Healthiest State Programs and Policies

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Decision Maker
Implementation in other States
Wisconsin Specifics
Expected Beneficial Outcomes
Evidence of Effectiveness
Strength of Evidence
Disparity Impact
Potential Population Reach
379 policies and programs
Strength of Evidence Scale
0 =  No evidence
1 =  1 study showing beneficial outcomes or 2-3 with inconsistent results/(insufficient evidence per Community Guide)
2 =  2-3 studies with consistent positive results/Recommended by credible group
3 =  More than 3 studies with positive results/ Recommended by multiple credible groups
4 =  Systematic review with sufficient evidence of effectiveness/(Recommended per Community Guide)
5 =  Systematic review with finding of strong evidence of effectiveness
Disparity Impact Scale
↓ =  likely to reduce racial/ethnic, socioeconomic, geographic, or other disparities
0 =  no impact on disparities likely
↑ =  may increase racial/ethnic, socioeconomic, geographic, or other disparities
Potential Population Reach
1 =  <1% of Wisconsin's population
2 =  1-9%
3 =  10-19%
4 =  20-49%
5 =  50-99%
6 =  100%
Sources of Information on Implementation for Health Care Access

AARP. Wisconsin - A State Fact Sheet for Grandparents and Other Relatives Raising Children Accessed on August 11, 2008

Christian S, Dower C, O’Neil E. Chart Overview of Nurse Practitioner Scopes of Practice in the United States Center for the Health Professions, University of California, San Francisco, 2007 Accessed on August 11, 2008

Cooperative Care Accessed on August 11, 2008

Crall, J. and Schneider, D., with American Dental Association (Ed.). Medicaid reimbursement: Using marketplace principles to increase access to dental services. 2004 Accessed on August 11, 2008

Dental Assisting National Board, Inc. State-specific Dental Assisting Information Accessed on August 11, 2008

Department of Workforce Development. Wisconsin Health Care Workforce Annual Report 2007 Accessed on August 11, 2008

Dower C, Christian S, O’Neil E. Promising Scopes of Practice Models for the Health Professions. Center for the Health Professions, University of California, San Francisco, 2007 Accessed on August 11, 2008

GAO. Health professional shortage areas.: Problems remain with primary care shortage area designation. October2006. Accessed on August 11, 2008

Schiff J and Ricketts A. The Minnesota Medical Learning Home Collaborative Minnesota Medicine January 2006 Accessed on August 11, 2008

Synposes of State and Territorial Dental Public Health Programs Accessed on August 11, 2008

TransforMEd Accessed on August 11, 2008

Yannacci J, Rivard J, Ganju Vijay. State Activities in Implementing Evidence-Based Programs for Children, Youth and Familiies. Paper presented at the 18th th Annual Research Conference, A System of Care for Children’s Mental Health: Expanding the Resear Accessed on August 11, 2008

AACN - American Association of Colleges of Nursing. State Legislative Initiatives to Address the Nursing Shortage. Issue Bulletin, October 2006 Accessed on August 11, 2008

ANCC - American Nurses Credentialing Center. Magnet Recognition Program Accessed on August 11, 2008

Family Care - Accessed on 01/26/2009

NHLP 2008 - National Health Law Program. Summary of State Law Requirements Addressing Language Needs in Health Care. 2008. Accessed on August 11, 2008

Sources of Information on Implementation for Health Care Quality and Costs

Ambulatory Surgical Centers-Quality: Rehnquist J. Quality oversight of ambulatory surgical centers. A system in neglect. Department of Health and Human Services. Office of Inspector General. 2002.

CDSS: Wright MO, Knobloch MJ, Pecher CA, Mejicano GC, Hall MC. Clinical decision support systems use in Wisconsin. Wisconsin Medical Journal. 2007; 106(3):126-129.

Children’s Hospice: A call for change: recommendations to improve the care of children living with life-threatening conditions. Children’s International Project on Palliative/Hospice Services (ChIPPS) Administrative/Policy Workgroup of the National Hospic

E-Technology: Foldy S. Inventory of electronic health information exchange in Wisconsin, 2006. Wisconsin Medical Journal. 2007; 106(3):120-125.

E-Technology: Foldy S, Coffey CO, Williams NF, Nickel K, Morse D, Wang J, Rohde-Szudy CR. Wisconsin ambulatory health information technology (HIT) survey 2006-2007. MetaStar. 2007.

E-Technology: Wisconisn eHealth Action Plan. Wisconsin eHealth Care Quality and Patient Safety Board. December 2006.

Health Literacy: Smith P. Literacy and health, the hidden problem that is everywhere. Family Medicine Newsletter. UW Department of Family Medicine. April/May 2006.

Linguistically Appropriate Services: Ore P, Darmody K. Resource and needs assessment: report of findings. Wisconsin Coalition for Linguistic Access to Healthcare. 2004.

Mandatory Reporting –Adverse Events: For state adverse event reporting information, see: Patient safety toolbox for states. National Academy for State Health Policy.

Medical Wristbands: Wristband color project, Quality Improvement Act lead WHA Medical and Professional Affairs agenda. The Valued Voice. Wisconsin Hospital Association. 2008; 52(6):4,9.

MRSA Screening: Kasprak J. MRSA screening and reporting. OLR Research Report 2008; 2008-R-0092.

No Reimbursement for Medical Errors: Links to no reimbursement/charge initiatives:

No Reimbursement for Medical Errors: Sipkoff M. Hospitals asked to account for errors on their watch. Manag Care. 2007; 16(7):30,35-37.

Pharmacy initiatives: Henry D, Mendelson D, Fallieras A. Clinical pharmacy management initiative: integrating quality into Medicaid cost containment. Center for Health Care Strategies, Inc. 2003.

Pharmacy initiatives: Hoadley J, Crowley J, Bergman D, Kaye N. Understanding key features of the Drug Effectiveness Review Project (DERP) and lessons for state policy makers. Issue Brief. National Academy for State Health Policy. 2006

State Continuing Medical Education Requirements State medical licensure requirements and statistics, 2008.

Accreditation - State Continuing Medical Education Requirements State accreditation requirements.

