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The SSRC Library allows visitors to access materials related to self-sufficiency programs, practice and research. Visitors can view common search terms, conduct a keyword search or create a custom search using any combination of the filters at the left side of this page. To conduct a keyword search, type a term or combination of terms into the search box below, select whether you want to search the exact phrase or the words in any order, and click on the blue button to the right of the search box to view relevant results.

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  • Individual Author: Zogg, Cheryl K.; Scott, John W.; Metcalfe, David; Gluck, Abbe R.; Curfman, Gregory D.; Davis, Kimberly A.; Dimick, Justin B.; Haider, Adil H.
    Reference Type: Journal Article
    Year: 2019

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado,...

    Importance Trauma is a leading cause of death and disability for patients of all ages, many of whom are also among the most likely to be uninsured. Passage of the Patient Protection and Affordable Care Act was intended to improve access to care through improvements in insurance. However, despite nationally reported changes in the payer mix of patients, the extent of the law’s impact on insurance coverage among trauma patients is unknown, as is its success in improving trauma outcomes and promoting increased access to rehabilitation.

    Objective To use rigorous quasi-experimental regression techniques to assess the extent of changes in insurance coverage, outcomes, and discharge to rehabilitation among adult trauma patients before and after Medicaid expansion and implementation of the remainder of the Patient Protection and Affordable Care Act.

    Design, Setting, and Participants Quasi-experimental, difference-in-difference analysis assessed adult trauma in patients aged 19 to 64 years in 5 Medicaid expansion (Colorado, Illinois, Minnesota, New Jersey, and New Mexico) and 4 nonexpansion (Florida, Nebraska, North Carolina, and Texas) states.

    Interventions/Exposure Policy implementation in January 2014.

    Main Outcomes and Measures Changes in insurance coverage, outcomes (mortality, morbidity, failure to rescue, and length of stay), and discharge to rehabilitation.

    Results A total of 283 878 patients from Medicaid expansion states and 285 851 patients from nonexpansion states were included (mean age [SD], 41.9 [14.1] years; 206 698 [36.3%] women). Adults with injuries in expansion states experienced a 13.7 percentage point increase in discharge to rehabilitation (95% CI, 7.0-7.8; baseline: 14.7%) that persisted across inpatient rehabilitation facilities (4.5 percentage points), home health agencies (2.9 percentage points), and skilled nursing facilities (1.0 percentage points). There was also a 2.6 percentage point drop in failure to rescue and a 0.84-day increase in length of stay. Rehabilitation changes were most pronounced among patients eligible for rehabilitation coverage under the 2-midnight (8.4 percentage points) and 60% (10.2 percentage points) Medicaid payment rules. Medicaid expansion increased rehabilitation access for patients with the most severe injuries and conditions requiring postdischarge care (eg, pelvic fracture). It mitigated race/ethnicity-, age-, and sex-based disparities in which patients use rehabilitation.

    Conclusions and relevance This multistate assessment demonstrated significant changes in insurance coverage and discharge to rehabilitation among adult trauma patients that were greater in Medicaid expansion than nonexpansion states. By targeting subgroups of the trauma population most likely to be uninsured, rehabilitation gains associated with Medicaid have the potential to improve survival and functional outcomes for more than 60 000 additional adult trauma patients nationally in expansion states. (Author abstract)

  • Individual Author: Schilling, Samantha ; Jamison, Shaundreal ; Wood, Charles ; Perrin, Eliana; Jansen Austin, Coby ; Sheridan, Juliet; Young, Allison ; Burchinal, Margaret ; Flower, Kori B.
    Reference Type: Journal Article
    Year: 2019

    In 2014, Family Success Alliance (FSA) was formed as a place-based initiative to build a pipeline of programs to reduce the impact of poverty on outcomes for children living in Orange County, North Carolina. In this study, FSA parents’ perception of child health, parent and child adverse childhood experiences (ACEs), and resilience were obtained by parent interview. Receipt of recommended health services were abstracted from primary care medical records of FSA children. Correlation coefficients investigated relationships among health, ACEs, and resilience. Among 87 parent-child dyads, 65% were Spanish speaking. At least 1 of the 7 ACEs measured was reported in 37% of children and 70% of parents. Parent perceptions of child health were lower than national averages. Routine preventive services included the following: autism screening at 18 months (15%) and 24 months (31%); ≥4 fluoride varnish applications (10%); lead screening (66%); and receipt of immunizations (94%). Parent perception of child health was moderately correlated with resilience. (Author abstract)

