Midwestern County Research Articles

Substantiated allegations of failure to protect in the child welfare system: Against whom, in what context, and with what justification?

Failure to protect (FTP), a sub-type of neglect, is used by child welfare systems to categorize and substantiate allegations of child maltreatment. Scholars and advocates have raised concerns that FTP is disproportionately used to substantiate mothers and people of color for harm perpetrated by others, particularly in the contexts of sexual abuse and domestic violence. Limited data exist about how FTP is used in practice or if substantiation of FTP varies by context across gendered or racialized groups. This study extends our understanding of use of FTP by examining who workers substantiate for FTP, in what context, and the justifications they use. Data for this study were drawn from child welfare records in a large, Midwestern county. Mixed methods were used to analyze data from 150 maltreatment referrals which included at least one substantiated allegation of FTP. Findings indicate that the contexts and rate at which caregivers were substantiated for FTP differed significantly across gendered groups. Mothers were most frequently substantiated for FTP in the contexts of sexual abuse, physical abuse, and domestic violence. Fathers were most frequently substantiated in the context of substance use. In addition, rates of FTP substantiation varied across racialized groups. Black caregivers were substantiated disproportionately across all contexts. White caregivers were overrepresented among those substantiated for FTP in the context of substance use. Notably, justification for substantiation decisions was often not documented in data. Implications for policy and practice are discussed.

Understanding the Role of Neighborhood Typology and Sociodemographic Characteristics on Time to Recidivism Among Adjudicated Youth

This study examined the effect of neighborhood disadvantage and criminogenic risk on juvenile recidivism. The sample included 893 youths involved in the delinquency/formal probation division of one Midwestern county juvenile court between 2004 and 2010. Juveniles were classified into one of three neighborhood typologies (i.e., Distressed/Disadvantage, Resilient/Mixed, Benchmark/Advantaged) based on the socioeconomic conditions in their neighborhoods. Survival models revealed that when examining the effect of neighborhood type, youth who lived in Resilient/Mixed neighborhoods, characterized by having the most transient residents, yet high graduation rates, were at greatest risk of recidivism. However, neighborhood effects disappeared after controlling for sociodemographic characteristics and criminogenic risk. Although there was no significant interaction between neighborhood and risk group classification, there was a significant interaction between risk group, age, and gender. These findings suggest the need for advanced statistical models that can disentangle the conflated effects of socioeconomic conditions and sociodemographic characteristics.

Getting rurality right: Investigating cancer across the rural-urban interface.

e19063 Background: Trends in oncology examine the influence of rural characteristics on cancer patient (pt) treatment and outcomes. Current definitions of rurality are broad and varied, with multiple standardized definitions. Few analyses exist to compare definitions and quality in assessing oncologic outcomes. We aim to determine which index is most suitable to define rurality in cancer research. Methods: 1,567 pancreatic cancer pts from the University of Wisconsin Cancer Registry, representing 84 Midwestern counties and 452 zip codes, were assigned rurality codes based on three indices spanning 1983-2013: Rural-Urban Continuum Code (RUCC), Rural-Urban Commuting Areas (RUCA), and Index of Relative Rurality (IRR). RUCC and IRR were assigned to pts at the county level and RUCA at the zip level. Pt rurality was compared across the three indices and over time via the median and interquartile range and inspected visually with violin plots. We compared indices with Spearman’s Rank Order Correlation (SROC). Results: RUCC 2003, RUCA 2004 (zip), and IRR 2000 were concordant in terms of metropolitan, micropolitan, and rural designations for 66.9% (1,049) of pancreatic cancer registry pts. The rural designation for almost one-third (489, 31.2%) of pts was discordant by one or two levels across the three indices (i.e. classified as metropolitan in one index and micropolitan or rural in another). SROC was 0.73 between RUCC 2003 and RUCA 2004 (zip) indices, 0.82 between IRR 2000 and RUCA 2004 (zip), and 0.85 between RUCC 2003 and IRR 2000. Across the 84 counties of registry pts’ residence, the median and interquartile range of RUCC decreased from 6 (3-7) in 1983 to 4 (2.25-6) in 2013 and of IRR decreased from 0.49 (0.44-0.53) in 2000 to 0.49 (0.43-0.53) in 2010. Across the 452 zip codes, RUCA decreased from 4 (1-10) in 1998 to 3 (1-8) in 2004. Pts’ median RUCC decreased from 3 (2-6) in 1983 to 3 (2-4) in 2013, median RUCA (zip) decreased from 2 (1-7) in 1990 to 1 (1-6) in 2000, and IRR remained constant at 0.42 (0.38-0.49) in 2000 and 2010. Conclusions: RUCC is preferable for state-level cancer studies incorporating rurality as it best distributes pts across the rural-urban interface compared to RUCA (skews urban) and IRR (skews central). County boundaries (RUCC) are consistent over time versus zip (RUCA) and census tract (RUCA). Our findings suggest that while the extremes of rural and urban are well-defined, rurality as a continuum is inconsistently measured. Researchers should continue to incorporate other measures of vulnerability to achieve health equity.