Health Behaviors
Policy/Program Decision
Maker
Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
Nutrition: Nutrition education & information
Submit a commentLabel foods served in public eating outlets to show serving size and/or nutritional content
    State government
    Local government
    Businesses & employers
    Healthcare
    Colleges & universities
    School boards
    New York City, King County (WA), and San Francisco now requires chain restaurants to post calorie counts on menu boards. On September 30, 2008, California became the first state in the nation to require nutritional menu labeling by chain restaurants.
    Wisconsin has no law that requires reporting of nutritional content.
    food portion sizes
    caloric intake
    Evidence-based program (EBP) from WIPAN-Worksites, French 2001, Story 2008
    3 0 5
    Submit a commentProvide nutrition info in clinic waiting rooms
    Provide nutrition self-assessments, display brochures and posters about nutrition programs and resources
      State government
      Healthcare providers
      Community organizations
      Local government
      Varies by provider.
      Recommended by WI DHS; implementation varies by provider.
      Improved dietary habits
      awareness about nutrition resources
      EBP WIPAN
      2 0 6
      Submit a commentProvide patients with nutrition “prescriptions” and tools for self-assessment and recording
        State government
        Healthcare providers
        Medicare supports medical nutrition therapy for the following conditions: diabetes, non-dialysis kidney disease, post-kidney transplants. Use of prescriptions for other patients varies from provider to provider.
        Recommended by WI DHS; implementation varies by provider.
        Improved dietary habits, increased awareness of the importance of diet and nutrition
        EBP WIPAN
        2 0 6
        Submit a commentBreastfeeding promotion programs
        Programs to increase breastfeeding initiation, exclusive breastfeeding, and duration.
          State government
          Healthcare
          Businesses & employers
          Community organizations
                Moderate evidence of effectiveness (CDC-Breastfeeding Guide)
          4 0 2
          Policy/Program Decision
          Maker
          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
          Nutrition: Nutrition standards
          Submit a commentSchool nutrition standards
            State government
            17 states have nutritional standards for schools that are more strict than the federal standards
            Wisconsin has no state nutritional standards, although all districts are now required to write wellness policies, many of which might include these standards
            fruit & vegetable consumption
            sweetened beverage consumption
            Recommended as Promising Practice by TX Obesity Policy Portfolio, French 2001, Story 2008
            2 0 3
            Submit a commentNutritional standards for competitive foods in schools
            Competitive foods are foods that “compete” with the standard school meal program, e.g., food and beverages sold in vending machines.
              School boards
              State government
              22 states have nutritional standards for competitive foods
              Wisconsin has no state nutritional standards for competitive foods, although all districts are now required to write wellness policies, many of which might include these standards
              fruit & vegetable consumption
              sweetened beverage consumption
              Evidence-based program (EBP) from WIPAN, Story 2008
              3 0 3
              Submit a commentLimited access to competitive food in schools
                School boards
                State government
                26 states limit access to competitive foods in schools
                Wisconsin has no state limitations on access to competitive foods, although all districts are now required to write wellness policies, many of which might include some limitations
                fruit & vegetable consumption
                sweetened beverage consumption
                EBP WIPAN, Story 2008
                3 0 3
                Submit a commentPolicy regulating nutrition education standards
                  State government
                  National Association of State Boards of Education (NASBE) runs the Obesity Prevention Project, which supports states in creating policy tools to reduce obesity rates. Did no find examples of state policies. “Team Nutrition” is a federal program supported by national policy.
                  Wisconsin participates in “Team Nutrition,” but unclear whether state has individual policy.
                  fruit & vegetable consumption
                  sweetened beverage consumption
                  Obesity prevention
                  Recommended as Promising Practice by TX Obesity Policy Portfolio, French 2001
                  2 3
                  Policy/Program Decision
                  Maker
                  Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                  Nutrition: Access to healthy food options
                  Submit a commentMake water available; promote consumption
                    School boards
                    Businesses & employers
                    State government
                    Local government
                    Healthcare providers
                    Colleges & universities
                    Expanded Food and Nutrition Program (OSU); many nutrition programs include this as a component
                    Appleton Central High School nutrition program provides water throughout the day
                    sweetened beverage consumption
                    EBP from WIPAN-Schools, Promising for worksites, French 2001
                    3 0 6
                    Submit a commentIncrease availability of fruits & vegetables, nutritious options
                    Increase healthy food options in lunchrooms, a la carte, vending and school stores; make options appealing
                      School boards
                      State government
                      Businesses & employers
                      Community organizations
                      Colleges & universities
                      Healthcare providers
                      Local government
                      Examples (available from CDC Making it Happen! Web site) include: Austin and Mercedes ISD (TX), Cambridge and Cortland School Districts (NY), Fairfax County (VA), Fayette County (KY), McComb School District (MS).
                      22 School Districts participated in the USDA’s Fresh Fruits and Vegetable Program as of 2006.
                      fruit & vegetable consumption
                      Promising from WIPAN, Story 2008
                      2 5
                      Submit a commentModify vending machine options to increase healthy beverage choices
                        School boards
                        State government
                        Businesses & employers
                        Healthcare providers
                        Colleges & universities
                        Community organizations
                        At least 19 states have vending machine standards in schools
                        Examples: Lac du Flambeau, Appleton, Madison, and Marshfield School Districts have started implementing vending machine standards.
                        sweetened beverage consumption
                        Promising from WIPAN, French 2001, Story 2008
                        2 0 5
                        Submit a commentSchool/ after-school fruit and vegetable gardens
                        Accompany with nutrition education
                          School boards
                          Kidsgardening.org has a registry of school gardens that lists several gardens throughout the U.S. with a nutrition focus.
                          WI youth gardens include Troy Gardens and Waisman Discovery Garden. DHS provides support to school gardens through its “Got Dirt? Gardening Initiative.” 19 WI schools are in the Kidsgardening.org register.
                          fruit & vegetable consumption
                          Promising from WIPAN
                          1 3
                          Submit a commentEnsure on-site cafeterias follow healthy cooking practices
                          Set nutritional standards for foods served that align with the US Dietary Guidelines for Americans
                            Businesses & employers
                            Local government
                            State government
                            Healthcare providers
                            Colleges & universities
                            School boards
                            Community organizations
                            Clark County, WA; Woodbury, IA; Contra Costa County, CA all regulate nutrition standards of food purchased for/ provided by local govt. Participating worksites in NH’s HEAL program.
                            Healthier WI Worksite Initiative funded 11 grantees which partnered 17 worksites, including: local government, manufacturing, nursing homes, Head Start, healthcare orgs., schools/ tech college/ university
                            fruit & vegetable consumption
                            EBP WIPAN
                            2 0 4
                            Submit a commentOffer healthy foods at meetings, conferences, and catered events
                              Businesses & employers
                              Local government
                              State government
                              UT Dept. of Health, Active Living by Design, several states offer Healthy Worksite toolkits
                              Healthier WI Worksite Initiative funded 11 grantees which partnered 17 worksites, including: local government, manufacturing, nursing homes, Head Start, healthcare orgs., schools/ tech college/ university
                              fruit & vegetable consumption
                              EBP WIPAN
                              2 0 4
                              Submit a commentAllocate funding to use electronic methods of payment at farmers’ markets
                                Local government
                                State government
                                31 states have farmers’ markets that take electronic payments.
                                Participants in WIC and Senior Farmers’ Market Programs can use electronic benefit transfer; electronic payment for other consumers is possible at some farmers’ market locations.
                                accessibility/ consumption of fruit & vegetables
                                Recommended as Promising Practice by TX Obesity Policy Portfolio
                                2 0 6
                                Submit a commentTax credits for locating farmers’ markets/ farm stands in lower-income neighborhoods
                                  Local government
                                  The Food Trust and Pennsylvania’s Legislation to Finance Fresh Food Markets in Underserved Communities earmarked funds to open fresh markets in poorer communities. USDA Farmers’ Market Promotion Program, Community Food Project Competitive Grants. No tax credits identified.
                                  None identified.
                                  fresh fruit and vegetable access/ consumption.
                                  Recommended as Promising Practice by TX Obesity Policy Portfolio
                                  2 3
                                  Submit a commentFarm-to-school programs
                                  Incorporates locally-grown foods into school meals and snacks
                                    School boards
                                    Businesses & employers
                                    39 of the 50 states operate as part of the USDA Farm to School program
                                    Wisconsin Homegrown Lunch program coordinated by REAP Food Group is currently being piloted in the Madison-area School District, Mt. Horeb, Sauk Prairie, Evansville, Waunakee, Monona Grove, and Oregon. Appleton Central Alternative Charter High School also coordinated with a local business to provide cafeteria service.
                                    fruit & vegetable consumption
                                    Recommended as Promising Practice by TX Obesity Policy Portfolio
                                    2 3
                                    Submit a commentAllocate funding to expand WIC and Senior Farmers’ Market Nutrition Programs
                                      State government
                                      46 state agencies support SFMNP and WIC FMNP.
                                      Wisconsin offers both WIC and Senior Farmers’ Market Programs. Criteria for participation or accessibility of farmers’ markets could be expanded.
                                      accessibility of fruit & vegetables, increased consumption
                                      Recommended as Effective by TX Obesity Policy Portfolio, supported by Perez-Escamilla 2000, Rose 1998
                                      3 3
                                      Submit a commentInstitute policies that facilitate the development of community gardens
                                      Tax incentives, land banking
                                        Local government
                                        State government
                                        Boston has zoning ordinance specifically for gardens, Chicago NeighborSpace is authorized to purchase vacant land to preserve for gardens, Seattle and Berkeley included community gardens in their comprehensive city plans.
                                        The Madison Comprehensive Plan supports urban agriculture projects and their expansion.
                                        access to fresh vegetables and fruit
                                        fruit & vegetable consumption
                                        Suggested by TX Obesity Policy Portfolio
                                        1 3
                                        Submit a commentProhibit the sale of (non-nutritious) food for school fund-raising activities
                                          School boards
                                          State government
                                          Local government
                                          See “competitive food sales/ pricing”
                                          See “competitive food sales/ pricing”
                                          access to non-nutritious foods
                                          Recommended as Promising Practice by TX Obesity Policy Portfolio
                                          2 0 3
                                          Policy/Program Decision
                                          Maker
                                          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                          Nutrition: Incentives to improve nutrition
                                          Submit a commentSnack taxes including food and sugared soft drinks
                                            State government
                                            17 states have snack taxes
                                            Wisconsin has no snack tax
                                            unhealthy food consumption
                                            Recommended as Promising Practice by TX Obesity Policy Portfolio, French 2001, Story 2008
                                            2 0 6
                                            Submit a commentUse point of decision/purchase prompts to highlight fruits and vegetables, and promote water consumption
                                              School boards
                                              Businesses & employers
                                              State government
                                              Local government
                                              Colleges & universities
                                              Healthcare
                                              Community organizations
                                              Examples in Washington State; Austin, TX; City of Los Angeles
                                              UW River Falls implements PODP, Dept. of Health Svcs. Provides worksite wellness kits.
                                              fruit & vegetable consumption
                                              sweetened beverage consumption
                                              EBP WIPAN, Story 2008
                                              3 0 6
                                              Submit a commentUse competitive pricing in schools; price non-nutritious foods at a higher cost
                                                School boards
                                                Carson City School District, San Jose School District, and San Francisco Unified School District have implemented competitive pricing. Maine Nutrition Network also recommends.
                                                Lac du Flambeau, Appleton, Marshfield, Platteville, Middleton-Cross Plains school districts all restrict or increase prices on non-nutritious foods.
                                                fruit & vegetable consumption
                                                sweetened beverage consumption
                                                EBP WIPAN, recommended by Maine Nutrition Network, French 2001, Story 2008, but definition of non-nutritious is contentious.
                                                3 0 3
                                                Submit a commentProvide taste testing opportunities to introduce new fruits & vegetables
                                                  School boards
                                                  State government
                                                  Businesses & employers
                                                  Colleges & universities
                                                  Local government
                                                  Healthcare providers
                                                  Community organizations
                                                  VT Feed!, Cobb County (GA), HOPE After school nutrition program (CA)
                                                  Wisconsin Homegrown Lunch program, Fresh Fruit and Vegetable program
                                                  fruit & vegetable consumption
                                                  EBP from WIPAN-Schools
                                                  2 5
                                                  Submit a commentTeach food preparation skills
                                                  Provide healthy cooking demonstrations, include a family component to cooking classes at worksites
                                                    School boards
                                                    State government
                                                    Businesses & employers
                                                    Colleges & universities
                                                    Healthcare
                                                    Local government
                                                    Community organizations
                                                    Colorado State University, University of GA Extension, community food pantry in IN, Utah State Education Board supports school-based cooking classes
                                                    Cooking classes offered through WIC, UW-Extension, Farm to School and Wisconsin Homegrown Lunch also offer cooking demonstrations/ lessons
                                                    fruit & vegetable consumption
                                                    EBP WIPAN
                                                    2 5
                                                    Submit a commentIdentify alternative revenue sources needed to replace existing incentives schools receive from current sales
                                                      School boards
                                                      School districts around the country have identified alternative revenue sources such as: student-led clean-up activities, walks, or runs; sales of wrapping paper; car washes; etc.
                                                      Examples not found, likely same as implementation in other states.
                                                      sweetened beverage consumption
                                                      Promising from WIPAN
                                                      1 0 3
                                                      Submit a commentReduce or eliminate beverage advertising of non-nutritious beverages
                                                        School boards
                                                        67 communities have banned exclusive rights for cola advertisers
                                                        In 2000, Madison became the first school district to back out of an exclusive cola contract.
                                                        sweetened beverage consumption
                                                        Promising from WIPAN
                                                        1 0 3
                                                        Submit a commentProvide healthy eating reminders and prompts to employees via multiple means (i.e. email, posters, payroll stuffers, etc.)
                                                          Businesses & employers
                                                          Colleges & universities
                                                          Healthcare
                                                          Local government
                                                          State government
                                                          Community organizations
                                                          School boards
                                                          Participating worksites in NH’s HEAL program
                                                          Healthier WI Worksite Initiative funded 11 grantees which partnered 17 worksites, including:local government, manufacturing, nursing homes, Head Start, healthcare orgs., schools/ tech college/ university
                                                          fruit & vegetable consumption
                                                          EBP WIPAN
                                                          2 0 4
                                                          Policy/Program Decision
                                                          Maker
                                                          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                          Nutrition: Comprehensive programs that promote nutrition
                                                          Submit a commentComprehensive, center-based early childhood development programs (Head Start)
                                                          Preschool and parenting support/ programs aimed at low income families (implementation varies)
                                                            Federal government
                                                            State government
                                                            School boards
                                                            Community organizations
                                                            National (implementation varies)
                                                            Have Head Start but not a universal program
                                                            teen pregnancy
                                                            delinquency
                                                            high school grad rates
                                                            crime
                                                            employment
                                                            Improved parenting
                                                            Sufficient according to the Community Guide (CG-Social); strong evidence base RAND-Karoly 2005
                                                            4 3
                                                            Submit a commentSchool based nutrition programs
                                                            These interventions have educational components (e.g., classroom instruction by teachers, integrating nutrition education across curricula, peer training), environmental components (e.g., school menus, classroom snacks & special treats), and/or other components (e.g., physical activity, family education and involvement, community involvement).
                                                              School boards
                                                              State government
                                                              In 1998, 14 states approved school-based nutrition programs; Illinois, Oregon
                                                              UW Extension offers nutrition education for students in schools at which 50% or more of the students are eligible for free or reduced price school meals
                                                              fruit & vegetable consumption
                                                              sweetened beverage consumption
                                                              Insufficient evidence in CG-Nutrition, EBP from WIPAN , UW-Extension program shows some success in youths eating fruit and vegetables. Howerton 2007 reviews 7 studies and finds moderate increases fruit/ veg consumption.
                                                              3 3
                                                              Policy/Program Decision
                                                              Maker
                                                              Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                              Physical Activity: Access to opportunities/facilities that promote physical activity
                                                              Submit a commentIncreased access to fitness or community centers or athletic facilities
                                                              • Physical access/ location
                                                              • Reduced cost or sliding scale fees to improve economic access
                                                              Local government
                                                              Businesses & employers
                                                              Colleges & universities
                                                              School boards
                                                              Community organizations
                                                              ID limits the liability of landowners for people using their land for recreation and several CA municipalities have agreements for joint use of school facilities for recreation programs.
                                                                leisure time physical activity.
                                                              Evidence-based program from WIPAN, Brownson 2006, recommended by NCPPA
                                                              4 6
                                                              Submit a commentOffer grants/ funding for mixed use development
                                                                Local government
                                                                State government
                                                                OR, MD, CA all offer support for Smart Growth development, which requires mixed-use design.
                                                                WI Comprehensive Planning Grants: Since the program began in 2000, 964 communities have participated. In 2007, 12 grantees were awarded funds, covering over 350,000 WI residents.
                                                                non-auto traffic and leisure time physical activity
                                                                overall physical activity
                                                                Recommended by CG-Physical Activity, Active Living by Design, Brownson 2006
                                                                4 5
                                                                Submit a commentIncrease green space/ parks, esp. those accessible by foot/ bike
                                                                • Rails to trails programs
                                                                Local government
                                                                State government
                                                                Brownfields redevelopment, community gardens, rails to trails programs are implemented (to some degree) in all 50 states.
                                                                Ozaukee Cty has comprehensive park and green space plan, Stevens Point has “Eco-City” initiative, several cities have received grants to renovate brownfields.
                                                                leisure time physical activity.
                                                                Recommended by NCPPA, Brownson 2006, and Active Living by Design
                                                                3 0 5
                                                                Submit a commentExtracurricular sports/ after-school activities for school children
                                                                • Soccer, baseball, tennis, football, volleyball teams at differ skill levels to encourage participation at all levels
                                                                School boards
                                                                State government
                                                                Community organizations
                                                                21st Century Community Learning Centers, intramural sports leagues
                                                                Chilton Rec Sports, WI Independent Youth Football League, MAJOR Youth Baseball League, Team Wisconsin hockey
                                                                physical activity during non-school hours.
                                                                Recommended by Active Living by Design
                                                                2 0 3
                                                                Submit a commentRecreational sports leagues for adults
                                                                  Community organizations
                                                                  DC Sports League Neighborhood Athletic Assoc., Underdog Sports League (Seattle), Players Sports (Chicago), UT Rec Sports
                                                                  UW Rec Sports, Madison Ultimate Frisbee Assoc., UW La Crosse, Chilton Rec Sports, Brookfield, Cedarburg, Greenfield, Milwaukee, Racine, Waukesha, West Allis
                                                                  leisure time physical activity.
                                                                  Recommended by Active Living by Design
                                                                  2 0 5
                                                                  Submit a commentNeighborhood watch/ safety walks to create safe communities
                                                                    Community organizations
                                                                    Law enforcement/ justice system
                                                                    Tenant associations
                                                                    > 15 states have crime prevention associations
                                                                    Milwaukee’s “Safe & Sound” initiative; Two Rivers’ “TRIAD” community policing program
                                                                    resident fear of crime
                                                                    feeling of personal safety
                                                                    Greater levels of leisure time physical activity (walking, running, biking)
                                                                    Saegert 2002, Saegert 2005, recommended by Active Living by Design
                                                                    2 5
                                                                    Policy/Program Decision
                                                                    Maker
                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                    Physical Activity: Physical activity information & education
                                                                    Submit a commentExpand school-based physical education classes
                                                                    Add new PE classes; Lengthen existing PE classes; Increase physical activity during PE class
                                                                      School boards
                                                                      State government
                                                                      Federal Carol M. White Physical Education program provides ~$73 million to states; MI Exemplary Physical Education Curriculum (EPEC) project team develops, tests, and disseminates materials and procedures that enable schools to promote PA.
                                                                      The Governor’s School Health Award encourages schools to adopt enhanced PE.
                                                                      physical activity during school hours.
                                                                      Evidence-based practice (EBP) from WIPAN, also recommended by NCPPA and Active Living by Design
                                                                      3 3
                                                                      Policy/Program Decision
                                                                      Maker
                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                      Physical Activity: Physical activity standards
                                                                      Submit a commentMinimum school physical education requirements and standards
                                                                      All schools should meet State requirements and standards; Monitor compliance; Consider adequacy of current standards
                                                                        School boards
                                                                        State government
                                                                        22 states require K-12 P.E.
                                                                        Recent study showed that 90% of all schools met state minimum requirements, but WI requires only 1.5 credits during HS for graduation.
                                                                        physical activity during school hours.
                                                                        EBP WIPAN and recommended by Active Living by Design
                                                                        3 3
                                                                        Submit a commentSchool policies to increase activity
                                                                        • Safe Routes to Schools
                                                                        School boards
                                                                        Local government
                                                                        State government
                                                                        Begun in CA; all states have SRTS coordinators as part of their state DOT. Level of SRTS implementation by state varies.
                                                                        In 2007, 47 WI communities received SRTS support from the state, only half planned for immediate changes to school environment.
                                                                        Promotes physical activity through healthier transportation behaviors.
                                                                        EBP WIPAN; SRTS has mostly anecdotal evidence, but rec. by Active Living by Design; Evidence supports increased # of children walking and biking to school, but GAO-08-789 recommends comprehensive assessment plan
                                                                        3 3
                                                                        Policy/Program Decision
                                                                        Maker
                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                        Physical Activity: Incentives to increase physical activity
                                                                        Submit a commentCommunity promotion of recreational activities
                                                                        Individually-adapted health behavior change; Community-wide campaigns to increase PA through media efforts; School-wide campaigns
                                                                          Local government
                                                                          School boards
                                                                          Community organizations
                                                                          Colleges & universities
                                                                          Healthcare
                                                                          Businesses & employers
                                                                          All states have some community-based efforts to promote PA and behavior change.
                                                                          Governor’s Challenge, Energize Eau Claire, Movin’ and Munchin’ Schools
                                                                          leisure time physical activity, non-auto transportation
                                                                          Recommended by CG-Physical Activity
                                                                          4 6
                                                                          Submit a commentImplement gasoline tax that covers the external costs of fuel use
                                                                          Tax revenue used to expand trails and pedestrian pathways
                                                                            State government
                                                                            Local government
                                                                            The highest state gas tax is in CA ($0.46/gal.), whereas taxes range from $0.61/gal in Canada to $7.61 in Germany.
                                                                            Wisconsin’s gas tax as of 1/2008 was $0.329/gal.
                                                                            non-auto traffic and physical activity.
                                                                            Recommended by NCPPA, Brownson 2006
                                                                            2 6
                                                                            Submit a commentWorkplace incentives for physical activity
                                                                            Cash payouts for not using parking facilities; Flex time policy; Reimbursement for gym memberships
                                                                              Businesses & employers
                                                                              State government
                                                                              Healthcare
                                                                              Local government
                                                                              Community organizations
                                                                              Healthy South Dakota program at worksites, Healthy Alberta (Canada), etc.
                                                                              HighSmith, LandsEnd and Quadgraphics offer incentives to staff.
                                                                              physical activity among working adults.
                                                                              EBP WIPAN, Brownson 2006 and recommended by Active Living by Design
                                                                              4 0 5
                                                                              Submit a commentSubsidized public transportation
                                                                                Local government
                                                                                New York City, Chicago are examples of municipal subsidies; most states receive some federal subsidies for mass transit.
                                                                                State Urban Mass Transit Operating Assistance Program dedicated ~$107m to areas with urban populations >2,500.
                                                                                driving, minor increase in physical activity (walking to/from transit stops).
                                                                                Recommended by Active Living by Design and Brownson 2006
                                                                                3 5
                                                                                Submit a commentPoint-of-decision prompts
                                                                                Signs placed by elevators and escalators to motivate people to use nearby stairs
                                                                                  Businesses & employers
                                                                                  Colleges & universities
                                                                                  Healthcare
                                                                                  State government
                                                                                  Local government
                                                                                  Community organizations
                                                                                  MN “DO” campaign which supports placement of PODP in workplaces around the state.
                                                                                  State office buildings have prompts, no list is available of in use in other worksites.
                                                                                  physical activity at the workplace.
                                                                                  Recommended by CG-Physical Activity, Active Living by Design, Brownson 2006, EBP from WIPAN
                                                                                  4 0 5
                                                                                  Submit a commentReduced health insurance premiums for members of fitness clubs/ YMCA
                                                                                    Health insurers
                                                                                    State government
                                                                                    Blue Cross Blue Shield, Harvard Pilgrim, United Healthcare, Tufts, CIGNA, Fallon are examples of insurance companies that reimburse for gym membership
                                                                                    State employees are offered reimbursement for gym membership & attendance.
                                                                                    gym attendance, leisure time physical activity.
                                                                                    EBP WIPAN and recommended by Active Living by Design
                                                                                    3 0 5
                                                                                    Policy/Program Decision
                                                                                    Maker
                                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                    Physical Activity: Comprehensive programs that promote physical activity
                                                                                    Submit a commentMulti-component interventions aimed at diet, physical activity, and cognitive change
                                                                                    Combinations of activities and support such as: nutrition education, prescriptions for aerobic/ strength training, training in behavioral techniques; providing self-help materials, specific dietary prescriptions, and group or supervised exercise sessions; and pedometers.
                                                                                      Healthcare providers
                                                                                      Community organizations
                                                                                      Colleges & universities
                                                                                      School boards
                                                                                        Efforts likely taking place in Wisconsin, but no list available
                                                                                      weight loss (six months after intervention has started)
                                                                                      Recommended by the CG-Physical Activity. Recommended by van Sluijs 2007. Key finding is that single component interventions have not yet been shown to work, while those incorporating multiple types of components show stronger results
                                                                                      5 0 5
                                                                                      Policy/Program Decision
                                                                                      Maker
                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                      Physical Activity: Initiatives to reduce unnecessary driving
                                                                                      Submit a commentDeveloping bicycle/ pedestrian master plans
                                                                                      Increase walking and biking trails; Improve connectivity of non-auto paths and trails
                                                                                        Local government
                                                                                        NJ, Salt Lake City, Santa Rosa (CA), Anne Arundel Cty. (MD), Shreveport (LA), Seattle are all examples of regions w/bike or pedestrian master plans
                                                                                        WI has a statewide Pedestrian Policy Plan, Madison/Dane County has a bicycling plan, City of West Allis has a bike/pedestrian master plan
                                                                                        non-auto traffic, increase in physical activity rates
                                                                                        Recommended by CG-Physical Activity, Active Living by Design, Brownson 2006, and NCPPA
                                                                                        4 6
                                                                                        Submit a commentZoning regulations that enable physical activity
                                                                                        Mixed use zoning
                                                                                          Local government
                                                                                          State government
                                                                                          OR, MD, CA all have Smart Growth Initiatives. Other states implement mixed use development at the municipal level.
                                                                                          In 2007, 12 grantees were awarded Smart Growth funds, covering over 350,000 WI residents. Smart Growth efforts typically implemented mixed used development
                                                                                          non-auto traffic, increase in physical activity rates
                                                                                          Recommended by CG-Physical Activity, Active Living by Design, Brownson 2006
                                                                                          4 5
                                                                                          Submit a commentImproved streetscape design to encourage walking
                                                                                          Improved street lighting; Traffic calming design elements; Increased sidewalk coverage; Infrastructure projects to increase ease and safety of street crossing; Increased connectivity of pedestrian walkways
                                                                                            Local government
                                                                                            State government
                                                                                            Private developers
                                                                                            IL DOT is required to include safe cycling/walking in all urban projects. 13 other states have “complete streets” policies.
                                                                                            WI DOT plans for 2020 and 2030 both include recommendations that all construct include space for walking and biking.
                                                                                            non-auto traffic and leisure time physical activity
                                                                                            overall physical activity
                                                                                            Recommended by CG-Physical Activity, Active Living by Design, Brownson 2006
                                                                                            4 5
                                                                                            Policy/Program Decision
                                                                                            Maker
                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                            Risky Sexual Behavior
                                                                                            Submit a commentComprehensive, curriculum- based sex and STD/HIV education programs (with minimum standards for teaching)
                                                                                            Curriculum programs are often implemented in schools; comprehensive programs emphasize abstinence but also include information on condom and contraceptive use
                                                                                              State government
                                                                                              School boards
                                                                                              32 states mandate that some form of sex education be taught.
                                                                                              WI law encourages, but does not require schools to provide sex education; a comprehensive approach to sex education is recommended by WI DPI but there are no minimum standards for the entire Human Growth and Development curriculum. Governor rejected federal funding tied to abstinence-only education in 2007.
                                                                                              Delayed initiation of sex
                                                                                              frequency of sex
                                                                                              incidence of unprotected sex
                                                                                              use of condoms
                                                                                              use of contraception
                                                                                              Effective per Alford 2003 & Kirby 2007, & Cochrane-Underhill 2008
                                                                                              Recommended by MASH 2007
                                                                                              3 2
                                                                                              Submit a commentCondom availability programs
                                                                                              These programs provide condoms free of charge or at a reduced cost and can be implemented in a variety of settings.
                                                                                                State government
                                                                                                School boards
                                                                                                Community organizations
                                                                                                Colleges & universities
                                                                                                Healthcare
                                                                                                Businesses & employers
                                                                                                Local government
                                                                                                As of the late 1990s, more than 400 public schools in the U.S. made condoms available to students
                                                                                                Free condoms are available at some clinics, health centers, and other establishments in Wisconsin. Milwaukee Health Department runs the No Condom No Way program. Unaware of any programs in WI schools
                                                                                                condom use
                                                                                                In communities – Cohen 1999; In schools – Blake 2003; Recommended by Advocates for Youth; promising program – Urban-Eisen 2000
                                                                                                3 5
                                                                                                Submit a commentIndividual-, group-, and community-level HIV behavioral interventions
                                                                                                  Local government
                                                                                                  Community organizations
                                                                                                  Colleges & universities
                                                                                                  School boards
                                                                                                  Healthcare
                                                                                                  Businesses & employers
                                                                                                    A number of agencies receiving funding from the WI HIV/AIDS Program conduct these types of interventions
                                                                                                  sexual risk behaviors, such as unprotected anal intercourse
                                                                                                  Recommended by Community Guide for adult men who have sex with men
                                                                                                  4 3
                                                                                                  Submit a commentMulti-component interventions
                                                                                                  These broad-based programs include multiple parts such as classroom instruction, individual counseling, and community events
                                                                                                  • Children’s Aid Society
                                                                                                  • Carrera Program
                                                                                                  School boards
                                                                                                  Community organizations
                                                                                                  Originally implemented in New York, the Carrera program has been replicated in 7 states and DC.
                                                                                                    Delayed initiation of sex
                                                                                                  use of condoms
                                                                                                  use of contraception
                                                                                                  teen pregnancies/ births
                                                                                                  Effective per Alford 2003 & Kirby 2007
                                                                                                  3 2
                                                                                                  Submit a commentPartner counseling and referral services (PCRS), including provider-referral partner notification
                                                                                                    Healthcare providers
                                                                                                    Local government
                                                                                                    Community organizations
                                                                                                    CDC requires states to establish standards and implement procedures for PCRS
                                                                                                    PCRS are included as part of the WI HIV/AIDS Program
                                                                                                    Identify members of a high-prevalence target population for HIV screening; initiate risk behavior changes with knowledge of status
                                                                                                    Recommended by Community Guide
                                                                                                    4 1
                                                                                                    Submit a commentService-learning programs
                                                                                                    These youth development programs include a volunteer component which is often linked to academic instruction that may include a health curriculum; they frequently address nonsexual factors
                                                                                                    • Reach for Health Community Youth Service Learning
                                                                                                    • Teen Outreach Program
                                                                                                    School boards
                                                                                                    Community organizations
                                                                                                    At least 14 states have service learning programs
                                                                                                    A variety of service-learning activities take place in WI schools; DPI receives Learn and Serve America grant funding annually to develop and support service-learning programs
                                                                                                    use of condoms
                                                                                                    Delayed initiation of sex
                                                                                                    Reducefrequency of sex
                                                                                                    use of contraception
                                                                                                    Reducein teen pregnancies/ births
                                                                                                    Effective per Alford 2003 & Kirby 2007; promising program Urban-Eisen 2000
                                                                                                    3 2
                                                                                                    Policy/Program Decision
                                                                                                    Maker
                                                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                    Smoking
                                                                                                    Submit a commentIncrease cigarette tax
                                                                                                      State government
                                                                                                      All states have some tax on cigarettes ranging from 2-40% of total pack price
                                                                                                      Cigarette excise tax is now $1.77 or approximately one-third of pack price.
                                                                                                      smoking prevalence
                                                                                                      Based on nationwide implementation levels, states can anticipate decrease in smoking prevalence from 0-20%; in Wisconsin, from 4-7% Recommended by the Community Guide (CG-tobacco)
                                                                                                      5 4
                                                                                                      Submit a commentBan smoking in public places
                                                                                                        State government
                                                                                                        Local government
                                                                                                        Every state has at least some restriction on smoking except Wyoming. 17 states have total bans on smoking in public places
                                                                                                        Smoking is banned in all government buildings, schools and child care centers. Communities ban smoking in restaurants and bars that serve less than 10% of state’s population.
                                                                                                        exposure to secondhand smoke
                                                                                                        smoking prevalence
                                                                                                        Recommended by the Community Guide (CG-tobacco)
                                                                                                        5 0 6
                                                                                                        Submit a commentIncrease funding for comprehensive tobacco program
                                                                                                        Includes mass media campaigns, community mobilization, community education to reduce environmental smoke in the home, and quitlines
                                                                                                          State government
                                                                                                          Healthcare
                                                                                                          Every State has a tobacco control program. Programs are funded between 3% and 141% of the CDC minimum.
                                                                                                          WI program is funded at $15 million/ year or 50% of CDC’s recommended minimum.
                                                                                                          smoking prevalence
                                                                                                          Recommended by the Community Guide (CG-tobacco)
                                                                                                          5 0 5
                                                                                                          Submit a commentQuitline
                                                                                                            State government
                                                                                                            Many states have quitlines
                                                                                                            Wisconsin has a quitline and provides 2-week nicotine replacement therapy kit to callers with a quit plan.
                                                                                                            quit rates, long-term
                                                                                                            prevalence
                                                                                                            Recommended by the Community Guide (CG-tobacco)
                                                                                                            5 0 5
                                                                                                            Submit a commentMass media education campaigns combined with other interventions
                                                                                                              State government
                                                                                                              Community organizations
                                                                                                              Many states use mass media campaigns with other interventions
                                                                                                              Mass media campaigns have been intermittently mounted to promote quitting and discourage take-up of smoking.
                                                                                                              quit rates
                                                                                                              smoking uptake by youth
                                                                                                              Recommended by the Community Guide (CG-tobacco)
                                                                                                              5 5
                                                                                                              Submit a commentEducation and outreach program
                                                                                                                Healthcare providers
                                                                                                                Health insurers
                                                                                                                About 11 states including WI have such programs
                                                                                                                State funds program run by UW-CTRI
                                                                                                                Dissemination of evidence-based tobacco dependence treatments
                                                                                                                insurance coverage
                                                                                                                access to cessation treatment
                                                                                                                tobacco use
                                                                                                                Recommended by CDC tobacco 2007
                                                                                                                5 0 4
                                                                                                                Policy/Program Decision
                                                                                                                Maker
                                                                                                                Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                Substance Misuse or Dependency: Policies and informational campaigns for those who might be providers of alcohol
                                                                                                                Submit a commentState-wide media campaign about extent and risk of early alcohol use and consequences of providing alcohol to underage youth.
                                                                                                                  State government
                                                                                                                      underage drinking
                                                                                                                  Recommended by IOM-2004. Warning posters etc. to deter adult providers recommended by UMN (see Toomey 2008
                                                                                                                  2 5
                                                                                                                  Submit a commentMinimum age (21 years old) for sellers and servers
                                                                                                                    State government
                                                                                                                    Varies between states: many require minimum age of 21, some 18, some do not specify.
                                                                                                                    Minimum age: 18
                                                                                                                    underage drinking
                                                                                                                    Recommended by Toomey 2008
                                                                                                                    2 0 3
                                                                                                                    Submit a commentRBS (responsible beverage service)
                                                                                                                    Also known as server training.
                                                                                                                      State government
                                                                                                                      Businesses & employers
                                                                                                                      Tested in Minnesota, Oregon
                                                                                                                      Fully implemented in Wisconsin, all beverage servers must undergo RBS training
                                                                                                                      underage drinking
                                                                                                                      Recommended by RAND-Imm 2007, UMN (see Toomey 2008, WHO 2007, IOM-2004. Not successful in all studies on its own, but combined with other community based programs it is. Most effective when there is legal liability Anderson 2006.
                                                                                                                      4 0 6
                                                                                                                      Submit a commentKeg registration
                                                                                                                        State government
                                                                                                                        Local government
                                                                                                                        Varies: some states have penalties for altering IDs, some make it a crime to possess unlabeled kegs, some have no registration reqs. Utah bans kegs.
                                                                                                                        Not required on a statewide basis in WI but some local communities have enacted ordinances.
                                                                                                                        underage drinking
                                                                                                                        Provides ability to identify and prosecute adults who provide kegs to youth.
                                                                                                                        Recommended by Toomey 2008, RAND-Imm 2007
                                                                                                                        2 0 3
                                                                                                                        Submit a commentPolicies regulating provision, possession, consumption, and purchase of alcohol for and by minors
                                                                                                                        • Underage possession consumption of alcohol
                                                                                                                        • Furnishing alcohol to minors
                                                                                                                        • Underage purchase of alcohol
                                                                                                                        State government
                                                                                                                        Only 14 states have no exceptions to the age 21 minimum legal drinking age. 5 states (including WI) provide an exception in the presence of family.
                                                                                                                        Consent and presence of parent guardian or spouse required for possession consumption. Minors are banned from purchasing alcohol with no exceptions
                                                                                                                        underage drinking
                                                                                                                        Best practice PRC 2004. Recommended by IOM-2004
                                                                                                                        3 0 3
                                                                                                                        Submit a commentVigorous enforcement of existing underage drinking laws and minimum legal drinking age (MLDA)
                                                                                                                          Local government
                                                                                                                              underage drinking
                                                                                                                          Best practice PRC 2004. Recommended by IOM-2004
                                                                                                                          3 0 3
                                                                                                                          Policy/Program Decision
                                                                                                                          Maker
                                                                                                                          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                          Substance Misuse or Dependency: Policies that raise the price of alcohol
                                                                                                                          Submit a commentIncrease alcohol excise tax
                                                                                                                            State government
                                                                                                                            Varies state to state
                                                                                                                            Wisconsin has 3rd lowest in the country, no change since 1969
                                                                                                                            underage drinking
                                                                                                                            binge drinking
                                                                                                                            OWI
                                                                                                                            Recommended by RAND-Imm 2007, WHO 2007, NIAAA 2007, and IOM-2004. Adolescents are especially price sensitive.
                                                                                                                            4 6
                                                                                                                            Submit a commentRestrict drink specials that encourage over-consumption
                                                                                                                              State government
                                                                                                                              Local government
                                                                                                                              Many states use a variety of policies to restrict “happy hours”, from total prohibition, to prohibiting free beverages, more servings, increased volumes, or prizes, etc
                                                                                                                              Wisconsin has enacted none of the laws that other states use to limit “happy hours”.
                                                                                                                              binge drinking
                                                                                                                              Recommended by RAND-Imm 2007. Promising strategy per NIAAA 2007.
                                                                                                                              2 2
                                                                                                                              Policy/Program Decision
                                                                                                                              Maker
                                                                                                                              Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                              Substance Misuse or Dependency: Policies that restrict the places and times in which alcohol can be consumed or purchased
                                                                                                                              Submit a commentReduce alcohol outlet density
                                                                                                                                State government
                                                                                                                                Local government
                                                                                                                                Examples cited from California and Illinois
                                                                                                                                Wisconsin has among the highest rates of alcohol outlet density in the US
                                                                                                                                underage drinking
                                                                                                                                binge drinking
                                                                                                                                OWI
                                                                                                                                Recommended by RAND-Imm 2007 and NIAAA 2002. Evidence for reducing drinking and driving, as well as reducing college and underage drinking Anderson 2006
                                                                                                                                3 5
                                                                                                                                Submit a commentCampus bans
                                                                                                                                Range from bans on consuming of alcohol anywhere on campus to banning alcohol in dormitories (unless all occupants are > age 21)
                                                                                                                                  Colleges & universities
                                                                                                                                  Mississippi State, Oklahoma State, Portland State, University of Missouri are examples of public universities with campus bans on alcohol
                                                                                                                                  Wisconsin Lutheran College is the only school with a campus ban on alcohol.
                                                                                                                                  student drinking
                                                                                                                                  Alcohol free campuses and dormitories considered promising strategies NIAAA 2002
                                                                                                                                  1 2
                                                                                                                                  Submit a commentAlcohol age compliance checks
                                                                                                                                    State government
                                                                                                                                    Local government
                                                                                                                                    Certain states (Connecticut, Alaska, Utah, etc) conduct routine statewide compliance checks
                                                                                                                                    Wisconsin cited as problem state. Some communities participate in WI CARD program with federal funding. Other communities conduct checks without federal funding.
                                                                                                                                    underage alcohol purchases
                                                                                                                                    Recommended by RAND-Imm 2007, WHO 2007, IOM-2004.
                                                                                                                                    3 0 2
                                                                                                                                    Submit a commentRestrict alcohol sales at public events
                                                                                                                                      State government
