in women as in men. Noticeably disturbed thought processes, poor communication and socialization, and sensory dysfunction indicate moderate depression. People with severe depression are withdrawn, indifferent toward their surroundings, and may show signs of delusional thinking and limited physical activity.

Desocsins
Methamphetamine

Desogtion
Methamphetamine

Diabetes
Diabetes is a life-long disease marked by elevated levels of sugar in the blood. It can be caused by too little insulin (a chemical produced by the pancreas to regulate blood sugar), resistance to insulin, or both. People with diabetes have high blood glucose. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both. There are three major types of diabetes: * Type 1 diabetes is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are required to sustain life. Without proper daily management, medical emergencies can arise. * Type 2 diabetes is far more common than type 1 and makes up about 90% of all cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity levels, and widespread failure to exercise. * Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes. High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, weight loss and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all. About 40% of type 2 diabetics have no symptoms of the condition.

Diagnostic Evaluation
The aims of a general psychiatric evaluation are 1) to establish a psychiatric diagnosis, 2) to collect data sufficient to permit a case formulation, and 3) to develop an initial treatment plan, with particular consideration of any immediate interventions that may be needed to ensure the patient's safety, or, if the evaluation is a reassessment of a patient in long-term treatment, to revise the plan of treatment in accord with new perspectives gained from the evaluation.

Diagnostic Related Groups (DRGs)
A payment system that reimburses healthcare providers a fixed amount for all care in connection with a standard diagnostic category. The DRG system was instituted by Medicare and is now used by many insurance companies. It is a form of case rate payment system.

Dietary Fiber
Dietary fiber is found in plant foods and humans cannot digest it. It has no calories because the body cannot absorb it. Dietary fiber provides a feeling of fullness and adds bulk in the diet. This assists digestion and elimination. Including fiber in your daily diet helps prevent many problems and brings many benefits. It may be helpful in controlling weight by making you feel full sooner. It helps prevent constipation. It may be helpful in the prevention or treatment of diverticulosis, diabetes, and heart disease (ask your health care provider or registered dietician about recommendations for these conditions). There are two forms of fiber: soluble and insoluble. Soluble fiber attracts water and turns to gel during digestion. This slows digestion and the rate of nutrient absorption from the stomach and intestine. It is found in oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables. Insoluble fiber is found in foods such as wheat bran, vegetables and whole grains. It appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool. The recommendation for older children, adolescents and adults is 20 to 35 grams per day. Younger children will not be able to eat enough calories to achieve this, but introducing whole grains, fresh fruits and other high fiber foods is suggested. To ensure an adequate fiber intake, eat a variety of foods, including more fruits, vegetables, whole grains, cereals, and dried beans and peas.

Discharge
A discharge is the formal termination of service, generally when treatment has been completed or through administrative authority.

Discount Rate
The rate at which future dollars or future units of effectiveness are devalued, relative to current dollars or units of effectiveness.

Discounting
The process of devaluing future dollars or units of effectiveness to reflect preferences for dollars or goods or services now, versus in the future.

Disease Management Programs
Comprehensive, integrated programs for managing patients' disease conditions. These programs usually target specific disease conditions for which there are effective, evidence-based practice guidelines, and are designed for diseases such as depression, diabetes, arthritis, hypertension, and heart disease.

Dopamine
A brain chemical, classified as a neurotransmitter, found in regions of the brain that regulate movement, emotion, motivation, and pleasure.

Drop-in Center
A social club offering peer support and flexible schedule of activities: may operate on evenings and/ weekends.

Dropping
Wrapping methamphetamine in bread and then consuming it

Drug
A chemical compound or substance that can alter the structure and function of the body. Psychoactive drugs affect the function of the brain, and some of these may be illegal to use and possess.

Drug abuse
The use of illegal drugs or the inappropriate use of legal drugs. The repeated use of drugs to produce pleasure, to alleviate stress, or to alter or avoid reality (or all three).

Drug Formulary
The list of prescription drugs for which a particular employer or State Medicaid program will pay. Formularies are either "closed," including only certain drugs or "open," including all drugs. Both types of formularies typically impose a cost scale requiring consumers to pay more for certain brands or types of drugs.

