Local County Research Articles

35 Enhanced Service Through An Integrated New Model of Care in A Buckinghamshire Care Home

Abstract Introduction Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes. Polypharmacy and medication errors are common. The frequency and quality of medication reviews is variable with limited general practice (GP) capacity to carry out comprehensive reviews. The initiative used a care home pharmacist, technician, geriatrician and GPs to tackle these issues on an individual and care home level. The objective being to ensure the safe and effective use of medicines for all care home residents. NICE guideline [NG56] recommends reducing pharmacological treatment burden for adults with multimorbidity at risk of adverse drug events such as unplanned hospital admissions. A study by Dilles et al1 found adverse drug reactions in 60% of residents. Methods A new interdisciplinary model of care was delivered in a 120 bedded Buckinghamshire care home. Clinical Commissioning Group pharmacist, general practitioners and pharmacy technician reviewed medication for all residents. The most complex individuals were reviewed by the geriatrician and if needed by other multidisciplinary team members specialist. Results Overall 115 medications were stopped for 109 residents, with 31 interventions to reduce falls risk and 19 interventions on medication at high risk2 of causing admission. Total cost savings on medicines optimisation, medicines waste and non-elective admission prevented was £35,211. Residents’ care plans were updated to reflect best practice standards. Conclusions Future direction of this project focuses on system wide improvements to promote interdisciplinary healthcare professionals work in care homes. The success of this integrated model of care has enabled recurrent funding of pharmacist by the local county council and an additional 42 geriatrician sessions into Buckinghamshire care homes.

Gastric tuberculosis mimicking submucosal tumor: a case series

BackgroundGastric tuberculosis mimicking submucosal tumors is extremely rare and often misdiagnosed.Case presentationThree cases of gastric tuberculosis mimicking submucosal tumors were identified among patients admitted to local county hospitals because of upper abdominal discomfort and pain, with gastroscopy showing gastric submucosal tumors. The patients were admitted to our hospital for endoscopic ultrasonography (EUS). As EUS revealed evidence of tuberculosis for the first two patients, we first considered gastric tuberculosis. However, because of atypical characteristics of the miniature ultrasonic probe and EUS, the lesion in the third patient was misdiagnosed as a stromal tumor, and the patient underwent endoscopic submucosal dissection (ESD), and intraoperative characteristics and postoperative pathology confirmed the lesion to be tuberculosis.ConclusionsEUS is of great value in the diagnosis of gastric tuberculosis, especially gastric tuberculosis mimicking submucosal tumors. Here, we summarize some significant characteristics of gastric tuberculosis by EUS, which will be of substantial value to clinical work.

Urban Dreams, Rural Commonwealth: The Rise of Plantation Society in the Chesapeake by Paul Musselwhite