                                                                                                                                      Local government
                                                                                                                                        Community events in WI require Temporary Class B licenses. Communities can vary the conditions of obtaining such licenses
                                                                                                                                      underage drinking
                                                                                                                                      Recommended by Toomey 2008, RAND-Imm 2007
                                                                                                                                      2 0 3
                                                                                                                                      Submit a commentLimitations on alcohol sales or use on public property.
                                                                                                                                        State government
                                                                                                                                        Local government
                                                                                                                                          No laws at the state level, but communities may do this on their own.
                                                                                                                                        underage drinking
                                                                                                                                        Recommended by Toomey 2008
                                                                                                                                        2 3
                                                                                                                                        Policy/Program Decision
                                                                                                                                        Maker
                                                                                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                        Substance Misuse or Dependency: Policies punishing suppliers of alcohol to minors or those who are already intoxicated
                                                                                                                                        Submit a commentNon-commercial access to alcohol/ social host laws
                                                                                                                                          State government
                                                                                                                                          Local government
                                                                                                                                          Exist in minority of states, specification vary
                                                                                                                                          Relatively strict laws for minors but a loophole does not allow criminal sanctions for 19 and 20-year olds who provide alcohol to underage residents.
                                                                                                                                          binge drinking
                                                                                                                                          OWI
                                                                                                                                          underage drinking
                                                                                                                                          Recommended by RAND-Imm 2007
                                                                                                                                          2 3
                                                                                                                                          Submit a commentDram shop liability laws
                                                                                                                                          Laws which hold retail establishments liable for the results of serving minors and intoxicated patrons
                                                                                                                                            State government
                                                                                                                                            Nearly all states have these laws in some form or another. They tend to vary by the total liability punishable
                                                                                                                                            A server is immune from liability unless server knew or “should have known” that the individual was under the legal age and the alcoholic beverages were a substantial factor in causing injury to a third party.
                                                                                                                                            OWI
                                                                                                                                            Supported by studies, see Toomey 2008, evidence of effectiveness Anderson 2006
                                                                                                                                            4 0 6
                                                                                                                                            Policy/Program Decision
                                                                                                                                            Maker
                                                                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                            Substance Misuse or Dependency: Effective school and community based prevention programs
                                                                                                                                            Submit a commentSpecific school and community programs
                                                                                                                                            Numerous programs have been shown to slow or prevent adolescent alcohol and illicit drug use (see web sites).
                                                                                                                                              School boards
                                                                                                                                              Local government
                                                                                                                                              Community organizations
                                                                                                                                              Implementation of these particular programs varies across states and communities
                                                                                                                                              Programs of these types likely implemented by school districts and community coalitions across the state.
                                                                                                                                              age of alcohol initiation
                                                                                                                                              underage drinking
                                                                                                                                              risky drinking behaviors
                                                                                                                                              age of initiation for illicit drugs
                                                                                                                                              Recommendations from SAMHSA-NREPP, SAMHSA, NIDA.
                                                                                                                                              3 3
                                                                                                                                              Submit a commentBroad-based community coalitions to assess specific issues and recommend alternatives
                                                                                                                                                Community organizations
                                                                                                                                                Local government
                                                                                                                                                Colleges & universities
                                                                                                                                                School boards
                                                                                                                                                Healthcare
                                                                                                                                                Businesses & employers
                                                                                                                                                    underage drinking by combining numerous community methods
                                                                                                                                                Recommended by IOM-2004 and NIAAA 2007.
                                                                                                                                                3 0 3
                                                                                                                                                Policy/Program Decision
                                                                                                                                                Maker
                                                                                                                                                Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                Substance Misuse or Dependency: Other programs and policies to reduce alcohol consumption
                                                                                                                                                Submit a commentRestrict advertising placement to reduce youth exposure to alcohol advertising
                                                                                                                                                  Local government
                                                                                                                                                  Businesses & employers
                                                                                                                                                  Numerous states place some restrictions on the types, locations, and content of alcohol advertisements. Numerous public transit systems ban alcohol advertising.
                                                                                                                                                  Individual communities have control over advertising within their community. Many restrictions exist but how many limit alcohol advertising is unknown.
                                                                                                                                                  underage drinking
                                                                                                                                                  Recommended by Toomey 2008, WHO 2007, IOM-2004.
                                                                                                                                                  3 0 4
                                                                                                                                                  Submit a commentAlcohol screening and brief intervention
                                                                                                                                                    Healthcare purchasers
                                                                                                                                                      Wisconsin is one of a number of states participating in a federal Screening, Brief Intervention, Referral and Treatment trial which aims to integrate substance abuse screening into regular primary care visits
                                                                                                                                                    illicit drug use
                                                                                                                                                    harmful alcohol consumption
                                                                                                                                                    Evidence for primary care advice reducing harmful alcohol consumption Anderson 2006 Recommended by NIAAA 2007, IOM-2004 and SAMHSA-NREPP.
                                                                                                                                                    4 0 5
                                                                                                                                                    Policy/Program Decision
                                                                                                                                                    Maker
                                                                                                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                    Substance Misuse or Dependency: Reduce alcohol-impaired driving
                                                                                                                                                    Submit a commentSobriety checkpoints
                                                                                                                                                      State government
                                                                                                                                                      Law enforcement/ justice system
                                                                                                                                                      Utilized in most states
                                                                                                                                                      Currently illegal in Wisconsin and 10 other states
                                                                                                                                                      impaired driving
                                                                                                                                                      Recommended by Community Guide CG-MVOI, RAND-Imm 2007, QNSLD and WHO 2007
                                                                                                                                                      4 5
                                                                                                                                                      Submit a commentSchool-based instructional programs to reduce alcohol-impaired driving
                                                                                                                                                        School boards
                                                                                                                                                        Local government
                                                                                                                                                        State government
                                                                                                                                                          Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                        impaired driving
                                                                                                                                                        Recommended by Community Guide (CG-MVOI)
                                                                                                                                                        4 0 3
                                                                                                                                                        Submit a commentIncrease penalties for drunk driving offenses
                                                                                                                                                        • Legislation to make 1st OWI offense with injury a misdemeanor, increase us of ignition Interlocks
                                                                                                                                                        State government
                                                                                                                                                        Law enforcement/ justice system
                                                                                                                                                        20 states mandate the use of ignition interlock devices for OWI offenders
                                                                                                                                                        Wisconsin is one of 25 states that allow for discretionary use of ignition interlock devices for offenders
                                                                                                                                                        impaired driving
                                                                                                                                                        Ignition interlock devices recommended by CG-MVOI, QNSLD and Anderson 2006 (more effective than license suspension)
                                                                                                                                                        4 0 5
                                                                                                                                                        Submit a commentMulticomponent interventions with community mobilization to reduce alcohol-impaired driving
                                                                                                                                                        These interventions may include sobriety checkpoints, responsible beverage service training, education and awareness-raising efforts, & limiting access to alcohol.
                                                                                                                                                          Local government
                                                                                                                                                          Law enforcement/ justice system
                                                                                                                                                          Colleges & universities
                                                                                                                                                          Healthcare
                                                                                                                                                          Businesses & employers
                                                                                                                                                          Community organizations
                                                                                                                                                            Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                          impaired driving
                                                                                                                                                          Recommended by the Community Guide CG-MVOI
                                                                                                                                                          4 5
                                                                                                                                                          Submit a commentLicense Suspension/ Revocation for Alcohol Violations by Minors
                                                                                                                                                            State government
                                                                                                                                                            Mandatory license revocation in most states. Purchase, possession, or consumption of alcoholic beverages leads to license suspension or revocation in many states.
                                                                                                                                                            License revocation discretionary; Lose license for: purchase, consumption, possession
                                                                                                                                                            impaired driving
                                                                                                                                                            Administrative license suspensions/ revocations are only moderately effective and are improved with some form of education, counseling or treatment program Anderson 2006
                                                                                                                                                            1 0 3
                                                                                                                                                            Submit a commentUnrestricted (random) breath testing
                                                                                                                                                              State government
                                                                                                                                                              Law enforcement/ justice system
                                                                                                                                                              Not implemented in the US, but used in Australia and several European countries
                                                                                                                                                              Not implemented in Wisconsin
                                                                                                                                                              impaired driving
                                                                                                                                                              Strong evidence of effectiveness, even more effective than sobriety checkpoints Anderson 2006
                                                                                                                                                              2 5
                                                                                                                                                              Submit a commentImpaired driving alternatives developed through social marketing (The Road Crew)
                                                                                                                                                                State government
                                                                                                                                                                Community organizations
                                                                                                                                                                The Road Crew program has at this time only been implemented in Wisconsin
                                                                                                                                                                The Road Crew program has been implemented in six service areas in the state and has given over 80,000 rides; start-up funding is available for additional communities.
                                                                                                                                                                impaired driving
                                                                                                                                                                Promising Rothschild 2003
                                                                                                                                                                1 2
                                                                                                                                                                Submit a commentState Driver Education Program
                                                                                                                                                                  State government
                                                                                                                                                                        No evidence of effectiveness in reducing novice driver crashes TRB 2007
                                                                                                                                                                  1 4
                                                                                                                                                                  Submit a commentMass media campaigns
                                                                                                                                                                    Community organizations
                                                                                                                                                                    State government
                                                                                                                                                                          Little supporting evidence Anderson 2006
                                                                                                                                                                    1 0 4
                                                                                                                                                                    Submit a commentSchool-based peer organization and social norming programs
                                                                                                                                                                      School boards
                                                                                                                                                                            Insufficient evidence found by the Community Guide CG-MVOI
                                                                                                                                                                      1 3
                                                                                                                                                                      Submit a commentDesignated driver programs – population-based and incentive programs
                                                                                                                                                                        Community organizations
                                                                                                                                                                              Insufficient evidence found by the Community Guide CG-MVOI
                                                                                                                                                                        1 0 4
                                                                                                                                                                        Policy/Program Decision
                                                                                                                                                                        Maker
                                                                                                                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                        Injury Prevention: Falls prevention/reduction of injury from falls
                                                                                                                                                                        Submit a commentScreening and intervention programs (e.g., medical screening, home hazard assessment, and exercise)
                                                                                                                                                                        May include medical screening, home hazard assessment, and exercise
                                                                                                                                                                          State government
                                                                                                                                                                          Healthcare providers
                                                                                                                                                                          Community organizations
                                                                                                                                                                            Sure Step fall prevention programs being implemented in several areas of state; community-based programs such as Stepping On also implemented.
                                                                                                                                                                          falls
                                                                                                                                                                          Moderately effective Cochrane-Gillespie 2003
                                                                                                                                                                          4 0 3
                                                                                                                                                                          Submit a commentHome hazard assessment/ modification
                                                                                                                                                                            State government
                                                                                                                                                                            Healthcare
                                                                                                                                                                            Community organizations
                                                                                                                                                                              Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                            falls
                                                                                                                                                                            Moderately effective Cochrane-Gillespie 2003
                                                                                                                                                                            4 0 1
                                                                                                                                                                            Submit a commentMuscle strengthening/ balance retraining in home setting
                                                                                                                                                                              State government
                                                                                                                                                                              Healthcare
                                                                                                                                                                              Community organizations
                                                                                                                                                                                Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                              falls
                                                                                                                                                                              Moderately effective Cochrane-Gillespie 2003
                                                                                                                                                                              4 0 3
                                                                                                                                                                              Submit a commentGroup exercise programs
                                                                                                                                                                              E.g. Tai Chi
                                                                                                                                                                                State government
                                                                                                                                                                                Healthcare
                                                                                                                                                                                Community organizations
                                                                                                                                                                                  Efforts taking place, e..g., Grant County
                                                                                                                                                                                falls
                                                                                                                                                                                Some evidence of effectiveness Cochrane-Gillespie 2003
                                                                                                                                                                                2 0 3
                                                                                                                                                                                Submit a commentDistribution (and installation) of window guards/ locks to parents
                                                                                                                                                                                  State government
                                                                                                                                                                                  Businesses & employers
                                                                                                                                                                                  Community organizations
                                                                                                                                                                                  Healthcare
                                                                                                                                                                                    Efforts likely taking place in Wisconsin, but no list available (Injury Free Coalition for Kids)
                                                                                                                                                                                  falls
                                                                                                                                                                                  Effective in one study in New York City Cochrane-McClure 2005
                                                                                                                                                                                  1 2
                                                                                                                                                                                  Submit a commentMandated installation of releasable (not fixed) window guards/ locks
                                                                                                                                                                                    State government
                                                                                                                                                                                        falls
                                                                                                                                                                                    Recommended by American Academy of Pediatrics AAP 2001
                                                                                                                                                                                    2 2
                                                                                                                                                                                    Submit a commentParent education (re window guards, discontinuing walker use, other potential home hazards)
                                                                                                                                                                                      State government
                                                                                                                                                                                      Community organizations
                                                                                                                                                                                      School boards
                                                                                                                                                                                      Healthcare
                                                                                                                                                                                        Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                      Improved home safety practices
                                                                                                                                                                                      child injury
                                                                                                                                                                                      Effective for safety practices but unknown re injury rates Cochrane-Kendrick 2007
                                                                                                                                                                                      3 0 2
                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                      Maker
                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                      Injury Prevention: Poison prevention
                                                                                                                                                                                      Submit a commentPoison control (call) centers
                                                                                                                                                                                        State government
                                                                                                                                                                                        All 50 states served by at least one poison control center
                                                                                                                                                                                        WI state law requires funding up to $375,000 per year
                                                                                                                                                                                        utilization of health care services
                                                                                                                                                                                        Improved poisoning outcomes
                                                                                                                                                                                        Poison control centers are both effective and cost-effective Miller 2000
                                                                                                                                                                                        5 6
                                                                                                                                                                                        Submit a commentParent education regarding safe storage of medications and cleaning supplies, and availability of poison control number, use of child resistant packaging for prescriptions
                                                                                                                                                                                          Community organizations
                                                                                                                                                                                          School boards
                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                          Businesses & employers
                                                                                                                                                                                            Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                          Improved home safety practices
                                                                                                                                                                                          child injury
                                                                                                                                                                                          Effective for safety practices but unknown re injury rates Cochrane-Kendrick 2007
                                                                                                                                                                                          3 0 3
                                                                                                                                                                                          Policy/Program Decision
                                                                                                                                                                                          Maker
                                                                                                                                                                                          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                          Injury Prevention: Prevention of burns and scalds
                                                                                                                                                                                          Submit a commentParent education (storage of matches, smoke detectors, fire extinguishers, avoiding hot water scalding, etc.)
                                                                                                                                                                                            Community organizations
                                                                                                                                                                                            School boards
                                                                                                                                                                                            Healthcare providers
                                                                                                                                                                                            Businesses & employers
                                                                                                                                                                                              Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                            Improved home safety practices
                                                                                                                                                                                            child injury
                                                                                                                                                                                            Effective for safety practices but unknown re injury rates Cochrane-Kendrick 2007
                                                                                                                                                                                            3 0 3
                                                                                                                                                                                            Submit a commentSmoke detector giveaway programs
                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                Safe Kids chapters, local fire departments are coupled with battery checks or giveaways.
                                                                                                                                                                                              smoke detector installation
                                                                                                                                                                                              fire-related injuries
                                                                                                                                                                                              Effective when targeted to high risk areas and include installation assistance HIPRC
                                                                                                                                                                                              4 6
                                                                                                                                                                                              Submit a commentRegulations requiring smoke detector installation in new and existing housing
                                                                                                                                                                                                State government
                                                                                                                                                                                                Local government
                                                                                                                                                                                                  Local regulations.
                                                                                                                                                                                                smoke detector installation
                                                                                                                                                                                                fire-related injuries
                                                                                                                                                                                                Effective, particularly in combination with media campaign and discount coupons HIPRC
                                                                                                                                                                                                4 6
                                                                                                                                                                                                Submit a commentZoning regulations that requiring connecting smoke detectors to building electrical systems
                                                                                                                                                                                                  Local government
                                                                                                                                                                                                  Ocean City, NJ prohibits downgrading hardwired smoke detectors to battery-operated detectors; CA requires all new construction to have hard-wired smoke detectors
                                                                                                                                                                                                  Superior, WI requires hard-wired smoke detectors in residential rental properties, may also be regulated in other communities.
                                                                                                                                                                                                  fire-related injuries
                                                                                                                                                                                                  Recommended by Injury Prevention Web.
                                                                                                                                                                                                  2 6
                                                                                                                                                                                                  Submit a commentLower maximum water temperatures to 110 F
                                                                                                                                                                                                    State government
                                                                                                                                                                                                    Hot water tank industry voluntarily agreed to pre-set tanks to 120o F (49o C)
                                                                                                                                                                                                    Law requires heaters sold/ installed in WI be set =125o F. Landlords must set at =125o F. Hot water tank industry voluntarily agreed to pre-set tanks to 120o F (49o C)
                                                                                                                                                                                                    frequency of scalds
                                                                                                                                                                                                    Recommended CAPT 2002
                                                                                                                                                                                                    2 2
                                                                                                                                                                                                    Policy/Program Decision
                                                                                                                                                                                                    Maker
                                                                                                                                                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                    Injury Prevention: Back injury prevention and treatment
                                                                                                                                                                                                    Submit a commentExercise programs to prevent injury
                                                                                                                                                                                                      Businesses & employers
                                                                                                                                                                                                      Healthcare
                                                                                                                                                                                                      Community organizations
                                                                                                                                                                                                        Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                      injury
                                                                                                                                                                                                      Moderately effective Tveito 2004
                                                                                                                                                                                                      4 0 2
                                                                                                                                                                                                      Submit a commentWork-oriented back pain management programs
                                                                                                                                                                                                        Businesses & employers
                                                                                                                                                                                                        Healthcare
                                                                                                                                                                                                          Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                        pain
                                                                                                                                                                                                        Fewer sick days
                                                                                                                                                                                                        Moderately effective Cochrane-Schonstein 2003
                                                                                                                                                                                                        4 0 2
                                                                                                                                                                                                        Policy/Program Decision
                                                                                                                                                                                                        Maker
                                                                                                                                                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                        Injury Prevention: Sports and recreation safety
                                                                                                                                                                                                        Submit a commentSAFE playgrounds (Supervised, age-appropriate, fall protection, adequately maintained equipment)
                                                                                                                                                                                                          School boards
                                                                                                                                                                                                          Local government
                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                          In an evaluation by the National Program For Playground Safety, the state average was C+. MN received a B.
                                                                                                                                                                                                          Wisconsin received a B+ in an evaluation by the National Program for Playground Safety
                                                                                                                                                                                                          injury
                                                                                                                                                                                                          Recommended by NPPS
                                                                                                                                                                                                          2 0 3
                                                                                                                                                                                                          Submit a commentUse of sport-specific protective equipment, e.g., mouth guards, easy release baseball bases, ankle taping, helmets for ATV, snowmobiles, rollerblades, etc., for prev injury
                                                                                                                                                                                                            School boards
                                                                                                                                                                                                            Businesses & employers
                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                              Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                            injury
                                                                                                                                                                                                            Effective EPPI-Centre 2007
                                                                                                                                                                                                            4 0 5
                                                                                                                                                                                                            Submit a commentEducation on sports-related mild traumatic brain injuries
                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                              School boards
                                                                                                                                                                                                              Healthcare
                                                                                                                                                                                                              Businesses & employers
                                                                                                                                                                                                                Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                              injury
                                                                                                                                                                                                              Recommended by CDC Injury Center
                                                                                                                                                                                                              2 0 5
                                                                                                                                                                                                              Submit a commentZoning regulations requiring fencing around (private) swimming pools
                                                                                                                                                                                                                Local government
                                                                                                                                                                                                                Common in most municipalities
                                                                                                                                                                                                                Not required at the state level, but common in most municipalities.
                                                                                                                                                                                                                injury and drowning deaths
                                                                                                                                                                                                                Effective Cochrane-Thompson 2007
                                                                                                                                                                                                                5 0 4
                                                                                                                                                                                                                Submit a commentLegislation mandating playground safety regulations
                                                                                                                                                                                                                Playground safety regulations based on Consumer Product Safety Commission (CPSC) guidelines
                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                  Local government
                                                                                                                                                                                                                  AR, CA, CT, FL, IL, MI, NJ, NC, OK, OR, RI, TN, TX, UT & VA all passed legislation addressing playground safety.
                                                                                                                                                                                                                    injury
                                                                                                                                                                                                                  Recommended by NPPS
                                                                                                                                                                                                                  2 0 3
                                                                                                                                                                                                                  Policy/Program Decision
                                                                                                                                                                                                                  Maker
                                                                                                                                                                                                                  Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                  Injury Prevention: Farm injuries
                                                                                                                                                                                                                  Submit a commentOccupational health and safety regulations
                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                    Children are exempt from most regulatory policies
                                                                                                                                                                                                                        Effective DeRoo 2000
                                                                                                                                                                                                                    3 2
                                                                                                                                                                                                                    Submit a commentModifications of work environment, e.g., rollover protection structures (ROPS) for tractors
                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                      Businesses & employers
                                                                                                                                                                                                                      Voluntary standard for inclusion of ROPS as standard equipment on new tractors only.
                                                                                                                                                                                                                          Effective DeRoo 2000
                                                                                                                                                                                                                      3 2
                                                                                                                                                                                                                      Submit a commentEducation about known hazards
                                                                                                                                                                                                                        Community organizations
                                                                                                                                                                                                                          Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                                        hazard awareness
                                                                                                                                                                                                                        injury
                                                                                                                                                                                                                        Inconclusive evidence – at most, improves hazard awareness Hartling 2004, DeRoo 2000
                                                                                                                                                                                                                        1 0 2
                                                                                                                                                                                                                        Policy/Program Decision
                                                                                                                                                                                                                        Maker
                                                                                                                                                                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                        Injury Prevention: Increase use of safety seats, seatbelts and helmets
                                                                                                                                                                                                                        Submit a commentCommunity-wide information & enhanced enforcement of use of child safety seats
                                                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                                                          Health insurers
                                                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                                                          Local government
                                                                                                                                                                                                                          School boards
                                                                                                                                                                                                                          Businesses & employers
                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                            Efforts likely taking place in Wisconsin, but no list available. Need improved systems for documentation, e.g., police report forms do not include “booster seat.”
                                                                                                                                                                                                                          use of child safety seats
                                                                                                                                                                                                                          Recommended by the Community Guide CG-MVOI
                                                                                                                                                                                                                          4 0 4
                                                                                                                                                                                                                          Submit a commentDistribution of safety seats & education campaigns
                                                                                                                                                                                                                            Health insurers
                                                                                                                                                                                                                            Healthcare providers
                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                            School boards
                                                                                                                                                                                                                            Businesses & employers
                                                                                                                                                                                                                              Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                                            use of child safety seats
                                                                                                                                                                                                                            Recommended by the Community Guide CG-MVOI
                                                                                                                                                                                                                            4 4
                                                                                                                                                                                                                            Submit a commentIncentive & education programs for use of child safety seats
                                                                                                                                                                                                                            • Reimbursement for child restraints
                                                                                                                                                                                                                            Health insurers
                                                                                                                                                                                                                            Healthcare providers
                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                            Businesses & employers
                                                                                                                                                                                                                            School boards
                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                              Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                                            use of child safety seats
                                                                                                                                                                                                                            Recommended by the Community Guide CG-MVOI; Medicaid reimbursement for disbursement and education found to be cost-effective Goldstein 2008
                                                                                                                                                                                                                            4 2
                                                                                                                                                                                                                            Submit a commentEducation programs for use of child safety seats when used alone
                                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                                              Healthcare providers
                                                                                                                                                                                                                                    Insufficient evidence from the Community Guide CG-MVOI
                                                                                                                                                                                                                              1    
                                                                                                                                                                                                                              Submit a commentPrimary seatbelt enforcement laws
                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                26 states have primary enforcement laws
                                                                                                                                                                                                                                Wisconsin currently has a secondary enforcement law, only allowing tickets for seatbelt use when a driver has already been pulled over for another violation.
                                                                                                                                                                                                                                use of safety belts
                                                                                                                                                                                                                                Recommended by the Community Guide CG-MVOI
                                                                                                                                                                                                                                4 0 5
                                                                                                                                                                                                                                Submit a commentEnhanced seatbelt enforcement through increased officers or increased citations per officer
                                                                                                                                                                                                                                  Law enforcement/ justice system
                                                                                                                                                                                                                                  Local government
                                                                                                                                                                                                                                      use of safety belts
                                                                                                                                                                                                                                  Recommended by the Community Guide CG-MVOI
                                                                                                                                                                                                                                  4 5
                                                                                                                                                                                                                                  Submit a commentMotorcycle helmet laws
                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                    20 states require helmets for all motorcyclists
                                                                                                                                                                                                                                    Wisconsin is among 27 states who require helmets for only specific riders: young (<18) motorcyclists and those with instructional permits
                                                                                                                                                                                                                                    use of helmets
                                                                                                                                                                                                                                    Recommended by NHTSA 2005
                                                                                                                                                                                                                                    2 0 2
                                                                                                                                                                                                                                    Submit a commentEducation regarding bicycle helmet use combined with giveaway program
                                                                                                                                                                                                                                      Community organizations
                                                                                                                                                                                                                                      School boards
                                                                                                                                                                                                                                      Healthcare
                                                                                                                                                                                                                                      Businesses & employers
                                                                                                                                                                                                                                        Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                                                      bicycle helmet use
                                                                                                                                                                                                                                      bicycle-related head injuries
                                                                                                                                                                                                                                      Effective Cochrane-Royal 2005
                                                                                                                                                                                                                                      5 0 3
                                                                                                                                                                                                                                      Submit a commentMandated bicycle helmet use
                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                        State laws for children in AL, CA, CT, DE, FL, GA, HI, LA, ME, MD, NH, NM, NY, NC, OR, PA, RI, TN, WV
                                                                                                                                                                                                                                        WI does not mandate bicycle helmet use. Port Washington has a local law.
                                                                                                                                                                                                                                        bicycle helmet use
                                                                                                                                                                                                                                        bicycle-related head injuries
                                                                                                                                                                                                                                        Effective Cochrane-Macpherson 2007
