Federal Title Research Articles

Assessing the impact of federal restrictions to the Title X program on reproductive health service provision between 2018-2022 in the United States

ObjectivesIn 2019, the Trump administration introduced rule changes, colloquially known as the “Domestic Gag Rule,” to the federal Title X program. As a result, many grantees withdrew from the program. This study aims to assess the impact of the rule change on service provision within the Title X program, both while the rule was in place and in the period following its reversal. Study DesignWe obtained disaggregated Family Planning Annual Report data for all states from 2018-2022. Using a previously-created variable determining the proportion of each state’s Title X capacity loss from the 2019 rule (0%, 1-24%, 25-50%, 50-89%, 90-99%, 100%), we conducted mixed effects linear regression exploring outcomes of interest (number of total clients served; number of female/male contraceptive methods provided; contraceptive method mix; sexually transmitted infection (STI) services provided) pre-rule change (2018), during the rule change (2019-2021), and post-rule change (2022). ResultsDuring the rule change period, the average total number of services Title X provided decreased by 16% nationwide from the pre-rule change period. However, states with higher levels of reduced capacity saw significant additional losses in reproductive health service provision. The total number of clients, the number of female/male contraceptive methods, and the number of STI services provided did not improve in the post-rule change period. In addition, the number of moderately effective methods provided decreased significantly during the rule change period and continued to decline post-rule change. ConclusionsTitle X services were significantly impacted by the rule change and subsequent recovery is slow.

Alaska

This paper examines Alaska’s education spending for fiscal year 2023, and the budget for 2024. Alaska’s funding priorities are highlighted in this study, such as increased funding for the state’s literacy act and an increase in the funding formula through a per student increase in the base student allocation. Alaska continues to address funding issues surrounding federal Title VII Impact Aid as well as finding ways to recruit and retain teachers.

State Implementation of Congregate Care Reforms for Children in Foster Care.

The Family First Prevention Services Act (FFPSA) allows states to use federal Title IV-E funds to provide time-limited, clinically appropriate use of congregate care, including Qualified Residential Treatment Programs (QRTPs), for youth in foster care. October 1, 2021 marked the deadline for states to begin implementing these FFPSA congregate care reforms. From June to September 2022, we conducted a mixed-methods study to obtain a baseline understanding of implementation barriers, successes, and recommendations to inform congregate care policy and practice. We fielded a national survey with state child welfare agency directors and conducted focus groups with youth with QRTP experiences, child welfare agency administrators, and QRTP executive leaders. We integrated a descriptive analysis of survey data with focus group themes to summarize state implementation progress. A total of 47 states (90%) responded to the survey. Most states reported ongoing congregate care reforms aligned with FFPSA, reducing the use of congregate care and increasing kinship foster care. QRTPs have become the primary congregate care setting. Top implementation barriers concerned workforce resource and capacity constraints, funding, and access to therapeutic foster care models and foster families. Focus group themes converged on the lack of tailored treatment, quality staff, coordinated aftercare, and a need for QRTP outcome evidence. Early implementation lessons of FFPSA congregate care reforms call for additional funding and technical assistance, oversight of congregate care, professionalization and investment in QRTP staff, youth advisory boards to promote youth-driven treatment, and performance- and outcome-based monitoring of QRTPs.

A Scoping Review of Bystander-Based Sexual Violence Prevention Training for College Students in Fraternities and Sororities.

Bystander-based sexual violence (SV) prevention trainings are offered on college campuses across the United States to meet federal Title IX requirements, as they have proven to be an effective strategy for violence prevention. Greek-affiliated students (fraternity and sorority members) are at a higher risk of sexual assault than their peers; however, few trainings consider the specific needs of this population, and program adaptations for this high-risk group may be needed. This scoping review identifies and describes the bystander trainings delivered to Greek-affiliated students in the US and Canada. An eight-database search was conducted following PRISMA-ScR guidelines. The review identified 81 unique sources, with 18 meeting the inclusion criteria. Eleven specific training programs were identified, encompassing qualitative, quantitative, and mixed-method studies. The thematic analysis revealed best practices, including the importance of peer leaders, interactive sessions, and tailored content to Greek culture, as well as barriers such as a lack of engagement and an inadequate session length. The review underscores the need for tailored interventions to effectively address the unique cultural characteristics and high-risk nature of Greek-affiliated students. These findings provide valuable insights for improving the design and implementation of bystander interventions to enhance their efficacy in preventing sexual violence within this population.

