Costs of promoting cancer screening: Evidence from CDC’s Colorectal Cancer Control Program (CRCCP)

The Colorectal Cancer Control Program (CRCCP) provided funding to 29 grantees to increase colorectal cancer screening. We describe the screening promotion costs of CRCCP grantees to evaluate the extent to which the program model resulted in the use of funding to support interventions recommended by the Guide to Community Preventive Services (Community Guide). We analyzed expenditures for screening promotion for the first three years of the CRCCP to assess cost per promotion strategy, and estimated the cost per person screened at the state level based on various projected increases in screening rates. All grantees engaged in small media activities and more than 90% used either client reminders, provider assessment and feedback, or patient navigation. Based on all expenditures, projected cost per eligible person screened for a 1%, 5%, and 10% increase in state-level screening proportions are $172, $34, and $17, respectively. CRCCP grantees expended the majority of their funding on Community Guide recommended screening promotion strategies but about a third was spent on other interventions. Based on this finding, future CRC programs should be provided with targeted education and information on evidence-based strategies, rather than broad based recommendations, to ensure that program funds are expended mainly on evidence-based interventions.     

Striking a Balance between Program-Specific and Portfolio-Level Evaluation: Lessons Learned from a Multi-Site Evaluation on the Texas-Mexico Border

Funders are increasingly making strategic investments across multiple grantees, aiming for their portfolio to improve targeted outcomes in a specific issue area. To this end, funders might use multi-site evaluation (MSE) approaches to examine the impact of their collective investments. However, it is important to recognize that each program—and its own program evaluation—must be tailored to its setting, population, and local context to best meet the needs of its target population. Therefore, multi-site evaluations need to account for this complexity. This paper describes the Sí Texas project, a large initiative of eight grantees implementing different integrated behavioral health models to improve physical and mental health outcomes along the Texas-Mexico border. With over 4,200 MSE study participants, the evaluation for Sí Texas used a partnership-centered approach to both enhance the evidence base and build local organizational capacity. This paper describes this approach, the process of tailoring evaluation practices to the grantees’ context, and the challenge of balancing consistency at the grantee-level for the portfolio multi-site evaluation. Successes, challenges, and lessons learned related to study design, data collection, grantee partnership, and capacity building are discussed.     

Environmental Justice Grantmaking: Elites and Activists Collaborate to Transform Philanthropy

The rise of environmental justice activism since the 1980s provides an exceptional opportunity to study the relations between a grassroots movement and philanthropic foundations. I utilize archival documents and interviews with activists and funders to pose two guiding questions. One, to what degree has the environmental justice movement gained access to foundations? Two, to what degree does this movement maintain self‐determination in its relations with foundations? This paper shows that the movement successfully established connections with a few key foundations. I also show how environmental justice grantee organizations maneuvered around some of the foundation‐related constraints that might otherwise present very real threats to their self‐determination. This analysis builds on, but also goes beyond, the channeling and co‐optation literatures that emphasize the potentially negative influence of foundation funding on grantees. It also contributes to the newly developing social relations perspective which conceptualizes social movement philanthropy as a relationship that is mediated by many factors (for instance, the political orientation of the funder and grantee, among others).     

A national evaluation of Safe Schools/Healthy Students: outcomes and influences

The Safe Schools/Healthy Students (SS/HS) Initiative has awarded over $2 billion in grants to more than 350 school districts in partnership with local mental health, law enforcement, and juvenile justice agencies. To estimate the impact of grantee characteristics, grant operations, and near-term outcomes in reducing violence and substance use, promoting mental health, and enhancing school safety, logged odds ratios (LORs) were calculated contrasting Year 3 with Baseline performance from grantee-provided data on seven outcome measures. After comparing grantee performance across outcomes and outcomes across grantees, the LORs were entered as dependent variables in a series of meta-regressions in which grantee characteristics, grant operations, and near-term outcomes were tested after controlling for pre-grant characteristics. Findings indicate that the SS/HS Initiative significantly improved most outcomes, that within-grantee performance varied greatly by outcome, and that random-effects meta-regression appreciably decreased the variance available for modeling. The approach demonstrates that the SS/HS Initiative is effective and that locally collected performance data can be used to estimate grantee success in improving youth outcomes.     