Predictors of emergency medical services use by adults with heart failure; 2009–2017

BackgroundHeart failure (HF) necessitates frequent transport by emergency medical services (EMS), but few studies have been conducted to evaluate predictors of EMS use and of multiple EMS transports that are amenable to intervention. ObjectivesTo characterize prehospital clinical status of community-dwelling adults with reported HF who used EMS across 8 years and to evaluate predictors of EMS use and multiple EMS transports. MethodsData were from a database in a large Midwestern county. Descriptive statistics, logistic and negative binomial regression were used for analysis. ResultsEMS transports were evaluated for 6582 adults with 16,905 transports. The most common chief complaints were respiratory problems, feeling sick, and chest pain. Shortness of breath, chest pain, level of consciousness, age, gender, race, and hospital site predicted multiple transports. ConclusionsClinicians need to educate patients with HF about ways to manage shortness of breath and chest pain and when to activate EMS.

Broke: Hardship and Resilience in a City of Broken Promises by Jodie Adams Kirshner

198 The Michigan Historical Review the dark side,” readers can come to a greater appreciation of the team’s glories. (8) Hunter’s book represents a worthy contribution to Detroit’s baseball history, and likewise belongs on the shelf of any true crime fan. Scott Ferkovich Detroit, Michigan Jodie Adams Kirshner. Broke: Hardship and Resilience in a City of Broken Promises. New York, NY: St. Martin’s Press, 2019. Pp. 368. Notes. Index. Hardcover: $28.99. The City of Detroit’s trip through municipal bankruptcy in 2013-14 is generally hailed as a great success. The process wiped $7 billion in debt from the city’s books. It gave Mayor Mike Duggan fiscal running room to expand programs like city planning. And it allowed the city to modernize its woefully inadequate city services. But as author Jodie Adams Kirshner points out in Broke: Hardship and Resilience in a City of Broken Promises, bankruptcy left important players in Detroit untouched—the ordinary residents mired in poverty and joblessness. Broke thus provides a needed corrective to the current image of Detroit as a “comeback city.” While great advances have been celebrated, particularly in the newly fashionable downtown, Midtown, Corktown, and other districts, vast areas of the sprawling city remain virtually untouched by any improvements. Kirshner’s pointillist approach follows several Detroiters identified by their first names—Joe, Miles, Cindy, Lola, among others—as they scrape out an economic existence in a city beset with high unemployment and little opportunity. Among other woes, the city’s housing market virtually collapsed during the Great Recession, and much of Broke follows Kirshner’s actors as they try to buy or hold on to a house facing tax foreclosure, vandalism, and heartless speculation by real estate vultures. The accumulation of detail creates a portrait of despair. At an ice cream parlor, workers dish up scoops from behind bullet-proof glass. A long-ago brush with the law that never leaves his record endlessly dogs the character Miles. Joe, a handyman, hires an ex-convict to help with some work and “the man agreed but told him robbing houses and selling drugs paid better.” (101) “Bankruptcy could not provide new remedies against financial problems,” Kirshner writes. “It could not directly reverse the population loss, employment loss, or property value loss that contributed to the Book Reviews 199 shrinking tax base, nor could bankruptcy bring back lost federal and state support to offset pressures on public welfare.” (xix) That last point about the loss of federal and state aid is a key to the puzzle. As Kirshner writes, assistance to cities peaked in 1978. Since then, Detroit and other cities have lost out on untold billions in dollars that were once promised but never delivered. “We have overestimated the ability of cities and their residents to combat powerful forces like automation, suburbanization, the recent financial crisis and deindustrialization,” she writes. (xxii) A reader might quibble that all cities suffer many of the same problems as Detroit. But, as Kirshner asserts, the Motor City may represent the extreme end of the scale of urban distress. And she is certainly on target that the highly touted bankruptcy—one of the transformative events in Detroit’s recent history—did little or nothing for many of the city’s struggling residents. “The lives that Broke chronicles show us what bankruptcy cannot accomplish,” she concludes in a downbeat cod. “They show us the hard work of combating individual poverty must take precedence over facile, short-term urban fixes.” (283) That’s a lesson of special relevance for Detroit. As Miles, one of the people Kirshner profiles, tells her in the book, “Detroit’s a good thing when it’s going good.” (xv) But no city can prosper if it’s at its best only when the going is good. John Gallagher Author and journalist William D. Lopez. Separated: Family and Community in the Aftermath of an Immigration Raid. Baltimore, MD: Johns Hopkins University Press, 2019. Pp. 232. Works cited. Hardcover: $27.95. William D. Lopez’s Separated details how mixed-status families navigate everyday life and institutions by focusing on a Midwestern county in Michigan. Mixed-status families are those that have a...

