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The North Carolina Institute of Medicine Task Force on Behavioral Health Services for the Military and Their Families examined the adequacy of Medicaid- and state-funded services for mental health conditions, developmental disabilities (including traumatic brain injury), and substance abuse that are currently available in North Carolina to military service members, veterans, and their families. The task force determined that there are several gaps in services and made 13 recommendations related to federal, state, and local community resources. This article reviews the work of the task force and current efforts to improve services in North Carolina. Language: en

Robbie is a 24-year old living in Albemarle, North Carolina at Carolina Farms. He has his own bedroom, a roommate, an active social life, and he helps around the farm by working in a garden and feeding the animals. He has his own computer, DVD player, Wii, and every week he gets to enjoy social outings with other individuals living at Carolina Farms. They go to the movies, roller skate, dance, and out to eat at local restaurants. With the amount of independence and level of flexibility over his schedule, one would never guess that Robbie lives in a community built for individuals with autism. Carolina Farms is a facility that allows individuals with autism to live and work independently on a beautiful farm. However, Robbie did not always have the opportunity of living at Carolina Farms. This is actually the third residential facility that he’s been in over the past six years. During his first stays at residential facilities, he had five and six roommates living under one roof. Unfortunately, having so many roommates aggravated Robbie’s aggressive behavior. Living in the group homes, he would have four or five episodes a day, but now at Carolina Farms, he has not experienced an episode in two years. Transitioning Robbie out of his group home, which was operated by a nonprofit organization providing residential and day care services for individuals with autism, required countless hours and a number of case managers. Moving Robbie involved the nonprofit residential center communicating with the Murdoch Center (an intermediate care facility that is one of North Carolina’s four state-run developmental centers) and the apartment supervised program at Carolina Farms. It took almost a year for the Murdoch Center to work with the Local Management Entity (LME) to get Robbie transferred over to Carolina Farms. Robbie’s mother now says, “I’m proud of this transition. It was not easy to do and it took a lot time and cooperation between the LME, the Murdoch Center, the local residential nonprofit, and Carolina Farms—but it has been worth it. I knew he needed to be in a smaller group home at some point; Carolina Farms was a good opportunity. For any parent who has a child with a disability, start planning for their adulthood as early as possible. Things surprise you, and you turn around and your child is 14, then 18. I think it’s important for children to grow up and live in a different community than their parents.”

N C Med J May/June 2008, Volume 69, Number 3 n the middle of the last century, chronic diseases overtook communicable diseases as the leading causes of death in the United States. Public health campaigns and the scientific community have responded and developed national strategies to prevent and cure diseases including cancer, diabetes, HIV/AIDS, and hypertension. While the morbidity and mortality resulting from these diseases warrant this attention, other equally serious chronic diseases unfortunately receive less attention. One of these conditions is chronic kidney disease (CKD). Death from kidney failure, the most severe form of CKD, is more common than many of the most prevalent forms of cancer. (See Figure 1.) Chronic kidney disease encompasses various levels of kidney damage ranging from a relatively asymptomatic decline in kidney function to kidney failure. Chronic kidney disease, in all its stages, is estimated to affect 13% of the United States population. In North Carolina alone, almost 1 million people have CKD not including those with kidney failure. Despite the large number of people living with CKD, there is an overall lack of knowledge about the disease even among people who have it. Nationally, only about 25% of Americans diagnosed with CKD reported awareness of weak or failing kidneys. Among the general population, there is even less awareness. Preliminary data from a University of North Carolina at Chapel Hill (UNC) Kidney Center study shows that many people are unfamiliar with the risk factors for CKD. The combination of high disease burden and low public awareness warranted an in-depth study of how North Carolina can best act to lower the CKD disease burden in the future. In 2006 the North Carolina General Assembly asked the North Carolina Institute of Medicine to convene a task force to study chronic kidney disease (Session Law 2006-248). The task force was funded by the state of North Carolina through its annual appropriation to the North Carolina Institute of Medicine. Marcus Plescia, MD, MPH, chief of the Chronic