Suburban Agencies Research Articles

Implementing Oral Systemic Corticosteroids for Pediatric Asthma into EMS Treatment Guidelines: A Qualitative Study

Introduction: Respiratory distress accounts for approximately 14% of all pediatric emergency medical services (EMS) encounters, with asthma being the most common diagnosis. In the emergency department (ED), early administration of systemic corticosteroids decreases hospital admission and speeds resolution of symptoms. For children treated by EMS, there is an opportunity for earlier corticosteroid administration. Most EMS agencies carry intravenous (IV) corticosteroids; yet given the challenges and low rates of EMS pediatric IV placement, oral corticosteroids (OCS) are a logical alternative. However, previous single-agency studies showed low adoption of OCS. Therefore, qualitative study of OCS implementation by EMS is warranted. Methods: This study’s objective was to explore uptake and implementation of OCS for pediatric asthma treatment through semi-structured interviews and focus groups with EMS clinicians. We thematically coded and analyzed transcripts using the domains and constructs of the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators that most strongly influenced OCS implementation and adoption by EMS clinicians. Results: We conducted five focus groups with a total of ten EMS clinicians from four EMS systems: one urban region with multiple agencies that hosted two focus groups, one suburban agency, one rural agency, and a mixed rural/suburban agency. Of the 36 CFIR constructs, 31 were addressed in the interviews. Most constructs coded were in the CFIR domains of the inner setting and characteristics of individuals, indicating that EMS agency factors as well as EMS clinician characteristics were impactful for implementation. Barriers to OCS adoption included unfamiliarity and inexperience with pediatric patients and pediatric dosing, and lack of knowledge of the benefits of corticosteroids. Facilitators included friendly competition with colleagues, having a pediatric medical director, and feedback from receiving EDs on patient outcomes. Conclusion: This qualitative focus group study of OCS implementation by EMS clinicians for the treatment of pediatric asthma found many barriers and facilitators that mapped to the structure of EMS agencies and characteristics of individual EMS clinicians. To fully implement this evidence-based intervention for pediatric asthma, more education on the intervention is required, and EMS clinicians will benefit from further pediatric training.

Environmental Influences on Sheriff Perceptions and Strategies

Scholars generally agree that law enforcement organizations are influenced by the environment. While most research on criminal justice organizations has focused on municipal law enforcement agencies, sheriff agencies are distinct from municipal police agencies for a variety of reasons. As such, sheriff agencies may be uniquely impacted by environmental pressures. In the current study, electronic surveys were sent to sheriffs in 9 states to assess their concern about juvenile trafficking, their perception of environmental groups’ concern, and the agency’s response to juvenile trafficking. Results suggested a complex relationship between environmental groups, respondent perceptions, and agency response. Most notably, sheriffs seemed to view themselves as most in sync with local groups, especially the community. Additionally, rural agencies did seem to be influenced differently by environmental groups than urban and suburban agencies. Future research should study rural agencies and also seek to more deeply understand the complex relationships between the environment and sheriffs.

Variation in Alcohol Policy Enforcement Across Urban and Nonurban Communities.

The goal of this study was to assess whether different types of communities (ie, urban, suburban, small town, and rural) vary in the alcohol enforcement activities they conduct. We conducted a cross-sectional study using data from a national survey of local law enforcement agencies. The survey assessed enforcement of a range of alcohol policies at 1,082 law enforcement agencies. U.S. Census data were used to categorize agencies based on community type. Agencies in urban areas conducted more enforcement activities than agencies in other community types. Urban agencies were more likely than rural agencies to conduct underage compliance checks (prevalence ratio [PR]: 0.42; CI: 0.34-0.53), saturation patrols (PR: 0.80; CI: 0.67-0.95), sobriety checkpoints (PR: 0.68; CI: 0.53-0.86), and enforcement aimed at illegal sales to intoxicated patrons (PR: 0.59; CI: 0.42-0.81). Urban agencies were also more likely than small town agencies to do compliance checks (PR: 0.66; CI: 0.56-0.79) and sobriety checkpoints (PR: 0.75; CI: 0.61-0.91), and they were more likely than suburban agencies to do compliance checks (PR: 0.67; CI: 0.57-0.78) and enforcement actions around the sale of alcohol to intoxicated patrons (PR: 0.64; CI: 0.45-0.90), provision of alcohol to minors (PR: 0.77; CI: 0.65-0.92), and consumption by minors (PR: 0.90; CI: 0.82-0.99). Enforcement of alcohol laws differs by community type. Future research is needed to identify mechanisms to increase enforcement by agencies in different types of communities.