Separated: Family and Community in the Aftermath of an Immigration Raid by William D. Lopez

Book Reviews 199 shrinking tax base, nor could bankruptcy bring back lost federal and state support to offset pressures on public welfare.” (xix) That last point about the loss of federal and state aid is a key to the puzzle. As Kirshner writes, assistance to cities peaked in 1978. Since then, Detroit and other cities have lost out on untold billions in dollars that were once promised but never delivered. “We have overestimated the ability of cities and their residents to combat powerful forces like automation, suburbanization, the recent financial crisis and deindustrialization,” she writes. (xxii) A reader might quibble that all cities suffer many of the same problems as Detroit. But, as Kirshner asserts, the Motor City may represent the extreme end of the scale of urban distress. And she is certainly on target that the highly touted bankruptcy—one of the transformative events in Detroit’s recent history—did little or nothing for many of the city’s struggling residents. “The lives that Broke chronicles show us what bankruptcy cannot accomplish,” she concludes in a downbeat cod. “They show us the hard work of combating individual poverty must take precedence over facile, short-term urban fixes.” (283) That’s a lesson of special relevance for Detroit. As Miles, one of the people Kirshner profiles, tells her in the book, “Detroit’s a good thing when it’s going good.” (xv) But no city can prosper if it’s at its best only when the going is good. John Gallagher Author and journalist William D. Lopez. Separated: Family and Community in the Aftermath of an Immigration Raid. Baltimore, MD: Johns Hopkins University Press, 2019. Pp. 232. Works cited. Hardcover: $27.95. William D. Lopez’s Separated details how mixed-status families navigate everyday life and institutions by focusing on a Midwestern county in Michigan. Mixed-status families are those that have a parent or parents in the United States without citizenship while their kids might. Separated focuses on an immigration raid of an auto shop and the deportation of a person named Santiago. It highlights the experiences of individuals in the raid beyond Santiago that was led by Immigration and Customs Enforcement (ICE) agents with the help of local police departments to show the trauma they create within multiple families via the deportability of individuals. 200 The Michigan Historical Review The interactions between people from Santiago’s family with agencies and institutions are used by Lopez to stress that the border is enforced far from a southern wall. He writes that the stories in the book are violent and life altering by showing how enforcement tactics are militarized with “little regard to the physical and psychological damage done to those at whom they are directed, their families, or their communities.” (15) Separated uses Washtenaw County to analyze people’s relationship with the US deportation machine by detailing how it operates in their everyday lives whether citizen or not. Lopez argues that while we must look at the extravagant displays of police violence, there is also much to be gained by examining the difficulty mixed-status families face when trying to navigate things as simple as purchasing groceries. The book is split into three sections surrounding the events of the raid. Part I explores the community and its people before the raid while the two chapters in Part II explore the raid itself. Part III approaches the aftermath of the raid, which is followed by a conclusion and epilogue that highlight the months post-raid to understand the longer-lasting ramifications and impact of deportations on families. Lopez uses over twenty-four interviews to analyze the context of the raid. This includes interviews with family members involved, local community activists, and police officials. He combines these with ethnography and thick description of the neighborhood based on living and volunteering in the community and going for ride-alongs with police officers. A major contribution the book makes about ICE, policing, and the deportation machine is the ramifications on mixed-status families and their mental and physical health. For example, Lopez indicates how a mother could no longer produce breast milk due to the susto, or scare, they experienced during the raid...