                                                                                                                                                                                                                                        5 0 3
                                                                                                                                                                                                                                        Policy/Program Decision
                                                                                                                                                                                                                                        Maker
                                                                                                                                                                                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                        Injury Prevention: Pedestrian and bicycle safety
                                                                                                                                                                                                                                        Submit a commentPedestrian safety education for children and parents
                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                          School boards
                                                                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                                                                          Businesses & employers
                                                                                                                                                                                                                                            Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                                                          Improved safety behaviors
                                                                                                                                                                                                                                          child injury
                                                                                                                                                                                                                                          Positive and mixed effects Bruce 2005
                                                                                                                                                                                                                                          2 0 4
                                                                                                                                                                                                                                          Submit a commentBicycle paths and bike lanes
                                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                                              Wisconsin has extensive network of recreational trails but less extensive use of bike lanes within urban areas other than Madison.
                                                                                                                                                                                                                                            bicycle use
                                                                                                                                                                                                                                            bicycle-related injuries
                                                                                                                                                                                                                                            Effective at increasing use but evidence is lacking regarding impact on injuries HIPRC.
                                                                                                                                                                                                                                            1 0 6
                                                                                                                                                                                                                                            Submit a commentEngineering improvements such as crosswalks, signs, signal, sidewalks, medians, lighting
                                                                                                                                                                                                                                              Local government
                                                                                                                                                                                                                                                Efforts likely taking place in Wisconsin, but no list available
                                                                                                                                                                                                                                              pedestrian injury
                                                                                                                                                                                                                                                0 0 6
                                                                                                                                                                                                                                              Policy/Program Decision
                                                                                                                                                                                                                                              Maker
                                                                                                                                                                                                                                              Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                              Injury Prevention: Environmental interventions to reduce motor vehicle crashes
                                                                                                                                                                                                                                              Submit a commentConstruction of out-of-town bypasses
                                                                                                                                                                                                                                                Local government
                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                Bypass roads are found throughout the United States, although design and operational practices likely vary.
                                                                                                                                                                                                                                                There are a number of bypasses around WI cities
                                                                                                                                                                                                                                                road traffic injuries
                                                                                                                                                                                                                                                Bypasses may decrease injuries on main roads through and around towns, but more research is needed on their impact on secondary roads Egan 2003
                                                                                                                                                                                                                                                1 0 4
                                                                                                                                                                                                                                                Submit a commentSpeed enforcement detection devices
                                                                                                                                                                                                                                                Use of speed cameras & radar and laser devices
                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                  Law enforcement/ justice system
                                                                                                                                                                                                                                                  25 states use automated enforcement of traffic violations, while 6 states prohibit this practice.
                                                                                                                                                                                                                                                  WI law prohibits automated photo-radar enforcement, but speed detection devices are used by officers.
                                                                                                                                                                                                                                                  road traffic injuries and deaths
                                                                                                                                                                                                                                                  Promising Cochrane-Wilson, Pilkington 2005
                                                                                                                                                                                                                                                  3 0 4
                                                                                                                                                                                                                                                  Submit a commentEngineering and traffic calming measures to reduce speed and motor vehicle and pedestrian-motor vehicle crashes
                                                                                                                                                                                                                                                  These strategies include single-lane roundabouts, sidewalks, exclusive pedestrian signal phasing, pedestrian refuge islands, increased intensity of roadway lighting, red-light-running cameras. Traffic calming measures include speed bumps, mini-roundabouts, road surface treatment, changes to road lighting, and creating one-way streets.
                                                                                                                                                                                                                                                    Local government
                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                      Traffic calming and roundabouts are listed by the WI DOT road design options to help traffic move safely. These strategies have been implemented around the state.
                                                                                                                                                                                                                                                    road traffic crashes and injuries
                                                                                                                                                                                                                                                    Engineering measures deemed effective Retting 2003
                                                                                                                                                                                                                                                    Traffic calming deemed promising Cochrane-Bunn 2003, Zein 1997, Morrison 2003
                                                                                                                                                                                                                                                    3 5
                                                                                                                                                                                                                                                    Policy/Program Decision
                                                                                                                                                                                                                                                    Maker
                                                                                                                                                                                                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                    Violent Behavior
                                                                                                                                                                                                                                                    Submit a commentClassroom- and community-based programs for the prevention of intimate partner violence
                                                                                                                                                                                                                                                    Programs often include a structured curriculum based on feminist and social learning theory combined with community services, awareness, and planning to target knowledge and attitudes.
                                                                                                                                                                                                                                                    • Safe Dates
                                                                                                                                                                                                                                                    • Youth Relationship Project
                                                                                                                                                                                                                                                    School boards
                                                                                                                                                                                                                                                    Community organizations
                                                                                                                                                                                                                                                      The Safe Dates program will be used by the New Concept Self Development Center in Milwaukee with funds received from a WI Coalition Against Sexual Assault grant
                                                                                                                                                                                                                                                    serious physical violence
                                                                                                                                                                                                                                                    sexual violence
                                                                                                                                                                                                                                                    perpetration of physical violence
                                                                                                                                                                                                                                                    dating violence norms
                                                                                                                                                                                                                                                    communication skills
                                                                                                                                                                                                                                                    responses to anger
                                                                                                                                                                                                                                                    Whitaker 2006
                                                                                                                                                                                                                                                    Whitaker 2007
                                                                                                                                                                                                                                                    1 0 2
                                                                                                                                                                                                                                                    Submit a commentEarly childhood education programs
                                                                                                                                                                                                                                                    These child-care and preschool programs promote healthy child development, school readiness, and parental skill development
                                                                                                                                                                                                                                                    • Abecedarian Project
                                                                                                                                                                                                                                                    • Child-Parent Centers
                                                                                                                                                                                                                                                    • High/Scope Perry Preschool
                                                                                                                                                                                                                                                    • Incredible Years
                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                    School boards
                                                                                                                                                                                                                                                    Community organizations
                                                                                                                                                                                                                                                      Wisconsin does have early childhood programs, but programs may not all be evidence-based and enrollment is not universal
                                                                                                                                                                                                                                                    arrests
                                                                                                                                                                                                                                                    abuse and neglect
                                                                                                                                                                                                                                                    incarcerations
                                                                                                                                                                                                                                                    educational outcomes
                                                                                                                                                                                                                                                    Blueprints Model Program
                                                                                                                                                                                                                                                    Promising: Kellerman 1998
                                                                                                                                                                                                                                                    What Works WI
                                                                                                                                                                                                                                                    3 4
                                                                                                                                                                                                                                                    Submit a commentEarly childhood home visitation to prevent child maltreatment
                                                                                                                                                                                                                                                    Programs such as the Nurse-Family Partnership (NFP) center around home visits of trained personnel to parents and their children and include a variety of prevention focused components.
                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                      Community organizations
                                                                                                                                                                                                                                                      Local government
                                                                                                                                                                                                                                                      290 counties served by NFP in 23 states
                                                                                                                                                                                                                                                      Milwaukee Health Department hosts the first and only NFP implementation site in Wisconsin but other home visiting programs exist in many Wisconsin counties
                                                                                                                                                                                                                                                      child abuse or neglect
                                                                                                                                                                                                                                                      maternal arrests
                                                                                                                                                                                                                                                      arrests of children by adolescence
                                                                                                                                                                                                                                                      maternal substance abuse problems
                                                                                                                                                                                                                                                      Recommended by Community Guide (CG-violence), Blueprints Model Program,
                                                                                                                                                                                                                                                      What Works WI, Kellerman 1998, OJJDP Model Programs Guide: exemplary
                                                                                                                                                                                                                                                      4 2
                                                                                                                                                                                                                                                      Submit a commentFunctional family therapy
                                                                                                                                                                                                                                                      Phasic family therapy program designed to treat a range of complex family problems through the stages of engagement, motivation, assessment, behavior change, and generalization.
                                                                                                                                                                                                                                                        Law enforcement/ justice system
                                                                                                                                                                                                                                                        Community organizations
                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                                        School boards
                                                                                                                                                                                                                                                        As of 2000, FFT had 50 active certified sites in 15 states
                                                                                                                                                                                                                                                        Not currently used in Wisconsin
                                                                                                                                                                                                                                                        re-offending
                                                                                                                                                                                                                                                        sibling delinquency
                                                                                                                                                                                                                                                        prevent entrance into adult criminal system
                                                                                                                                                                                                                                                        family communication
                                                                                                                                                                                                                                                        Blueprints Model Program
                                                                                                                                                                                                                                                        What Works WI
                                                                                                                                                                                                                                                        OJJDP Model Programs Guide: exemplary
                                                                                                                                                                                                                                                        3 2
                                                                                                                                                                                                                                                        Submit a commentMentoring programs – Big Brothers Big Sisters of America
                                                                                                                                                                                                                                                        Mentoring program in which adults interact with youth in a one-on-one relationship, meeting 2-4 times a month for at least a year. Matches are made and supervised by case managers.
                                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                                          Businesses & employers
                                                                                                                                                                                                                                                          Nationwide and in 12 countries
                                                                                                                                                                                                                                                          There are multiple Big Brothers Big Sisters organizations throughout Wisconsin
                                                                                                                                                                                                                                                          violent behavior
                                                                                                                                                                                                                                                          initiation of drug and alcohol use
                                                                                                                                                                                                                                                          school behavior
                                                                                                                                                                                                                                                          achievement
                                                                                                                                                                                                                                                          Blueprints Model Program
                                                                                                                                                                                                                                                          What Works WI
                                                                                                                                                                                                                                                          OJJDP Model Programs Guide: exemplary
                                                                                                                                                                                                                                                          3 2
                                                                                                                                                                                                                                                          Submit a commentMultisystemic therapy (MST)
                                                                                                                                                                                                                                                          Intensive family- and community-based therapy program that includes a focus on development of parenting skills and youth coping skills.
                                                                                                                                                                                                                                                            Law enforcement/ justice system
                                                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                                                            Healthcare providers
                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                            31 states have licensed MST providers
                                                                                                                                                                                                                                                            Wisconsin does not have any licensed MST providers
                                                                                                                                                                                                                                                            re-arrests
                                                                                                                                                                                                                                                            out-of home placements
                                                                                                                                                                                                                                                            mental health problems
                                                                                                                                                                                                                                                            family functioning
                                                                                                                                                                                                                                                            Blueprints Model Program
                                                                                                                                                                                                                                                            Social Progs that Work
                                                                                                                                                                                                                                                            What Works WI
                                                                                                                                                                                                                                                            OJJDP Model Programs Guide: exemplary
                                                                                                                                                                                                                                                            SAMHSA-NREPP
                                                                                                                                                                                                                                                            Systematic Campbell review
                                                                                                                                                                                                                                                            4 1
                                                                                                                                                                                                                                                            Submit a commentTherapeutic (multidimensional treatment) foster care for chronically delinquent juveniles
                                                                                                                                                                                                                                                            Individuals are placed with specially trained foster families for several months, often as an alternative to incarceration, hospitalization, or other residential treatment programs.
                                                                                                                                                                                                                                                              Law enforcement/ justice system
                                                                                                                                                                                                                                                              Local government
                                                                                                                                                                                                                                                              Healthcare providers
                                                                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                                                                              Used across the country
                                                                                                                                                                                                                                                              There are agencies in Wisconsin, such as REM Wisconsin and Family Works, that arrange for and oversee these services
                                                                                                                                                                                                                                                              re-arrests
                                                                                                                                                                                                                                                              violent crime
                                                                                                                                                                                                                                                              subsequent days incarcerated
                                                                                                                                                                                                                                                              rates of general delinquency
                                                                                                                                                                                                                                                              school performance
                                                                                                                                                                                                                                                              Recommended by Community Guide (CG-violence), Blueprints Model Program,
                                                                                                                                                                                                                                                              Social Progs that Work, What Works WI, OJJDP Model Programs Guide: exemplary
                                                                                                                                                                                                                                                              4 1
                                                                                                                                                                                                                                                              Submit a commentUniversal school-based programs to reduce violence and bullying
                                                                                                                                                                                                                                                              Classroom based programs that are addressed to all children regardless of their risk for or prior demonstration of violent behavior. Programs and content differ by school level.
                                                                                                                                                                                                                                                              • Skills, Opportunities, and Recognition
                                                                                                                                                                                                                                                              • Olweus Bullying Prevention Program
                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                              School boards
                                                                                                                                                                                                                                                              A variety of these programs are used across the country
                                                                                                                                                                                                                                                              WI DPI provides an assessment tool for schools to evaluate their violence prevention program; WI DPI also has its own Bullying Prevention Curriculum
                                                                                                                                                                                                                                                              violent behavior reduction in all age-levels, all school environments, and all school populations
                                                                                                                                                                                                                                                              vandalism, fighting, theft, & bullying
                                                                                                                                                                                                                                                              school social climate
                                                                                                                                                                                                                                                              conduct problems
                                                                                                                                                                                                                                                              Blueprints Model Program, What Works WI, Recommended by Community Guide (CG-violence)
                                                                                                                                                                                                                                                              4 0 3
                                                                                                                                                                                                                                                              Submit a commentEnvironmental modifications for the prevention and control of violence
                                                                                                                                                                                                                                                              Modifications to physical design and immediate situational factors can reduce opportunities for violence in the community.
                                                                                                                                                                                                                                                                Local government
                                                                                                                                                                                                                                                                Businesses & employers
                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                    violent crime
                                                                                                                                                                                                                                                                Mair 2003
                                                                                                                                                                                                                                                                2 6
                                                                                                                                                                                                                                                                Submit a commentFirearm laws
                                                                                                                                                                                                                                                                Laws reviewed include specific firearm or ammunition bans, restrictions on acquisition, waiting periods, registration, licensing, concealed carry laws, child access prevention laws, zero tolerance of firearms in schools, & combinations of laws.
                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                  MN has a similar profile of firearm laws to WI except that they allow for the carrying of concealed weapons
                                                                                                                                                                                                                                                                  No – ban on assault weapons
                                                                                                                                                                                                                                                                  No – registration or licensing requirement
                                                                                                                                                                                                                                                                  Yes – waiting period
                                                                                                                                                                                                                                                                  Yes – prohibit concealed carry
                                                                                                                                                                                                                                                                  Yes – child access prevention
                                                                                                                                                                                                                                                                  Yes – not allowed on school grounds
                                                                                                                                                                                                                                                                  firearm deaths (homicide and suicide) and injuries
                                                                                                                                                                                                                                                                  assaults
                                                                                                                                                                                                                                                                  weapon carrying on school property
                                                                                                                                                                                                                                                                  loaded and unlocked firearms kept in homes
                                                                                                                                                                                                                                                                  Community Guide finds insufficient evidence to determine the effectiveness of firearm laws on violent outcomes CG-violence
                                                                                                                                                                                                                                                                  1 6
                                                                                                                                                                                                                                                                  Submit a commentHomicide review committees
                                                                                                                                                                                                                                                                  Review process to examine each homicide from a multi-level, multi-disciplinary, and multi-agency perspective and make recommendations for violence prevention.
                                                                                                                                                                                                                                                                    Law enforcement/ justice system
                                                                                                                                                                                                                                                                    Community organizations
                                                                                                                                                                                                                                                                    Local government
                                                                                                                                                                                                                                                                      Milwaukee Homicide Review Commission
                                                                                                                                                                                                                                                                    homicide rates
                                                                                                                                                                                                                                                                    Unknown; however, Milwaukee Homicide Review Commission has reported numerous process outcomes and a decline in homicides in the review districts
                                                                                                                                                                                                                                                                    0 6
                                                                                                                                                                                                                                                                    Submit a commentWraparound programs
                                                                                                                                                                                                                                                                    A coordinated and individualized system of community based care for children with serious behavioral, emotional, and mental health needs.
                                                                                                                                                                                                                                                                      Law enforcement/ justice system
                                                                                                                                                                                                                                                                      Local government
                                                                                                                                                                                                                                                                      Healthcare
                                                                                                                                                                                                                                                                      Community organizations
                                                                                                                                                                                                                                                                      SAMHSA estimates that wraparound programs are being utilized in nearly all states, although likely with varying consistency
                                                                                                                                                                                                                                                                      Wraparound Milwaukee has been recognized as a promising program by the OJJDP Model Programs Guide
                                                                                                                                                                                                                                                                      recidivism for multiple types of offenses including sex, property, assault, and weapons offenses
                                                                                                                                                                                                                                                                      functioning at home, school, and in community
                                                                                                                                                                                                                                                                      OJJDP Model Programs Guide: promising
                                                                                                                                                                                                                                                                      2 0 2
                                                                                                                                                                                                                                                                      Public Health & Health Care Systems
                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                      Quality of Public Health Services: Strong foundation for state and local health departments (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                      Submit a commentAdequate and stable financing of local health departments (local health departments)
                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                                                        Median per capita local health department expenditures in 2005 ranged from a low of $9 in MA to a high of $94 in MD, with a median of $29
                                                                                                                                                                                                                                                                        Wisconsin ranked 47th for its overall governmental public health spending in 2004-2005 and was one of only six states that, when adjusted for inflation, cut funding for public health from FY 2005-06 to FY 2006-07. Per capita local health departmentexpenditures in WI were below the national median. In 2005, 41% of state spending was federally funded, 35% came from local taxes and 7% came from state GPR.
                                                                                                                                                                                                                                                                        Improved public health performance
                                                                                                                                                                                                                                                                        Increased local health department spending associated with higher levels of public health performance (Erwin 2008)
                                                                                                                                                                                                                                                                        3 0 6
                                                                                                                                                                                                                                                                        Submit a commentRecruit and retain sufficient, competent public health workforce
                                                                                                                                                                                                                                                                        • Enhanced recruitment (work on the “pipeline”) and retention;
                                                                                                                                                                                                                                                                        • more competitive compensation;
                                                                                                                                                                                                                                                                        • build skills and competencies.
                                                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                                                        Colleges & universities
                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                        Nationl 2005 mean local health department FTEs was 9.3 per 10,000 pop. for small town rural health departments and 5.7 per 10,000 people for all other health departments.
                                                                                                                                                                                                                                                                        20% of local health departmentemployees nationally eligible for retirement in 5 years. 40% of national local health departmentworkforce are nurses, environmental health specialists, and managers.
                                                                                                                                                                                                                                                                        24 states (including WI) subscribe to the TrainingFinder Real-time Affiliate Integrated Network (TRAIN) system.
                                                                                                                                                                                                                                                                        See Health Care Access worksheet for information on general health care workforce
                                                                                                                                                                                                                                                                        WI local health departmentworkforce:
                                                                                                                                                                                                                                                                        3.2 full time equivalents (FTE) per 10,000 pop
                                                                                                                                                                                                                                                                        State Division of Public Health (DPH) workforce:
                                                                                                                                                                                                                                                                        Average age of DPH staff is 50.
                                                                                                                                                                                                                                                                        Turnover rate in 2005 was 25.2%.
                                                                                                                                                                                                                                                                        13.3% of positions were vacant in 2006
                                                                                                                                                                                                                                                                        Average age of a new hire in 2006 was 47
                                                                                                                                                                                                                                                                        The percent of DPH staff eligible to retire will increase by 20% to 54% in five years (from 2006)
                                                                                                                                                                                                                                                                        Recent Wisconsin - National Public Health Performance Standard review indicated participants believe that WI has achieved partial performance in developing adequate competent workforce.
                                                                                                                                                                                                                                                                        Healthy Wisconsin Leadership Institute has provided training and support to more than 500 public health practitioners statewide.
                                                                                                                                                                                                                                                                        Linking Education and Practice for Excellence in Public Health Nursing (LEAP) is a state-wide project to improve competency for public health nursing practice in a changing public health system
                                                                                                                                                                                                                                                                        Three MPH programs now available: UWSMPH, UW-La Crosse, Medical College of Wisconsin (distance-based)
                                                                                                                                                                                                                                                                        TRAIN is the statewide public health learning management system with 16,116 active Wisconsin users.
                                                                                                                                                                                                                                                                        UW Whitewater is developing a undergraduate minor in Public Health
                                                                                                                                                                                                                                                                        Improved public health performance
                                                                                                                                                                                                                                                                        Increased local health department staffing associated with higher levels of public health performance Erwin 2008
                                                                                                                                                                                                                                                                        3 0 6
                                                                                                                                                                                                                                                                        Submit a commentIntegrated public health electronic data and information systems
                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                          Local government
                                                                                                                                                                                                                                                                          CDC’s Public Health Information Network (PHIN) is in varying stages of implementation, e.g., in 2007 44 states have integrated disease data repositories, 41 receive standard electronic lab results, 44 use web-based disease reporting systems; 137 public health jurisdictions had access to PHIN-BioSense data
                                                                                                                                                                                                                                                                          98% of local health departments have some type of Internet access, and 93% have high-speed Internet access.
                                                                                                                                                                                                                                                                          70% of local health departments have a Web site.
                                                                                                                                                                                                                                                                          Partial implementation of Wisconsin Public Health Information Network (WPHIN) – a network under development by WI DHS that will provide statewide and community-level population data needed for community health status assessment, policy development, assurance, service delivery, resources management and accountability.
                                                                                                                                                                                                                                                                          Full implementation of Wisconsin’s Health Alert Network and Training (HAN) program includes secure web site for urgent public health communication
                                                                                                                                                                                                                                                                          See Health Care Quality worksheet for information on implementation of electronic health records.
                                                                                                                                                                                                                                                                          Improved disease detection & monitoring
                                                                                                                                                                                                                                                                          Prevention of spread of infectious diseases
                                                                                                                                                                                                                                                                          Improved emergency alert and response
                                                                                                                                                                                                                                                                          Improved preparation for and response to disasters
                                                                                                                                                                                                                                                                          Recommended by IOM-PH 2002 and NPHPSP.
                                                                                                                                                                                                                                                                          3 0 6
                                                                                                                                                                                                                                                                          Submit a commentIncrease state and local public health system partnerships
                                                                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                            88% of local health departments in 2005 increased collaboration with other community organizations over last three years.
                                                                                                                                                                                                                                                                            Over 90% of local health departments partnered with schools, emergency responders, the media, physicians, and/or community organizations.
                                                                                                                                                                                                                                                                            95% of local health departments reported involved in a partnership for community health assessment
                                                                                                                                                                                                                                                                            awareness and action toward community health improvement
                                                                                                                                                                                                                                                                            Recommended by NPHPSP
                                                                                                                                                                                                                                                                            2 0 6
                                                                                                                                                                                                                                                                            Submit a commentCommunity health improvement processes and plans
                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                              Local government
                                                                                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                                                                                              In 2005, 51% of local health departments nationally completed community health assessment in last 3 years.
                                                                                                                                                                                                                                                                              54% of local health departments participated in community health improvement planning in last 3 years.
                                                                                                                                                                                                                                                                              Local health departments in Wisconsin required to complete community health assessments. Recently passed 2007 Wisconsin Act 130 requires local health departments to develop community health improvement plans.
                                                                                                                                                                                                                                                                              Improving health through identification of, and ways to address, health risks and needs
                                                                                                                                                                                                                                                                              Community engagement in improving health
                                                                                                                                                                                                                                                                              Recommended by NPHPSP
                                                                                                                                                                                                                                                                              Less than 4 out of 10 metropolitan health officers perceived community health assessment as effective Mays 2004.
                                                                                                                                                                                                                                                                              2 6
                                                                                                                                                                                                                                                                              Submit a commentIncreasing emphasis on quality improvement (QI) in local health departments
                                                                                                                                                                                                                                                                                Local government
                                                                                                                                                                                                                                                                                National movement toward accreditation of local health departments. 16 states (including WI) participating in Multi-State Learning Collaborative to improve public health services and community health by implementing QI practices. Some states, e.g., NC, have begun accrediting local health departments.
                                                                                                                                                                                                                                                                                Per WI state statutes, local health departments can meet one of 3 levels of certification. Level 1 local health departments meet the minimum performance standards as outlined by the HFS 140 Local Health Department Review, which encompasses the local health department and Board of Health organizational structures as well as performance of the essential public health services. Level 2 departments provide basic services, plus additional services as guided by the state health plan. Level 3 departments provide a full range of public health services, and are led by a health officer with a higher level of credentials.
                                                                                                                                                                                                                                                                                Sets benchmark of consistent standards for public health (PH) services
                                                                                                                                                                                                                                                                                Improve quality of PH services
                                                                                                                                                                                                                                                                                  0 6
                                                                                                                                                                                                                                                                                Policy/Program Decision
                                                                                                                                                                                                                                                                                Maker
                                                                                                                                                                                                                                                                                Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                Health Care Access: Comprehensive health coverage reform (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                Submit a commentEmployer mandates (‘pay-or-play’)
                                                                                                                                                                                                                                                                                require employers to offer health insurance to workers
                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                  HI first implemented employer mandates in 1972.
                                                                                                                                                                                                                                                                                  Although not termed a “mandate,” MA employers (>10 employees) are required to offer insurance or pay portion of employees’ premiums.
                                                                                                                                                                                                                                                                                    number of employers offering health insurance coverage
                                                                                                                                                                                                                                                                                  utilization of health services
                                                                                                                                                                                                                                                                                  NGA Best Practices
                                                                                                                                                                                                                                                                                  Some evidence of effectiveness Glied 2007
                                                                                                                                                                                                                                                                                  2 2
                                                                                                                                                                                                                                                                                  Submit a commentIndividual mandates
                                                                                                                                                                                                                                                                                  individuals found not to have insurance (through state income tax filings) are fined
                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                    MA, ME, CA (proposed)
                                                                                                                                                                                                                                                                                      health insurance coverage take-up by individuals