Reviewed by: Urban Dreams, Rural Commonwealth: The Rise of Plantation Society in the Chesapeake by Paul Musselwhite Patrick D. Hagge Urban Dreams, Rural Commonwealth: The Rise of Plantation Society in the Chesapeake. Paul Musselwhite. Chicago: University of Chicago Press, 2019. Pp. xii+341 maps, illustrations, notes. $50.00, hardcover, ISBN 978-0-226-58528-4. During the seventeenth and eighteenth centuries, the wider Chesapeake Bay region was full of plantation landscapes. Few cities, however, dotted [End Page 169] this overwhelmingly rural world. The conventional historiography of the Chesapeake suggests that the dual factors of plantation agriculture and physical geography limited urban growth, as nearby rivers allowed for planters to export their product without the need for city-based economic services. A plantation-dominated Chesapeake was viewed as destined to remain rural, and even Thomas Jefferson argued that nature itself dictated the lack of towns in the region. However, this view erases the historical fact that Chesapeake residents both understood their own region's rurality and anticipated eventual city growth. In Urban Dreams, Rural Commonwealth: The Rise of Plantation Society in the Chesapeake, Paul Musselwhite contests the dominant theme of the rural historic Chesapeake Bay region, what Musselwhite calls the "artificial belief in the incompatibility between plantations and cities" (3). Instead, he notes that while ultimately unsuccessful, Chesapeake urbanization incorporated wide-ranging experimentation in city building and deep debates over the very necessity of cities themselves. The book's seven major chapters are arranged chronologically, with each section centering on a particular time period that experienced the possibility of urban growth, such as the early decades of the Virginia Company or the Restoration era. Each chapter addresses the contemporary debates surrounding urbanization, as well as the resulting failures of urban development in that era. An epilogue describes contested urban development in the years immediately aft er the American Revolution. Throughout Urban Dreams, the author delivers an efficient discussion of the rural Chesapeake—a region whose lack of towns differentiated it from other English colonial domains in North America. Multiple parts of this book deserve additional recommendation. Of particular note is Musselwhite's superior quality of research. Part historical narrative, part historical geography, and part historical analysis, Urban Dreams centers on a well-researched argument, drawing from a seemingly endless number of archival sources housed on both sides of the Atlantic. Personal papers, government documents, and business records result in a full sixty pages of footnotes covering nearly two centuries of Chesapeake history. Several maps representing plantation sites are also effective. This well-sourced history gives more credence to Musselwhite's narratives of different key players' motivations in plans for the urban [End Page 170] Chesapeake, including the "intense contemporary concern" of Chesapeake residents over expected urban development (8). To use one chapter as an example, "Towns, Improvements, and the Contest for Authority in the 1680s" weaves a successful treatment of plans for regional reform in the years aft er Bacon's Rebellion. The different points of view in this chapter include the positions of the English Crown and the Stuart court, the Virginia House of Burgesses, local county government officials, and Chesapeake Bay planters. Was a city primarily a civic institution or an economic engine? At times, different regional stakeholders had conflicting answers to that question. Urban Dreams, Rural Commonwealth is one volume in "American Beginnings, 1500–1900," a series of seventeen books on American history published by the University of Chicago Press. However, this text is important not only to historians but also to urban and economic scholars alike. Urban Dreams appears at the end of a recent period with renewed focus on the historical Chesapeake, in texts such as Jean Russo and J. Elliot Russo's Planting an Empire: The Early Chesapeake in British North America (Johns Hopkins University Press, 2012). The rurality of the pre-European Chesapeake was explored in James Rice's 2009 work, Nature and History in the Potomac Country: From Hunter-Gatherers to the Age of Jefferson (John Hopkins University Press). Virginia 1619: Slavery and Freedom in the Making of English America is a 2019 volume edited by Paul Musselwhite, Peter Mancall, and James Horn exploring society building of the colonial Chesapeake (University of North...

The Southern Illinois Well Water Quality Project: A Service-Learning Project in Environmental Chemistry

An environmental chemistry service-learning project was implemented by Greenville University in coordination with the local county health department to test the quality of well water for residents ...

Simple Approaches to Examine Economic Impacts of Water Reallocations from Agriculture

AbstractFacing an anticipated shortage declaration on the Colorado River and reductions in surface water for agricultural use, rural stakeholder groups are concerned about how water cutbacks will affect their local economies. Local farm groups and county governments often lack the analytical tools to measure such impacts. While one can learn much from large‐scale hydro‐economic models, data, cost, and time limitations have been barriers to such model development. This article introduces three basic modeling approaches, using relatively low‐cost and accessible data, to examine local economic impacts of water reallocations from agriculture. An empirical application estimates the effect of agricultural water reductions to Pinal County, Arizona, the county that would be most affected by a Colorado River Shortage Declaration. Water cutbacks to agriculture are modeled using two variants of a “rationing” model, which assumes that farmers will fallow their acres that generate the lowest gross returns (Rationing Model I) or the lowest net returns (Rationing Model II) per acre‐foot of water. Rationing models have modest data requirements given that crop and region specific data are available. Building off these simpler rationing models, an input‐output (I‐O) model provides more detailed information about the impacts on different rural stakeholder groups as well as the impacts to non‐agricultural sectors and the local tax base. Given imminent water cutbacks, access to low‐cost data and information that are easy to interpret is essential for effective community dialogue.

Emulation of Community Water Fluoridation Coverage Across US Counties.