Foreign language education in Louisiana: A cluster analysis

AbstractLouisiana is currently the only state in the United States that requires foreign language (FL) study for some, but not all of their high school students, and these requirements are undergoing seismic changes. Considering that geographic, economic, and integration factors contribute to whether a school can provide FL at all—and biased counseling dissuades minoritized students from taking FL—this study asks: has FL education been equitably accessible to all Louisiana high school students who want to pursue it, regardless of race or economic background? To address this question, this paper presents results from two analyses. First, program‐internal equity variables (e.g., [dis]similarity between school‐wide and FL student demographics) were clustered to produce “profiles” of FL programs. Next, a multinomial logistic regression using program‐external factors (e.g., federal funding status, desegregation orders) was conducted to isolate the factors impacting equity. Federal funding and rurality were both found to be significant, with schools receiving federal Title I funds and rural schools being much more likely to exhibit inequitable access to FL courses. In (a) identifying schools with enrollment inequities and (b) the outside factors associated with greater inequity, this paper aims to provide policymakers with empirically based tools to address (in)equity in Louisiana high school FL education. These findings can be especially helpful in light of the state's recent (2023‐2024 school year) expansion of FL requirements to accept computer science courses.

The diffusion of federal Title IX complaints throughout U.S. colleges and universities, 1994–2014

This article uses an original dataset of federal Title IX complaints to assess whether and how mobilization of the law to confront sexual harassment has diffused throughout four-year (and above) nonprofit colleges and universities. Event history analyses show that complaints spread more rapidly among schools of similar selectivity as well as among institutions linked by a new indicator for social proximity—school Twitter ties—that encompasses multiple forms of social proximity simultaneously. The same diffusion patterns do not emerge for other types of sex discrimination complaints filed under Title IX, indicating that networks channel the capacity to mobilize law differently across different types of claims. The findings illuminate a dramatic transformation in the deployment of Title IX that has reshaped how colleges and universities govern gender relations.

Developing and Validating a Predictive Risk Model for Youth Placement in Residential Care to Support Decision-Making under the Family First Prevention Services Act

ABSTRACT Under the Family First Prevention Services Act, federal Title IV-E claiming requirements for youth who are placed in Qualified Residential Treatment Programs (QRTPs) are more stringent than previous criteria for residential care. Independent Qualified Individuals are required to assess the appropriateness of QRTP placements and judicial reviews must formally approve these placements. Child welfare agencies can use administrative data and empirical methods to adapt to these changes from a prevention standpoint. The current study detailed an approach for developing and validating a Cox proportional-hazards model predicting time-to-first placement in residential care among 43,770 legal spells for youth under the care of one large Midwest child welfare agency. Internal validation using 200 bootstrap resamples yielded stable predictors consistent with those in the literature, strong discriminative ability, and high prediction accuracy. External validation applied the model to examine the risk of residential care placement in the first 90 days of youth’s legal spells. This proactive risk prediction encapsulates a preventive approach preceding the 90-day timeline of QRTP assessment and court review. Results suggest that robust prediction of existing practice of residential care placement has the potential to inform caseworker-level service and placement planning, and build system-level capacity for residential and community-based care.

THE LANDS WERE NOT EMPTY

THE LANDS WERE NOT EMPTY

The impact of policy changes from the perspective of providers of family planning care in the US: results from a qualitative study

In recent years, there have been several state and federal policies that have disrupted access to publicly supported family planning care in the United States, including the 2019 rule that altered the federal Title X family planning program. In late 2020, we conducted in-depth interviews with health care providers from 55 facilities providing family planning care in Arizona, Iowa, and Wisconsin with the aim of learning how sites were affected by policy changes. We identified perceived effects on clinic finances, patient confidentiality, contraceptive counselling and service provision, and options counselling resulting from state and federal policy changes. Some clinics lost funding and had to pass some of the cost of services on to patients, raising new confidentiality concerns and creating new burdens on staff to carry out financial counselling with patients. Other sites had to grapple with restrictions on the pregnancy options counselling that they could provide, concentrate counselling on fertility awareness-based methods, and increase efforts to include parents/guardians in the care of adolescent patients. State and federal policies impact how publicly supported family planning care is provided, and compromise efforts to provide patient-centred care.

Title X Improved Access To Most Effective And Moderately Effective Contraception In US Safety-Net Clinics, 2016-18.

