Federally-funded Program Research Articles

Impact of the COVID-19 Pandemic on Early Intervention Services Use Among Children with Developmental Disabilities

Early Intervention (EI) is a federally-funded program that provides therapies for children with developmental delays. Due to the COVID-19 pandemic and lockdown restrictions in Philadelphia in 2020, these services made a rapid change to virtual service delivery. We sought to explore the experiences of families in accessing online therapy. We recruited families to participate in a mixed methods study in order to evaluate changes in the initiation and use of EI services pre- and post-pandemic lockdown. Of the 94 who completed surveys, 27 families were purposively sampled for semi-structured telephonic interviews to identify their perceptions of program assistance and needs. Themes developed from these interviews included participant satisfaction with the communication of program changes and concerns related to the effectiveness of virtual EI services. This information can be used in plans for transitioning to hybrid therapy as well as for future pandemics requiring a return to fully virtual services.

Testing for COVID-19 Using a Mobile Clinic Approach: A Collaborative Approach Focused on Underserved and At-Risk Populations in Louisville Kentucky

Testing for COVID-19 is an essential component of pandemic response, but equitable access across the communities has been a challenge due to failure of federally-funded programs to reach areas of greatest need. A partnership between the Louisville Metro Department of Public Health and Wellness, the Kentucky Nurses Association, and community leaders helped enable and facilitate a novel, community-based approach. Using a core of trained nurses and a larger group of volunteers, a mobile testing clinic process was developed and implemented in Louisville, Kentucky. From November 11, 2020 through June 30, 2022, 187 mobile testing clinics were held at 26 unique sites with 9337 tests performed. Sites focused on areas of Louisville where poverty density is the greatest, where recognized outbreaks occurred, and where community partners requested testing access. Fourteen nurse team leaders and more than 750 volunteers supported these efforts which were largely funded by existing resources. Standard Operating Procedures were developed to enable standardized training and activities across all clinics. The result is a process that has continued and has formed the basis for mobile vaccination clinics using many of the same processes.

VARIATION AND CONSISTENCY IN ALLOCATION OF HCBS: MASSACHUSETTS AGING SERVICES ACCESS POINTS

Abstract Massachusetts’ 27 Aging Services Access Points (ASAPs) are nonprofit organizations responsible for guiding clients and families in their geographic service areas through a maze of financial and functional eligibility criteria to receive needed home and community-based services (HCBS). These services aim to sustain function and promote engagement for older adults and persons with disabilities, and to maintain individuals in the community rather than in residential settings. Payment for HCBS flows from numerous state and Federal funding programs, including but not limited to state Medicaid waivers and Older American Act programs. We conducted semi-structured interviews with 10 ASAP directors and gathered information from documentary sources to delineate the pathways to funded HCBS that these agencies open for clients. We identified variation in the 27 ASAPs’ contractual relationships with service providers. State data revealed variation in budgetary resources and area population characteristics. These nonprofit corporations appear to flexibly adapt to local conditions and needs. Understanding variation across ASAPs will support analysis of client data to examine whether ASAP processes result in different service outcomes for similar clients. Alternate payment models for health services (managed care, managed long-term services and supports, accountable care organizations) are broadening their reach, encouraging health systems to recognize the importance of functional supports and services. Some health systems are charging their own dedicated units with assigning HCBS to enrollees, avoiding the ASAPs. Understanding and modeling the allocation of services by the ASAPs will allow investigation of trends in services for persons with varying needs under various payment methods.

Community Engagement With Proactive Wildfire Management in British Columbia, Canada: Perceptions, Preferences, and Barriers to Action

Wildfires in the wildland-urban interface (WUI) are increasingly threatening lives and livelihoods. These growing impacts have prompted a paradigm shift toward proactive wildfire management that prioritizes prevention and preparedness instead of response. Despite this shift, many communities remain unprepared for wildfires in the WUI due to diverse individual and social-political factors influencing engagement with proactive management approaches. The catastrophic fire seasons of 2017, 2018, and 2021 in British Columbia (BC), Canada, highlighted just how vulnerable communities continue to be and the urgent need to understand the factors limiting engagement to future resilience to wildfire. Our study, conducted prior to the catastrophic fire season in 2017, surveyed 77 community leaders across BC to better understand the factors driving engagement, including risk perception, preferences and support for approaches, and key barriers limiting progress. We demonstrate that wildfire risk is an urgent issue facing communities across BC, but a range of factors drive variable community engagement with proactive wildfire management. First Nations and smaller (≤5,000 residents) communities were less likely to have developed a community wildfire plan, even though First Nations were significantly more concerned than municipalities/regional districts about certain values (such as drinking water and biodiversity) that were at risk from wildfire. In general, proactive approaches that were considered effective were also the most supported. The most highly supported approaches included enforcement of regulations and education, both of which are considered provincial responsibility in BC and are unlikely to alter community values in the WUI. In contrast, approaches involving prescribed burning of the understory had the highest levels of opposition. Despite variability in these individual factors, social-political barriers related to financial and social (time and expertise) capacity primarily limited engagement with proactive wildfire management, including provincial and federal funding programs. However, these barriers are not equally felt across community groups; First Nations identified social capacity (such as expertise on government-sponsored approaches and awareness of funding programs) as significantly more limiting than municipalities/regional districts. Our study illustrates the limitations of implementing a “shared responsibility” of proactive wildfire management in the WUI in BC without targeted supports to address unequal capacity barriers.

