Background: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to t... more Background: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served. Methods: We developed a survey using the Consolidated Framework of Implementation to determine schools’ implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served. Results: Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation wer...
This report is a summary of select research on the blocked opportunities and oppressive burden th... more This report is a summary of select research on the blocked opportunities and oppressive burden that young men of color experience. The authors hope that these findings fuel action by our government leaders, policy makers, advocacy and provider organizations and communities. In addition, this report highlights select promising policy and programmatic interventions that could provide steps to address the serious inequities that appear to be fueling the accumulating number of young men of color whose lives are cut short by violence or diminished by lack of opportunities, resources and supports
Background Pregnancy and postpartum periods represent critical times to support nutrition and hou... more Background Pregnancy and postpartum periods represent critical times to support nutrition and household food security, especially for families with limited or strained economic resources. The Fresh Rx: Nourishing Healthy Starts study uses a randomized design to examine a comprehensive, holistic “food is medicine” program targeting food insecure expectant mothers in an area with high rates of inequitable adverse maternal and birth outcomes. Participants receive weekly fresh food deliveries from a Combined Community Supported Agriculture partner, cooking and nutrition supports, access to culinary skills education from a trained chef, and counseling and care management. In addition to providing basic cooking tools and pantry staples, the program links participants with locally available community resources and federal food assistance programs such as the Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children. Design and met...
New York State has one of the most richly funded Medicaid programs in the United States. In an ef... more New York State has one of the most richly funded Medicaid programs in the United States. In an effort to achieve the triple aim New York State is undergoing a significant redesign of its Medicaid program including transitioning nearly all Medicaid funded behavioral health services into Medicaid managed care. In preparation for this transition, a state funded technical assistance center assessed the behavioral health care system’s readiness to undergo this reform across 11 domains. Between September and November, 2014, the TA center electronically distributed a readiness survey to 897 mental health and substance abuse agencies: 313 (n = 269, 33%) organizations completed the assessment. As a whole, the sample felt partially ready to transition; analysis by domain revealed agencies were most ready to interface with managed care providers, and least ready to collect and evaluate outcome data. Significant differences in readiness were found depending by organizational characteristics (number of programs, licensure, and region). In anticipation of large-scale reforms, states would benefit from an initial needs assessment to identify gaps in knowledge and skills, which in turn, can then guide preparatory efforts and provide needed supports to facilitate major changes in service delivery and billing.
Journal of Housing and the Built Environment, 2019
Housing access and the built environment are both recognized as significant social determinants o... more Housing access and the built environment are both recognized as significant social determinants of health. Numerous studies and articles detail housing-based interventions that result in improved health outcomes. However, less is known about potential financial impacts and which programs and initiatives not only improve health but also generate return on investment (ROI). Through a systematic literature review, the authors identified evidence regarding the economic benefits of housing interventions aimed at improving health, using ROI as a measure of program success. Specifically, housing interventions that are aimed at childhood asthma, HIV, chronic illness among the homeless, and urban blight have demonstrated a positive ROI ranging from 30 to 480%, with most cost savings attributed to meaningful reductions in hospitalizations and emergency department visits.
Journal of Insurance and Financial Management, 2022
While supports for people with disabilities have increased, significant healthcare and financial ... more While supports for people with disabilities have increased, significant healthcare and financial barriers persist. Stateadministered Medicaid Buy-In programs for working people with disabilities, distinct from broader buy-in discussions that have emerged as some states consider expanding access to health insurance, are intended to incentivize employment and protect against a loss of Long-Term Services and Supports. Loss of these services would be detrimental to a person's ability to access daily living and workforce participation supporting services. This paper explores identified drivers of and barriers to participation, outcomes, and the current state of programs that are currently in place. Authors conducted a systematic literature search to identify evidence published in peer-review journals. Additionally, a policy scan using information from government sources for the 45 stateadministered buy-in programs was completed. The results indicate that state Medicaid Buy-In programs vary dramatically in their construction and presentation, with eligibility and administration information or lack thereof having the potential to significantly affect a person's decision making around benefit enrollment and employment. Findings are discussed in the context of additional recent state and federal policy efforts to improve outcomes around employment, income, and asset generation for people with disabilities.