Providing effective asthma care at a pediatric patient-centered medical home.

A recent assessment of the national annual burden of the cost of asthma among school-aged children was nearly $6 million. In a Midwestern county, the incidence of childhood asthma was 15.8%, which was above both state and national levels. Effective asthma care was not being provided at a rural, pediatric patient-centered medical home due to a lack of standardization. This quality improvement (QI) initiative aimed to increase the mean effective asthma care score to 78% for patients with asthma over the course of 90 days. This right care initiative was implemented using a rapid-cycle Plan-Do-Study-Act methodology. Tests of change in the areas of team engagement, patient engagement, and two process measures were analyzed through chart audits and run charts over four cycles. Likert scale surveys were used to analyze qualitative data. Interventions included developing the Asthma Patient Identification Tool, implementing an asthma education protocol with teach-back, creating standardized smart phrases for effective documentation, and initiating asthma care huddles. The delivery of effective asthma care increased to 84%. The number of patients receiving the asthma education protocol increased to 65%, with 80% of the patients participating in effective teach-back sessions. The mean effective documentation score increased to 92%. A standardized approach to asthma care grounded in evidence-based guidelines positively affected the delivery of care. Nurse practitioners are effective team leaders for clinical QI initiatives.

Validation of the Ohio Youth Assessment System Dispositional Tool (OYAS-DIS): An Examination of Race and Gender Differences

The Ohio Youth Assessment System-Disposition Tool (OYAS-DIS) is a juvenile risk assessment that is used in numerous states and jurisdictions to assess criminogenic risk of juvenile offenders. Still, there is little published research on the predictive validity of the tool. The purpose of the current study was to examine the predictive validity of OYAS-DIS, with a specific focus on understanding prediction of recidivism across racial and gender subgroups. The sample consisted of 4,383 youth that received a court petition in a single large Midwestern county juvenile court. The findings indicated that the OYAS-DIS was a statistically significant predictor of recidivism across all racial and gender subgroups. However, there was statistically significant variation in predictive validity across subgroups. For instance, the tool was a statistically significantly better predictor of recidivism for White males as compared to Black male youth. There was also statistically significant variation in the predictive validity of certain domains (e.g., juvenile justice history) on the OYAS-DIS across racial and gender subgroups. Implications of research favor the use of the OYAS-DIS to predict recidivism for adjudicated juveniles.

Risk assessment as a mechanism for reducing differential treatment of minorities by a juvenile justice system

Disparities in treatment of African American juvenile offenders persist in juvenile justice systems across the United States. This study examined adjudication trends over a ten-year span within a Mid-Western County’s juvenile court for African American young offenders subsequent of the system’s implementation of the Risk Need Responsivity Model (RNR-Model). Special attention was given to changes in disproportionate minority contact with intensive interventions within the Delinquency Division versus informal probation, which is considered a low intensity and less punitive adjudication path. The findings indicated African Americans were more likely to be referred to low intensity interventions at Intake (Informal Probation) after the RNR Model was implemented, suggesting disparities in contact were partially mitigated by the risk assessment approach. Implications for policy are discussed.

