Recently in State and Local Category
Nov 21 2013Implementation Matters
So much of public policy work focuses on passing legislation and securing funding for programs. Less attention is typically paid to the less sexy but equally important task of figuring out how programs are carried out once they're passed and funded.
When it comes to preventing teen pregnancy, there have been game-changing developments on the legislative funding front. In 2010, Congress enacted two complementary federal funding streams for evidence-based teen pregnancy prevention programs. The Teen Pregnancy Prevention Program (TPPP), administered by the Office of Adolescent Health (OAH), provides $105 million annually for five-year competitive grants to a range of organizations, most of which are to replicate a variety of models already proven to change teens' behavior. The Personal Responsibility Education Program (PREP), administered by the Administration on Children and Families (ACF), provides $75 million annually for five years. Most of the PREP funds consist of formula grants to states and territories, also to replicate effective programs.
There is a growing commitment on the part of public and private sector funders to invest dollars in programs that work, and the TPPP and PREP grants are leading the way. While it is too early to have outcomes from the programs, two new reports shed important light on how these programs are being implemented and the picture so far looks rosy.
A report by the Bridgespan Group describes how OAH selected the evidence-based programs and grantees (a process they describe as being as competitive as getting into Yale or Cal Tech!), and provided high-quality program support. It gives high marks to OAH and the grantees for their efforts to ensure that effective programs are being implemented "with fidelity" to the original model. While not always easy, this increases the chance that programs will achieve similar positive outcomes to the original evaluation. The report underscores the importance of providing adequate planning time, training, and resources to "do evidence based programs right."
A second report, by Mathematica Policy Research, looks at how states have gone about implementing PREP, including 1) who to serve, 2) how to reach them, 3) where services will be provided, and 4) what evidence-based programs to use. The report contains a slew of fascinating details about the decisions states made and what these important grants look like in communities across the country. Not surprisingly, there is considerable variation among states since the program offers quite a bit of flexibility to respond to local circumstances. However, some common themes emerge: a strong commitment to using programs that work, targeting funds to high-risk youth, and making thoughtful decisions to make the most of available resources. Again, the report highlights the commitment to providing solid program support and infrastructure to ensure high-quality results.
Together, these reports confirm that TPPP and PREP are well on their way to helping more than 400,000 young people avoid teen pregnancy. They also serve as excellent models of how to implement evidence-based programs on a large scale.
Kudos to the federal agencies, grantees, and the various organizations helping grantees to implement the programs well. Now, let's make sure Congress continues funding them so these impressive efforts can continue.
Oct 09 2013Coming Soon: Making Proud Choices! For Youth in Out-of-Home Care
Image of the 2010 Youth Leadership Team (YLT) class: ©2009 SNAP! Joe Portnoy.
In 2011, The National Campaign began a three-year project in partnership with the American Public Human Services Association (APHSA) with a focus on reducing teen pregnancy rates among youth involved with the child welfare system. With support from the Annie E. Casey Foundation, we adapted the evidence-based sex education curriculum Making Proud Choices! for youth in foster care and provided technical assistance and support to five teams of state and local child welfare professionals while they implemented the program. It's hard to believe we are in the middle of the third year but so much exciting work has been accomplished!
Throughout the project, the five teams--located in Alameda County (CA), Minnesota, North Carolina, Rhode Island, and Hawaii--have established critical partnerships between public health and child welfare organizations that have enabled them to implement the program at a larger scale and with a heightened focus on making the program sustainable. Since February 2013, the teams have been delivering the program to youth in care and participating in an ongoing process evaluation which is beginning to provide valuable insight about the types of partnerships and support systems that need to be in place to implement teen pregnancy prevention into daily child welfare practice.
Over the next few months, we will begin disseminating these results and will also work on the final revisions to the adapted curriculum which will be available for use by early 2014. To read more about the project, check out the recent article published in APHSA's magazine Policy & Practice and keep an eye out for more updates to come!
Sep 18 2013A Big Problem With a Simple Solution
So, I'm a data nerd, and I see plenty of data regarding the health of low-income Americans that I promise you would find depressing. Often it's depressing because the solution, if there is one, is so complex and obscure. But then there's data that, while it will make your jaw drop, actually has a straightforward solution, and one simple enough that 31 states are doing it now, with another 10 soon to add to that.
So, first the jaw-dropping part--a new study found that nearly half of all births in the U.S. are covered by Medicaid, the publicly-funded health insurance program for low-income Americans, up from roughly 40 percent in 2008. That's right, I said HALF! While the economy likely plays a role in the increase, the high rates of unplanned pregnancy in the U.S. overall are a huge concern (half of all pregnancies in the U.S. are unplanned, as reported by women themselves). For low-income women--many of whom do not qualify for Medicaid coverage until they get pregnant even when they live well below the poverty line--coverage and access to contraception is paramount to reducing these numbers. One Medicaid-funded birth costs $12,770 in 2010 dollars--and folks, that's just prenatal, labor, delivery and first year of infant care. By contrast, providing a woman with publicly-funded contraception for one year is $239. Hmmm... I'm no math whiz (trust me, I have a slew of teachers who can attest to that) but I know the savings there! Also, helping women to get contraception reduces abortion... there's your common ground people! For more on the myriad benefits of publicly-funded contraception, check out this great report.