                                                                                                                                                                                                                                                                                    utilization of primary and preventive services
                                                                                                                                                                                                                                                                                    uncompensated care
                                                                                                                                                                                                                                                                                    NGA Best Practices
                                                                                                                                                                                                                                                                                    Some evidence of effectiveness Glied 2007
                                                                                                                                                                                                                                                                                    2 2
                                                                                                                                                                                                                                                                                    Submit a commentConnector/ exchange model
                                                                                                                                                                                                                                                                                    offers health coverage through quasi-governmental authority negotiating affordable packages (benefits/ rates) for individuals and small businesses
                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                      MA: Commonwealth Health Insurance Connector Authority
                                                                                                                                                                                                                                                                                      MN: Minnesota Health Insurance Exchange
                                                                                                                                                                                                                                                                                      Wisconsin’s BadgerCare Plus program will utilize a similar model when it adds coverage for childless adults in January 2009. Governor Doyle has proposed a statewide “Connector” model termed “BadgerChoice”
                                                                                                                                                                                                                                                                                      utilization of health services
                                                                                                                                                                                                                                                                                      number with health insurance coverage
                                                                                                                                                                                                                                                                                      NGA Best Practices
                                                                                                                                                                                                                                                                                      No supporting evidence specific to quasi-public “connectors” but there is some evidence that purchasing cooperatives can increase plan choice, and if large enough, lower premiums (Wicks 2002, SCI-Lischko 2007).
                                                                                                                                                                                                                                                                                      1 3
                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                      Health Care Access: Incremental health coverage reform (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                      Submit a commentExtend eligibility for BadgerCarePlus beyond age 18
                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                        12 states have extended coverage to include some adults: AZ, ID, IL, MI, MN, NJ, NM, OR, RI, WI, AK, NV
                                                                                                                                                                                                                                                                                        BadgerCare Plus covers parents with incomes up to 200% of poverty. Childless adults to be added in Jan 09.
                                                                                                                                                                                                                                                                                        number with health insurance coverage
                                                                                                                                                                                                                                                                                        Improved enrollment of eligible for eligible children
                                                                                                                                                                                                                                                                                        utilization of primary and preventive health services
                                                                                                                                                                                                                                                                                        appropriate utilization of health care system, including reduced inappropriate ER utilization
                                                                                                                                                                                                                                                                                        Strong evidence that extending insurance to parents along with children increases overall take-up of coverage by eligible children and improves utilization of primary and preventive services by all family members GAO-SCHIP2007.
                                                                                                                                                                                                                                                                                        2 3
                                                                                                                                                                                                                                                                                        Submit a commentEncourage enrollment in Medicaid and BadgerCare for eligible participants
                                                                                                                                                                                                                                                                                        (outreach/ education and expedited enrollment)
                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                                                                                                                          Most states have various forms of enrollment and outreach promotion, expedited enrollment and presumptive eligibility.
                                                                                                                                                                                                                                                                                          Implementation of BadgerCarePlus in Jan 08 included presumptive eligibility for children below 150% or poverty, new points of entry, and simplified employment verification
                                                                                                                                                                                                                                                                                          health insurance coverage take-up by eligible children and families
                                                                                                                                                                                                                                                                                          Promising practice Dorn 2006, MPR-SCHIP 2007
                                                                                                                                                                                                                                                                                          2 3
                                                                                                                                                                                                                                                                                          Submit a commentSmall business programs
                                                                                                                                                                                                                                                                                          • create authority to provide reinsurance
                                                                                                                                                                                                                                                                                          • insurance plan targeting small businesses
                                                                                                                                                                                                                                                                                          • exemptions or exceptions from state mandates
                                                                                                                                                                                                                                                                                          • premium subsidies
                                                                                                                                                                                                                                                                                          • tax credits or deductions for offering insurance
                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                          Maine’s DirigoChoice
                                                                                                                                                                                                                                                                                          OK’s O-EPIC program created to assist small businesses in offering health insurance to employees.
                                                                                                                                                                                                                                                                                          Insure Montana initiative offers tax credit to small businesses (<10 employees) who offer and contribute to coverage for employees.
                                                                                                                                                                                                                                                                                          For other examples, see NCSL. State Programs to Subsidize or Reduce the Cost of Health Insurance for Small Businesses and Individuals.
                                                                                                                                                                                                                                                                                          Wisconsin passed a state law (SB 204) allowing formation of health purchasing cooperatives e.g., Farmer’s Health Cooperative of Wisconsin
                                                                                                                                                                                                                                                                                          number of small business offering health insurance coverage
                                                                                                                                                                                                                                                                                          Mixed evidence depending upon specifics, e.g., limited evidence of small effect of premium subsidies for small business HSC-IB46
                                                                                                                                                                                                                                                                                          1 4
                                                                                                                                                                                                                                                                                          Submit a commentPrograms to subsidize or reduce the cost of health insurance to individuals
                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                            UT, MN, TX
                                                                                                                                                                                                                                                                                            Maine’s DirigoChoice
                                                                                                                                                                                                                                                                                              health insurance coverage take-up by individuals
                                                                                                                                                                                                                                                                                            Some evidence of small effect Buchmueller 2006
                                                                                                                                                                                                                                                                                            1 5
                                                                                                                                                                                                                                                                                            Submit a commentState legislation extending maximum age beyond age 19 for dependents on parents’ health coverage
                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                              17 states have increased age limit and/or extended coverage to dependents who are not full-time students
                                                                                                                                                                                                                                                                                                number with health insurance coverage
                                                                                                                                                                                                                                                                                              Recommended Collins 2007
                                                                                                                                                                                                                                                                                              2 0 2
                                                                                                                                                                                                                                                                                              Submit a commentState legislation mandating colleges to require health insurance for all students
                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                In addition, NH mandates continued coverage during a medical leave of absence
                                                                                                                                                                                                                                                                                                  number with health insurance coverage
                                                                                                                                                                                                                                                                                                Recommended Collins 2007
                                                                                                                                                                                                                                                                                                2 2
                                                                                                                                                                                                                                                                                                Submit a commentMental health and substance abuse (MHSA) treatment parity
                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                  23 states mandate mental health parity or equal coverage.
                                                                                                                                                                                                                                                                                                  Senate Bill 375 requiring comparable coverage for MHSA and other services failed to pass.
                                                                                                                                                                                                                                                                                                  access to mental health and substance abuse services
                                                                                                                                                                                                                                                                                                  Some evidence that parity laws increase access to services RAND-RB9254, Harris 2006, CHBPR-AB423.
                                                                                                                                                                                                                                                                                                  3 5
                                                                                                                                                                                                                                                                                                  Submit a commentImplement Long-Term Care (LTC) Partnership Program
                                                                                                                                                                                                                                                                                                  Access to affordable LTC insurance for moderate-income consumers with guarantee that if benefits do not sufficiently cover cost of care, may qualify for Medicaid under special eligibility rules while retaining pre-specified amount of assets.
                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                    CA, IN, CT, NY, AR, CO, GA, MI, MN, OK, OH, SD, TX, VA offer Partnership policies that protect consumers from having to become impoverished to qualify for Medicaid, and states avoid the entire burden of long-term-care costs. Other states have implemented enabling legislation.
                                                                                                                                                                                                                                                                                                      take-up of LTC insurance
                                                                                                                                                                                                                                                                                                    Medicaid spending
                                                                                                                                                                                                                                                                                                    Early results show some evidence of increased take-up, no evidence of savings to Medicaid (GAO-LTCPP 2007)
                                                                                                                                                                                                                                                                                                    2 0 4
                                                                                                                                                                                                                                                                                                    Submit a commentExpand Family Care entitlement for long term care
                                                                                                                                                                                                                                                                                                    Serves people with physical disabilities, people with developmental disabilities and frail elders, giving people better choices about where they live and what kinds of services and supports they get to meet their needs and improving access to services; through aging and disability resource centers and managed care organizations.
                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                        Family Care is currently available in 29 counties.
                                                                                                                                                                                                                                                                                                      access to LTC services
                                                                                                                                                                                                                                                                                                      APS Healthcare conducted an independent assessment of the early years of Family Care for CMS.
                                                                                                                                                                                                                                                                                                      2 3
                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                      Health Care Access: Health care workforce: recruitment and retention (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                      Submit a commentPublic-private workforce partnerships to assure adequate competent healthcare workforce
                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                        Businesses & employers
                                                                                                                                                                                                                                                                                                        Colleges & universities
                                                                                                                                                                                                                                                                                                        Healthcare
                                                                                                                                                                                                                                                                                                        Community organizations
                                                                                                                                                                                                                                                                                                        GA Health Professionals Initiative
                                                                                                                                                                                                                                                                                                        FL Healthcare Worker + Initiative
                                                                                                                                                                                                                                                                                                        Selected regional activities underway, e.g., regional Workforce Investment Boards and Workforce Development Boards
                                                                                                                                                                                                                                                                                                        recruitment and retention of health care professionals
                                                                                                                                                                                                                                                                                                        NGA Best Practice NGA-CBP 2004
                                                                                                                                                                                                                                                                                                        2 6
                                                                                                                                                                                                                                                                                                        Submit a commentIncreased loan repayment and direct incentive programs for primary care physicians who agree to serve in rural and other underserved areas
                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                          Many states have loan forgiveness programs. MN established a program at the same time as WI and has invested nearly $8m since its inception.
                                                                                                                                                                                                                                                                                                          Healthcare professionals can get up to $50,000 in educational loan assistance through the Health Professions Loan Assistance Program (HPLAP). Since HPLAP was set up in 1990 , over 150 primary care providers practicing in federally-designated Health Professional Shortage Areas HPSAs) have received over $5m in repayment awards.
                                                                                                                                                                                                                                                                                                          recruitment and retention of primary care physicians in rural and other underserved areas
                                                                                                                                                                                                                                                                                                          Moderate evidence for physician loan repayment programs Pathman 2004
                                                                                                                                                                                                                                                                                                          2 4
                                                                                                                                                                                                                                                                                                          Submit a commentIncrease Medicaid reimbursement rates for dentists to 75% of regional market rates
                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                            39 states have higher Medicaid payment rates than WI for dental services.
                                                                                                                                                                                                                                                                                                            WI reimbursement rates for dental Medicaid services average about 40% of national market rates.
                                                                                                                                                                                                                                                                                                            Medicaid dentist participation
                                                                                                                                                                                                                                                                                                            use of dental services
                                                                                                                                                                                                                                                                                                            Mixed results GAO-OH 2000, NASHP-Dental 2008
                                                                                                                                                                                                                                                                                                            1 3
                                                                                                                                                                                                                                                                                                            Submit a commentOffer better wages and benefits for LTC workers through Medicaid
                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                              20 states reported implementing wage pass-throughs for some type of worker
                                                                                                                                                                                                                                                                                                              WI implemented wage pass-through for SNF workers only, not home care or personal care.
                                                                                                                                                                                                                                                                                                              retention of direct care workers
                                                                                                                                                                                                                                                                                                              NGA Best Practices
                                                                                                                                                                                                                                                                                                              2 0 3
                                                                                                                                                                                                                                                                                                              Submit a commentExpand higher education incentive programs for mental health (MH) professionals who agree to serve in rural and other underserved areas
                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                CA, MN, MI, CO, NE, DE are among the states that offer loan repayment programs for mental health professionals who practice in designated shortage areas.
                                                                                                                                                                                                                                                                                                                WI has loan forgiveness programs for psychiatrists only
                                                                                                                                                                                                                                                                                                                availability of MH providers in underserved areas
                                                                                                                                                                                                                                                                                                                use of MH services
                                                                                                                                                                                                                                                                                                                Moderate evidence for physician loan repayment programs Pathman 2004
                                                                                                                                                                                                                                                                                                                2 4
                                                                                                                                                                                                                                                                                                                Submit a commentNurse retention programs
                                                                                                                                                                                                                                                                                                                • Flexible staffing systems such as shift-bidding
                                                                                                                                                                                                                                                                                                                • Magnet Recognition Program
                                                                                                                                                                                                                                                                                                                • Retirement plans to reward long tenure
                                                                                                                                                                                                                                                                                                                Healthcare
                                                                                                                                                                                                                                                                                                                287 health-care organizations in 48 states recognized by Commission on Magnet Recognition Program, for providing nursing excellence.
                                                                                                                                                                                                                                                                                                                10 health care organizations in WI are Magnet-Designated Facilities. Other nurse retention efforts likely underway at other facilities
                                                                                                                                                                                                                                                                                                                nurse job satisfaction
                                                                                                                                                                                                                                                                                                                nurse retention
                                                                                                                                                                                                                                                                                                                Some limited evidence, e.g.,for e-bidding see Daniel 2006 , Magnet program see Triolo 2006
                                                                                                                                                                                                                                                                                                                1 0 2
                                                                                                                                                                                                                                                                                                                Submit a commentExpand higher education incentive programs for nursing graduate students who agree to teach in nursing undergraduate programs
                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                  Several states including CO, GA, IL, MD, MN, MO, NE, ND, RI, TX, and VT have implemented loan forgiveness programs for nursing faculty.
                                                                                                                                                                                                                                                                                                                  WI recently implemented a partial loan forgiveness program.
                                                                                                                                                                                                                                                                                                                  availability of nursing faculty
                                                                                                                                                                                                                                                                                                                  Promising practice AACN
                                                                                                                                                                                                                                                                                                                  2 2
                                                                                                                                                                                                                                                                                                                  Submit a commentImplement higher education incentive programs for pharmacy and physical therapy students who agree to serve in rural and other underserved areas.
                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                      AB 440 creating loan forgiveness program for pharmacy students failed to pass.
                                                                                                                                                                                                                                                                                                                    availability of pharmacists & physical therapists in underserved areas
                                                                                                                                                                                                                                                                                                                    use of services
                                                                                                                                                                                                                                                                                                                      0 4
                                                                                                                                                                                                                                                                                                                    Submit a commentBonus payments for physicians who serve in underserved areas
                                                                                                                                                                                                                                                                                                                    • CMS's Medicare Incentive Payment program pays physicians a 10% bonus for services provided to Medicare beneficiaries in a geographic Health Professional Shortage Area.
                                                                                                                                                                                                                                                                                                                    • A program under which CMS paid Physician Scarcity Incentives of 5% to primary care physicians who practiced in federally designated physician scarcity areas expired June 30, 2008.
                                                                                                                                                                                                                                                                                                                    Federal government
                                                                                                                                                                                                                                                                                                                    Healthcare
                                                                                                                                                                                                                                                                                                                      349 primary care physicians in Wisconsin would potentially be affected by a proposed change to health professional shortage areas
                                                                                                                                                                                                                                                                                                                    access to primary care in underserved areas
                                                                                                                                                                                                                                                                                                                    Mueller 2006
                                                                                                                                                                                                                                                                                                                    2 4
                                                                                                                                                                                                                                                                                                                    Submit a commentHealth workforce data collection for paid and volunteer workers
                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                      Foundations
                                                                                                                                                                                                                                                                                                                      Healthcare
                                                                                                                                                                                                                                                                                                                        Wisconsin Health Workforce Data Collaborative is applying for grants to establish data infrastructure for workforce projection and analysis. Rural EMS and long-term care workforce are primarily volunteer-based.
                                                                                                                                                                                                                                                                                                                      knowledge about current and future workforce gaps.
                                                                                                                                                                                                                                                                                                                      Recommended by DWD Select Committee on Health Care Workforce Development.
                                                                                                                                                                                                                                                                                                                      2 0 6
                                                                                                                                                                                                                                                                                                                      Submit a commentIncentives for academic institutions
                                                                                                                                                                                                                                                                                                                      Incentives for academic institutions to make programmatic decisions that will increase likelihood of students practicing in underserved areas.
                                                                                                                                                                                                                                                                                                                        Colleges & universities
                                                                                                                                                                                                                                                                                                                            the number of health professional students who choose to practice in underserved areas.
                                                                                                                                                                                                                                                                                                                          0 4
                                                                                                                                                                                                                                                                                                                        Policy/Program Decision
                                                                                                                                                                                                                                                                                                                        Maker
                                                                                                                                                                                                                                                                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                        Health Care Access: Health care workforce: scope of practice within and across professions (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                        Submit a commentExpand scope of practice for dental hygienists
                                                                                                                                                                                                                                                                                                                        expand types of settings where dental hygienists may practice independently of a dentist
                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                          22 states have direct access laws in some settings allowing dental hygienists to initiate treatment without specific dentist authorization, treat patients without presence of a dentist, and maintain provider-patient relationships.
                                                                                                                                                                                                                                                                                                                          With limited exceptions, dental hygienists may only practice or perform procedures as authorized by a dentist.
                                                                                                                                                                                                                                                                                                                          access to dental screening and treatment
                                                                                                                                                                                                                                                                                                                          Moderate evidence that dental hygienists can effectively diagnose and treat dental disease NHS-Galloway 2002
                                                                                                                                                                                                                                                                                                                          4 4
                                                                                                                                                                                                                                                                                                                          Submit a commentExtend scope of practice for pediatric and psychiatric nurse practitioners (NP)
                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                            11 states allow nurse practitioners to practice without MD involved
                                                                                                                                                                                                                                                                                                                            Nurse practitioners not allowed to practice or prescribe without MD involvement
                                                                                                                                                                                                                                                                                                                            availability of services
                                                                                                                                                                                                                                                                                                                            Moderate evidence that NPs provide primary care of similar quality to MDs Cochrane-Laurant 2004
                                                                                                                                                                                                                                                                                                                            4 4
                                                                                                                                                                                                                                                                                                                            Submit a commentAllow alternative dental care providers
                                                                                                                                                                                                                                                                                                                            • Expanded function dental assistants that supplement and support dentists by performing basic dental procedures enabling dentists to see more patients.
                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                            24 states recognize “expanded function dental assistants”.
                                                                                                                                                                                                                                                                                                                              access to dental screening
                                                                                                                                                                                                                                                                                                                            use of preventive services
                                                                                                                                                                                                                                                                                                                            Limited evidence Fisher-Owens 2008
                                                                                                                                                                                                                                                                                                                            1 4
                                                                                                                                                                                                                                                                                                                            Submit a commentExpand use of community health workers (CHW)
                                                                                                                                                                                                                                                                                                                            funding, role definition, and standardize education curriculum
                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                              Healthcare providers
                                                                                                                                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                                                                                                                                              TX& OH have general certification legislation. A few other states have program-specific (e.g., Medicaid) certification.
                                                                                                                                                                                                                                                                                                                              Approximately 1300 paid and 500 volunteer CHWs in Wisconsin. No certification required.
                                                                                                                                                                                                                                                                                                                              use of preventive services
                                                                                                                                                                                                                                                                                                                              health practices, e.g., breastfeeding (doulas)
                                                                                                                                                                                                                                                                                                                              Some evidence of CHW contributions to delivery of care, prevention and education HRSA-CHW 2007. Effective for promoting immunization and improving outcomes for some diseases; promising for breast-feeding promotion Cochrane-Lewin 2005.
                                                                                                                                                                                                                                                                                                                              4 3
                                                                                                                                                                                                                                                                                                                              Submit a commentPhysician-level pay-for-performance program for Early and Periodic Screening Diagnostic and Treatment (EPSDT)
                                                                                                                                                                                                                                                                                                                              Rewards PCPs who increase the number of children receiving Early and Periodic Screening Diagnostic and Treatment (EPSDT) primary care visits and perform developmental screenings.
                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                CT
                                                                                                                                                                                                                                                                                                                                DC
                                                                                                                                                                                                                                                                                                                                DE
                                                                                                                                                                                                                                                                                                                                MO
                                                                                                                                                                                                                                                                                                                                NJ
                                                                                                                                                                                                                                                                                                                                  appropriate screening and access to treatment for children
                                                                                                                                                                                                                                                                                                                                  0 2
                                                                                                                                                                                                                                                                                                                                Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                Maker
                                                                                                                                                                                                                                                                                                                                Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                Health Care Access: Cultural competency (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                Submit a commentExpand efforts to recruit health care professionals from minority groups
                                                                                                                                                                                                                                                                                                                                • grants, scholarships, loans
                                                                                                                                                                                                                                                                                                                                Healthcare providers
                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                Community organizations
                                                                                                                                                                                                                                                                                                                                Colleges & universities
                                                                                                                                                                                                                                                                                                                                School boards
                                                                                                                                                                                                                                                                                                                                    access to care for underserved populations
                                                                                                                                                                                                                                                                                                                                quality of interpersonal care
                                                                                                                                                                                                                                                                                                                                Moderate evidence (HRSA-Diversity 2006)
                                                                                                                                                                                                                                                                                                                                4 3
                                                                                                                                                                                                                                                                                                                                Submit a commentRequire health care professions education to include curriculum on knowledge, attitudes, practice skills necessary to care for diverse populations
                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                  Colleges & universities
                                                                                                                                                                                                                                                                                                                                  NJ, WA, MD have legislated cultural competency training requirements. States considering similar bills: AZ, IL, NY
                                                                                                                                                                                                                                                                                                                                    professionals’ knowledge
                                                                                                                                                                                                                                                                                                                                  professionals’ attitude & skills
                                                                                                                                                                                                                                                                                                                                  Moderate to strong evidence for cultural competence training Cochrane-Beach 2006
                                                                                                                                                                                                                                                                                                                                  5 3
                                                                                                                                                                                                                                                                                                                                  Submit a commentAuthorize and require hospitals with a continuing education program to offer and require medical staff to attend CE courses on health disparities
                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                    MD
                                                                                                                                                                                                                                                                                                                                      professionals’ knowledge
                                                                                                                                                                                                                                                                                                                                    professionals’ attitude & skills
                                                                                                                                                                                                                                                                                                                                    Moderate to strong evidence for cultural competence training Cochrane-Beach 2006
                                                                                                                                                                                                                                                                                                                                    5 3
                                                                                                                                                                                                                                                                                                                                    Submit a commentImplement laws requiring facilities to offer interpreters for LEP (Limited English Proficiency) individuals
                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                      43 states have laws addressing language access in health care settings
                                                                                                                                                                                                                                                                                                                                        quality of care for LEP individuals
                                                                                                                                                                                                                                                                                                                                      Strong evidence Flores 2005
                                                                                                                                                                                                                                                                                                                                      5 2
                                                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                      Health Care Access: Other programs and policies to improve access to care (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                      Submit a commentIncrease funding for safety net providers
                                                                                                                                                                                                                                                                                                                                      providers who have either legal mandate or explicit policy to provide services regardless of ability to pay
                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                        Healthcare
                                                                                                                                                                                                                                                                                                                                        36 states directly fund community health centers. 28 states increased funding between FY04 and FY08.
                                                                                                                                                                                                                                                                                                                                        WI has provided $3m in funding each year for the past 5 years.
                                                                                                                                                                                                                                                                                                                                        likelihood of health care needs being met
                                                                                                                                                                                                                                                                                                                                        inappropriate utilization of ER
                                                                                                                                                                                                                                                                                                                                        health outcomes for high risk populations
                                                                                                                                                                                                                                                                                                                                        Evidence supporting effectiveness of community health centers in increasing access to primary care for uninsured NACHC 2007.
                                                                                                                                                                                                                                                                                                                                        2 3
                                                                                                                                                                                                                                                                                                                                        Submit a commentMedical homes
                                                                                                                                                                                                                                                                                                                                        central primary care locus ensuring accessible, continuous, coordinated, comprehensive care
                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                          Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                          MN Medical Home Learning Collaborative-focuses on coordination of care for medically fragile children. AAFP’s TranforMED launched a 24-month National Demonstration Project (NDP) in offices in multiple states.
                                                                                                                                                                                                                                                                                                                                            likelihood of health care needs being met
                                                                                                                                                                                                                                                                                                                                          disparities in health care
                                                                                                                                                                                                                                                                                                                                          Medical home concept endorsed by AAFP, AAP, ACP and AOA. Some evidence, e.g., Strickland 2004, Starfield 2005.
                                                                                                                                                                                                                                                                                                                                          3 6
                                                                                                                                                                                                                                                                                                                                          Submit a commentMobile dental health program for on-site dental care
                                                                                                                                                                                                                                                                                                                                            Healthcare providers
                                                                                                                                                                                                                                                                                                                                            Mobile dental clinics are used in many states including AZ, CA, IL, KS, LA, MI, MO, NC, NV, and TX.
                                                                                                                                                                                                                                                                                                                                            Rural dental health program funds clinics in Menominee and Ladysmith –these operate mobile clinics. Another mobile clinic rotates to Langlade, Lincoln, Oneida, & Forest counties. Ronald McDonald Care Mobile serves SC WI.
                                                                                                                                                                                                                                                                                                                                            access to dental screening and treatment
                                                                                                                                                                                                                                                                                                                                            Limited evidence.
                                                                                                                                                                                                                                                                                                                                            1 4
                                                                                                                                                                                                                                                                                                                                            Submit a commentKinship Care Navigator Program
                                                                                                                                                                                                                                                                                                                                            to help grandparents and other relatives access needed services
                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                              AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IN, KS, LA, MD, MS, MO, MT, NV, NM, NY, NC, ND, OH, OK, PA, SC, SD, TX, UT, VA, WA & WY have enacted laws to enable grandparent & other relatives to access care & treatment for children. OH, WA, NJ, CT, KY, NY IN, MN, OH and DE have authorized navigator programs.
                                                                                                                                                                                                                                                                                                                                              The Grandparents Raising Grandchildren (GRG) Partnership of Wisconsin is a statewide network of kinship caregivers and service providers that work together on issues and concerns facing grandparents raising grandchildren.
                                                                                                                                                                                                                                                                                                                                              access to needed services for children being raised by relatives other than parents
                                                                                                                                                                                                                                                                                                                                              No evidence to-date.