The Bridging Activity of Multiracial Congregations

The growing diversity of U.S. communities has led scholars to explore how racial/ethnic diversity effects social capital, civic engagement, and social trust. Less is known about the relationship between diversity and the work of community-based organizations (CBOs). In this study, we examine how the racial/ethnic composition of one ubiquitous type of CBO, religious congregations, is related to measures of organizational bridging social capital. Analyzing data collected through a census of congregations in one Midwestern county, we explore the relationship between racial/ethnic diversity and the bridging activity of religious congregations. We find that multiracial congregations are more likely to be involved with externally focused service programs, tend to support a larger number of programs, and report more interorganizational collaborators than other congregations. Our findings suggest that multiracial congregations can provide a valuable resource for increasingly diverse communities and civil society.

Mental Health Crisis Location and Police Transportation Decisions: The Impact of Crisis Intervention Team Training on Crisis Center Utilization

Crisis Intervention Team (CIT) research has shown increases in officer transports of individuals with serious mental illness to emergency departments (ED) which, while more appropriate than incarceration, can be expensive and lack linkage to long-term mental health services. Mental health crisis centers offer a promising alternative, but impact may be limited by proximal distance and lack of officer awareness. To address this concern, this study asked, “Does CIT training affect officer transport decisions to a crisis center over a nearby ED?” Researchers analyzed crisis call reports in a Midwestern county and found increased use of the crisis center and decreased use of EDs by officers after CIT was implemented. The crisis location affected officer transport decisions, yet CIT officers were more likely than non-CIT officers to travel farther for appropriate linkage. Findings suggest CIT changes officer behavior, which could potentially lead to long-term, low-cost treatment for individuals with serious mental illnesses when there is a mental health crisis center.

141. School Connectedness Protective Against Bullying In A Rural Community

Bullying has long-term detrimental effects on the mental and physical health of early adolescents. Rural adolescents may be at particular risk because their communities have fewer resources to combat bullying. For these adolescents, schools may be an important resource. We examine the influence of parent and school connectedness on experiences of bullying among middle school students in a rural Midwestern county. Sixth to eighth grade students completed surveys in health classes in a rural Midwestern, low-to-middle income school district. Outcome measures included: (1) social bullying (3-items, e.g., “Have you been excluded from a group or completely ignored?”, α=0.786), (2) physical bullying (1-item, e.g., “Has someone hurt you physically?”) and, (3) electronic bullying (2-items; e.g., “Had anyone used your username or screen-name to spread rumors or lies about someone else?”). All bullying items had a 5-point response scale ranging from never-several times/week. Predictor variables included: gender, race/ethnicity, sexual orientation (heterosexual/sexual minority), grade level (6th/7th/8th), parent connectedness (5-items, range: 0-20, α=.922, e.g., “How close do you feel to …?”) and school connectedness (5-items, range: 5-20, α= .799, e.g., “I feel close to people at my school”). Three ordinal logistic regressions were used to estimate the effect of parent- and school-connectedness on experiencing the different types of bullying, controlling for gender, sexual orientation and grade level (SPSS, 25.0). The study was IRB approved. We recruited 1319 participants, 51% male, 8.3% sexual minority, 52% Latinx, 37% White, 11% other or mixed race, and mean(SD) age = 12.5 (SD1.0). Social bullying was most commonly reported by students (50%), followed by physical (24%) and electronic bullying (15%). Social bullying was more common with female students (OR=2.58, CI=2.04-3.26) and less common among Latinx students (OR=0.60, CI=0.47-0.76), 7th (OR=0.72, CI=0.54-0.96) and 8th graders (OR=0.73, CI=0.55-0.97), and among students who reported higher school connectedness (OR=0.85, CI=0.81-0.88). Sexual orientation and parent connectedness were not significant. Physical bullying was less common among Latinx students (OR=0.70, CI=0.51-0.97) and lower with increased parent (OR=0.95, CI=0.92-0.98) and school connectedness (OR=0.89, CI=0.85-0.94). Gender, sexual orientation and grade were not significant. Electronic bullying was more common among female (OR=3.08, CI=2.25-4.21) and sexual minority students (OR=1.74, CI=1.06-2.86), and less common among students who reported higher school connectedness (OR=0.84, CI=0.80-0.88). Grade and parent connectedness were not significant. Bullying was common among rural middle school youth. School connectedness was protective against all bullying types, whereas parent connectedness was only protective against physical bullying. Higher rates of social and electronic bullying among girls and sexual minority youth are consistent with known patterns; however, the protective effects of Latinx ethnicity in this rural context deserves further exploration. These data emphasize the importance of creating safe and supportive learning environments for diverse youth.