Drug Free Workplace Act
The 1988 Federal act that laid the groundwork for subsequent regulation of workplace drug testing.

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition)
An official manual of mental health problems developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other health and mental health care providers use this reference book to understand and diagnose mental health problems. Insurance companies and health care providers also use the terms and explanations in this book when discussing mental health problems.

Dual Diagnosis
Identification of dual diseases, disorders, or injuries, commonly used to describe individuals diagnosed with both mental disorders and addictive diseases.

Dyslexia
A reading disability resulting from a defect in the ability to process graphic symbols. There are about 2 to 8% of elementary-age children that have some degree of reading disability. Developmental reading disorder (DRD) or dyslexia is not attributable to eye problems but instead is a defect of higher cortical (brain) processing of symbols. Children with DRD may have trouble rhyming and separating the sounds in spoken words. These abilities appear critical in the process of learning to read. Initial reading skills are based on word recognition. More developed reading skills require the linking of words into a coherent sentence (thought). DRD children may be unable to form images from the meanings of the words or to process the words into an idea which is understandable. At this level, reading may fail at its primary function, which is to convey information. Dyslexia or developmental reading disorder may appear in combination with developmental writing disorder and developmental arithmetic disorder. All of these processes involve the manipulation of symbols and the conveyance of information by their manipulation. These conditions may appear singly or in any combination. Other causes of learning disability and, in particular, reading disability, must be ruled out before a diagnosis of DRD can be made. Cultural and educational shortfalls, emotional problems, mental retardation, and diseases of the brain (for example AIDS) can all cause learning disabilities. Remedial instruction has remained the best approach to this type of reading disorder.

E-Mail
electronic mail, or written messages that people exchange via computer in ordinary language. It is created, sent, delivered and read using a specific software product that must be bought by the user and loaded onto his or her computer. Microsoft Outlook, Lotus Mail, and Eudora are all e-mail products. E- mail sent from one person to another on the same LAN or WAN is delivered by the network itself. E-mail from one network or computer system to another is delivered via the internet by an INTERNET SERVICE PROVIDER.

Early Intervention
Refers to identifying persons at high risk prior to their having a serious consequence, or persons at high risk who have had limited serious consequences related to substance use on the job, or having a significant personal, economic, legal, or health/mental health consequence, and providing these persons at high risk with appropriate counseling, treatment, education, or other intervention.

Ecstasy (MDMA)
Aa stimulant that combines the effects of amphetamines and hallucinogens. MDMA is a synthetic, psychoactive drug with both stimulant (amphetamine-like) and hallucinogenic (LSD-like) properties. Street names for MDMA include Ecstasy, Adam, XTC, hug, beans, and love drug. Its chemical structure (3-4 methylenedioxymethamphetamine, "MDMA") is similar to methamphetamine, methylenedioxyamphetamine (MDA), and mescaline - other synthetic drugs known to cause brain damage. MDMA also is neurotoxic. In addition, in high doses it can cause a sharp increase in body temperature (malignant hyperthermia) leading to muscle breakdown and kidney and cardiovascular system failure.

Education Services link
Locating or providing a full range of educational services from basic literacy through the General Equivalency Diploma and college courses. Includes special education at the pre-primary, primary, secondary, and adult levels.

Effect Size
The magnitude of a relationship between the dependent and independent variables in the population, or the degree of departure from the null hypothesis. Typical measures of effect size include d, eta, and r.

Elbows
One pound of methamphetamine

Electroconvulsive Therapy
Also known as ECT, this highly controversial technique uses low voltage electrical stimulation of the brain to treat some forms of major depression, acute mania, and some forms of schizophrenia. This potentially life- saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines, and anesthesia have significantly reduced the possibility of side effects.

Eligible Employee
An employee who qualifies to receive health benefits through his/her employer.

Emergency
A planned program to provide psychiatric care in emergency situations with staff specifically assigned for this purpose. Includes crisis intervention, which enables the individual, family members and friends to cope with the emergency while maintaining the individual's status as a functioning community member to the greatest extent possible.