Expansion of community water fluoridation has stalled in the United States, leaving 115 million Americans without fluoridated drinking water. This study used spatial regression methods to assess contributions of supply-side factors (neighboring counties' fluoridation coverage) and demand-side factors (health literacy, education, and population density of the local county) in predicting the extent of fluoridation in US counties. For this cross-sectional ecological analysis, data from the 2014 Water Fluoridation Reporting System for all 3,135 US counties were merged with sociodemographic data from the 2014 American Community Survey and county-level estimates of health literacy based on the National Association of Adult Literacy Survey. We employed multilevel geographically weighted autoregressive models to predict fluoridation coverage of each county as a function of fluoridation coverage of neighboring counties and local-county covariates: either health literacy or sociodemographic characteristics. Akaike's Information Criterion was used to distinguish the better model in terms of explanatory power and parsimony. In the best-fit model, an increase from the first to third quartile of neighboring counties' fluoridation coverage was associated with an increase of 27.76 percentage points (95% confidence limits [CI] = 27.71, 27.81) in a local county's fluoridation coverage, while an increase from the first to third quartile of local county's health literacy was associated with an increase of 2.8 percentage points (95% CL = 2.68, 2.89). The results are consistent with a process of emulation, in which counties implement fluoridation based upon their population's health literacy and the extent of fluoridation practiced in neighboring counties. These results suggest that demand for community water fluoridation will increase as health literacy increases within a county. Furthermore, when considering expansion of fluoridation, non-fluoridated communities can benefit from precedents from nearby communities that are fluoridated. Expanded coverage of community water fluoridation has stalled in the United States. The economic theory of diffusion describes how, over time and space, policy enacted in one community can influence public opinion in a neighboring community. This study applies geospatial analysis of county-level data and the theory of policy diffusion to demonstrate that fluoridated counties can promote the implementation of community water fluoridation in their neighboring, non-fluoridated communities.

P6212The NAILED ACS trial - telephone-based long-term follow-up reduces risk factors after 36 months

Abstract Background Cardiovascular secondary preventive strategies need improvement. The proportion of patients reaching guideline recommended treatment targets are low. Purpose We investigated if nurse-led, telephone-based follow-up including medical titration was superior to usual care in controlling blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) levels 36 months after an acute coronary syndrome (ACS). Methods All patients admitted with ACS at the local county hospital between 1st January 2010 and 31st December 2014 were screened for inclusion based on their ability to participate in a telephone-based follow-up. Participants were randomized into two parallel groups, an intervention group and a control group receiving usual care. BP and LDL-C were measured at one month, 12, 24 and 36 months. The intervention group received counseling and medical titration to attain treatment targets of BP (<140/<90 mmHG) and LDL-C (<2.5/<1.8 mmol/L). The primary outcome was LDL-C at 36 months. Results Out of 962 randomized patients, 797 were available for analysis after 36 months. In the intervention group, mean systolic blood pressure (SBP) was 4.1 mmHg lower (95% CI 1.7 - 6.4, p=0.001), diastolic blood pressure (DBP) was 2.8 mmHg lower (95% CI 1.4- 4.4, p<0.001) and mean LDL-C was 0.26 mmol/L lower (95% CI 0.12 - 0.4, p<0.001) when compared to the control group. The proportion of patients reaching treatment target goals was also significantly higher in the intervention group. Conclusions After 36 months of follow-up the nurse-led, telephone-based intervention led to significantly lower systolic blood pressure, diastolic blood pressure and LDL-C levels when compared to the control group. The intervention group also had a larger proportion of patients reaching target values. Acknowledgement/Funding The study received funding from the research and development unit, Region Jämtland Härjedalen.

309 Overcoming Brick and Mortar: Feasibility of Implementation of a Medication for Addiction Treatment and Linkage to Treatment Program by Leveraging Community Partnerships