Community health centers are a crucial source of health care for reproductive-age women. Some community health centers receive funding from the federal Title X program, which provides funding for family planning services for low-income women. We describe the provision of the most effective (intrauterine devices and implants) and moderately effective (short-acting hormonal methods) contraceptive methods in a large network of 384 community health center clinics across twenty states in 2016-18. Title X clinics provided more most and moderately effective contraception at all time points and for all age groups (adolescent, young adult, and adult). They provided 52percent more of the most effective contraceptives to women at risk for pregnancy than clinics not funded by Title X. This finding was especially notable for adolescents (58percent more). Title X clinics play a key role in access to effective contraception across the US safety net. Strengthening the Title X program should continue to be a policy priority for public health for the Biden-Harris administration.

Title IX and the Alleged Victimization of Men: Applying Twombly to Federal Title IX Lawsuits Brought by Men Accused of Sexual Assault

This Note provides a survey of the current state of Title IX law as applied to anti-male bias lawsuits and suggests how courts should apply Twombly’s plausibility standard to anti-male bias claims going forward. Part I of this Note provides an overview of sexual violence on college campuses and the history of Title IX regulations and jurisprudence. Part II offers a brief history of Title IX anti-male bias lawsuits, examines the structure of anti-male bias lawsuits, and analyzes the various pleading standards applied by courts. Part III lays out the types of facts pled by Title IX anti-male bias plaintiffs and discusses what facts should be viewed as sufficient to meet Twombly’s plausibility standard. In Part IV, this Note looks at the future of Title IX anti-male bias lawsuits in light of new federal regulations and discusses the implications of these lawsuits for claimants and respondents in campus Title IX proceedings.

Награждение знаком «Житель осажденного Севастополя» как новое основание отнесения лиц к категории ветеранов Великой Отечественной войны

In this article, the author considers persons awarded the sign “Resident of Beleaguered Sevastopol” as a new basis for classifying persons as veterans of the Great Patriotic War, introduced into the legislation of the Russian Federation in 2020, drawing an analogy with the status of persons awarded with the sign “Resident of Blockaded Leningrad » In order to improve the specified subcategory of veterans of the Great Patriotic War. According to the author, the legal relationship regarding the assignment of the federal title of veteran of the Great Patriotic War for persons who lived in beleaguered Sevastopol currently includes, in addition to the material and legal component (the fact of a person’s residence in Sevastopol during the specified period), also procedural component in the sphere of awards of the subject of the Russian Federation, which is at the discretion of the legislator of the subject of the Russian Federation. The author proposes to abandon the criterion for awarding a sign in favor of establishing in the federal law specific criteria for the residence of persons in a certain territory during the Great Patriotic War, to adopt a Resolution of the Government of the Russian Federation on the procedure for determining persons falling under the criteria of residence in these cities, so that this determination can be carried out on the entire territory of the Russian Federation, and also establish a single criterion for referring to veterans of the Great Patriotic War for residents of beleaguered Sevastopol and blockaded Leningrad, associated with the fact of living in these cities during the beleaguer (blockade).

Adding Confusion to the Muddy Waters of the Oswego Lake Decision: A Response to Dean Huffman

Dean Jim Huffman’s recent article in Environmental Law on the Oswego Lake decision claims that the Oregon Supreme Court’s opinion is a “confused treatise on the public trust doctrine.” Objecting to the court’s decision on a number of grounds, Dean Huffman took issue with the court’s recognition of public access rights, its creation of a so-called “public use” doctrine, its use of the law of private trusts, and its recognition of the state’s claim of ownership of water within its jurisdiction. Moreover, and somewhat astonishingly, Huffman claims that the rights of the people cannot be violated by the representatives of the people, seemingly at odds with over a century of case law. Although we agree with a few of Huffman’s criticisms, he overlooks some critical public trust interpretations of the Oswego Lake court, such as its recognition of the trustee status of municipalities. He also confuses other issues, like the state’s distinction between what it calls “navigable-in-fact” waters (those which support recreational watercraft today) and those waterways that are navigable under the federal title test (commercially navigable around the time of statehood). We explain our criticisms in this essay.

"This Isn't Just a Police Issue": Tensions between Criminal Justice and University Responses to Sexual Assault among College Students.