Equity and public finance issues in the state subsidy of public transit

Purpose Public transit is an essential service for people without access to an automobile, particularly those who are low income, elderly, or with disabilities. Previous research has found that large urban transit agencies receive less state funding per ride provided than suburban agencies. The paper aims to discuss this issue. Design/methodology/approach Using data from the National Transit Database for 37 of the largest US transit agencies, the authors create a panel data set of services provided and sources of operating funds for the period 1991-2009. The authors develop an equity index that represents the difference between the share of state funding that an agency receives and the share of the total transit rides in the state that it provides. The authors use fixed-effects regression modeling to examine the determinants of fiscal balance and the equity index. Findings The authors find that the share of an agency’s operating funds that come from dedicated taxes is a significant predictor of fiscal health as measured by its fiscal balance; reliance on passenger fares and provision of bus service are significant predictors of operating deficits. The equity index finds that large agencies receive less than their fair share of state transit funding based on ridership. Practical implications Dedicated tax revenues are a key ingredient to transit agencies’ fiscal stability. Transit agencies’ fiscal condition in states and localities that do not have a dedicated tax could benefit from such a tax. Social implications Transit is an essential service for people who are unable to drive or own an automobile; funding inequities maintain old patterns of segregation and isolation for “transit dependents.” Originality/value This study supports earlier research finding that large agencies receive less than their fair share of state funding based on ridership. It contributes to the literature on transportation equity and transit finance.

Racial Disparity in Juvenile Diversion

Purpose: Interpretations of focal concerns and “loose coupling” are used to explain juvenile diversion decisions by police and prosecutors from a large metropolitan county in the Midwest. Methods: Juveniles eligible for police diversion are compared to those actually diverted using a population of juveniles arrested in eight police urban and suburban agencies. Multinomial logistic regression is used to analyze data on juveniles referred for charging in the same county. Results: Non-White juveniles were significantly less likely to be diverted by police, formally entering them into the juvenile justice system earlier than their White counterparts. Prosecutors charged, rather than diverted, non-White juveniles significantly more frequently than White juveniles, particularly for theft cases. Conclusion: The racial disparity observed may result from differing focal concerns and loose coupling in the first stages of the justice system.

Assessing the Underutilization of Supported Employment Services.

Supported Employment Services (SES) are evidence-based practices that appear to be underutilized. This study evaluated the level of SES underutilization at both urban and suburban agencies that served people with psychiatric disabilities. Two hundred sixty-nine unemployed consumers indicated their intentions to accept a referral to SES in the next 6 months. The 54 practitioners who served these consumers indicated their intentions to refer these consumers to SES during that time period. The concordance rate between the consumers' and practitioners' intentions was 55%. Urban and suburban agencies did not differ in concordance rate. Forty-nine percent of the consumers intended to accept a referral but their practitioners intended to refer 21%. An underutilization rate of 28% was found for the combined agencies. The factors contributing to the consumers' and practitioners' intentions were also investigated. The low concordance rate between these consumers and practitioners may have been due to their different perspectives about the importance of the consumers' felt need to work.

Addressing the “elephant in the living room”

PurposeTo present systematic social observation (SSO) data concerning the work routines and citizen interactions of suburban police officers, including a detailed breakdown of how these officers spent time on their shift and the nature in which they interacted with citizens.Design/methodology/approachThis paper presents systematic social observation.FindingsIn some ways, suburban police officers behave much like other types of officers, especially the manner in which they spend time alone on shift. There appears to be some degree of variability in terms of the nature of police‐citizen encounters both within the observed group of suburban officers and between them and other types of police.Research limitations/implicationsResearchers interested in describing variations in police behavior across agencies should strive to include suburban agencies in their samples, so that it can be investigated whether or not, and to what degree, suburban community structures impact police behavior on the street.Originality/valueOf value to those involved with, or interested in, variations in police behavior across suburban communities.

Community characteristics and policing styles in suburban agencies

Recent policing reforms have strongly emphasized the role of community context in determining the form and content of effective policing, along with the traditional influence of organizational structures. Recognizing the increasing suburbanization of US communities, this study examines the empirical support for the underlying contextual and structural premises of these reforms in a sample of midwestern suburban communities. Merging data from a telephone survey of 194 municipal police departments in the five counties of the Chicago metropolitan statistical area with data on communities from other government sources, multiple regression was used to assess the relative importance of community context and organizational structure factors in accounting for differences in departmental policing styles. The findings both support and contradict some basic assumptions of current community‐oriented policing reforms, as well as some of the findings of prior studies. They underline the importance of empirically testing our theoretical assumptions in all types of community settings.

Satisfaction of nurse managers in long-term care.

Nurse managers control quality and cost of the principal service provided by long-term care agencies. Job satisfaction was higher for long-term care nurse managers in metropolitan than in rural or suburban agencies. Findings suggest that continuing education may increase task satisfaction, as well as job knowledge of diploma-prepared nurse managers.

Marketing the services of a suburban agency

Marketing the services of a suburban agency