Child Appraisals of Interparental Conflict: The Effects of Intimate Partner Violence and Parent-Child Relationship Quality.

Children's appraisals of interparental violence, including appraisals of high threat and low coping efficacy, are robust predictors of behavioral and emotional problems. However, few studies have examined the factors that account for children's use of these maladaptive appraisals, particularly among children exposed to more severe forms of interparental conflict. The current study examines parent-child relationship quality as a mediator of the effect of intimate partner violence (IPV) exposure on children's appraisals of conflict. Participants were 118 mother-child dyads (54 girls and 64 boys), recruited from three Midwestern counties. Consistent with previous reports, child exposure to IPV, as reported by children's mothers, predicted higher threat and lower coping efficacy appraisals. In addition, mediation analyses showed child reports of parent-child relationship quality mediated the association between IPV and coping efficacy, but not the effects of IPV on threat appraisals. The role of parent-child relationships in shaping cognitive appraisals in the context of IPV exposure can have implications for prevention and intervention efforts as well as public policy.

Care Experiences of Women Who Used Opioids and Experienced Fetal or Infant Loss

ObjectiveTo explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss. DesignA qualitative, descriptive design with secondary data analysis. SettingThe Fetal and Infant Mortality Review program in an urban Midwestern county in the United States. ParticipantsEleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review. MethodsWe used thematic analysis to analyze interview data. ResultsFive themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death. ConclusionOur findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances.

A Mixed-Methods Approach to Evaluate the Effectiveness of Rural Community Health Coalitions: Comparing Coalition Capacity and Social Network Analysis

To determine how multiple indicators of coalition capacity (robustness, strength, sustainability, and growth) may predict effectiveness of community health coalitions in rural settings. Community coalitions in two rural Midwestern counties focusing on building capacity to reduce obesity participated in this study. Local community facilitators were hired to assist coalitions in forming partnerships, creating mission statements and goals, and identifying/addressing community needs. We are taking a novel mixed-methods approach to assess associations across indicators of coalition capacity within and between counties to determine which variables are most salient to coalition effectiveness. Participants are completing interviews and surveys over a two-year period that measure the study variables. Indicators of coalition capacity are being assessed using social network analysis and factor analysis to determine how assessment approaches converge. We are comparing network robustness, density, and centrality to coalition growth, health, and sustainability. We expect to demonstrate the unique and shared power of coalition capacity indicators and determine which indicators may serve as instrumental predictors of coalition effectiveness. Comparing quantitative network parameters (i.e. density and centrality) with other capacity building assessments will allow us to determine how specific modifications to the network (e.g. increasing density and/or centrality or restructuring the network geometry) may predict and improve coalition effectiveness over time. This novel methodology can be used for long-term evaluation and planning for local, state, and regional coalitions.

The Children First Program: The Effectiveness of a Parent Education Program for Divorcing Parents

ABSTRACTThis study evaluated the effectiveness of the 2nd and 3rd editions of the Children First parent education programs for parents experiencing divorce or separation. Participants were 678 parents experiencing separation or divorce in 2 Midwestern counties. Changes from pretest to posttest on participants’ knowledge, attitudes, and likelihood of adaptive coparenting were assessed. Both editions of the program had a significant positive effect on all 3 measures of adaptive coparenting. The effect sizes from pretest to posttest for the 2nd edition were small, whereas the effect sizes for the 3rd edition of the program were nearly twice as large. Superiority of the 3rd edition might be due to an increased focus on explicit training on adaptive coparenting behaviors.