UPSTREAM! Together evaluation results from community efforts to prevent mental,emotional, and behavioral health problems

Mental, emotional, and behavioral (MEB) health problems are prevalent globally. Despite effective programs that can prevent MEB problems and promote mental health, there has not been widespread adoption. UPSTREAM! Together was a planning project in three Colorado communities. Communities partnered with academic and policy entities to 1) translate evidence about MEB problem prevention into locally-relevant messages and materials and 2) develop long-term plans for broad implementation of interventions to prevent high-priority MEB problems. Community members recognized the need to talk about MEB problems to prevent them. The UPSTREAM! communities localized messages designed to start conversations and sustain attention on preventing MEB problems. The communities understood that prevention takes sustained community attention and advocacy, knowing that important outcomes may be years away. Long-term implementation plans aimed to strengthen families and enhance social connections among youth. Despite community readiness and capacity to implement evidence-based programs, there were few funding opportunities, delaying program implementation and revealing gaps between funding policies and community readiness. This community-engaged experience suggests an achievable approach, acceptable to communities, and worthy of further development and testing. Policies that cultivate and support local expertise may help to increase wider community adoption of evidence-based programs that promote mental health among youth.     

Traditional birth attendant training and local birthing practices in India

Training birth attendants (TBAs) provide essential maternal and infant health care services during delivery and ongoing community care in developing countries. Despite inadequate evidence of relevance and effectiveness of TBA training programmes, there has been a policy shift since the 1990s in that many donor agencies funding TBA training programmes redirected funds to providing skilled attendants during delivery. This study aimed to assess the ways in which a TBA training programme in India has been successful in disseminating evidence-based knowledge on birthing practices. TBAs practicing within 16 villages targeted by training programme initiatives were administered with structured questionnaires. The post training birthing practices of trained (24) and untrained (14) TBAs was compared and birthing practices adopted by women assisted by trained (16) and untrained (9) TBAs was analysed. Positive post training practices were hand washing, use of a clean blade for cutting the cord, immediate breastfeeding and weighing of babies. Nevertheless, the training could be further improved with up to date and evidence-based information and more comprehensive instructions. The findings suggest an integration of local and evidence-based knowledge is needed to improve the training. Raising community awareness of public health measures related to maternal and child health is also recommended.     

Community-based behavioral health interventions: Developing strong community partnerships

The popularity of community-based interventions has experienced a revival over the last two decades. The general theme behind this trend is that greater community involvement provides researchers and practitioners with culturally relevant information to make interventions successful. This involvement is usually solicited through the formation of community coalitions and advisory boards. Although the positive influence of community partnerships is well established, strategies for successfully developing and sustaining these partnerships are less clear. To address this gap, this paper presents evaluation findings from The Making Connections Initiative, a national effort emphasizing community-level prevention strategies for improving the mental health of men/boys. Sixteen grantees were tasked with developing a coalition of community organizations to provide input into the development and implementation of a local prevention initiative. An evaluation of the 16 grantees’ planning activities identified four themes related to developing and sustaining successful community partnerships. This article reports on the strategies that were found most successful across grantees. With the increasing popularity of community-based programs, strategies for successfully partnering with local organizations are particularly important. This study adds to the limited research on best practices for forming community partnerships and should serve as a guide for community-based evaluators and program planners.     