Sexual assault among college students is both a crime and a civil rights violation under U.S. federal Title IX policy, which prohibits discrimination on the basis of sex in educational institutions. The current study sought to understand the extent to which the criminal justice system influences university Title IX proceedings, as well as potential consequences of this influence. For this study, we conducted in-depth qualitative interviews with a sample of 22 multidisciplinary, nationally-recognized subject matter experts in the area of campus sexual assault response. The results indicated that criminal justice concepts and goals are indeed being conflated with and influencing university Title IX proceedings. Participants also reported that criminal investigations are often prioritized over or seen as higher quality than Title IX investigations. As a result, participants described diminished educational and civil rights protections for survivors. We discuss how the community psychology values of social justice, promoting health and well-being, and accountability to oppressed groups can guide future efforts to reduce the spread of criminal justice influence into Title IX, improve existing Title IX proceedings, and explore alternative models of accountability beyond traditional criminal and civil approaches.

Amnesty: Title IX Policies and Christian Colleges

Underreporting of sexual assault on college campuses is a growing concern for institutions of higher education. Amnesty clauses in Title IX policies intend to reduce barriers to reporting, encouraging victims and witnesses to come forward with any knowledge or experience of an incident of sexual assault. However, little research has been conducted on Christian college campuses and Title IX issues. In an effort to close this scholarly gap, this study explores the 112 Council for Christian Colleges & Universities (CCCU) member institutions located in the United States to determine what, if any, types and extent of amnesty they afford complainants and/or witnesses during Title IX investigations. The findings of this study demonstrate that some form of amnesty provision is apparent in about half of CCCU institutions. However, after a content analysis of these institutions’ Title IX policies, this study reveals that only five out of the 112 CCCU member institutions afford complete and comprehensive amnesty to complainants and witnesses during a Title IX investigation. As relevant literature and federal Title IX guidance suggest, this lack of true amnesty has major implications for Title IX reporting and best practices on Christian college campuses.

Judge Blocks Abortion ‘Gag Rule’ for Title X Providers

Back to table of contents Previous article Next article Government NewsFull AccessJudge Blocks Abortion ‘Gag Rule’ for Title X ProvidersLinda M. RichmondLinda M. RichmondSearch for more papers by this authorPublished Online:9 May 2019https://doi.org/10.1176/appi.pn.2019.5b26AbstractThe Trump administration’s “gag rule” on abortion referrals or counseling for health care professionals who accept federal Title X funding was blocked in federal court April 29.A federal district court judge in Oregon blocked a Trump administration rule that would have barred health care professionals accepting federal funding from counseling women on abortion.iStock/Worawee Meepian“At the heart of these rules is an arrogant assumption that the government is better suited to direct women’s health care than their providers,” said Judge Michael McShane of the U.S. District Court in the District of Oregon, before announcing his plans to issue a preliminary injunction to block the rule from taking effect.Federal laws have long prohibited the use of taxpayer funds to pay for most abortions, but the Trump administration’s new policy, which had been set to take effect May 3, would go much further. It would have barred health care professionals who counsel patients on or refer them for abortion from receiving Title X funding, a program for low-income women under the Public Health Service Act. It also included a costly new requirement that clinics be physically and financially separate from facilities that provide abortions and added new requirements around involving families in the family planning decisions of minors.Title X is the only federal reproductive-health services program for low-income and underinsured women. Each year it provides more than 4 million women with family planning and contraceptive care, preventive health screenings for breast and cervical cancers, and treatment for sexually transmitted infections.Since the rule was issued in February (Psychiatric News, March 29, 2019), half a dozen lawsuits have been filed around the country, including one by the AMA and Planned Parenthood that called the policy a government-imposed “gag rule” and said it would be illegal and unethical and threaten the health care of millions of women. Planned Parenthood, which serves 41% of patients served by the Title X program, said it will leave the program if Trump’s rule takes effect. California also filed suit, as did 20 Democrat-led states and the District of Columbia.APA joined with 17 other physician leaders and medical specialty organizations representing 4.3 million health care professionals to denounce the rule, saying it disregards the expertise of the medical and scientific communities and evidence-based standards.“To allow this gag rule to take effect would interfere with our fundamental right as physicians to discuss the full range of options for care with our patients based on their individual medical situation and personal wishes,” said Maureen Sayres Van Niel, M.D., president of APA’s Caucus of Women Psychiatrists and a reproductive psychiatrist in Cambridge, Mass. “This is a blatant attempt to politicize a fundamental right of women patients, and, like many other national medical associations, we condemn these efforts.”In 1996 Congress mandated that patients receiving information about their pregnancies through Title X receive “nondirective” counseling. And in 2010 Congress mandated that the Department of Health and Human Services cannot impose rules that create unreasonable barriers to care, interfere with doctors giving their patients a full range of options, restrict the ability of health care providers to disclose all relevant information to patients, or violate the ethical standards of health care professionals.“The gag rule blatantly violates Congress’ mandate by forcing doctors to withhold information from their patients and imposing unreasonable barriers to care,” Planned Parenthood wrote in a statement.Leana Wen, M.D., president of Planned Parenthood Federation of America, said this latest ruling represents a victory for patients and doctors.“Because of this, our patients across the country can still access life-saving health care,” she said. “However, while this is a victory for patients and doctors, this relief is preliminary, and we will continue to fight the Trump-Pence administration in court and in Congress to ensure our patients’ health and rights are protected.”AMA President Barbara L. McAneny, M.D., expressed similar sentiments. “Judge McShane got it exactly right when he called the new Title X rule a ‘ham-fisted’ approach to health care,” she said. “The judge repeatedly asked how the new gag rule would improve health outcomes. The government was unable to answer. The new rule would have placed obstacles to health care for low-income patients. We are pleased the judge shared the AMA’s concern about the physician-patient relationship.” ■The coalition’s statement can be accessed here. ISSUES NewArchived