Green Renewable Power and Policy in Canada: A Just Energy Transition to Net-Zero

A just and sustainable future requires green renewable power. Net-zero by 2050 is the international goal to limit global warming to 1.5 degrees Celsius and sustain the biosphere. Green renewable energy, including wind, solar, biomass and small hydro is abundant in Canada, with potential to satisfy demand with 100% green renewables. This paper compares the renewable power landscape across Canada’s provinces considering four factors—electricity energy mix, renewable energy targets (RETs), renewable energy standard offer programs (RESOPs), feed-in tariff (FITs) or community FITs (comFITs). The provinces with green renewable energy sources typically have enabling policies of RESOP, RETs and FITS, as Prince Edward Island, Nova Scotia, Ontario and New Brunswick do. In contrast, provinces with abundant oil and gas or large-scale hydro are without pro-renewable energy policies, nor community power options, excepting green renewables in Indigenous communities due to federal funding programs. Community green renewable power projects, such as the “Indigenous off-diesel initiative”, are creating jobs, community revenue and energy sovereignty, towards just and inclusive energy in off-grid Indigenous communities. To reduce climate change, fast-tracking net-zero electricity by 2035 is recommended with the prioritization of community renewable energy by RESOPs, FITs and comFITs. For the transportation and other sectors, banning of all fossil fuels before 2040 is needed. Finally, a long-term plan to reduce the negative impacts of hydroelectricity water fluctuation is needed, considering decommissioning some dams.

Disparities in Dental Service Use Among Adult Populations in the United States

This paper aimed to examine disparities of dental service utilization for younger (20-49), middle-aged (50-64), and older adults (65+), among Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives (AIAN), and Native Hawaiian or other Pacific Islanders (NHOPI). Weighted logistic regression models were conducted to analyze nine waves of data (2002-2018) from the Behavioral Risk Factor Surveillance System. Results show that the all-wave average prevalence was 71% and racial/ethnic disparities increased with age. Black older adults had the lowest level of dental service utilization (65%), comparing to the two highest groups: White older adults (79%) and Asian older adults (76%). The younger adult populations had low prevalences with the lowest among Asians (65%). The AIAN and NHOPI all age groups tended to have average or below average prevalences. Health policy, federal funding, and community-based programs should address needs of dental service utilization for racial/ethnic minorities including Blacks, AIANs, and NHOPIs.

School-based health centers as a context to engage and serve communities.

School-based health centers (SBHCs) primarily serve underserved students and families through removing barriers to care. The number of SBHCs have increased dramatically with investments from state-funding and federal-funding programs, including expanded funding from the American Rescue Plan. This article reviews findings on the perceived importance of school and community partnership. It also provides a critical review of the evidence base on impact on health, mental health, and education indicators. Recent findings underscore the importance of SBHCs engaging the school and community to build trust while identifying and responding to needs. Engagement supports planning, implementing, and sustaining SBHCs. Studies of impact find that SBHCs increase participation in preventive and routine health and decrease emergency department utilization and hospitalization. However, additional research needs to rigorously test for effects of SBHCs on symptoms and indicators of wellbeing, especially with respect to mental health and education. SBHCs increase participation of students from marginalized groups in preventive and routine care. School and community engagement are vital aspects of SBHCs, likely removing barriers related to trust. Additional rigorous evidence is needed testing efficacy of SBHCs when it comes to improving health, mental health, and education.

Training a diverse workforce to address the opioid crisis

ABSTRACT This article describes an interprofessional workforce development program that aims to train current and future behavioral health professionals in culturally- and developmentally-appropriate, integrated care for adolescents and transitional-aged youth. This federally-funded program is implemented in one region in the United States because the location has a substantial shortage of providers. The program meets the local needs by training a diverse group of master-level graduate students and community partners on evidence-based practices for substance misuse, including opioid misuse, and common mental health conditions. This article includes recommendations on key aspects to include in behavioral health workforce development programs.