Substance use disorder (SUD) annually costs the US over $440 billion. Medication for addiction treatment (MAT) helps manage withdrawal and cravings to reduce relapse and promote engagement in psychosocial interventions that promote healing. Implementing MAT and a linkage to treatment program in the hospital setting can improve care for SUD patients. Our Department of Emergency and Hospital Medicine implemented a protocol to screen and identify patients with SUD. A county-supported warm handoff approach began using screening, brief intervention, and referral to treatment to link patients with treatment options. Since 2017, a county-funded hospital opioid support team (HOST) provided a bedside level of care assessment and warm hand off to treatment. Also, a hospital-employed addiction recovery specialist (ARS), who is a licensed social worker and certified recovery specialist, provided bedside motivational interviews and care management. On July 1, 2018, a MAT program began with free county-supported interventions: seven-day discharge supply of buprenorphine and a transportation voucher. MAT is maintained by a partnership with a local drug and alcohol treatment center staffed by our MAT-trained toxicologists, where patients also receive individual/group counseling, certified recovery specialist support, and psychiatric treatment. Since January 2018, 1363 patients were linked to treatment through the ARS (218 patients) and HOST (1145 patients). Since July 2018, 123 patients were linked to treatment by the ARS: 54.97% to outpatient treatment, 10.48% to inpatient treatment, 4.22% discharged home with referral to inpatient treatment, 3.46% to a psychiatric/dual diagnosis facility, and 16.81% refused services. Over 70% of those evaluated by ARS since July 2018 were initiated on MAT. During January-March 2019, 62% of initiated patients received buprenorphine/naloxone, 15-17% received oral or intramuscular naltrexone, and up to 3% received acamprosate. Of those induced on MAT, 92 followed up at the MAT maintenance clinic during July 2018-March 2019, 71 of which received care management by the ARS. During July 2018-February 2019, most common dispositions by HOST were: 17.82% to detox facility, 11.2% to intensive outpatient treatment, and 9.52% to short- or long-term residential facility. An institutional linkage to treatment initiative with warm handoff to SUD treatment and induction/maintenance of MAT provides a solution that transcends the brick and mortar limitations of a hospital setting. HOST is a collaboration with local county drug and alcohol authority; and ARS combines care management and peer recovery support. Embedding MAT prescribers in a local drug and alcohol treatment facility ensures follow-up for hospital MAT initiated patients.

Reflexive Challenges in Community Engaged Research in a County Jail

As local, participatory research becomes more common, the logistics of conducting such research continues to challenge anthropologists' and other researchers' traditional sense of disconnection from research participants. Using interviews with the researchers involved in a study conducted in a local county jail, we consider major barriers to conducting research with incarcerated individuals. Challenges stemmed from concerns about getting to know inmates at the local jail in a small community, as well as frustration with navigating a highly structured and inherently unequal situation. This article will discuss our process, the challenges that have been experienced by others, new challenges we faced, and strategies we utilized to overcome those challenges. In addition, this article will address and explain the specific experience of the authors related to managing the research process, navigating the jail, and working within the established structures of a jail setting.

Posttraumatic stress, panic disorder, violence, and recidivism among local jail detainees.

Most research on posttraumatic stress disorder (PTSD) and offending has been conducted with special populations (e.g. veterans and female inmates) and generally overlooks the additive effect of panic disorder (PD) in offending patterns. The purpose of this paper is to assess the prevalence of PTSD and PD among jail inmates, while simultaneously examining the relationships between these disorders, offending types and frequency. A random sample of adults recently booked into a local county jail participated in the Comprehensive Addictions and Psychological Evaluation-5 (CAAPE-5), a structured psychological assessment. The study sample was comprised of 200 male and 83 female inmates. Indications of PTSD were observed among 44.0 percent of male inmates and 57.8 percent of female inmates. Most male inmates (78.4 percent) with positive PTSD indications also met criteria for PD, with a similar proportion (78.1 percent) of female inmates also meeting criteria for both. The combination of PTSD and PD was not associated with offending frequency, but inmates presenting indications of both PTSD and PD were more likely to be charged with a violent offense relative to those with only PTSD. Inmates with PTSD who also have panic attacks may have a more severe condition with possible implications for other risks. Observations of these conditions among adults recently booked into local jails should coincide with each other. Few studies have examined mental health conditions among local jail detainees, despite the ever-present need to address them. The current study considers this important population and investigates the prevalence of co-occurring conditions.

Utilizing Student Health and Academic Data: A County-Level Demonstration Project.

Students with chronic health conditions miss more school days than their peers and are at increased risk for performing worse on standardized tests and not completing a high school degree. University-based researchers, state government leaders, and a local county school system collaborated to use existing health and academic data to (1) evaluate the strength of the relationship between health status and school performance (absenteeism, grades) and (2) describe the health status of students who are chronically absent. Analyses included descriptive statistics, chi-square tests, negative binomial regression models, and estimated marginal means. The most common health conditions among the 3,663 kindergarten through Grade 12 students were ADD (attention deficit disorder)/ADHD (attention deficit hyperactivity disorder), asthma, migraine headaches, mental health conditions, and eczema/psoriasis/skin disorders. After controlling for covariates, having asthma or a mental health diagnosis was positively associated with absences; and having an ADD/ADHD or mental health diagnosis was negatively associated with GPA (grade point average). Chronically absent students had significantly lower GPAs, and a higher number of health conditions than other students. The success of this demonstration project encourages strengthening existing collaborations and establishing new multidisciplinary partnerships to analyze existing data sources to learn more about the relationship between student health and academic achievement. Moreover, connecting health status to academic achievement might be a chief tactic for advocating for additional resources to improve the care and management of chronic disease conditions among students.