Emergency and crisis services
A group of services that is available 24 hours a day, 7 days a week, to help during a mental health emergency. Examples include telephone crisis hotlines, suicide hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care.

Emergency Medical Treatment and Labor Act (EMTALA)
EMTALA, also referred to as the Federal Anti- patient Dumping Law link An act pertaining to emergency medical situations. EMTALA requires hospitals to provide emergency treatment to individuals, regardless of insurance status and ability to pay (EMTALA, 2002).

Employed
This is a broad category of employment that includes competitive, supported, and sheltered employment.

Employee Assistance Program (EAP)
Programs to assist employees, their family members, and employers in finding solutions for workplace and personal problems. The EAP may be provided directly by the employer or be part of the healthcare contract with a managed care organization or managed behavioral healthcare organization. Components of An EAP program may include some or all of the following components: employee education, supervisor training, drug testing, needs assessments, wellness programs, support for parents, health fairs, peer-to-peer counseling, interactive Web sites, health risk appraisals, newsletters, and employee seminars and information campaigns.

Employee Retirement Income Security Act of 1974 (ERISA)
Also called the Pension Reform Act, this act regulates the majority of private pension and welfare group benefit plans in the United States. It sets forth requirements governing, among many areas, participation, crediting of service, vesting, communication and disclosure, funding, and fiduciary conduct.

Employment/Vocational Rehabilitation Services
A broad range of services designed to address skills necessary for participation in job- related activities.

Endogenous
Something produced by the brain or body.

Enrollee
A person eligible for services from a managed care plan.

Enrollment
The total number of covered persons (employees and their dependents) enrolled in a health plan. Also refers to the process by which a health plan signs up groups and individuals for membership, or to the number of enrollees who sign up in any one group.

Ethyl Alcohol
Ethyl Alcohol or ethanol is the member of the alcohol series of chemicals which is used in alcoholic beverages. It is less toxic than other members of this series, but it is a central nervous system depressant and has a high abuse potential.

Exclusive Provider Organization
A plan in which the patient must remain in the network to receive benefits (out-of- network costs are paid by the patient); a plan regulated under State insurance statute that provides coverage only for contracted providers and does not extend to non- preferred-provider services.

Face Time
Time spent at the employer's offices interacting with colleagues, supervisors, etc. Many employers require regular face time to ensure the teleworker's integration into company culture and practices.

Family-centered services
Help designed to meet the specific needs of each individual child and family. Children and families should not be expected to fit into services that do not meet their needs. Also see appropriate services, coordinated services, wraparound services, and cultural competence.

Family-like arrangements
A broad range of living arrangements that simulate a family situation. This includes foster care and small group homes.

Family support services
Help designed to keep the family together, while coping with mental health problems that affect them. These services may include consumer information workshops, in-home supports, family therapy, parenting training, crisis services, and respite care.

Fast
Methamphetamine

Fee for Service
A type of health care plan under which health care providers are paid for individual medical services rendered.

Fetal Alcohol Syndrome
The manifestation of specific growth, mental, and physical birth defects associated with the mother's high levels of alcohol use during pregnancy. Alcohol use or abuse by the pregnant woman subjects her to the same range of risks that alcohol has in the general population. However, it poses extreme and unique risks to the fetus and is associated with fetal alcohol syndrome (FAS). Timing of alcohol use during pregnancy is also of importance. Alcohol use during the first trimester is more damaging than during the second trimester, which is, in turn, more damaging than use in the third trimester. Alcohol ingested by a pregnant woman easily passes across the placental barrier to the fetus. Because of this, drinking alcohol can adversely affect the development of the baby. A pregnant woman who drinks any amount of alcohol is at risk, since a "safe" level of alcohol ingestion during pregnancy has not been established. However, larger amounts appear to cause increased problems. Multiple birth defects associated with "classical" fetal alcohol syndrome are more commonly associated with heavy alcohol use or alcoholism. Fetal alcohol syndrome consists of the following abnormalities: * Intrauterine growth retardation: growth deficiency in the fetus and newborn in all parameters -- head circumference, weight, height) * Delayed development with decreased mental functioning (mild to severe) * Facial abnormalities including small head; small upper jaw; short, up-turned nose; groove in upper lip; smooth and thin upper lip; and narrow, small, and unusual-appearing eyes with prominent epicanthal folds * Heart defects * Limb abnormalities of joints, hands, feet, fingers, and toes