Monitoring vested health partnerships.

This article is based on the experience of the Public Health Agency of Canada Innovation Strategy (PHAC-IS) federal funding program in building Canadian population health partnerships. The PHAC-IS addressed complex public health issues by funding evidence-based population health interventions in communities across Canada. These interventions were multifaceted and required the development of diverse "vested" partners to sustain systemic impact. This article explores the key elements of a vested partnership that affect systems change, and how to monitor the effects and achievements of vested partnerships as greater than what individual partners can achieve on their own. Vested health partnerships have diverse partners that fit the system they are trying to change, a clear, public sectoral agenda, partner alignment, and pooling of both human and financial assets. A vested health partnership assumes strength in the diversity and governance of the partnership as well as in how it demonstrates collaborative systems change. It is important to monitor and measure both the partners and the synergy and collective impact of the partnership. Short-term reach may need to be compromised for the brokering required to establish broad vested partners. Alignment, vestedness, and outcome measurement seem linked since strong partners that grow and adapt together change the way each sees and monitors the solution. Sophisticated partnerships, like a murmuration of starlings, act inconcert to push learning andchange practices, policies and societal norms. Capturing the movement of the flock is as important as counting the birds.

Conceptualizing and Measuring the Promotion of Nonprofit Organizations’ Evidence Use by U.S. Social Service Funding Programs

Previous research on U.S. federal promotion of evidence-based programming has focused on evidence-based program registries and concludes their usefulness is undermined by prioritizing internal validity over external validity. This research explores how federal funding programs are actually promoting funded nonprofit organizations’ evidence use instead of what we might infer from registries alone. An inductively developed conceptual framework is applied to describe all 53 fiscal year (FY) 2019 social service funding programs that include nonprofit organizations among the eligible applicants, finding they promote multiple types of evidence use, with generally low coerciveness, and with applicants frequently co-determining what counts as evidence. These findings point to promotion of evidence use that balances evidence-driven prescriptiveness and enabling nonprofits’ innovation.

Methodology to design district heating systems with respect to local energy potentials, CO2-emission restrictions, and federal subsidies using oemof

To combine a variety of different heat generating technologies, static design methods will not be sufficient to design future heat supply systems. New energy system design approaches are being developed with consideration of fluctuating renewable energy sources, different subsidy measures, as well as CO2-emission reduction targets. The motive of this study is to develop a new methodology to design and optimise an energy system considering these constraints. The methodology is developed based on the Open Energy Modelling Framework (oemof) and applied on a sub-urban region in northern Germany. Local specifics of energy source potentials are taken into account. It adapts the boundary conditions of a German federal funding program for innovative heat supply networks “Heating Network Systems 4.0.” Federal funding restrictions of combined heat and power systems and self-consumption are also considered. An economic optimisation was conducted considering a variety of energy sources. Cost optimal energy system design was computed regarding investments costs, energy prices and annual CO2-emission restrictions. The integration of combined heat and power (CHP), photovoltaic (PV) and heat pump (HP) systems in combination with storage size optimisation can reduce CO2-emission of heat production by approx. 69% compared to the current state of heat production.

Disparities in Dental Service Use among Adult Populations in the United States.

This article aims to examine the disparities in dental service utilization among 3 age groups: younger adults (20-49 y), middle-aged adults (50-64 y), and older adults (65+ y), among Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives (AIAN), and Native Hawaiian or other Pacific Islanders (NHOPI). Weighted logistic regression models were conducted to analyze 9 waves of cross-sectional survey data (2002-2018) from the Behavioral Risk Factor Surveillance System. We estimated age group- and race/ethnic-specific prevalences of dental service utilization adjusting sociodemographics and self-rated health for each wave and compared with crude analysis. Next, we performed linear regression analysis of the trend of adjusted prevalences over time and the average level by race/ethnicity and age groups. Racial/ethnic disparities increased with age, even though the adjusted prevalences of dental service utilization were less apparent than the crude analysis. The all-wave average prevalence was 71%. Black older adults had the lowest level of dental service utilization (65%) as compared with the 2 highest groups: White older adults (79%) and Asian older adults (76%). The general younger adult populations had low prevalences, with the lowest among Asian younger adults (65%). AIAN and NHOPI individuals from all age groups tended to have average or below average prevalences. In addition, a decreasing trend of dental service utilization was observed among White individuals of all age groups (0.2%-0.3% lower per year, P < 0.01) and AIAN younger adults (0.5% lower per year, P < 0.01). Health policy, federal funding, and community-based programs should address the needs of dental service utilization for racial/ethnic minorities including Blacks, AIANs, and NHOPIs. Our study offers insights into our understanding of disparities in dental service utilization among minority racial/ethnic groups. As health policy, federal funding, and community-based programs seek to improve oral health, there is a need to address access to and utilization of dental service for Blacks, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders.