Iowa county officials say Medicaid program creates burdens on local providers

New children mental health services and the state's privatized Medicaid program are creating a potential burden for local counties to comply with growing state rules and polices, the Louisa County Board of Supervisors were told July 23 during a relatively light meeting, the Muscatine Journal reported July 24. While the law signed by Gov. Kim Reynolds this year established the first children's mental health program in Iowa, it failed to address a stable funding source. That has left the state's regional mental health system workers and the counties that provide much of the system's financial support, wondering about the long‐term impacts of the new law. Wulf said regional mental health workers had an opportunity to discuss possible ideas for implementing the children's mental health program during a recent training session. “We talked about some of the modifications we are going to have to make this fall,” she said, explaining Southeast Iowa Link (SEIL), the regional mental health program that includes Louisa County, had started the process. Part of that process will be to establish a separate advisory board that will help guide the SEIL governing board on children mental health services and incorporating those new services into the regional mental health plan. Wulf pointed to the July 1 startup date next year to begin offering the children mental health services.

Practice and reflection of short-term orthopedics training in primary hospitals

In order to provide more practicable and convenient continuing medical education for orthopedic surgeons in primary hospitals and expand the academic influence of expert lecturers and host hospitals in the region, our department hosted nine short-term training courses of orthopedic surgery jointly with primary hospitals, which lasted for 1 to 1.5 days on weekends from June 2001 to October 2017, with expert lectures as the main form. Traumatic orthopedics was the main topic, and most expert lecturers were orthopedic experts from famous hospitals within the province and the whole country, as well as the experts from the host hospital. More than 1 200 orthopedic and surgical physicians in local districts and counties participated in the training, and excellent social effect has been achieved. For short-term orthopedic training jointly held with hospitals in prefecture-level cities, the topic of training should be carefully selected, and duration of the training and number of lecturers should be controlled, so as to achieve satisfactory social effects under the premise of low cost of administrative resources. Key words: Continuing medical education; Orthopedics; Short-term training course; Primary hospital; Primary care physician; Prefecture-level city

Effects of State Income on Regional Growth at the County Levels in the US

The paper empirically investigates effects of state income levels on economic growth of US counties in order to support a theoretical explanation for hindering regional growth based on efficiency wages theories. The study briefly reviews the related literature and then runs cross-section growth regressions for local counties by using data for 3061 counties in 50 US states for the period of 1982-2006. The analysis mainly finds an adverse relationship of state income with county growth, which is in line with the EU evidence reported by Kim (2015). This effect is found to be weaker than the effect observed for the period before the IT crash. It is also shown that a rise in state income tends to enhance county convergence within states in contrast to the EU evidence. Such main findings contribute to providing new evidence of an adverse effect of state average income in line with the previous EU evidence, which give a lesson for the US and industrialized countries experiencing economic growth with widening regional inequality. For future research, it would be meaningful to examine such effect for regions in Korea that recently faces with widening income inequality too.

Retention Strategies in Working With Justice-Involved Women.

Research-based findings with vulnerable populations are strengthened by strong retention rates at the time of postintervention data collection. Women in the criminal justice system face a variety of gender-specific challenges including histories of childhood and adult sexual and physical abuse, substance abuse, untreated mental health problems, and chronic housing insecurity that can hinder follow-up of a research sample. The authors highlight a variety of retention strategies that they successfully used in their work with women following incarceration in local county jails.

Updating Accounting Systems: Longitudinal Evidence from the Healthcare Sector

This paper provides evidence on the determinants and economic outcomes of updates of accounting systems (AS) over a 24-year timespan in a large sample of U.S. hospitals. We provide evidence that hospitals update their AS in response to three types of pressures: economic pressures, such as increases in the quality of accounting information driven by vendor rollouts of improved AS; coercive pressures imposed by regulators mandating certain practices, such as internal control practices imposed by Sarbanes–Oxley Section 404; and mimetic pressures for hospitals to conform their AS to those of their peers, such as local county and prominent “celebrity” peers. We find that only economically driven updates lead to economic benefits in the form of lower operating expenses and higher revenues. In contrast, we find some evidence that AS updates prompted by coercive regulatory pressures actually impose economic costs in the form of higher operating expenses.This paper was accepted by Suraj Srinivasan, accounting.