School meals provide significant access to food and nutrition for children and adolescents, parti... more School meals provide significant access to food and nutrition for children and adolescents, particularly through universal free meal mechanisms. Alongside added nutritional meal requirements under the Healthy, Hunger-Free Kids Act (2010), schools can utilize meal program and policy mechanisms such as the Community Eligibility Provision (CEP) and Breakfast after the Bell (BATB) to increase participation. This study examines longitudinal statewide school-level CEP and BATB adoption and estimates the impact on increased free and reduced-price (FRP) breakfast participation. We find that FRP breakfast participation increased for schools that utilize both CEP and BATB (14-percentage-point increase) and that CEP-participating schools are more likely to use BATB approaches such as breakfast in the classroom, grab-and-go carts, and second-chance breakfast. Additionally, using a conditional Difference-in-Differences (DiD) approach, we find that BATB adoption accounted for a 1.4-percentage-poi...
Abstract: In the wake of COVID-19, universities and schools of social work face unprecedented cha... more Abstract: In the wake of COVID-19, universities and schools of social work face unprecedented challenges and uncertainty in aligning their academic models with public heath protocols and best practices, while prioritizing the safety and well-being of their students. In order to best respond to these challenges and uncertainty, more research is needed to advance a greater understanding of (1) what challenges students face, (2) who is most at risk and impacted by these challenges, and (3) how universities can best support students. Through a survey administered during the spring 2020 semester at a large research university in the Midwest, we explored the attitudes, experiences, and needs of graduate students in social work, public health, and social policy programs. We observed notable disparities by race and ethnicity, international student status, first-generation student status, and gender. Additionally, our survey results suggest that protective factors, such as university and soc...
International Journal of Environmental Research and Public Health
SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited ... more SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students—especially those in low-income households—lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the “supply” (meal access points) and the “demand” (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the earl...
Background: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to t... more Background: In 2018, the United States Department of Agriculture (USDA) issued flexibilities to the National School Lunch and Breakfast Programs, relaxing the nutrition standards for milk, whole grains, and sodium. This study examines the implementation decision-making among Missouri school food services and the impact of implementing these flexibilities on the meals served. Methods: We developed a survey using the Consolidated Framework of Implementation to determine schools’ implementation of the flexibilities and factors related to implementation. To determine how the implementation of flexibilities affected participation, we merged the survey results with school-level meal county data from the Missouri Department of Elementary and Secondary Education. We used ordinary least squares regression to examine how flexibility adoption related to the number of meals served. Results: Most schools implemented the wheat, milk, and sodium flexibilities. Common reasons for implementation wer...
This report is a summary of select research on the blocked opportunities and oppressive burden th... more This report is a summary of select research on the blocked opportunities and oppressive burden that young men of color experience. The authors hope that these findings fuel action by our government leaders, policy makers, advocacy and provider organizations and communities. In addition, this report highlights select promising policy and programmatic interventions that could provide steps to address the serious inequities that appear to be fueling the accumulating number of young men of color whose lives are cut short by violence or diminished by lack of opportunities, resources and supports
Background Pregnancy and postpartum periods represent critical times to support nutrition and hou... more Background Pregnancy and postpartum periods represent critical times to support nutrition and household food security, especially for families with limited or strained economic resources. The Fresh Rx: Nourishing Healthy Starts study uses a randomized design to examine a comprehensive, holistic “food is medicine” program targeting food insecure expectant mothers in an area with high rates of inequitable adverse maternal and birth outcomes. Participants receive weekly fresh food deliveries from a Combined Community Supported Agriculture partner, cooking and nutrition supports, access to culinary skills education from a trained chef, and counseling and care management. In addition to providing basic cooking tools and pantry staples, the program links participants with locally available community resources and federal food assistance programs such as the Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children. Design and met...
New York State has one of the most richly funded Medicaid programs in the United States. In an ef... more New York State has one of the most richly funded Medicaid programs in the United States. In an effort to achieve the triple aim New York State is undergoing a significant redesign of its Medicaid program including transitioning nearly all Medicaid funded behavioral health services into Medicaid managed care. In preparation for this transition, a state funded technical assistance center assessed the behavioral health care system’s readiness to undergo this reform across 11 domains. Between September and November, 2014, the TA center electronically distributed a readiness survey to 897 mental health and substance abuse agencies: 313 (n = 269, 33%) organizations completed the assessment. As a whole, the sample felt partially ready to transition; analysis by domain revealed agencies were most ready to interface with managed care providers, and least ready to collect and evaluate outcome data. Significant differences in readiness were found depending by organizational characteristics (number of programs, licensure, and region). In anticipation of large-scale reforms, states would benefit from an initial needs assessment to identify gaps in knowledge and skills, which in turn, can then guide preparatory efforts and provide needed supports to facilitate major changes in service delivery and billing.