                                                                                                                                                                                                                                                                                                                                              0 1
                                                                                                                                                                                                                                                                                                                                              Submit a commentIncrease use of telemedicine
                                                                                                                                                                                                                                                                                                                                              as a means of access to qualified health care and mental health professionals
                                                                                                                                                                                                                                                                                                                                                Healthcare providers
                                                                                                                                                                                                                                                                                                                                                Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                    Comparable diagnosis and management
                                                                                                                                                                                                                                                                                                                                                health outcomes
                                                                                                                                                                                                                                                                                                                                                access to care
                                                                                                                                                                                                                                                                                                                                                Moderate evidence in general AHRQ-Hersh 2006. Strong evidence for certain chronic diseases (e.g., Clark 2007)
                                                                                                                                                                                                                                                                                                                                                4 4
                                                                                                                                                                                                                                                                                                                                                Submit a commentExpand collaborative systems of care
                                                                                                                                                                                                                                                                                                                                                (i.e., wraparound), with a goal of having children's wraparound systems in each of Wisconsin's 72 counties within 6 years
                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                  Wraparound programs reported in 24 states.
                                                                                                                                                                                                                                                                                                                                                  Assembly Bill 700 modifying current law relating to integrated service programs to expand its coverage to include children who are involved in multiple systems of care as well as children with severe disabilities –failed to pass.
                                                                                                                                                                                                                                                                                                                                                  institutional stays
                                                                                                                                                                                                                                                                                                                                                  school, social, behavioral and emotional function
                                                                                                                                                                                                                                                                                                                                                  Some evidence Burchard 2002
                                                                                                                                                                                                                                                                                                                                                  1 2
                                                                                                                                                                                                                                                                                                                                                  Submit a commentRemoval of structural impairments that limit access to care for patients with disabilities
                                                                                                                                                                                                                                                                                                                                                    Healthcare providers
                                                                                                                                                                                                                                                                                                                                                            0 2
                                                                                                                                                                                                                                                                                                                                                    Submit a commentLicense organizations instead of individuals
                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                          availability of services
                                                                                                                                                                                                                                                                                                                                                        0 0 6
                                                                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                      Health Care Quality and Costs: Health information technology (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                      Submit a commentAdoption of electronic health/ medical records by all providers & practices
                                                                                                                                                                                                                                                                                                                                                        Healthcare providers
                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                          2006/07 Survey of 928 physician practices: 13% of mostly large practices reported full EMR status, 41% reported at least partially EMRs, 45% reported no EMRs
                                                                                                                                                                                                                                                                                                                                                        36% of physicians practice at sites with full EMR status, over 83% practice at sites with at least partially EMRs
                                                                                                                                                                                                                                                                                                                                                        A fall 2008 statewide survey of physician practices is planned by DHS and WMS
                                                                                                                                                                                                                                                                                                                                                        CMS EHR demo project: WMS, Metastar and WCHQ working with small practices
                                                                                                                                                                                                                                                                                                                                                        2006 WHA Survey of 147 hospitals: 16% of hospitals have fully implemented all electronic systems that comprise an EHR
                                                                                                                                                                                                                                                                                                                                                        14% of hospitals reported full/ partial implementation of all systems that comprise EHR
                                                                                                                                                                                                                                                                                                                                                        Improved provider access to complete patient information
                                                                                                                                                                                                                                                                                                                                                        Improved patient outcomes
                                                                                                                                                                                                                                                                                                                                                        cost by eliminating redundant tests and services
                                                                                                                                                                                                                                                                                                                                                        Some evidence of effectiveness when clinical information management & decision support tools are integrated within an HER system AHRQ Shekelle 2006
                                                                                                                                                                                                                                                                                                                                                        4 0 6
                                                                                                                                                                                                                                                                                                                                                        Submit a commentElectronic health records linkage across systems
                                                                                                                                                                                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                                                                                                                                                                                          Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                            Several Independent Physician Associations and Integrated Physician Networks in WI have adopted or are mandating implement-ation of designed EHR systems by their affiliated physicians, with work in creating data platforms for interoperability underway
                                                                                                                                                                                                                                                                                                                                                          DHS-MMIS County Pilot interchange system: expected completion in 2008 but will still need to link to other systems such as Public Health Information System (PHIN)
                                                                                                                                                                                                                                                                                                                                                          WI Health Information Exchange (WI RHIO)
                                                                                                                                                                                                                                                                                                                                                          WI Medicaid ER query system
                                                                                                                                                                                                                                                                                                                                                          eHealth Care Quality and Patient Safety Board: goal is development of a statewide electronic health information infrastructure
                                                                                                                                                                                                                                                                                                                                                          2006 Inventory of WI health information exchange (HIE): -6 orgs had no HIE projects
                                                                                                                                                                                                                                                                                                                                                          21 orgs identified 16 operational exchange projects: 15 deliver info to centralized registries for pub health or quality surveillance; 9 deliver info to clinical care providers; 2 deliver info to patients
                                                                                                                                                                                                                                                                                                                                                          Efficiency
                                                                                                                                                                                                                                                                                                                                                          Automation of public health operations, early detection and response
                                                                                                                                                                                                                                                                                                                                                          Limited evidence of effectiveness based upon cost-benefit analyses AHRQ Shekelle 2006
                                                                                                                                                                                                                                                                                                                                                          3 0 6
                                                                                                                                                                                                                                                                                                                                                          Submit a commentClinical decision support systems
                                                                                                                                                                                                                                                                                                                                                          See Disease management also
                                                                                                                                                                                                                                                                                                                                                            Healthcare providers
                                                                                                                                                                                                                                                                                                                                                              Web-based e-mailed survey to 5783 members of WI Medical Society w/ 496 responding and 356 eligible
                                                                                                                                                                                                                                                                                                                                                            38%: CDSS were in place in their facility; less than a third were computer based
                                                                                                                                                                                                                                                                                                                                                            38% unfamiliar with CDSS or their use in medical practice
                                                                                                                                                                                                                                                                                                                                                            79% receptive to new decision support tools
                                                                                                                                                                                                                                                                                                                                                            CMS Patient Registry Pilot: UW Medical Foundation and WMS were selected to create and test an electronic mechanism to submit clinical data to CMS for performance measurement
                                                                                                                                                                                                                                                                                                                                                            WI Medicaid program has been evaluating role of patient registries in their Pay for Performance strategies
                                                                                                                                                                                                                                                                                                                                                            Improve practitioner peformance
                                                                                                                                                                                                                                                                                                                                                            Improve patient outcomes
                                                                                                                                                                                                                                                                                                                                                            Mixed evidence of effectiveness in improving practitioner performance; very little/ mixed evidence for improved patient outcomes, Garg 2005
                                                                                                                                                                                                                                                                                                                                                            2 0 6
                                                                                                                                                                                                                                                                                                                                                            Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                            Maker
                                                                                                                                                                                                                                                                                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                            Health Care Quality and Costs: Care management & effectiveness (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                            Submit a commentCHI PACC: Program for All-Inclusive Care for Children and Their Families
                                                                                                                                                                                                                                                                                                                                                              Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                              States with current CHI PACC demonstration projects: UT, CO, KY, VA, NY, FL—working with a number of states including Penn, CA and Indiana to expand
                                                                                                                                                                                                                                                                                                                                                              States served by CHI PACC demonstration projects: MT, WY, NM, KS, NE, SD
                                                                                                                                                                                                                                                                                                                                                              The Jane B. Pettit Pain and Palliative Care Center at the Children’s Hospital of Wisconsin, Milwaukee
                                                                                                                                                                                                                                                                                                                                                              Families do not need to choose between hospice and palliative care
                                                                                                                                                                                                                                                                                                                                                              Promising, no evidence of effectiveness.
                                                                                                                                                                                                                                                                                                                                                              0 0 2
                                                                                                                                                                                                                                                                                                                                                              Submit a commentLinguistically appropriate services
                                                                                                                                                                                                                                                                                                                                                                Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                  Wisconsin Coalition for Linguistic Access to Healthcare
                                                                                                                                                                                                                                                                                                                                                                According to study of 214 WI orgs “Well over half of all respondents indicated that they sometimes or usually have difficulty providing services. Most use national telephone interpreter services or reschedule visits to a time when an interpreter is available, but 20% provide care to LEP patients without any interpreting at times.”
                                                                                                                                                                                                                                                                                                                                                                Improved patient-provider communication
                                                                                                                                                                                                                                                                                                                                                                risks to patient safety Improved patient satisfaction
                                                                                                                                                                                                                                                                                                                                                                Improved clinical outcomes
                                                                                                                                                                                                                                                                                                                                                                Karliner 2007 found positive benefits of interpreter services on communication, patient satisfaction, and clinical outcomes
                                                                                                                                                                                                                                                                                                                                                                Little to some evidence that limited English proficiency results in graver adverse events Divi 2007
                                                                                                                                                                                                                                                                                                                                                                4 2
                                                                                                                                                                                                                                                                                                                                                                Submit a commentAligning Forces for Quality
                                                                                                                                                                                                                                                                                                                                                                  Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                  Aligning Forces for Quality is implementing programs in 14 other communities in the US
                                                                                                                                                                                                                                                                                                                                                                  WI received a 3 year grant from Aligning Forces for Quality to improve the quality of care for chronic disease in ambulatory settings. Application submitted for Aligning Forces for Quality grant focused on improving care in the inpatient setting and reducing disparities
                                                                                                                                                                                                                                                                                                                                                                  Measurement & public reporting of performance
                                                                                                                                                                                                                                                                                                                                                                  delivery of quality care
                                                                                                                                                                                                                                                                                                                                                                  Teach consumers importance of recognizing quality
                                                                                                                                                                                                                                                                                                                                                                  Schlough 2007
                                                                                                                                                                                                                                                                                                                                                                  0 0 6
                                                                                                                                                                                                                                                                                                                                                                  Submit a commentGreen House Project
                                                                                                                                                                                                                                                                                                                                                                    Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                    31 Projects in 21 States
                                                                                                                                                                                                                                                                                                                                                                    None
                                                                                                                                                                                                                                                                                                                                                                    Improve quality of life
                                                                                                                                                                                                                                                                                                                                                                    A little evidence of effectiveness Kane 2007
                                                                                                                                                                                                                                                                                                                                                                    2 0 2
                                                                                                                                                                                                                                                                                                                                                                    Submit a commentStandardized quality and performance measurement and public reporting
                                                                                                                                                                                                                                                                                                                                                                      Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                      The Joint Commission (TJC)
                                                                                                                                                                                                                                                                                                                                                                      NCQA-HEDIS
                                                                                                                                                                                                                                                                                                                                                                      CMS Hospital/ Home Health/ Nursing Home Compare
                                                                                                                                                                                                                                                                                                                                                                      Multiple state have quality & charge reporting Web sites
                                                                                                                                                                                                                                                                                                                                                                      Other states with Chartered Value Exchanges: Tenn., Mich., N.Y., Ore., Pa., Wash., Utah, La., Maine, Minn., Mass.
                                                                                                                                                                                                                                                                                                                                                                      Leapfrog Group Hospital Quality Ratings: 77 out of 128 WI hospitals participated in Leapfrog in 2007
                                                                                                                                                                                                                                                                                                                                                                      Wisconsin Collaborative for Health Care Quality (WCHQ) Performance Report. Partici-pation (2007 estimates): 40% of WI physicians, 50% of WI primary care physicians
                                                                                                                                                                                                                                                                                                                                                                      WCHQ also part of P4P public-private collaboration of the Dept. of Health & Human Services, the Quality Alliance Steering Committee (AQA/HQA) and selected pilot communities
                                                                                                                                                                                                                                                                                                                                                                      Wisconsin Hospital Association: Publishes health care quality and safety data, open to public: CheckPoint & PricePoint. Since 2007, consumer portal provides access to these and WCHQ data: .www.wisconsinhealthreports.org
                                                                                                                                                                                                                                                                                                                                                                      Wisconsin Dept. of Employee Trust Funds has reported HEDIS and CAHPS results for ~10 years
                                                                                                                                                                                                                                                                                                                                                                      Medicaid/ BadgerCare HMO Report Card
                                                                                                                                                                                                                                                                                                                                                                      Wisconsin Healthcare Value Exchange—(HHS CVE) will have access to Medicare quality information and will become part of nationwide learning network
                                                                                                                                                                                                                                                                                                                                                                      The Alliance (report only available to members)
                                                                                                                                                                                                                                                                                                                                                                      Wisconsin Health Information Organization collects data -- focus will be on cost-efficiency measurement, administrative claims database projected for Dec 08. Authorizing statute refers to consumer information on provider performance being available.
                                                                                                                                                                                                                                                                                                                                                                      WMS enhancing its continuing medical education (CME) criteria to allow physicians to receive CME credit for conducting quality improvement activities based on standardized performance measures
                                                                                                                                                                                                                                                                                                                                                                      Improved quality, safety and service of care
                                                                                                                                                                                                                                                                                                                                                                      Improved adherence to clinical guidelines
                                                                                                                                                                                                                                                                                                                                                                      health outcomes & patient satisfaction
                                                                                                                                                                                                                                                                                                                                                                      Improve/ promote hospital QI efforts
                                                                                                                                                                                                                                                                                                                                                                      Improve effectiveness, safety and patient-centeredness
                                                                                                                                                                                                                                                                                                                                                                      A little evidence of effectiveness Silow-Carroll 2007
                                                                                                                                                                                                                                                                                                                                                                      See identified “Quality Improvement Sequence”
                                                                                                                                                                                                                                                                                                                                                                      Systematic review found some evidence of effectiveness for increased QI efforts at the hospital level, mixed evidence for improvement in patient outcomes Fung 2008
                                                                                                                                                                                                                                                                                                                                                                      3 0 6
                                                                                                                                                                                                                                                                                                                                                                      Submit a commentNational Surgical Quality Improvement Program
                                                                                                                                                                                                                                                                                                                                                                        Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                        VA Hospitals, some private sector hospitals
                                                                                                                                                                                                                                                                                                                                                                        Participating sites: Gundersen Lutheran Medical Center, La Crosse; St. Joseph’s Hospital, Marshfield; University of WI Hospitals and Clinics, Madison; Waukesha Memorial Hospital, Waukesha
                                                                                                                                                                                                                                                                                                                                                                        Surgical quality improvement
                                                                                                                                                                                                                                                                                                                                                                        Some evidence of effectiveness Rowell 2007, Khuri 2002
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                                                                                                                                                                                                                                                                                                                                                                        Submit a commentCollaborative improvement projects (provider directed using data and evidence based guidelines to support process changes)
                                                                                                                                                                                                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                          Institute for Healthcare Improvement (IHI)
                                                                                                                                                                                                                                                                                                                                                                          MetaStar supports multiple targeted improvement projects as part of their CMS contract that are based in data
                                                                                                                                                                                                                                                                                                                                                                          WHA has lead 2 rural hospital improvement project on surgical care and stroke (funding from WORH) using data to support process changes
                                                                                                                                                                                                                                                                                                                                                                          WCHQ supported the STEMI hospital improvement project
                                                                                                                                                                                                                                                                                                                                                                          WI HMO Diabetes Quality Improvement Collaborative
                                                                                                                                                                                                                                                                                                                                                                          Improved quality & safety of care
                                                                                                                                                                                                                                                                                                                                                                          Improved adherence to clinical guidelines
                                                                                                                                                                                                                                                                                                                                                                          health outcomes & patient satisfaction
                                                                                                                                                                                                                                                                                                                                                                          Recommended by CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                          2 0 5
                                                                                                                                                                                                                                                                                                                                                                          Submit a commentPreferred drug list/ medication management
                                                                                                                                                                                                                                                                                                                                                                            Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                              Preferred Drug List (PDL) for WI Medicaid, BadgerCare & SeniorCare
                                                                                                                                                                                                                                                                                                                                                                            WI is a Drug Effectiveness Review Project (DERP) participant
                                                                                                                                                                                                                                                                                                                                                                            WI ETF implemented a centralized pharmacy benefit with a 3-tier formulary in 2004
                                                                                                                                                                                                                                                                                                                                                                            Promote clinically sound drug therapy
                                                                                                                                                                                                                                                                                                                                                                            Control costs
                                                                                                                                                                                                                                                                                                                                                                            DERP is an evidence-based process; however there is no direct evidence of the actual impact of DERP Bergman 2006, Neumann 2006
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                                                                                                                                                                                                                                                                                                                                                                            Submit a commentDisease management
                                                                                                                                                                                                                                                                                                                                                                            Can include a variety of approaches to care including disease registries, patient & clinician reminders
                                                                                                                                                                                                                                                                                                                                                                              Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                WI Diabetes Prevention and Control Program
                                                                                                                                                                                                                                                                                                                                                                              WI Chronic Disease Program [chronic renal disease program, hemophilia home care program, adult cystic fibrosis program]
                                                                                                                                                                                                                                                                                                                                                                              WI Partnership Program [modified version of PACE model] 8 counties served (2,689 indiv)
                                                                                                                                                                                                                                                                                                                                                                              PACE 1 county (809)
                                                                                                                                                                                                                                                                                                                                                                              WI Family Care Program 7 counties 11,926)
                                                                                                                                                                                                                                                                                                                                                                              Wraparound Milwaukee Program
                                                                                                                                                                                                                                                                                                                                                                              Children Come First (CCF)
                                                                                                                                                                                                                                                                                                                                                                              Southeast Wisconsin Business Coalition funded the NCQA Physician Recognition Program for diabetic management in Milwaukee contiguous counties in 2007
                                                                                                                                                                                                                                                                                                                                                                              Improved care through effective communication, coordination & completeness of care
                                                                                                                                                                                                                                                                                                                                                                              health outcomes & patient satisfaction
                                                                                                                                                                                                                                                                                                                                                                              AHRQ-McDonald 2007, Mattke 2007
                                                                                                                                                                                                                                                                                                                                                                              some evidence of effectiveness for condition- specific disease manage-ment programs, particularly in mental health, diabetes and heart failure: evidence it improves process of care, less evidence for health outcomes improvement
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                                                                                                                                                                                                                                                                                                                                                                              Submit a commentCase management
                                                                                                                                                                                                                                                                                                                                                                              Typically involves assignment of a single person (case manager) who coordinates all aspects of a patient's care (e.g., providing information to multiple providers, seeing that the patient receives services in a timely manner etc.).
                                                                                                                                                                                                                                                                                                                                                                                Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                    Improved care through effective communication, coordination &completeness of care
                                                                                                                                                                                                                                                                                                                                                                                health outcomes & patient satisfaction
                                                                                                                                                                                                                                                                                                                                                                                Case managers appear to improve patient outcomes for patients who have mental health problems, heart failure or diabetes AHRQ-McDonald 2007
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                                                                                                                                                                                                                                                                                                                                                                                Submit a commentPOLST (Physician’s Order for Life Sustaining Treatment) forms
                                                                                                                                                                                                                                                                                                                                                                                See definition and comparison with an advance directive.
                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                  Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                  33 states have either been endorsed, are developing, or have identified a contact as a POLST Paradigm Program
                                                                                                                                                                                                                                                                                                                                                                                  Used by nursing homes in Kenosha (city), and counties of La Crosse, Monroe, Vernon, Richland and parts of Trempealeau county. Some of northern Wisconsin
                                                                                                                                                                                                                                                                                                                                                                                  WMS having preliminary conversations with members re statewide Advanced Directive initiative
                                                                                                                                                                                                                                                                                                                                                                                  Promotes adherence to individual’s specific life-sustaining treatment wishes
                                                                                                                                                                                                                                                                                                                                                                                  A little evidence of effectiveness Lee 2000
                                                                                                                                                                                                                                                                                                                                                                                  2 0 1
                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentPay for performance/ value-based purchasing
                                                                                                                                                                                                                                                                                                                                                                                    Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                    Multiple Medicare demonstrations underway, e.g., Physician Group Practice, Medical Home, Coordinated Care, Care Management
                                                                                                                                                                                                                                                                                                                                                                                    Marshfield Clinic: CMS Pay-for-Performance initiative
                                                                                                                                                                                                                                                                                                                                                                                    CMS Premier Demonstration Project: Aurora
                                                                                                                                                                                                                                                                                                                                                                                    DeanCareHMO: P4P contracting with network hospitals
                                                                                                                                                                                                                                                                                                                                                                                    The Alliance: P4P contracting with network hospitals and physician practices
                                                                                                                                                                                                                                                                                                                                                                                    Improve quality of care
                                                                                                                                                                                                                                                                                                                                                                                    costs
                                                                                                                                                                                                                                                                                                                                                                                    Controlled Studies-- A little evidence of effectiveness Christianson 2007
                                                                                                                                                                                                                                                                                                                                                                                    Program Evaluations--Some evidence of effectiveness
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                                                                                                                                                                                                                                                                                                                                                                                    Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                    Maker
                                                                                                                                                                                                                                                                                                                                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                    Health Care Quality and Costs: Patient safety (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentMandatory reporting of nosocomial infections
                                                                                                                                                                                                                                                                                                                                                                                    Reporting by hospitals and other healthcare organizations
                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                      26 states and the District of Columbia have some level of legislation or regulation. Approximately 300 hospitals participate in the CDC’s National Nosocomial Infections Surveillance (NNIS) system
                                                                                                                                                                                                                                                                                                                                                                                      The Quality Improvement Act is currently in the formulation process; it would update WI peer review statutes. Very few WI hospitals currently participate in NNIS
                                                                                                                                                                                                                                                                                                                                                                                      Hospital-Acquired Infections (HAIs)
                                                                                                                                                                                                                                                                                                                                                                                      Mixed/Limited evidence of effectiveness. AHRQ-Ranji 2007 indicates insufficient evidence regarding the effectiveness of QI strategies geared towards HAIs prevention.
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                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentStatewide colored wristband standardization
                                                                                                                                                                                                                                                                                                                                                                                       Used to denote patient status
                                                                                                                                                                                                                                                                                                                                                                                        Healthcare
                                                                                                                                                                                                                                                                                                                                                                                        11 States have standardized on the same colors including WI and MN. IL, IN, MI are considering standardization
                                                                                                                                                                                                                                                                                                                                                                                        WHA Board of Directors approved voluntary standardization of color-coded alerts for hospitals that use them to communicate patient risk information – targeted for 100% compliance by March 2009
                                                                                                                                                                                                                                                                                                                                                                                        hospital errors
                                                                                                                                                                                                                                                                                                                                                                                        Rollins 2007: Anecdotal evidence that lack of standardization leads to errors
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                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentAccreditation requirement for ambulatory surgery centers
                                                                                                                                                                                                                                                                                                                                                                                        For centers that use moderate or heavy sedation
                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                          25 states and D.C. require or recognize accreditation of certain types of ambulatory surgical centers or facilities
                                                                                                                                                                                                                                                                                                                                                                                          Wisconsin recognizes AAAHC accreditation for Medicaid managed care plans
                                                                                                                                                                                                                                                                                                                                                                                          Improve quality oversight
                                                                                                                                                                                                                                                                                                                                                                                          Promising, no evidence of effectiveness
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                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentRoutinely screen & culture high risk patients for MRSA
                                                                                                                                                                                                                                                                                                                                                                                          Methicillin-resistant Staphylococcus aureus (MRSA) and other multidrug resistant organisms
                                                                                                                                                                                                                                                                                                                                                                                            Healthcare
                                                                                                                                                                                                                                                                                                                                                                                            Six states and New York City with some level of activities regarding MRSA screening
                                                                                                                                                                                                                                                                                                                                                                                            None identified
                                                                                                                                                                                                                                                                                                                                                                                            incidence of Methicillin-resistant Staphylococcus aureus (MRSA)
                                                                                                                                                                                                                                                                                                                                                                                            Mixed evidence of effectiveness. Clancy 2006, Shitrit 2006, DerGurahian 2007 indicate there is some evidence of effectiveness
                                                                                                                                                                                                                                                                                                                                                                                            1 0 2
                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentNo reimbursement for hospital medical errors
                                                                                                                                                                                                                                                                                                                                                                                              Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                              CMS will not pay for some “never events”. Aetna and Blue Cross Blue Shield to stop reimbursement for hospital care resulting from serious medical errors. Some enactment in PA, MN, WA and MA
                                                                                                                                                                                                                                                                                                                                                                                              In June 2008, WMS and WHA jointly endorsed a set of nine adverse events for hospital non-billing—encouraging purchasers and payers to support. Several WI health plans are adding CMS list of adverse events for non-billing to their hospital contracts. WMS has activated a physician advisory group to study impact on physician care & reimbursement. Following federal regulations allowing for establishment of patient safety organizations, WMS, WHA and Metastar held initial meeting; protects providers in reporting events and allows for process improvement.
                                                                                                                                                                                                                                                                                                                                                                                              hospital errors
                                                                                                                                                                                                                                                                                                                                                                                              Promising-no evidence of effectiveness Rosenthal 2007
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                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentOther patient safety initiatives
                                                                                                                                                                                                                                                                                                                                                                                                    SafeCare WI launched a public campaign called “List It; Don’t Risk It” on Medication Management in 2008; MRSA will be their next awareness campaign. Madison Patient Safety Institute and the Milwaukee Patient Safety . Metastar leads Wisconsin’s involvement in the IHI 5 Million Lives Campaign Collaborative.
                                                                                                                                                                                                                                                                                                                                                                                                         