    In 2014, Family Success Alliance (FSA) was formed as a place-based initiative to build a pipeline of programs to reduce the impact of poverty on outcomes for children living in Orange County, North Carolina. In this study, FSA parents’ perception of child health, parent and child adverse childhood experiences (ACEs), and resilience were obtained by parent interview. Receipt of recommended health services were abstracted from primary care medical records of FSA children. Correlation coefficients investigated relationships among health, ACEs, and resilience. Among 87 parent-child dyads, 65% were Spanish speaking. At least 1 of the 7 ACEs measured was reported in 37% of children and 70% of parents. Parent perceptions of child health were lower than national averages. Routine preventive services included the following: autism screening at 18 months (15%) and 24 months (31%); ≥4 fluoride varnish applications (10%); lead screening (66%); and receipt of immunizations (94%). Parent perception of child health was moderately correlated with resilience. (Author abstract)

  • Individual Author: Levy, Diane K. ; Edmonds, Leiha; Simington, Jasmine
    Reference Type: Report
    Year: 2018

    This brief presents information on work requirement policies implemented by public housing agencies and estimates the percent of households affected by the requirements. Noting the lack of evidence on the outcomes and effects of work requirements on households’ employment and income and on the agencies’ implementation costs, it closes with questions to guide future research and policy considerations. (Author abstract) 

    This brief presents information on work requirement policies implemented by public housing agencies and estimates the percent of households affected by the requirements. Noting the lack of evidence on the outcomes and effects of work requirements on households’ employment and income and on the agencies’ implementation costs, it closes with questions to guide future research and policy considerations. (Author abstract) 

  • Individual Author: Radel, Laura; Baldwin, Melinda; Crouse, Gilbert; Ghertner, Robin; Waters, Annette
    Reference Type: Report
    Year: 2018

    This study examined the relationship between parental substance misuse and child welfare caseloads, which began rising in 2012 after more than a decade of decline. We examined county level variation in both phenomena and qualitative interviews documented the perspectives and experiences of local professionals in the child welfare agency, substance use disorder treatment programs, family courts, and other community partners in 11 communities across the country. Results describe how the child welfare system interacts with community partners to serve an increasing population of parents whose substance use has impaired their parenting and placed their children at risk. (Author abstract) 

    This study examined the relationship between parental substance misuse and child welfare caseloads, which began rising in 2012 after more than a decade of decline. We examined county level variation in both phenomena and qualitative interviews documented the perspectives and experiences of local professionals in the child welfare agency, substance use disorder treatment programs, family courts, and other community partners in 11 communities across the country. Results describe how the child welfare system interacts with community partners to serve an increasing population of parents whose substance use has impaired their parenting and placed their children at risk. (Author abstract) 

  • Individual Author: Hahn, Heather; Rohacek, Monica; Isaacs, Julia
    Reference Type: Report
    Year: 2018

    Child care subsidies are critical for the well-being of low-income families, including parents’ economic success and children’s development. To inform state efforts to simplify access to child care subsidies and improve service delivery, this report highlights steps taken and lessons learned by five states that participated in the Work Support Strategies initiative between 2012 and 2015. These states worked to improve child care subsidy access and retention, efficiency of service delivery, quality of client service, and alignment with other benefit programs. The report also discusses the implications of these findings for implementation of the reauthorized Child Care and Development Fund. (Author abstract)

    Child care subsidies are critical for the well-being of low-income families, including parents’ economic success and children’s development. To inform state efforts to simplify access to child care subsidies and improve service delivery, this report highlights steps taken and lessons learned by five states that participated in the Work Support Strategies initiative between 2012 and 2015. These states worked to improve child care subsidy access and retention, efficiency of service delivery, quality of client service, and alignment with other benefit programs. The report also discusses the implications of these findings for implementation of the reauthorized Child Care and Development Fund. (Author abstract)

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