Evidence from the field: Findings on issues related to planning,implementing and evaluating gender-based programs

An Initiative of the United States Department of Health and Human Services’ Office on Women's Health (OWH), Coalition for a Healthier Community (CHC), supports ten grantees across the U.S. in the implementation of gender-based health interventions targeting women and girls. A national evaluation is assessing whether gender-focused public health systems approaches are sustainable and cost effective in addressing health disparities in women and girls. To inform the evaluation, a systematic examination was conducted of literature in both the public and private sector designed to track, assess, understand, and improve women's health, public health systems approaches, and the cost-effectiveness and sustainability of gender-based programs. A two-person team assured the quality of the results following the review of abstracts and full-text articles. Of 123 articles meeting eligibility criteria (See inclusion criteria described in Section 2.2 below), only 18 met inclusion criteria specific to a focus on a systems approach, cost-effectiveness and/or sustainability. Studies assessing systems approaches suggested their effectiveness in changing perceptions and increasing knowledge within a community; increasing involvement of local decision-makers and other community leaders in women's health issues; and increasing community capacity to address women and girls’ health. Further evaluation of the cost-effectiveness and sustainability of gender-based approaches is needed.     

Willing but unable? Extending theory to investigate community capacity to participate in Ghana’s community-based health planning and service implementation

While primary health care programmes based on community participation are widely implemented in low- and middle- income settings, empirical evidence on whether and to what extent local people have the capacity to participate, support and drive such programmes scale up is scant in these countries. This paper assessed the level of community capacity to participate in one such programme – the Community-Based Health Planning and Service (CHPS) in Ghana. The capacity assessments were drawn from Chaskin’s (2001) theorised indicators of community capacity with modifications to include: sense of community; community members commitment; community leadership commitment; problem solving mechanisms; and access to resources. These capacity measures guided the design of an interview guide used to collect data from community informants, frontline health providers (FLP) and district health managers. Key qualitative themes were built into a questionnaire administered to households selected through systematic sampling approach. Findings showed that growing individualism, low trust in neighbours and apathetic behaviours undermined the capacity of mutual support for CHPS. The capacity to support CHPS was high for local leadership and community social mobilisation groups who often dedicated time to working with FLP to promote maternal and reproductive health service use, and in advocating broader support for CHPS. Within the wider community, commitment to voluntarism was low as members perceived CHPS to be owned by, and run on government funds and resources. Poor voluntarism was compounded by poverty that crippled the capacity to provide needed resource support for CHPS. Findings have great implications for building strong capable communities for participation in community oriented health programmes.     

Deinstitutionalisation: What Went Wrong

‘Deinstitutionalisation’ has been the twin policy to ‘community care’ and has been a key welfare strategy in Britain for some 30 years. In the 1980s considerable political and professional activity was focused upon the shortcomings of community care, but relatively little attention was paid to the failure of ‘deinstitutionalisation’. Why has it proved so difficult to close long-stay hospitals? This article examines the gulf between official strategies on closure and the reality of continuing institutionalisation. It seeks explanations not only in terms of funding crises, but also in inter-professional, inter-organisational and inter-governmental relations. It concludes that the problems are deeply entrenched and that if deinstitutionalisation is to succeed, a major new initiative will be needed at the central level.     

The successes and challenges of implementing individualised funding and supports for disabled people: an Irish perspective

‘Individualised funding’, which is rooted in the Independent Living Movement, has formed part of a global paradigm shift in support services for disabled people. Against the backdrop of international experience, a political system aligned with the United Kingdom and emergent critics of individualised funding, this article presents findings from an evaluation of four pilot programmes in Ireland. Exemplified by independent-skills development and community integration, these initiatives have been welcomed as a progressive development beyond traditional service provision, with perceived improvements across a range of organisational, personal, health and social care domains. The article explores the importance of ‘natural supports’ and how overly protective behaviour may unintentionally act as a barrier to full implementation. The findings also indicate that unnecessarily complex systems can lead to individual burn-out. Furthermore, a national resource allocation system working in partnership with existing social care professionals and the wider community is recommended, as is learning from overly simplified, group-based ideologies.     