                                                                                                                                                                                                                                                                                                                                                                                                Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                Maker
                                                                                                                                                                                                                                                                                                                                                                                                Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                Health Care Quality and Costs: Other health care quality programs and policies (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentHealth literacy improvement
                                                                                                                                                                                                                                                                                                                                                                                                Patient testing for health literacy; effort to not assume health literacy; Use of standardized communication tools
                                                                                                                                                                                                                                                                                                                                                                                                  Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                  Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                  Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                  School boards
                                                                                                                                                                                                                                                                                                                                                                                                  Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                  Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                    Wisconsin DHFS, in partnership with WCHQ and WMS, will pilot the Ask-Me-3™ program, developed by the Partnership for Clear Health Communications.
                                                                                                                                                                                                                                                                                                                                                                                                  From a prelim. analysis of 462 responses to a survey of WI family physicians, approx 85% believed low literacy did affect quality of care and health outcomes, estimated 17% of their patients had low literacy, 7% screened for literacy levels.
                                                                                                                                                                                                                                                                                                                                                                                                  Wisconsin Literacy: Supports adult, family & workplace literacy program. Provides some health literacy resources.
                                                                                                                                                                                                                                                                                                                                                                                                  A consortium of entities in the La Crosse area has formed an effort to increase patients’ health literacy.
                                                                                                                                                                                                                                                                                                                                                                                                  Improvement of health outcomes
                                                                                                                                                                                                                                                                                                                                                                                                  Some evidence that patients with low literacy have poorer health outcomes AHRQ-Berkman 2004
                                                                                                                                                                                                                                                                                                                                                                                                  Limited evidence that interventions impact this association between low literacy and health outcomes IOM 2004
                                                                                                                                                                                                                                                                                                                                                                                                  3 4
                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentMember Agreements
                                                                                                                                                                                                                                                                                                                                                                                                    Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                    West Virginia
                                                                                                                                                                                                                                                                                                                                                                                                    Idaho and Kentucky have submitted similar plans (as of 2006)
                                                                                                                                                                                                                                                                                                                                                                                                    Wisconsin’s BadgerCare Plus program is piloting a Member Pledge
                                                                                                                                                                                                                                                                                                                                                                                                    Health status
                                                                                                                                                                                                                                                                                                                                                                                                    Utilization of preventative care and other recommended practices
                                                                                                                                                                                                                                                                                                                                                                                                    Costs
                                                                                                                                                                                                                                                                                                                                                                                                    Mixed opinions on whether promising, Bishop 2006, although physican-patient goal setting can improve health-related behaviors.
                                                                                                                                                                                                                                                                                                                                                                                                    physician-patient goal setting can improve health-related behaviors
                                                                                                                                                                                                                                                                                                                                                                                                    1 0 3
                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentContinuing Medical Education
                                                                                                                                                                                                                                                                                                                                                                                                      Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                      Avg. National Requirements:
                                                                                                                                                                                                                                                                                                                                                                                                      Required number of CME credits per Year(s): 66 credits per 2.2 years
                                                                                                                                                                                                                                                                                                                                                                                                      AMA PRA Category 1 or Equivalent AOA, AAFP or ACOG Credits: 37.8
                                                                                                                                                                                                                                                                                                                                                                                                      Multiple states have specific mandated CME content
                                                                                                                                                                                                                                                                                                                                                                                                      Required Number of CME Credits per Year(s):
                                                                                                                                                                                                                                                                                                                                                                                                      30 credits per 2 yrs
                                                                                                                                                                                                                                                                                                                                                                                                      AMA Category 1 or Equivalent AOA, AAFP or ACOG Credits:
                                                                                                                                                                                                                                                                                                                                                                                                      30
                                                                                                                                                                                                                                                                                                                                                                                                      No specific mandated CME content
                                                                                                                                                                                                                                                                                                                                                                                                      Achieving/ maintaining the following objectives:
                                                                                                                                                                                                                                                                                                                                                                                                      Knowledge
                                                                                                                                                                                                                                                                                                                                                                                                      Attitudes
                                                                                                                                                                                                                                                                                                                                                                                                      Skills
                                                                                                                                                                                                                                                                                                                                                                                                      Practice Behavior
                                                                                                                                                                                                                                                                                                                                                                                                      Clinical Practice Outcomes
                                                                                                                                                                                                                                                                                                                                                                                                      Mixed evidence [predominantly positive] that CME is effective AHRQ-Marionopoulus 2006
                                                                                                                                                                                                                                                                                                                                                                                                      No evidence regarding relationship between CME amount & effectiveness
                                                                                                                                                                                                                                                                                                                                                                                                      1 0 6
                                                                                                                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                      Health Care Quality and Costs: Strategies to reduce amount paid for services (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentIncrease competition through competitive bidding
                                                                                                                                                                                                                                                                                                                                                                                                      Extend use of or access to competitively bid health coverage
                                                                                                                                                                                                                                                                                                                                                                                                        Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                        Competitive bidding used by various purchaser coalitions and approx 1 in 3 states Medicaid managed care plans (NAHSP)
                                                                                                                                                                                                                                                                                                                                                                                                        ETF uses competitive bidding for state employees (as part of its value-based purchasing): includes consumer choice of health plans with financial incentives to sekect low cost/ high quality plans.
                                                                                                                                                                                                                                                                                                                                                                                                        Purchasing pools and cooperatives, e.g., Employer Health Care Alliance Cooperative, Wisconsin Employers Health Care Cooperative, Co-op Care of SE WI
                                                                                                                                                                                                                                                                                                                                                                                                        premiums
                                                                                                                                                                                                                                                                                                                                                                                                        Commonwealth Fund identified potential net savings for Medicare based on Lewin modeling CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                        1 0 6
                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentNegotiated prescription drug prices
                                                                                                                                                                                                                                                                                                                                                                                                        • Statewide purchasing pool
                                                                                                                                                                                                                                                                                                                                                                                                        Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                        Public purchasers
                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                        Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                        MMCAP is a voluntary group purchasing organization whose members include state correctional, mental health and public health facilities in 45 states.
                                                                                                                                                                                                                                                                                                                                                                                                        Wisconsin Medicaid belongs to a buying pool with 6 other states organized by Provider Synergies.
                                                                                                                                                                                                                                                                                                                                                                                                        Various government health, health care and correctional facilities who dispense medicines participate in MMCAP.
                                                                                                                                                                                                                                                                                                                                                                                                        HealthyWisconsin proposal includes bulk purchasing of prescription drugs.
                                                                                                                                                                                                                                                                                                                                                                                                        prescription drug prices
                                                                                                                                                                                                                                                                                                                                                                                                        Group purchasing is a widely accepted cost saving practice in health care. Commonwealth Fund identified potential net savings for Medicare based on Lewin modeling CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                        3 0 6
                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentTiered drug, reference and other drug pricing policies
                                                                                                                                                                                                                                                                                                                                                                                                          Health insurers
                                                                                                                                                                                                                                                                                                                                                                                                          Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                          Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                          CalPERS considered for hospitals in 2002 but rejected it
                                                                                                                                                                                                                                                                                                                                                                                                          ETF uses tiered drug pricing.
                                                                                                                                                                                                                                                                                                                                                                                                          Very common in commercial health insurance.
                                                                                                                                                                                                                                                                                                                                                                                                          cost of entire drug benefit
                                                                                                                                                                                                                                                                                                                                                                                                          Reference drug pricing, (i.e., a maximum level of reimbursement for group of drugs assumed to be therapeutically equivalent) found to shift use to lower cost drugs Cochrane-Aaserud 2006.
                                                                                                                                                                                                                                                                                                                                                                                                          Tiered pricing also effective Nair 2003
                                                                                                                                                                                                                                                                                                                                                                                                          4 0 6
                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentIncrease consumer awareness of prices
                                                                                                                                                                                                                                                                                                                                                                                                          Price transparency
                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                            Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                            Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                            CA publishes information on hospital prices.
                                                                                                                                                                                                                                                                                                                                                                                                            NH collects insurance claims and publishes estimated prices for entire episodes of care, including physician prices.
                                                                                                                                                                                                                                                                                                                                                                                                            Wisconsin Hospital Association publishes prices on average and median hospital charges for all inpatient procedures and selected outpatient procedures. Wisconsin Association of Health Plans' Transparency Initiative involves a pledge by its members to provide estimates of anticipated out-of-pocket costs for expected medical procedures.
                                                                                                                                                                                                                                                                                                                                                                                                            use of providers with lower prices
                                                                                                                                                                                                                                                                                                                                                                                                            Uncertain effectiveness CBO-EBIB 2008: prices are most relevant when reflective of consumer out-of-pocket costs. (This information is probably best delivered by insurers.)
                                                                                                                                                                                                                                                                                                                                                                                                            1 6
                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentRevise payment methodologies
                                                                                                                                                                                                                                                                                                                                                                                                            • Limit payment updates in high cost areas
                                                                                                                                                                                                                                                                                                                                                                                                            Federal government
                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                            Health insurers
                                                                                                                                                                                                                                                                                                                                                                                                            Despite widespread variations in costs, current Medicare practice involves uniform updating of hospital and physician payment rates across the US.
                                                                                                                                                                                                                                                                                                                                                                                                            Less variation within WI than across nation but still considerable
                                                                                                                                                                                                                                                                                                                                                                                                            rate of growth in spending
                                                                                                                                                                                                                                                                                                                                                                                                            Commonwealth Fund identified potential net savings for Medicare based on Lewin modeling assuming updates regulated to national benchmark, preventing equal rate increase in high cost areas CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                            1 0 6
                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentAll-payer payment methods and rates
                                                                                                                                                                                                                                                                                                                                                                                                            • Require all payers to adopt Medicare rates and methods for MD/ hospitals thus increasing payments to Medicaid providers and reduce cost shifting to private insurers
                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                            No states
                                                                                                                                                                                                                                                                                                                                                                                                            Medicare payments to WI hospitals often viewed as low compared to other states therefore more cost-shifting to private insurers may exist.
                                                                                                                                                                                                                                                                                                                                                                                                              Commonwealth Fund identified potential net savings for all-payor system for the US based on Lewin modeling however setting all rates to that of Medicare would like cause severe financial hardship to providers. CW Fund-Schoen 2007
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                                                                                                                                                                                                                                                                                                                                                                                                            Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                            Maker
                                                                                                                                                                                                                                                                                                                                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                            Health Care Quality and Costs: Strategies to reduce inappropriate or duplicative use of services (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentRegulatory approaches to reduce duplication of services by reducing availability
                                                                                                                                                                                                                                                                                                                                                                                                            For information on reducing duplication through EMR linkage across systems, see Health Care Quality worksheet
                                                                                                                                                                                                                                                                                                                                                                                                              Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                              Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                              36 states have certificate of need (CON) programs. Most commonly required for hospitals, ambulatory surgery centers and/or nursing homes. Some states extend the requirements to physician groups and physician-owned facilities.
                                                                                                                                                                                                                                                                                                                                                                                                              Wisconsin’s CON program for hospitals was repealed by 1983 Wisconsin Act 27. The only health care providers subject to a CON-type review are long term care facilities.
                                                                                                                                                                                                                                                                                                                                                                                                              duplication of facilities and services
                                                                                                                                                                                                                                                                                                                                                                                                              utilization of services
                                                                                                                                                                                                                                                                                                                                                                                                              health care costs
                                                                                                                                                                                                                                                                                                                                                                                                              Conflicting evidence regarding effectiveness of cerficate of need programs in reducing health care costs Rivers 2007, Conover 2003
                                                                                                                                                                                                                                                                                                                                                                                                              1 0 6
                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentReduce inappropriate care through patient shared decision making
                                                                                                                                                                                                                                                                                                                                                                                                              Provide incentives for providers to educate patients about treatment alternatives through decision aids
                                                                                                                                                                                                                                                                                                                                                                                                                Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                                Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                  Some debate over the extent of current practice.
                                                                                                                                                                                                                                                                                                                                                                                                                use of expensive procedures
                                                                                                                                                                                                                                                                                                                                                                                                                use of cost-savings procedures
                                                                                                                                                                                                                                                                                                                                                                                                                Commonwealth Fund identified potential net savings for the US based on Lewin modeling CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                                Moderate evidence of effectiveness in impacting treatment choices Cochrane-O'Connor 2003
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                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentReduce need for health care by providing positive incentives for health
                                                                                                                                                                                                                                                                                                                                                                                                                Provide incentives to employees for wellness/ improved health behavior (involves initial investment and coverage of preventive services)
                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                  Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                  Health insurers
                                                                                                                                                                                                                                                                                                                                                                                                                  Employers, particularly large one, are using a wide range of financial incentives to promote healthier lifestyles
                                                                                                                                                                                                                                                                                                                                                                                                                  United Health estimates minimum $100 incentive necessary to ensure participation.
                                                                                                                                                                                                                                                                                                                                                                                                                  State of MN employees have option of completing Health Risk Assessment – if they agree to a follow up call, they have lower co-pays for subsequent visits.
                                                                                                                                                                                                                                                                                                                                                                                                                  Wisconsin’s BadgerCare Plus Healthy Living program
                                                                                                                                                                                                                                                                                                                                                                                                                  Employer wellness programs
                                                                                                                                                                                                                                                                                                                                                                                                                  Strong Rural Communities initiative
                                                                                                                                                                                                                                                                                                                                                                                                                  Use of financial incentives for State of WI employees would require legislative and collective bargaining approval.
                                                                                                                                                                                                                                                                                                                                                                                                                  health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                  absenteeism
                                                                                                                                                                                                                                                                                                                                                                                                                  productivity
                                                                                                                                                                                                                                                                                                                                                                                                                  Commonwealth Fund identified potential net savings for the US based on Lewin modeling CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                                  Chapman 2005
                                                                                                                                                                                                                                                                                                                                                                                                                  3 5
                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentPayment reform to eliminate fee-for-service (FFS) incentives
                                                                                                                                                                                                                                                                                                                                                                                                                  • Per capita payments
                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                  Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                  Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                  Widespread.
                                                                                                                                                                                                                                                                                                                                                                                                                  Large proportion of Wisconsin Employee Trust Fund (> 90%) and Medicaid enrollees are in managed care plans – with some capitation. More widespread use elsewhere in the 1990s but then public dissatisfaction with managed care led to decline in use.
                                                                                                                                                                                                                                                                                                                                                                                                                  use of unnecessary services
                                                                                                                                                                                                                                                                                                                                                                                                                  efficiency
                                                                                                                                                                                                                                                                                                                                                                                                                  health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                  Evidence that managed care reduces rate of cost growth Chernew 1998
                                                                                                                                                                                                                                                                                                                                                                                                                  Evidence that primary care physicians paid by capitation provided less services than those paid by FFS Cochrane-Gosden 2000
                                                                                                                                                                                                                                                                                                                                                                                                                  4 0 6
                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentPayment reform to shift risk or incentivize providers and reward efficient providers
                                                                                                                                                                                                                                                                                                                                                                                                                  • Per episode payments to reward more efficient and coordinated care
                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                  Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                  Medicare has initiated
                                                                                                                                                                                                                                                                                                                                                                                                                  a) per-episode payments for non-acute care and
                                                                                                                                                                                                                                                                                                                                                                                                                  b) incentivizing hospitals
                                                                                                                                                                                                                                                                                                                                                                                                                    use of unnecessary services
                                                                                                                                                                                                                                                                                                                                                                                                                  efficiency
                                                                                                                                                                                                                                                                                                                                                                                                                  health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                  Commonwealth Fund identified potential net savings for per episode payments in Medicare, based on Lewin modeling CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                                  Davis 2007
                                                                                                                                                                                                                                                                                                                                                                                                                  1 0 6
                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentTort reform to reduce defensive medicine
                                                                                                                                                                                                                                                                                                                                                                                                                  • Reinstate limits on medical malpractice damage payments
                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                      medical malpractice premiums
                                                                                                                                                                                                                                                                                                                                                                                                                  defensive medicine, i.e.., use of some services
                                                                                                                                                                                                                                                                                                                                                                                                                  supply of medical professionals
                                                                                                                                                                                                                                                                                                                                                                                                                  Limits are associated with somewhat lower malpractice premiums.
                                                                                                                                                                                                                                                                                                                                                                                                                  Inconclusive evidence re impact on practice of defensive medicine CBO-EBEB 2004
                                                                                                                                                                                                                                                                                                                                                                                                                  1 0 6
                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentAdoption of electronic health/ medical records by all providers & practices
                                                                                                                                                                                                                                                                                                                                                                                                                    Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                      2006/07 Survey of 928 physician practices: 13% of mostly large practices reported full EMR status, 41% reported at least partially EMRs, 45% reported no EMRs
                                                                                                                                                                                                                                                                                                                                                                                                                    36% of physicians practice at sites with full EMR status, over 83% practice at sites with at least partially EMRs
                                                                                                                                                                                                                                                                                                                                                                                                                    A fall 2008 statewide survey of physician practices is planned by DHS and WMS
                                                                                                                                                                                                                                                                                                                                                                                                                    CMS EHR demo project: WMS, Metastar and WCHQ working with small practices
                                                                                                                                                                                                                                                                                                                                                                                                                    2006 WHA Survey of 147 hospitals: 16% of hospitals have fully implemented all electronic systems that comprise an EHR
                                                                                                                                                                                                                                                                                                                                                                                                                    14% of hospitals reported full/ partial implementation of all systems that comprise EHR
                                                                                                                                                                                                                                                                                                                                                                                                                    Improved provider access to complete patient information
                                                                                                                                                                                                                                                                                                                                                                                                                    Improved patient outcomes
                                                                                                                                                                                                                                                                                                                                                                                                                    cost by eliminating redundant tests and services
                                                                                                                                                                                                                                                                                                                                                                                                                    Some evidence of effectiveness when clinical information management & decision support tools are integrated within an HER system AHRQ Shekelle 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentReduce need for health care
                                                                                                                                                                                                                                                                                                                                                                                                                    Programs and policies to encourage healthy behaviors and make use of effective clinical preventive services are addressed under Physical Activity, Nutrition, Smoking, etc.
                                                                                                                                                                                                                                                                                                                                                                                                                                     
