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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: Hamadyk, Jill; Gardiner, Karen
    Reference Type: Report
    Year: 2019

    This brief summarizes the experiences of leaders and staff from eight career pathways programs that participated in the Pathways for Advancing Careers and Education (PACE) Evaluation. Based on firsthand accounts, the brief describes how staff perceived the benefits of participating in the randomized controlled trial (RCT) evaluation, the challenges they experienced—in particular recruiting study participants and implementing its random assignment procedures—and how they overcame challenges. The brief then describes lessons staff learned from participating in PACE. The insights presented below will be helpful for future evaluation teams as they approach potential study sites, as well as for programs considering participating in a rigorous evaluation. (Edited author introduction)

     

    This brief summarizes the experiences of leaders and staff from eight career pathways programs that participated in the Pathways for Advancing Careers and Education (PACE) Evaluation. Based on firsthand accounts, the brief describes how staff perceived the benefits of participating in the randomized controlled trial (RCT) evaluation, the challenges they experienced—in particular recruiting study participants and implementing its random assignment procedures—and how they overcame challenges. The brief then describes lessons staff learned from participating in PACE. The insights presented below will be helpful for future evaluation teams as they approach potential study sites, as well as for programs considering participating in a rigorous evaluation. (Edited author introduction)

     

  • Individual Author: Edin, Kathryn; Nelson, Timothy J.; Butler, Rachel; Francis, Robert
    Reference Type: Journal Article
    Year: 2019

    U.S. children are more likely to live apart from a biological parent than at any time in history. Although the Child Support Enforcement system has tremendous reach, its policies have not kept pace with significant economic, demographic, and cultural changes. Narrative analysis of in-depth interviews with 429 low-income noncustodial fathers suggests that the system faces a crisis of legitimacy. Visualization of language used to describe all forms child support show that the formal system is considered punitive and to lead to a loss of power and autonomy. Further, it is not associated with coparenting or the father–child bond—themes closely associated with informal and in-kind support. Rather than stoking men’s identities as providers, the system becomes “just another bill to pay.” Orders must be sustainable, all fathers should have coparenting agreements, and alternative forms of support should count toward fathers’ obligations. Recovery of government welfare costs should be eliminated. (Author abstract)

    U.S. children are more likely to live apart from a biological parent than at any time in history. Although the Child Support Enforcement system has tremendous reach, its policies have not kept pace with significant economic, demographic, and cultural changes. Narrative analysis of in-depth interviews with 429 low-income noncustodial fathers suggests that the system faces a crisis of legitimacy. Visualization of language used to describe all forms child support show that the formal system is considered punitive and to lead to a loss of power and autonomy. Further, it is not associated with coparenting or the father–child bond—themes closely associated with informal and in-kind support. Rather than stoking men’s identities as providers, the system becomes “just another bill to pay.” Orders must be sustainable, all fathers should have coparenting agreements, and alternative forms of support should count toward fathers’ obligations. Recovery of government welfare costs should be eliminated. (Author abstract)

  • Individual Author: Farrell, Mary; Morrison, Carly
    Reference Type: Report
    Year: 2019

    The Behavioral Interventions for Child Support Services (BICS) project aims to improve federally funded child support services by increasing program efficiency, developing interventions informed by behavioral science, and building a culture of rapid-cycle evaluation. The Texas Office of the Attorney General (OAG) and the BICS team developed an intervention designed to increase the percentage of employed parents who made payments during the first months after an order was established. The intervention, called Start Smart, was designed to inform parents about the likely delay in income withholding and to help them plan to make payments during that time. Start Smart used strategies from behavioral science to clarify the process and encourage parents to make required payments. Start Smart was implemented in four regions of Texas: Amarillo, Dallas, El Paso, and Paris/Tyler.

    Start Smart increased the percentage of parents who made payments in the first month after an order was established by 4.9 percentage points, from 56.5 percent to 61.4 percent. This difference is...

    The Behavioral Interventions for Child Support Services (BICS) project aims to improve federally funded child support services by increasing program efficiency, developing interventions informed by behavioral science, and building a culture of rapid-cycle evaluation. The Texas Office of the Attorney General (OAG) and the BICS team developed an intervention designed to increase the percentage of employed parents who made payments during the first months after an order was established. The intervention, called Start Smart, was designed to inform parents about the likely delay in income withholding and to help them plan to make payments during that time. Start Smart used strategies from behavioral science to clarify the process and encourage parents to make required payments. Start Smart was implemented in four regions of Texas: Amarillo, Dallas, El Paso, and Paris/Tyler.

    Start Smart increased the percentage of parents who made payments in the first month after an order was established by 4.9 percentage points, from 56.5 percent to 61.4 percent. This difference is statistically significant at the 10 percent level (which suggests that it is due to the Start Smart intervention rather than random chance), and represents a 9 percent increase in payments made during the first month. Start Smart did not produce statistically significant differences in payments made in the second or third month. (Edited author overview)

  • Individual Author: Moore, Quinn ; Avellar, Sarah; Covington, Reginald; Wu, April; Patnaik, Ankita
    Reference Type: Report
    Year: 2019

    Research shows that parents and children tend to fare better on a range of outcomes when they live in low-conflict, two-parent families. Recognizing the potential benefits of healthy relationships for low-income families, Congress has funded three rounds of grants for Healthy Marriage (HM) programs since 2006. The Office of Family Assistance (OFA), in the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services awards and oversees the grants, which aim to promote the well-being and long-term success of children and families by fostering parents’ relationship stability and economic well-being. To learn more about the effectiveness of HM programs, OFA funded, and ACF’s Office of Planning, Research, and Evaluation oversaw, a contract with Mathematica Policy Research to conduct the multicomponent Parents and Children Together (PACT) evaluation. This evaluation included a large-scale, random assignment examination of two federally funded HM programs serving low-income couples that received grants in 2011. This brief presents the impacts of...

    Research shows that parents and children tend to fare better on a range of outcomes when they live in low-conflict, two-parent families. Recognizing the potential benefits of healthy relationships for low-income families, Congress has funded three rounds of grants for Healthy Marriage (HM) programs since 2006. The Office of Family Assistance (OFA), in the Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services awards and oversees the grants, which aim to promote the well-being and long-term success of children and families by fostering parents’ relationship stability and economic well-being. To learn more about the effectiveness of HM programs, OFA funded, and ACF’s Office of Planning, Research, and Evaluation oversaw, a contract with Mathematica Policy Research to conduct the multicomponent Parents and Children Together (PACT) evaluation. This evaluation included a large-scale, random assignment examination of two federally funded HM programs serving low-income couples that received grants in 2011. This brief presents the impacts of these programs about one year after study enrollment on:

    1. the status and quality of the couples’ relationships
    2. the co-parenting relationships
    3. job and career advancement

    (Excerpt from introduction) 

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