A systematic review of interventions to improve post-secondary educational outcomes among foster care alumni

In their transition to adulthood, youth who have aged out of foster care struggle in a variety of areas. One area of concern is achieving success in post-secondary education. In response, universities and community colleges around the country offer support programs for these youth, in order to assist them in gaining a college education. The purpose of this study was to utilize a systematic review process to uncover the current status of what is known about campus support programs for foster care alumni in two areas—student views of their program experiences and outcomes of interventions to improve post-secondary educational success. We adapted the Participants, Interventions, Comparison groups, Outcomes, and Study designs (PICOS) model in conducting the systematic review. A search of six electronic databases and other gray literature sources yielded seven articles. Results revealed valuable insight from students regarding the ways in which program implementation was beneficial, and highlighted important strategies future programs should consider. Further, findings of outcome studies are favorable. However, additional outcome evaluations are needed in order to validate and confirm their impact.     

Community mobilization, organizing, and media advocacy. A discussion of methodological issues

Community Mobilization refers to those activities that prepare communities to accept, receive, and support prevention interventions designed to reduce alcohol-involved trauma. Media advocacy refers to the strategic use of media by those seeking to advance a social or public policy initiative. Within the Community Prevention Trial, both of these activities were critical elements. This article presents the evaluation design for community mobilization and media advocacy implemented for the project. Here the authors argue for the need to include both structured and unstructured community monitoring instruments, coding of local alcohol-related news coverage, and surveying community members about the exposure to alcohol-related problems, and support for project interventions. This article also presents an audience segmentation analysis and discusses the implications of this analysis for media advocacy efforts.     

Supporting systemic social and emotional learning with a schoolwide implementation model

A strong body of research indicates that evidence-based programs designed to promote social and emotional learning (SEL) can lead to positive developmental outcomes for children and youth. Although these evidence-based programs have demonstrated benefits for students, it is also well-established that programs must be implemented with quality and sustained to maximize positive outcomes. To support schools in implementing SEL that is integrated into all aspects of a school community, the CASEL School Guide implementation model was developed to guide school leadership teams in establishing a vision; selecting, implementing, and sustaining evidence-based programs; and integrating SEL schoolwide. The School Guide model is based on CASEL’s School Theory of Action which includes planning, implementing, and monitoring schoolwide SEL. This paper describes findings about the feasibility and degree of implementation of this model as carried out by 14 school leadership teams who were supported by SEL coaches. The participating schools implemented an evidence-based SEL program as the foundation of their efforts to promote schoolwide SEL. Findings demonstrate the feasibility of implementing this model in urban schools that primarily serve students of color, as all teams successfully carried out the implementation model and demonstrated increased levels of capacity related to supporting schoolwide SEL.     

Using database linkages to measure innovation,commercialization, and survival of small businesses

Here, we report the results of an outcomes evaluation of the Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) Programs at the National Institute of General Medical Sciences (NIGMS). Since the programs’ inception, assessments of the SBIR/STTR programs at several federal agencies have utilized surveys of former grantees as the primary source of data. Response rates have typically been low, making non-response bias a potential threat to the validity of some of these studies’ results. Meanwhile, the availability of large publicly-available datasets continues to grow and methods of text mining and linking databases continue to improve. By linking NIGMS grant funding records, U.S. Patent and Trademark Office data, and business intelligence databases, we explored innovation, commercialization and survival for recipients of NIGMS SBIR/STTR funding. In doing so, we were able to more completely assess several key outcomes of the NIGMS SBIR/STTR program. Our evaluation demonstrated that the NIGMS program performed above baseline expectations along all dimensions, and comparably to other federal agency SBIR/STTR grant programs. In addition, we show that the use of extant data increasingly is a viable, less expensive, and more reliable approach to gathering data for evaluation studies.     

The Transformative Power of Youth Grants: Sparks and Ripples of Change Affecting Marginalised Youth and their Communities

This study, based on research into a youth empowerment initiative in Canada, examines the transformational power of youth grants for marginalised youth and their communities. The positive changes on individual youth included increased confidence and skills, as well as strengthened social interactions between youth, and involved adults and organisations. To leverage grant impact, we identify the critical role of creating accountability at multiple levels, promoting sharing among grantees, and fostering allies and system thinkers. The evaluation points to the potential of grants for changing community's perception that youth are incapable of fostering community youth development.     