Addressing opioid misuse and mental health conditions through interdisciplinary workforce development programs

ABSTRACT The purpose of this article is to describe two innovative, interdisciplinary workforce development programs that aim to meet the needs of individuals who misuse opioids and may contend with mental health conditions in historically underserved communities. The article begins by highlighting the need for interdisciplinary workforce development programs for social work and occupational therapy graduate students as well as for peer support workers and community providers. Next, a detailed description of two federally-funded training programs is provided. The article concludes with recommendations for workforce development programs.

Federal adaptation and mitigation programs supporting Community investment in electricity resilience to extreme weather

Extreme weather events and associated damages to the electricity system are increasing. Actions are being taken to enhance resilience, but the pace of these enhancements do not meet the challenges faced by communities. This paper reviews federal funding programs that support community resilience efforts for electricity resilience, provides case studies, and highlights opportunities to reduce electricity system vulnerabilities including increasing awareness of federal funding opportunities, and adopting hazard-based design standards.

Predicting Hospital Closure Using Popular Financial Indicators: An Exploratory Study of Muhlenberg Hospital

The role of government in the U.S. healthcare system is critical and hospitals play fundamental roles in our communities, among them critical healthcare provider and major employer. The federal funding program Medicare, and the federal-state funding source, Medicaid, are the two public health financing mechanisms that comprise significant funding to hospitals. Further, Medicare and Medicaid account for approximately 37 percent of all health expenditures in the U.S. (United States Centers for Medicare and Medicaid Services, 2018), and more than 60 percent of all hospital care (American Hospital Association, 2016). The public administration roles in the $3.4 trillion U.S. healthcare industry span that of provider, purchaser of services, initiatives and research funder, regulator, and policy implementer. In today's precarious political climate, amidst layers of government bureaucracies and an increased focus on better and fairer healthcare outcomes, the integration of public policy, administration, and healthcare has become increasingly important to practitioners and researchers. Indeed, the American Hospital Association tallies 5,564 hospitals in the United States, with 16 million employees and accounting for about one-sixth of the U.S. economy. Recently, of particular importance is the rise in U.S. hospital closures that impact healthcare and the economy in our local communities. This study contributes to the literature by identifying indicators for detecting warning trends in hospital financial condition before closures occur using a parsimonious system that can be replicated by both practitioners and policymakers with minimal data gathering efforts. The findings discussed here suggest that in the case of Muhlenberg Hospital, a clear trend of worsening financial condition could be detected at least four years prior to its closure. Current ratio, total margin, and debt to net asset ratio for Muhlenberg Hospital evidenced very clear indicators of financial instability. Consequently, the question emerges as to why neither the hospital nor the community was able to adequately negotiate these treacherous financial challenges to retain this valuable community asset.

Legal regulation of scientific and technopark structures of Germany

The article reveals important aspects of the creation and activities of sci­entific and technopark structures in Germany. The author examined the legislation of Germany on the activities of universities, mechanisms for supporting innovation, pro­tecting the rights to intellectual property, obtained under state financing of develop­ments and other issues. The author traces the development of scientific and technopark structures in Germany. Innovative structures and their features are con­sidered. The analysis of researches of scientists concerning state-legal regulation of higher education, research institutions, technological parks is carried out.The modern condition and tendencies of activity of scientific and technopark struc­tures in Germany are characterized. The author states that financial support for in­novation in Germany is carried out through grants. The Bavarian Financial Regula­tion stipulates that the grant recipient must provide evidence of the targeted use of the grant. In addition, the right to audit the competent service or its representative should be established. The author notes that, with regard to research funding, the federal government focuses on six priority tasks of the future within the framework of a modern high technology strategy to strengthen Germany's innovative capacity. These are research areas with high potential for innovation, which are also reflected in current federal funding programs.