Fire
Crack and methamphetamine; to inject a drug

Fire Safety
Fire Safety-In the event of a fire, remember time is the biggest enemy and every second counts! Escape first, then call for help. Develop a home fire escape plan and designate a meeting place outside. Make sure everyone in the family knows two ways to escape from every room. Practice feeling your way out with your eyes closed. Never stand up in a fire, always crawl low under the smoke and try to keep your mouth covered. Never return to a burning building for any reason; it may cost you your life. Finally, having a working smoke alarm dramatically increases your chances of surviving a fire. And remember to practice a home escape plan frequently with your family. In less than 30 seconds a small flame can get completely out of control and turn into a major fire. It only takes minutes for thick black smoke to fill a house. In minutes, a house can be engulfed in flames. Most fires occur in the home when people are asleep. If you wake up to a fire, you won't have time to grab valuables because fire spreads too quickly and the smoke is too thick. There is only time to escape. A fire's heat alone can kill. Room temperatures in a fire can be 100 degrees at floor level and rise to 600 degrees at eye level. Inhaling this super hot air will scorch your lungs. This heat can melt clothes to your skin. In five minutes a room can get so hot that everything in it ignites at once: this is called flashover. Fire starts bright, but quickly produces black smoke and complete darkness. If you wake up to a fire you may be blinded, disoriented and unable to find your way around the home you've lived in for years. Fire uses up the oxygen you need and produces smoke and poisonous gases that kill. Breathing even small amounts of smoke and toxic gases can make you drowsy, disoriented and short of breath. The odorless, colorless fumes can lull you into a deep sleep before the flames reach your door. You may not wake up in time to escape.

Firewall
a secure way of setting up a computer network so that users 'outside' the firewall cannot gain access. For example ABC Company may have an internal information system (sometimes called an intranet) that everyone in the company can use to communicate, but no one outside the company can access it because of the ABC's firewall.

First Aid
First Aid-Know CPR and/or first aid techniques. Post emergency numbers near the telephone. Know how and when to call 911 or other emergency numbers. Keep a first aid kit available.

Five-way
Combines snorting of heroin, cocaine, methamphetamine, ground up flunitrazepam pills, and drinking alcohol

The five way
Heroin plus cocaine plus methamphetamine plus Rohypnol (flunitrazepam) plus alcohol

Flexible Work
Denotes a range of working practices defined by employers and documented in employment policies. Flexible work policies give employees latitude as to how work will get done. Examples are flexible hours (the policy states a minimum number of hours to be worked and parameters for when those hours can be); flexible work location (various permissible work locations are defined); and flexible work contracts (for example the employee's role may vary within defined parameters).

Folic Acid
Folic Acid is a water-soluble vitamin of the B-complex group (B9). Folic acid acts as a coenzyme (with vitamin B-12 and vitamin C) in the breakdown (metabolism) of proteins and in the synthesis of new proteins. It is necessary for the production of red blood cells and the synthesis of DNA (which controls heredity), as well as tissue growth and cell function. It also increases the appetite and stimulates the formation of digestive acids. Synthetic folic acid supplements may be used in the treatment of disorders associated with folic acid deficiency, and may also be part of the recommended treatment for certain menstrual problems and leg ulcers. Food sources of folic acid include: beans and legumes, citrus fruits and juices, wheat bran and other whole grains, dark green leafy vegetables, poultry, pork, shellfish, and liver.

Food Safety
Refers to the conditions and practices that preserve the quality of food to prevent contamination and food-borne illnesses. Proper handling and preparation of food greatly reduces the risks of getting foodborne illnesses. Food can be contaminated in many different ways -- during the packaging process, by inadequate cooking or storage. Different food products may already have different microorganisms such as bacteria or parasites which may be allowed to multiply and cause disease if food is not appropriately handled. Higher risk foods include red meats and poultry; eggs; cheese and dairy products; raw sprouts; and raw