湖南省解决农村贫困重度残疾人托养照护问题的实践与启示

解决农村贫困重度残疾人照护问题,既是党和政府的明确要求,也是残疾人和家属的热切期盼.湖南省农村贫困重度残疾人托养照护专项实践的主要启示:一是照护服务能有效改善农村重度残疾人生活质量和巩固脱贫攻坚成果;二是规划部署和经费配置是解决照顾问题的关键所在;三是"家庭自付+村社支持+政府补贴"的付费方式在实践中具有可行性和可持续性;四是农村地区需要优先发展保障急需的基本生活照护和寄宿照护服务,需要根据残疾人生活自理能力和家庭照护能力精准提供适合的照护服务.建议将"优先重点解决城乡低收入重度残疾人照护问题"纳入"十四五"规划及政府实事工程任务,加快建立以家庭照护为基础、社会化照护为支持、集中照护为补充的重度残疾人照护服务体系,完善以生活自理能力和家庭照护能力为核心指标的优先保障对象精准识别机制,通过"两补提标"、建立家庭照护和集中照护机构统一认定制度、评价制度和支持机制,完善残疾人帮扶机制.     

Impact of the Health Resources and Services Administration’s state oral health workforce grant program on dental workforce density and access to oral health care

BackgroundThe Health Resources and Services Administration’s Grants to States to Support Oral Health Workforce Activities, otherwise known as the State Oral Health Workforce Program (SOHWP), help states develop and implement innovations that address the workforce needs of dental Health Professional Shortage Areas in a manner appropriate to the states’ individual needs.AimThis cross-sectional study explores the broad impact of the SOHWP by comparing measures of dental workforce density and access to oral health care in states with multiple years of funding versus states with few or no years of funding.MethodsWe used data for 2006–2016 SOHWP awardees together with data from the 2016–2017 Area Health Resources Files and the 2016 Behavioral Risk Factor Surveillance System to compare numbers of dentists per 100,000 population and age-adjusted prevalence of annual dental visits among adults for long-term SOHWP-funded states versus states with few or no years of funding.ResultsMulti-year SOHWP funding is associated with higher workforce density and greater access to oral health care, especially in the Midwest and West.ConclusionAllowing states funding utilization flexibility may result in improved outcomes. This finding can help inform planning and policy about whether and how to scale future training and workforce programs to achieve greater impact.     

An exploration of older Hong Kong residents’ willingness to make copayments toward vouchers for community care

Because of its rapidly aging population, Hong Kong faces great challenges in the provision and financing of long-term care (LTC) and needs to explore sustainable funding mechanisms. However, there is a paucity of research on older people’s willingness to pay (WTP) for LTC services in Hong Kong. This study utilizes data collected in Hong Kong in 2011 (N = 536) to investigate older people’s receptivity to this financing mode by assessing their co-payments for a community care service voucher scheme and then testing how potential factors affect respondents’ amount of co-payment. Results show that respondents’ WTP was positively associated with family financial support, financial condition, and positive attitudes toward this novel policy and negatively associated with family caregiving support. Direct and moderating effects of family financial support on WTP were found. The policy-related implications of LTC financing to improve older people’s acceptance of co-payment mechanisms, financial condition, and shared responsibility of care are discussed.     

Exploring e-Mental Health Preferences of Generation Y

E-Mental Health services could substantially increase the capacity of the mental health care system. This article explores youth consumer preferences for online interventions targeting depression and anxiety. Twenty-three participants who had experienced suicidal ideation and either depression or anxiety and completed one qualitative interview were included. Interviews were topically guided to cover themes of e-Mental Health service preferences around online help-seeking behavior, appearance, content, privacy, and support. We found that youth positively received the idea of, and appreciated the need for, e-Mental Health services. Noted preferences for services were those that are simple to use, interactive, and include support through an online community.