The Importance of Interagency Collaboration for Crossover Youth

Crossover or dually involved youth are youth enmeshed in the child welfare system (CWS) and juvenile justice system (JJS). Given their dual status and high needs, attention has recently focused on how to best respond to them in an integrated, interagency fashion. The Crossover Youth Practice Model (CYPM) is designed to facilitate interagency collaboration between the CWS and JJS in order to enhance services and diversion to these youths. This study reports on the benefits and challenges that the JJS and CWS, as well as the personnel working within them, experience by participating in a CYPM effort in a Midwestern county, and provides recommendations for continued improvements in interagency collaborations for crossover youth.

The impact of transfer payments on urban-rural income gap: based on fuzzy RD analysis of China’s midwestern county data

China’s long term Gini coefficient is higher than the international warning line and the urban-rural income gap is still serious, meanwhile the transfer payments targeted adjusting the income distribution are increasing in recent years, which indicate that we should examine the impact of current transfer payment system on income gap. By choosing Develop-the-west Strategy that is a quasi-natural experiment and applying regression of discontinuity of location, using 1054 counties data of 15 provinces in Midwestern China from 2000 to 2007, we analyze the impact of transfer payments on urban-rural income gap in this paper. The results show that local government in western China paid more transfer payments than in the central region, however, the income gap between urban-rural residents in the western region increased by 20%. The widening effects are robust in different bandwidth situation such as distance or latitude and longitude. Meanwhile, the mechanism analyses find that urban residents benefit more than rural residents from transfer payments. Therefore, we believe that transfer payments should be more targeted to invest in rural areas, at the same time, the central government should rationalize the structure of transfer payments as soon as possible, and correct the urban bias and structure bias of local fiscal expenditure.

Overcoming barriers to rural children’s mental health: an interconnected systems public health model

AbstractA large, Midwestern county implemented a four-tiered public health model of children’s mental health with an interconnected systems approach involving education, health care, juvenile justice and community mental health sectors. The community sought to promote protective factors in the lives of all youth, while improving the capacity, accessibility and coordination of the continuum of care available to children and families. This article describes efforts to improve services for children in rural communities by connecting traditionally separated sectors and engaging doctoral psychology interns in the continuum of care. This article articulates lessons learned in practice, provides a case study and community outcomes; universal screening data, graduation rates and juvenile arrest rates suggest efforts are yielding positive results. Considerations for implementation in other rural communities are discussed.

Incidence of Type 1 Diabetes Is Not Increasing in a Population-Based Cohort in Olmsted County, Minnesota, USA

ObjectivesTo investigate the recent incidence of T1D in a US Midwestern county to determine whether this increase has been sustained and compare it with the incidence of celiac disease (CD) and also investigate the prevalence of CD, an associated autoimmune disease, within the cohort. Patients and MethodsA broad search strategy was used to identify all incident cases of T1D in Olmsted County, Minnesota, between January 1, 1994, and December 31, 2010, using the Rochester Epidemiology Project. Diagnosis and residency status were confirmed through the medical record. Incidence rates were directly standardized to the 2010 US population. Poisson regression was used to test for a change in incidence rate. Clinical charts were reviewed to confirm case status. ResultsThere were 233 incident cases of T1D. Directly adjusting for age and sex with respect to the 2010 US white population, the overall annual incidence of T1D was 9.2 (95% CI, 8.0-10.4) per 100,000 people per year among all ages and 19.9 (95% CI, 16.6-23.2) per 100,000 people per year for those younger than 20 years. There was no significant increase in the incidence of T1D over time (P=.45). Despite the overall stability in annual incidence, there was an initial increasing trend followed by a plateau. Of the 109 patients with T1D (47%) tested for CD, 12% (13) had biopsy-proven CD. ConclusionThe incidence of T1D has stopped increasing in Olmsted County, Minnesota, in the most recent decade. Further studies are needed to confirm this finding and explore reasons for this plateau.