So, where's the completely simple solution, you ask? Provide low-income women with contraception so we reduce unplanned pregnancies, which is exactly the same formula for reducing unplanned pregnancy in any population--access to effective contraception. Currently 31 states have expanded contraceptive coverage through Medicaid for women who wouldn't qualify for Medicaid otherwise, up to the level where they'd be eligible for Medicaid if they got pregnant. This saves these states and the federal government boatloads of money (what's that you say? "boatload" isn't a numerical quantity? Well, generally speaking, studies show that for every one dollar spent on publicly-funded family planning, taxpayers save $6). An additional 9 states plus the District of Columbia, who don't currently offered this expanded Medicaid coverage of contraception will effectively do so when they expand their Medicaid programs to cover low-income Americans up to 133% of the federal poverty level in 2014 as health reform allows. That means one way or another, come 2014 40 states and DC will be covering more low-income women either for all their health needs or for contraception. Now THAT can help make a difference.
Image by Horia Varlan.
Sep 05 2013Before You Head to Purellistan, Head to the Marketplace
"America's uninsured, take personal responsibility. If you can't afford #insurance, move some place without bacteria." --@ColbertReport, 8:03pm on Sun, Sep 01, 2013.
Despite a gigantic amount of policy, political, and media attention over the past several years, Kaiser Family Foundation reports that half the public (51%) say they don't know enough about the Affordable Care Act to understand how it will impact them and their family. This is a particular shame when it comes to young adults, many of whom say they want health insurance but are concerned about how to pay for it.
The good news according to a recent Commonwealth Fund survey is that more young adults are now aware of, and benefiting from, the Obamacare provision allowing them to stay on their parents' insurance. More good news: many women with insurance are now able to get a birth control method that works best for them without cost being a barrier.
But, not everyone has insurance (young adults aged 19-34 make up 40% of the uninsured), and not everyone knows how to get it. For example, Commonwealth also found only 27% of 19 to 29 year olds are aware of the new health insurance marketplaces (or exchanges) where they could get insurance.
With enrollment in the health insurance marketplaces opening up on October 1st, it's time to pay attention folks. There are many creative efforts underway to help educate consumers about how all this will work.
Bedsider is doing its part to help. Check out this new article that breaks down as simply as possible (given that this is pretty complex stuff) how the Affordable Care Act can help people who don't currently have insurance get access to birth control, not to mention other important health care. Then share it with a friend or two, or with anyone who is in touch with young adults.
No, it isn't all easy or simple--important things rarely are. Yes, it is better in some states than others. But, give it your best shot and take responsibility to get informed. Believe me, that beats Stephen Colbert's advice.
Aug 19 2013Making it Harder for Teens to Be Responsible
$54? $54? This was my friend Suzanah, dumbstruck, at the pharmacy last week.
Our small, local Planned Parenthood closed its doors in June, having struggled valiantly to stay open despite year after year of budget cuts. Losing this Planned Parenthood leaves thousands of teens and adults with low incomes without a place to get contraception and STD testing and treatment. It is a huge, and inevitable, loss as state and federal funding are cut. The loss is most acute for teens because the Title X-funded Planned Parenthood that closed was the only place in our town where they could go to confidentially seek out birth control, save buying condoms at the grocery store. Adults with low enough incomes might be able to receive services at our community clinic (which is not funded by Title X), but a teen must have a parent or guardian along to apply at that clinic.
Suzanah was able to get the birth control patch at our Planned Parenthood for free. She also appreciated the kindness and professionalism with which she was always treated at Planned Parenthood. Suzanah went to the clinic during its last week, and was told that they would write a prescription for her to take to the pharmacy to get next month's patches. When she arrived at the pharmacy, she was charged a $54 co-pay for the item that she used to get for free, because Planned Parenthood is not a part of her health insurance network. For a teenager who goes to school full-time and works about 12 hours a week, this was a pricey leap.
Suzanah was lucky. She was able to schedule a visit to her mom's gynecologist and get a new prescription for the patch. Many of her friends aren't so lucky; either they are hesitant to talk to their parents about birth control* or their parents do not have health insurance coverage. With cuts to the Title X Family Planning Program, and the subsequent closure of our local Planned Parenthood, teens find themselves limited to condoms for birth control and without a place to get confidentially tested and treated for STDs.
As a society, we encourage teens to act responsibly, but we are cutting off avenues through which they can do so. We have seen a tremendous reduction in teen pregnancy rates during the last two decades, but I wonder if the political choices that are being made now will wipe out some of that progress?
*NOTE: For some young people on their parents' health insurance, it may be possible to call their insurance company to request that their health care expenditures be kept private.
"Closed" image by Khairil Zhafri.