Housing status among single adults following Homelessness Prevention and Rapid Re-housing Program participation in Indianapolis

The Homelessness Prevention and Rapid Re-housing Program (HPRP) was a federally-funded program in the United States that provided short-term financial and support services to individuals and families who were at-risk or currently experiencing homelessness. There is limited research on factors that predict placement in permanent housing following prevention and rapid rehousing interventions, particularly for single adult populations. The present study examined demographic and program-related predictors of permanent housing upon program exit among two groups of adults enrolled in HPRP in Indianapolis, IN: Homelessness Prevention (HP) recipients (n = 219) and Rapid Re-housing (RRH) recipients (n = 296). Results revealed that 76.3% of HP and 68.8% of RRH recipients were living in permanent housing when they exited HPRP. For HP recipients, completion of HPRP and outreach and engagement services were significant predictors of remaining in permanent housing. For RRH recipients, individuals who were African American, did not have a disabling condition, completed HPRP, received a greater amount of financial assistance, and received case management services had significantly greater odds of permanent housing. Findings have implications for informing short-term housing support programs for precariously housed or homeless single adults and highlight the need for future research on prevention and rehousing interventions.

The quality of nutrition and physical activity environments of child-care centers across three states in the southern U.S

This cross-sectional study assessed the quality of nutrition and physical activity environments of child-care centers in three southern states and examined differences by rural versus urban location, participation in the Child and Adult Care Food Program, and Head Start status. The sample included 354 centers that enroll children aged 2–5: 154 centers from Georgia, 103 from Kentucky, and 97 centers from Mississippi. Directors and 1–2 teachers per center completed the Environment and Policy Assessment and Observation Self-Report (EPAO-SR) tool that assesses nutrition and physical activity environments of child-care centers. The EPAO-SR items were scored to capture six nutrition domains and six physical activity domains that were averaged and then summed to create a combined nutrition and physical activity environment score (range = 0–36); higher scores indicated that centers met more best practices, which translated to higher-quality environments. Overall, the centers had an average combined nutrition and physical activity environment score of 20.2 out of 36. The scores did not differ between rural and urban centers (mean = 20.3 versus 20.2, p = 0.98). Centers in the Child and Adult Care Food Program had higher combined nutrition and physical activity environment scores than non-participating centers (mean = 20.6 versus 19.1, p < 0.01). Head Start centers also had higher combined environment scores than non-Head Start centers (mean = 22.3 versus 19.6, p < 0.01). Findings highlight the vital role of federal programs in supporting healthy child-care environments. Providing technical assistance and training to centers that are not enrolled in well-regulated, federally-funded programs might help to enhance the quality of their nutrition and physical activity environments.

Crossing borders: A citation analysis of connections between Cognitive Science and Educational Research … and the fields in between

For decades, there have been calls for bringing the Cognitive Science literature and Educational Research literature into greater and more systematic contact, resulting in the publication of a number of influential papers and the launch of targeted federal funding programs around the turn of the century. This article explores the extent of the integration of Cognitive Science into the Educational Research literature at around that time by means of a citation analysis of journal articles published between 1994 and 2014. Results reveal a marked increase in the citation of Cognitive Science articles by Educational Research articles beginning around the year 2000. They also show a similar increase in citation by Educational Research articles of articles appearing in ‘Border field’ journals (i.e. Educational Psychology, the Learning Sciences, Human–Computer Interaction, and Applied Linguistics). Border Field articles, in turn, show a relatively high percentage of citation of articles in both Education Research and Cognitive Science, suggesting that they may serve as a pathway for the flow of knowledge between fields. These trends held for papers with US authors as well as those with non-US authors. Limitations of citation analysis are discussed along with suggestions for future research.

Extending systems thinking in planning and evaluation using group concept mapping and system dynamics to tackle complex problems

Group concept mapping (GCM) has been successfully employed in program planning and evaluation for over 25 years. The broader set of systems thinking methodologies (of which GCM is one), have only recently found their way into the field. We present an overview of systems thinking emerging from a system dynamics (SD) perspective, and illustrate the potential synergy between GCM and SD. As with GCM, participatory processes are frequently employed when building SD models; however, it can be challenging to engage a large and diverse group of stakeholders in the iterative cycles of divergent thinking and consensus building required, while maintaining a broad perspective on the issue being studied. GCM provides a compelling resource for overcoming this challenge, by richly engaging a diverse set of stakeholders in broad exploration, structuring, and prioritization. SD provides an opportunity to extend GCM findings by embedding constructs in a testable hypothesis (SD model) describing how system structure and changes in constructs affect outcomes over time. SD can be used to simulate the hypothesized dynamics inherent in GCM concept maps. We illustrate the potential of the marriage of these methodologies in a case study of BECOMING, a federally-funded program aimed at strengthening the cross-sector system of care for youth with severe emotional disturbances.