Journal of Housing and the Built Environment, 2019
Housing access and the built environment are both recognized as significant social determinants o... more Housing access and the built environment are both recognized as significant social determinants of health. Numerous studies and articles detail housing-based interventions that result in improved health outcomes. However, less is known about potential financial impacts and which programs and initiatives not only improve health but also generate return on investment (ROI). Through a systematic literature review, the authors identified evidence regarding the economic benefits of housing interventions aimed at improving health, using ROI as a measure of program success. Specifically, housing interventions that are aimed at childhood asthma, HIV, chronic illness among the homeless, and urban blight have demonstrated a positive ROI ranging from 30 to 480%, with most cost savings attributed to meaningful reductions in hospitalizations and emergency department visits.
Journal of Insurance and Financial Management, 2022
While supports for people with disabilities have increased, significant healthcare and financial ... more While supports for people with disabilities have increased, significant healthcare and financial barriers persist. Stateadministered Medicaid Buy-In programs for working people with disabilities, distinct from broader buy-in discussions that have emerged as some states consider expanding access to health insurance, are intended to incentivize employment and protect against a loss of Long-Term Services and Supports. Loss of these services would be detrimental to a person's ability to access daily living and workforce participation supporting services. This paper explores identified drivers of and barriers to participation, outcomes, and the current state of programs that are currently in place. Authors conducted a systematic literature search to identify evidence published in peer-review journals. Additionally, a policy scan using information from government sources for the 45 stateadministered buy-in programs was completed. The results indicate that state Medicaid Buy-In programs vary dramatically in their construction and presentation, with eligibility and administration information or lack thereof having the potential to significantly affect a person's decision making around benefit enrollment and employment. Findings are discussed in the context of additional recent state and federal policy efforts to improve outcomes around employment, income, and asset generation for people with disabilities.
School meals provide significant access to food and nutrition for children and adolescents, parti... more School meals provide significant access to food and nutrition for children and adolescents, particularly through universal free meal mechanisms. Alongside added nutritional meal requirements under the Healthy, Hunger-Free Kids Act (2010), schools can utilize meal program and policy mechanisms such as the Community Eligibility Provision (CEP) and Breakfast after the Bell (BATB) to increase participation. This study examines longitudinal statewide school-level CEP and BATB adoption and estimates the impact on increased free and reduced-price (FRP) breakfast participation. We find that FRP breakfast participation increased for schools that utilize both CEP and BATB (14-percentage-point increase) and that CEP-participating schools are more likely to use BATB approaches such as breakfast in the classroom, grab-and-go carts, and second-chance breakfast. Additionally, using a conditional Difference-in-Differences (DiD) approach, we find that BATB adoption accounted for a 1.4-percentage-poi...
Abstract: In the wake of COVID-19, universities and schools of social work face unprecedented cha... more Abstract: In the wake of COVID-19, universities and schools of social work face unprecedented challenges and uncertainty in aligning their academic models with public heath protocols and best practices, while prioritizing the safety and well-being of their students. In order to best respond to these challenges and uncertainty, more research is needed to advance a greater understanding of (1) what challenges students face, (2) who is most at risk and impacted by these challenges, and (3) how universities can best support students. Through a survey administered during the spring 2020 semester at a large research university in the Midwest, we explored the attitudes, experiences, and needs of graduate students in social work, public health, and social policy programs. We observed notable disparities by race and ethnicity, international student status, first-generation student status, and gender. Additionally, our survey results suggest that protective factors, such as university and soc...
International Journal of Environmental Research and Public Health
SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited ... more SARS-CoV-2 (COVID-19) resulted in school closures and contingencies across the U.S. that limited access to school meals for students. While some schools attempted to provide alternative meal access points where students or parents could pick up meals, many students—especially those in low-income households—lacked adequate transportation to these access points. Thus, physical proximity to meal access points was particularly important during the pandemic. In this study, we explore how school meal access changed during the COVID-19 pandemic, especially as it relates to race/ethnicity and socio-economic status. Taking into account both the “supply” (meal access points) and the “demand” (low-income students) for free meals, we employed a two-step floating catchment area analysis to compare meal accessibility in St. Louis, Missouri before and during the pandemic in the spring and summer of 2019 and 2020. Overall, while school meal access decreased during the spring of 2020 during the earl...
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