Proprietary and Sovereign Public Trust Obligations: From Justinian and Hale to Lamprey and Oswego Lake

The public trust doctrine (PTD) has sometimes been mischaracterized as applicable only to state-owned resources. But this “proprietary PTD” is only half of the scope of the PTD, for the doctrine also contains a “sovereign” component. The latter has been recognized for over a century and is not dependent on state ownership of the public trust res. This article examines the evolution of both the proprietary and sovereign PTDs. We first trace the development of the former from Roman and English law through several prominent and recent decisions of the U.S. Supreme Court. We then turn to the lesser-recognized sovereign PTD, which grew out of a largely overlooked, but highly influential, decision of the Minnesota Supreme Court. The article explains the legacy of that case, Lamprey v. Metcalf, which established the now-dominant state-law view that the PTD applies to waterbodies whose beds are privately owned. Unlike the proprietary PTD, which employs the federal test for title navigability, the sovereign usufructuary PTD is not tethered to the federal title test, but is instead the product of state definitions of navigability, which often are much broader than the federal test. The article assesses the implications of widespread judicial recognition of the sovereign PTD as distinct from the proprietary PTD, spotlighting a case pending before the Oregon Supreme Court involving a 400-acre Oregon lake, Oswego Lake, in suburban Portland. But the implications are much broader than that controversy and point to the application of the PTD to all resources of public concern like wildlife, groundwater, and the atmosphere.

There's a New Alphabet in Town: ESSA and Its Implications for Students, Schools, and School Nurses.

The 2015 passage of the Every Student Succeeds Act (ESSA) provides state education agencies with more local control over educational planning, requires development of state accountability plans, and provides opportunities for advocacy surrounding school nursing-sensitive indicators of student success. Federal Title I, II, and IV funds are available for state and local education agency utilization in meeting educational needs of impoverished students and for development of high-quality instructional and support personnel. As Specialized Instructional Support Personnel, school nurses can utilize ESSA Title funding to positively impact chronic absenteeism, school climate, and school nurse staffing. ESSA can be a resource for funding school health services and professional education. This article will assist school nurses in better understanding ESSA and how funding is allocated to states and local education agencies.

Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005-2015.

The federal Title X Family Planning Program supports the delivery of family planning services and related preventive care to 4 million individuals annually in the United States. The implementation of the 2010 Affordable Care Act's (ACA's) Medicaid expansion and provisions expanding access to health insurance, which took effect in January 2014, resulted in higher rates of health insurance coverage in the U.S. population; the ACA's impact on individuals served by the Title X program has not yet been evaluated. Using administrative data we examined changes in health insurance coverage among Title X clinic patients during 2005-2015. We found that the percentage of clients without health insurance decreased from 60% in 2005 to 48% in 2015, with the greatest annual decrease occurring between 2013 and 2014 (63% to 54%). Meanwhile, between 2005 and 2015, the percentage of clients with Medicaid or other public health insurance increased from 20% to 35% and the percentage of clients with private health insurance increased from 8% to 15%. Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance.

Stigma and the Structure of Title IX Compliance

This article analyzes the relationship between the structure of federal Title IX investigations and the existing evidence addressing the emotional and mental health needs of sexual harassment and sexual assault victims. The article argues that federal requirements for investigating sexual harassment should be restructured so as to address the challenges stigma poses for the realization of Title IX's objectives.