Using ESSENCE to Meet Local Needs for Mental Health Data: Query & Results

Using ESSENCE to Meet Local Needs for Mental Health Data: Query & Results

Local authority sustainable planning for tourism: lessons from Ireland

PurposeSustainability is an essential word in the vocabulary of modern planning; it is the key principle that underpins the Irish planning process. Yet, despite decades of academic and practical debate on sustainable planning and its application to tourism, there still exist many gaps, especially when it comes to its implementation. The purpose of this paper is to highlight, over a 10-year period, how Local Authorities in Ireland have responded to the increasing tourism arrivals, which is having major implications for tourism planning.Design/methodology/approachThis study used a multi-method approach to determine the level of sustainable planning for tourism as evident from all legally required Local Authority County Development Plans (CDPs) in Ireland.FindingsWhile findings have identified a slight increase in the provision for sustainable planning for tourism over the decade, there continues to be poor levels of policy provision in key areas. Despite the responsibilities placed on Local Authorities to sustainably plan for tourism, findings continue to question the ability of Local Authorities in Ireland to plan sustainably for tourism and protect the tourism product.Originality/valueThis research provides the first longitudinal study on the level of sustainable planning for tourism by Local Authorities in Ireland. It provides an assessment of the current state of sustainable planning as evident from CDPs in 2016 compared to the original study of 2006, while developing new knowledge on Local Authority sustainable planning for tourism and the incorporation of tourism indicators.

Nurse Home-Visiting Program and Postpartum Care

According to claims data and medical record reviews, the National Committee for Quality Assurance reported that only 61.8% of Medicaid recipients had a postpartum visit between 21 and 56 days after delivery compared with 76.9% of mothers with commercial insurance. In two Medicaid–self-pay community obstetric clinics in the Piedmont region of North Carolina, the clinics reported that only 52% of their patients returned for their 6-week postpartum visit. At a large birthing facility in the same community, a grant-funded, universal, postpartum, short-term, nurse home-visiting program was developed for all women who gave birth at the facility and their families and who resided in the local county. The evidence-based practice project evaluated the improvement strategies of providing patient education, assuring transportation, and providing an appointment reminder by a postnatal nurse home-visiting program on return rates for the 6-week postpartum visit. A comprehensive literature review was conducted using OVID, PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to explore all relevant knowledge and research related to the 6-week postpartum visit to affect return rates and postnatal nurse home-visiting programs. After review of the retrieved articles, 54 were identified to be significant for this project. After creation of an evidence-based educational pamphlet, the postnatal home-visiting nurses and schedulers were trained on providing the educational pamphlet, setting up transportation if needed, and calling patients 2 days before their 6-week visit. First-quarter 2017 preimplementation data and first-quarter 2018 postimplementation data on demographics and return rates were collected and outcomes were compared. The population demographics of age, race, ethnicity, marital status, parity, payor group, and obstetric-provider group for postnatal women who received visits were similar in both groups. In the preimplementation group (n = 172), 91 (52.9%) postnatal women returned for their 6-week postpartum visit. In the postimplementation group (n = 131), 98 (74.8%) postnatal women returned for their 6-week postpartum visit, an increase of 21.9% (p < .001). Improvement of 6-week postpartum return rates can positively affect health, wellness, and contraception use in postpartum women, potentially leading to prevention of unintended pregnancies.

College Cops around the Nation: A 30-Year and 40-Year Update on the State of Higher Education in US Policing

Abstract This article describes the findings of a recent national survey of 958 local (municipal and county) law enforcement agencies on the subject of higher education in US policing. It is the first national study in 30 years to examine the issue and in 40 years to examine higher education in small departments. Findings reveal that minimum education requirements to be hired, which are primarily dictated by state standards, have not changed significantly since 1988 but CEO education has changed and is highly important for agency policy and practice. Although a college degree is not usually required to be hired, it is usually required to promote to higher ranks. About half (51.5%) of sworn officers in the US who work for local agencies have a 2-year degree or higher, 28.6% have a 4-year degree or higher, and 5.4% have a graduate degree but this varies considerably by agency size, type, region, Chief/Sheriff education level, and union presence. Implications for improving education in policing are discussed.