                                                                                                                                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                      Health Care Quality and Costs: Strategies to encourage use of lower cost services that might reduce need for higher cost services (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentEnhanced information on clinical and cost-effectiveness to enhance coverage policy
                                                                                                                                                                                                                                                                                                                                                                                                                        Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                        Oregon has established Drug Effectiveness Review Project (DERP)
                                                                                                                                                                                                                                                                                                                                                                                                                        Wisconsin Medicaid participates in Oregon’s DERP. WI Medical Society, WI Hospital Association and the Pharmacy Society of WI and others are considering forming a coalition to address issues related to drug efficacy and evidence-based practices examining 1) gift bans from pharmaceutical companies, 2) academic detailing
                                                                                                                                                                                                                                                                                                                                                                                                                        use of unnecessary services
                                                                                                                                                                                                                                                                                                                                                                                                                        health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                        AHRQ established Effective Health Care Program
                                                                                                                                                                                                                                                                                                                                                                                                                        IOM convened Round-table on Evidence-Based Medicine
                                                                                                                                                                                                                                                                                                                                                                                                                        1 0 6
                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentStrengthen primary care and care coordination through medical homes
                                                                                                                                                                                                                                                                                                                                                                                                                        See Health Care Access worksheet also
                                                                                                                                                                                                                                                                                                                                                                                                                          Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                          Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                          Demonstration projects (see Health Care Access worksheet)
                                                                                                                                                                                                                                                                                                                                                                                                                            health outcomes
                                                                                                                                                                                                                                                                                                                                                                                                                          health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                          Commonwealth Fund identified potential net savings for medical homes in Medicare, based on Lewin modeling CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                                          Starfield 2005
                                                                                                                                                                                                                                                                                                                                                                                                                          3 6
                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentChronic disease management programs to reduce repeat hospitalizations
                                                                                                                                                                                                                                                                                                                                                                                                                          • For congestive heart failure, for children with moderate to severe asthma
                                                                                                                                                                                                                                                                                                                                                                                                                          Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                          Many state Medicaid and private insurer experiences
                                                                                                                                                                                                                                                                                                                                                                                                                            health outcomes
                                                                                                                                                                                                                                                                                                                                                                                                                          health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                          Mixed evidence of effectiveness AHRQ-McDonald 2007, some evidence Mattke 2007
                                                                                                                                                                                                                                                                                                                                                                                                                          3 6
                                                                                                                                                                                                                                                                                                                                                                                                                          Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                          Maker
                                                                                                                                                                                                                                                                                                                                                                                                                          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                          Health Care Quality and Costs: Other strategies to reduce health care spending (Sources of Information on Implementation)
                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentIncentives to set up/ use health savings accounts (HSAs) and high deductible health plans
                                                                                                                                                                                                                                                                                                                                                                                                                          consumer-directed health plans
                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                            Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                            Healthy Indiana program for adults with income < 200% poverty includes an HSA. KS offers small businesses tax credit for offering and contributing to HSAs for employees.
                                                                                                                                                                                                                                                                                                                                                                                                                            For other examples, see NCSL.
                                                                                                                                                                                                                                                                                                                                                                                                                            Private sector employers increasingly offer HSAs, although still not large scale adoption. Governor has vetoed legislature-approved HSA tax benefits.
                                                                                                                                                                                                                                                                                                                                                                                                                            number with health insurance coverage
                                                                                                                                                                                                                                                                                                                                                                                                                            decisions based on cost & quality
                                                                                                                                                                                                                                                                                                                                                                                                                            Little to no evidence supporting increased take-up by uninsured. Conflicting evidence about impact on costs and quality of care. Fronstin 2008 also found low impact on currently uninsured; participants tend to have higher incomes, better health status; more cost-conscious behavior AHRQ-Baker 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentAdministrative simplification to reduce administrative costs
                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                              MN passed legislation in 2007 requiring standardized, electronic health care billing transactions (eligibility, claims, payment and remittance.
                                                                                                                                                                                                                                                                                                                                                                                                                              Healthy Wisconsin proposal suggests that it will reduce health insurance administrative costs but estimates of costs savings are controversial.
                                                                                                                                                                                                                                                                                                                                                                                                                              administrative costs
                                                                                                                                                                                                                                                                                                                                                                                                                              Estimates suggest that 20% of private hc expenditures in CA are administrative costs (Kahn 2005).
                                                                                                                                                                                                                                                                                                                                                                                                                              MN Dept of Health expects to save approximately $20m annually just on eligibility checking under its latest health care reform initiative (MN HRI).
                                                                                                                                                                                                                                                                                                                                                                                                                              0 0 6
                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentSet state goals for per capita annual expenditures and annual increases
                                                                                                                                                                                                                                                                                                                                                                                                                              Based on premise that setting goals and monitoring progress will keep focus on reducing costs
                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                Clinton 1993 proposal suggested a target of reducing MPI to CPI over 5 years
                                                                                                                                                                                                                                                                                                                                                                                                                                Vermont proposed legislation
                                                                                                                                                                                                                                                                                                                                                                                                                                Healthy Wisconsin proposal aims for cost increases tied to national Medical Price Inflation
                                                                                                                                                                                                                                                                                                                                                                                                                                health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                                  0 0 6
                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentLimit state tax exemption for premiums for high-premium plans
                                                                                                                                                                                                                                                                                                                                                                                                                                Provide incentives to enroll in less expensive plans
                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                    Current efforts have focused on extending the exemption to the self-employed, without limits.
                                                                                                                                                                                                                                                                                                                                                                                                                                  enrollment in high cost plans
                                                                                                                                                                                                                                                                                                                                                                                                                                  Commonwealth Fund identified potential net savings for a limit on the federal exemption, based on Lewin modeling CW Fund-Schoen 2007
                                                                                                                                                                                                                                                                                                                                                                                                                                  Tax exemption shown to be costly and provides greater value for higher income employees, Antos 2006, Sheils 2004
                                                                                                                                                                                                                                                                                                                                                                                                                                  3 5
                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentProvide opportunity to purchase lower benefit/ catastrophic coverage by removing mandated benefits
                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                    Number of mandated benefits in other states ranges from 15 in Idaho to 63 in Maryland (see CAHI for more details).
                                                                                                                                                                                                                                                                                                                                                                                                                                    Wisconsin currently has 34 mandated benefits including coverage for childhood immunizations, diabetic equipment and supplies, lead screening, kidney disease treatment, mammography, newborn infant care, HIV treatment drugs, nervous and mental disorders, AODA, breast reconstruction post-mastectomy, home health care, skilled nursing care, hospital and ambulatory surgery care for some dental treatment, TMJ treatment, services for adopted and handicapped children, and certain services provided by chiropractors, nurse practitioners, and optometrists.
                                                                                                                                                                                                                                                                                                                                                                                                                                    premiums for plans that chose to eliminate coverage
                                                                                                                                                                                                                                                                                                                                                                                                                                    proportion of population with at least some coverage in low cost plans
                                                                                                                                                                                                                                                                                                                                                                                                                                    OCI 2002 report showed that top 2 mandated benefits cost approximately 7 percent of premiums but other evidence suggests that mandated benefits do not not add significantly to costs, since most of the services would have to be paid for in the system somehow, if not by insurance coverage then by uncompensated or delayed care.
                                                                                                                                                                                                                                                                                                                                                                                                                                    1 5
                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentPrograms to reduce health care fraud
                                                                                                                                                                                                                                                                                                                                                                                                                                    Programs to reduce inflated claims, fictitious claims, or claims for non-covered services
                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                      Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                      Healthcare purchasers
                                                                                                                                                                                                                                                                                                                                                                                                                                      Health insurers
                                                                                                                                                                                                                                                                                                                                                                                                                                      Federal government won or negotiated approx. $2.2 billion in fraud cases.
                                                                                                                                                                                                                                                                                                                                                                                                                                      All but 3 states have Medicaid Fraud Control units.
                                                                                                                                                                                                                                                                                                                                                                                                                                      Wisconsin Senior Medicare Patrol Project (SMP) educates seniors about Medicare and other health care fraud, waste, and abuse.
                                                                                                                                                                                                                                                                                                                                                                                                                                      WI Department of Justice has a Medicaid Fraud Control unit.
                                                                                                                                                                                                                                                                                                                                                                                                                                      health care costs
                                                                                                                                                                                                                                                                                                                                                                                                                                      The National Health Care Anti-Fraud Association (NHCAA) estimates that 3% of all health care spending—or $68 billion—is lost to health care fraud.
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                                                                                                                                                                                                                                                                                                                                                                                                                                      Social and Physical Environment
                                                                                                                                                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                      Healthy Child Development and Education: Alternatives for a comprehensive, state-wide system for high quality early child care and education
                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentComprehensive, state-wide system similar to Smart Start (North Carolina)
                                                                                                                                                                                                                                                                                                                                                                                                                                      Broad goals but implementation is local so services vary.
                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                        School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                        North Carolina; 14 other states have used program as a model.
                                                                                                                                                                                                                                                                                                                                                                                                                                        Not present in Wisconsin
                                                                                                                                                                                                                                                                                                                                                                                                                                        affordability of services
                                                                                                                                                                                                                                                                                                                                                                                                                                        quality of services
                                                                                                                                                                                                                                                                                                                                                                                                                                        in fragmentation and duplication of services
                                                                                                                                                                                                                                                                                                                                                                                                                                        Clearer access points for parents
                                                                                                                                                                                                                                                                                                                                                                                                                                        access to child care
                                                                                                                                                                                                                                                                                                                                                                                                                                        school readiness
                                                                                                                                                                                                                                                                                                                                                                                                                                        child care quality
                                                                                                                                                                                                                                                                                                                                                                                                                                        access to health services
                                                                                                                                                                                                                                                                                                                                                                                                                                        Multiple studies with positive outcomes Bryant 2008
                                                                                                                                                                                                                                                                                                                                                                                                                                        3 3
                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentComprehensive, center-based early childhood development programs (Head Start)
                                                                                                                                                                                                                                                                                                                                                                                                                                        Preschool and parenting support/ programs aimed at low income families (implementation varies)
                                                                                                                                                                                                                                                                                                                                                                                                                                          Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                          School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                          National (implementation varies)
                                                                                                                                                                                                                                                                                                                                                                                                                                          Have Head Start but not a universal program
                                                                                                                                                                                                                                                                                                                                                                                                                                          teen pregnancy
                                                                                                                                                                                                                                                                                                                                                                                                                                          delinquency
                                                                                                                                                                                                                                                                                                                                                                                                                                          high school grad rates
                                                                                                                                                                                                                                                                                                                                                                                                                                          crime
                                                                                                                                                                                                                                                                                                                                                                                                                                          employment
                                                                                                                                                                                                                                                                                                                                                                                                                                          Improved parenting
                                                                                                                                                                                                                                                                                                                                                                                                                                          Sufficient according to the Community Guide (CG-Social); strong evidence base RAND-Karoly 2005
                                                                                                                                                                                                                                                                                                                                                                                                                                          4 3
                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentEarly Head Start
                                                                                                                                                                                                                                                                                                                                                                                                                                          Focus on prenatal outcomes, infants and toddlers; home visits, child care, parenting education, health and family services
                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                            School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                            National
                                                                                                                                                                                                                                                                                                                                                                                                                                            Have Early Head Start but not a universal program
                                                                                                                                                                                                                                                                                                                                                                                                                                            healthy prenatal outcomes
                                                                                                                                                                                                                                                                                                                                                                                                                                            achievement test scores
                                                                                                                                                                                                                                                                                                                                                                                                                                            positive behaviors
                                                                                                                                                                                                                                                                                                                                                                                                                                            child health rating
                                                                                                                                                                                                                                                                                                                                                                                                                                            family functioning
                                                                                                                                                                                                                                                                                                                                                                                                                                            RAND-Karoly 2005 – promising evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                            2 3
                                                                                                                                                                                                                                                                                                                                                                                                                                            Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                            Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                            Healthy Child Development and Education: Healthy child development policies
                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentIncrease funding for child care subsidy (Wisconsin Shares Program)
                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                              Less than 1/3 of states have eligibility limits above 200% FPL
                                                                                                                                                                                                                                                                                                                                                                                                                                              Working WI families are eligible if at or below 185% of poverty level
                                                                                                                                                                                                                                                                                                                                                                                                                                              low-income parents’ employment outcomes
                                                                                                                                                                                                                                                                                                                                                                                                                                              quality of subsidized child care
                                                                                                                                                                                                                                                                                                                                                                                                                                              children’s school readiness and well-being
                                                                                                                                                                                                                                                                                                                                                                                                                                              Child care subsidies shown to be effective in increasing welfare-to-work Kimmel 1995; No overall review.
                                                                                                                                                                                                                                                                                                                                                                                                                                              2 3
                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentRefundable state dependent care tax credit
                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                Tax credit is offered in 13 states
                                                                                                                                                                                                                                                                                                                                                                                                                                                Deduction (not a credit) to be phased in starting in 2009
                                                                                                                                                                                                                                                                                                                                                                                                                                                ability to afford quality child care
                                                                                                                                                                                                                                                                                                                                                                                                                                                Recommended by NWLC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                2 0 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentStatewide child care quality rating system
                                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                  13 states have established quality rating systems, e.g, NC, RI, OH. In some states, child care subsidies are tiered to quality ratings
                                                                                                                                                                                                                                                                                                                                                                                                                                                  None.
                                                                                                                                                                                                                                                                                                                                                                                                                                                  early learning
                                                                                                                                                                                                                                                                                                                                                                                                                                                  informed consumer choices
                                                                                                                                                                                                                                                                                                                                                                                                                                                  incentives for quality through state subsidy program
                                                                                                                                                                                                                                                                                                                                                                                                                                                  WCCF recommends. Most evaluations focus on validity of rating system not on impact on overall quality.
                                                                                                                                                                                                                                                                                                                                                                                                                                                  2 0 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentUniversal Pre-Kindergarten (Oklahoma Pre-K)
                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                    School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                    OK is leader with near-universal enrollment; 39 states fund some pre-K
                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are some pre-K programs in WI & a startup grant program in current budget
                                                                                                                                                                                                                                                                                                                                                                                                                                                    achievement test scores
                                                                                                                                                                                                                                                                                                                                                                                                                                                    school readiness
                                                                                                                                                                                                                                                                                                                                                                                                                                                    RAND-Karoly 2005 – strong evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                    WCCF recommends
                                                                                                                                                                                                                                                                                                                                                                                                                                                    3 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                    Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                    Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                    Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Child Development and Education: Home visiting or parent education programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentDARE to Be You
                                                                                                                                                                                                                                                                                                                                                                                                                                                    Parent/ child workshops designed to improve parenting skills and introduce activities for improved child development
                                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                      School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                      Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                      Western states
                                                                                                                                                                                                                                                                                                                                                                                                                                                        developmental level
                                                                                                                                                                                                                                                                                                                                                                                                                                                      behavior problems
                                                                                                                                                                                                                                                                                                                                                                                                                                                      RAND-Karoly 2005 – promising evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                      Level 1 rating – Community Guide to Helping America’s Youth
                                                                                                                                                                                                                                                                                                                                                                                                                                                      4 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentDevelopmentally Supportive Care (and NIDCAP)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      Family training in NICU and home visits aimed at avoiding developmental delays and impairment for low birth weight infants
                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                        School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                        Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                        National
                                                                                                                                                                                                                                                                                                                                                                                                                                                          mental indices
                                                                                                                                                                                                                                                                                                                                                                                                                                                        developmental delay
                                                                                                                                                                                                                                                                                                                                                                                                                                                        reflexes
                                                                                                                                                                                                                                                                                                                                                                                                                                                        weight gain
                                                                                                                                                                                                                                                                                                                                                                                                                                                        hospital stays
                                                                                                                                                                                                                                                                                                                                                                                                                                                        RAND-Karoly 2005 – promising evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                        2 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentHIPPY (Home Instruction Program for Preschool Youngsters)
                                                                                                                                                                                                                                                                                                                                                                                                                                                        Parenting classes/ training and home visits aimed to help parents with limited education/ income prepare children for school
                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                          School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                          Multiple
                                                                                                                                                                                                                                                                                                                                                                                                                                                            achievement test scores
                                                                                                                                                                                                                                                                                                                                                                                                                                                          RAND-Karoly 2005 – strong evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                          3 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentIncredible Years
                                                                                                                                                                                                                                                                                                                                                                                                                                                          Parenting classes and children’s programs (care center or school) designed to address behavior and emotional problems
                                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                            School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                            Multiple
                                                                                                                                                                                                                                                                                                                                                                                                                                                              behavior problems
                                                                                                                                                                                                                                                                                                                                                                                                                                                            social competence
                                                                                                                                                                                                                                                                                                                                                                                                                                                            RAND-Karoly 2005 – strong evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                            3 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentNurse home-visiting program (Nurse-Family Partnership)
                                                                                                                                                                                                                                                                                                                                                                                                                                                            Nurse home visits and referral services for mothers until child is age 2; aims to improve prenatal, birth, and early childhood outcomes
                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Healthcare
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Multiple states
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Family Foundations provides home visits for first-time parents in some areas of WI. Some local health departments also conduct newborn home visits.
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Delay in second births
                                                                                                                                                                                                                                                                                                                                                                                                                                                              abuse, injury risks
                                                                                                                                                                                                                                                                                                                                                                                                                                                              child’s cognitive, socio-emotional outcomes
                                                                                                                                                                                                                                                                                                                                                                                                                                                              maternal employment
                                                                                                                                                                                                                                                                                                                                                                                                                                                              ER visits
                                                                                                                                                                                                                                                                                                                                                                                                                                                              juvenile delinquency
                                                                                                                                                                                                                                                                                                                                                                                                                                                              RAND-Karoly 2005 – strong evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                              What Works WI
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Level 1 rating – Community Guide to Helping America’s Youth
                                                                                                                                                                                                                                                                                                                                                                                                                                                              5 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentParents as Teachers
                                                                                                                                                                                                                                                                                                                                                                                                                                                              Home visits, parent education, health screenings, and family support designed to prepare children for school, empower parents, and prevent/ reduce child abuse
                                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                National
                                                                                                                                                                                                                                                                                                                                                                                                                                                                Operates in some WI counties, e.g., Eau Claire, Fond du Lac, Lincoln, Ozaukee, Sheboygan
                                                                                                                                                                                                                                                                                                                                                                                                                                                                achievement test scores
                                                                                                                                                                                                                                                                                                                                                                                                                                                                positive behaviors
                                                                                                                                                                                                                                                                                                                                                                                                                                                                child maltreatment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                child health rating
                                                                                                                                                                                                                                                                                                                                                                                                                                                                child injuries
                                                                                                                                                                                                                                                                                                                                                                                                                                                                RAND-Karoly 2005 – promising evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                                Level 3 rating – Community Guide to Helping America’s Youth
                                                                                                                                                                                                                                                                                                                                                                                                                                                                2 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentReach Out and Read
                                                                                                                                                                                                                                                                                                                                                                                                                                                                Parents are given books at well child visits and advice on reading with their children
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Healthcare providers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      vocabulary
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  RAND-Karoly 2005 – promising evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  2 0 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Healthy Child Development and Education: Other broad focused early care and education programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentBirth to 3 Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Wisconsin’s early intervention program for infants/ toddlers with development delays and disabilities & their families: family & developmental education services, communication and health services, and occupational/ physical therapy.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    The Program for Infants and Toddlers with Disabilities (IDEA part C) outlines minimum requirements for states
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Program is available in every WI county
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    declines in children’s intellectual development
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    support for families
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    In general, early intervention found to reduce decline in intellectual development Guralnick 2005 and improve motor abilities Blauw-Hospers 2005). No findings specific to WI program.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    2 1
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentChild-Parent Centers (Chicago)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Promotes healthy development and school preparedness with part day preschool, continued programs through early elementary school, and family, education, and health services
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Chicago
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        achievement test scores
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      social competence
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      special education
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      grade retention
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      child abuse
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      delinquency
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      high school graduation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      highest grade completed
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      arrests
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      RAND-Karoly 2005 – strong evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Evidence of positive outcomes for day care Cochrane-Zaritch 2000
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Level 2 rating – Community Guide to Helping America’s Youth
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      4 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentHigh/ Scope Perry Preschool approach
                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Home visits and preschool aimed at improving children’s intellectual and social development; still exists as curriculum and teacher training with plan-do-review approach to learning
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            IQ
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        achievement test scores
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        special education
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        teen pregnancy
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        high school graduation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        employment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        earnings
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        income
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        use of social services
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        arrests
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        prison/ jail time
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        RAND-Karoly 2005 – strong evidence base
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Evidence of positive outcomes for day care Cochrane-Zaritch 2000
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Level 1 rating – Community Guide to Helping America’s Youth
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        5 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentFamilies and Schools Together (FAST)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Intensive group-based family intervention with follow up programs; intended to improve school outcomes and prevent delinquency and substance abuse
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Has been implemented in 45 states and 5 countries.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Program was started in Madison, WI. Operates in various locations around the state.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          school performance
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          behavior
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          increased parent involvement in school
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          juvenile delinquency
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          substance abuse
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          OJJDP and SAMHSA recommend
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Level 1 rating – Community Guide to Helping America’s Youth
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          3 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Healthy Child Development and Education: Improve quality of K-12 education
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentComprehensive school reform to improve student achievement
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Direct Instruction
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • School Development Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Success for All
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          The 2006 federal budget eliminated funding for the Comprehensive School Reform project
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Over 100 WI schools participated in the Wisconsin Comprehensive School Reform Demonstration project and have used many research-based programs including Direct Instruction and Success for All. The final funding for the program was awarded in the fall of 2006 from the state for schools in progress to complete the program after end of federal funding
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Improve academic success
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          These three models were noted as having the strongest evidence of effectiveness BEE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          4 0 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentPolicies and practices to improve teacher quality
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Recruiting talented and diverse teachers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Improving teacher preparation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Raising licensing and certification standards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Providing professional support to beginning teachers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Improving professional development practices
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Improving teacher accountability
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          The U.S. department of education offers grants to states and administers other programs aimed at improving teacher quality.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          The Wisconsin Quality Educator Initiative was adopted in 2000
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Improve teacher quality
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          US DoEduc 1998
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          2 0 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentReduced class size
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            A number of states have attempted initiatives to reduce class sizes to 20 or fewer students per teacher through mandate, voluntary, and grant programs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Wisconsin’s SAGE (Student Achievement Guarantee in Education) program requires participating schools to promote academic achievement through four strategies, one of which is class sizes of no more than 15:1 in grades K-3. Title II, Part A used 51% of funds in reducing class size.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Improve student achievement
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Evidence supports reductions in all grades from K-3 for higher sustained achievement Grissmer 1999
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentHealth education programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Programs that a are sequenced across grad; meet National Health Education Standards (NHES); and extend to colleges and universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              The NHES include standards related to understanding health concepts, accessing info, and ability to advocate for personal, family, & community health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Wisconsin does not have mandated standards but has Model Academic Standards for Health Education as well as a guide to Curriculum Planning in Health Education.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Improve health literacy
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Opportunity to increase health literacy from IOM-Literacy 2004 report
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              2 0 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentEmbed health literacy instruction in existing education programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                              For all levels and ages (science, math, literacy, adult education, etc)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Program details not available.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Improve health literacy
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Opportunity to increase health literacy from IOM-Literacy 2004 report
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                2 0 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentTeaching of stress management skills as part of health education curriculum
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Stress and coping skills are not currently included as part of the National Health Education Standards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Stress management skills are imbedded some health education standards.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve stress coping skills
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  stress
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    0 0 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Healthy Child Development and Education: Increase high school graduation rates
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentBroad youth development programs that aim to improve graduation rates through a collaboration of school, home, & community approaches
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  • Carrera Adolescent Pregnancy Prevention Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  • Achievement for Latinos through Academic Success (ALAS)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Healthcare
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Originally implemented in New York, the Carrera program has been replicated in 7 states and DC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  ALAS was originally implemented in Los Angeles.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Some programs may exist.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  dropout rates
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve recovery rate (students who left school but then returned)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve credits to be on track to graduate
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve high school graduation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve college enrollment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Social Progs that Work; Fashola 1998 review
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  4 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentMentorship-model programs to improve graduation rates
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  • Check and Connect – an assigned monitor serves as mentor to student
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  • Valued Youth Program (VYP) – student gains experience and skills as mentor to younger students
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Check and Connect was first developed and implemented in Minnesota.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  The VYP was developed and piloted in San Antonio but has been widely replicated across the country.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  The location of some Madison Work and Learn alternative school programs at sites with elementary students has provided the opportunity for the older students to serve in a mentorship role to the younger students. Other similar programs may also exist throughout the state.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  dropout rates
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve reading level
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve self esteem
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve attitude towards school
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve attendance
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improve academic credits earned
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Social Progs that Work; Fashola 1998 review
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  4 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentAlternative schools/ programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  These provide alternatives to traditional school models and are aimed at better meeting needs of students who may be struggling in traditional school model
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    In the 2000-2001 school year, 39% of public school districts had at least one alternative school or program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Also, several community-based organization partnerships serve as alternative education programs, e.g.,
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Operation Fresh Start in Madison,
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Wisconsin Fresh Start, Milwaukee Public Schools’ Partnership schools.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    A variety of alternative education programs exist in many school districts across WI. WI Alternative Education Program legislation (1999) provides funds for grants to school districts and consortia of school districts to develop new or expand existing programs or schools. More than 82 school districts also offer WI’s GED Option #2 (GEDO #2) Program. This allows authorized school districts to use GED test battery to measure proficiency in lieu of high school credit for students enrolled in an alternative education program. Students who pass GED tests & complete other requirements for graduation are entitled to earn traditional high school diploma. Programs must achieve 80% success rate to continue.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    barriers to learning
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Improve high school graduation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Improve employment and wages
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Mixed evidence
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lange 2002, no significant evidence Dynarski
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    1 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentPrograms to help students and dropouts obtain General Education Development (GED) certificates
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sometimes combined with counseling & social services
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Colleges & tech schools
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      GED programs have been offered in New York, St. Louis, Tulsa, and elsewhere across the US.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Wisconsin has a GED program and a higher level credential (High School Equivalency Diploma).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Improve GED certificate completion as an alternative to complete dropout
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Improve post-secondary education
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Improve earnings
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      GED programs effective at increasing GED certificate completion Dynarski.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      GED completion associated with higher earnings but not necessarily more post-secondary education Tyler 2005
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      3 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Healthy Child Development and Education: Increase education beyond high school
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentAdult literacy education programs that address alphabetics, fluency, vocabulary, and comprehension
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Colleges & tech schools
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Program details not available.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Improve adult literacy
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        National Institute for Literacy: The Partnership for Reading
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        2 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentTargeted programs to improve college enrollment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        for low income students, low-achieving but high-potential students, first-generation college entrants, and students at risk of dropping out of school or not enrolling in college
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Upward Bound (TRIO)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        • SCORE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Project Advancement Via Individual Determination (AVID)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Talent Search
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Upward Bound is one of the federally funded and locally operated TRIO programs implemented across the US.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        SCORE was started in California.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        AVID has been implemented in California & Texas.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        A number of WI colleges and universities have Upward Bound and other TRIO programs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Improve rates of entering post-secondary education;
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Improve college eligibility and academic credits earned
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Improve enrollment in college prep classes
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Improve likelihood of meeting college requirements; Improve rates of college enrollment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Fashola 1998
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        4 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentCollege savings plans (529)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        These programs allow parents and grandparents to invest dollars tax-free to save for future college expenses.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Every state has at least one 529 college savings program, with maximum state tax deductions varying widely.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Wisconsin’s programs:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          EdVest
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          tomorrow’s scholar
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          A Wisconsin state college savings program began in 1996 and serves over 225,000 future students; up to $3000 per beneficiary per year can be deducted from WI state taxable income.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Improve financial resources available for attending college
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          These plans can be helpful for setting aside college funds, but the financial benefits are greater at higher incomes Dynarski 2004
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          1 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentCollege tuition support programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          These programs provide some level of college tuition or financial aid support to students who complete high school, sometimes also requiring a specific GPA level or other criteria. Programs may also include support services to assist students in completi
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Graduation Really Achieves Dreams (GRAD)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Kalamazoo Promise
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          • Wisconsin Covenant
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Started in 2005, the Kalamazoo Promise offers full scholarships to any public college in Michigan for Kalamazoo graduates who have completed all of their schooling in the city’s public school system.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Georgia (Project Hope-merit based) and Indiana (21st Century Scholars –targets low income studetns) subsidize college tuition.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Other programs, such as GRAD, offer smaller set amounts for tuition.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          WI Covenant was started in 2006 and promises admission to an institution of higher education in the state and an affordable financial aid package to students who sign the Covenant contract, maintain a B average, take classes to prepare for college, apply for financial aid in a timely manner, graduate, and participate in their communities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Improve rates of college attendance
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          GRAD has been cited as an effective program for increasing rates of college attendance, Fashola 1998
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          The Kalamazoo Promise and Wisconsin Covenant are relatively new, promising programs that have not yet been evaluated.
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentCareer Academies
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Small learning communities within large high schools in low-income, urban areas that usually focus on a specific field and provide preparatory, technical, & occupational courses to connect coursework to job opportunities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            41 states have at least 1 official Career Academy site; California has over 500 sites
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            There are 5 official Career Academy sites in WI (Green Bay and Milwaukee); similar programs may also exist in the state
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Improve earnings
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Social Progs that Work
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2 1
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentCollege student retention programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            • Freshman seminar
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            • Organizational practices designed to create an institutional culture conducive to student retention
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            • Early alert, assessment, and monitoring systems to identify students at risk of dropping out for early intervention
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            A recent survey of public and private colleges found that only 59% offered a freshman seminar (51% for credit and 8% non-credit).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            A number of UW system school offer freshman seminars to incoming students.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Improve college retention and graduation rates
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            ACT 2004
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentComprehensive state career pathway and bridge program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Arkansas Career Pathways Initiative and Washington State’s I-BEST program are two examples
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              There are some individual programs in Wisconsin, such as the WI Regional Training Partnership, the Regional Industry Skills Education (RISE) Initiative, and W-2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Improve job skills, often for industries with skilled worker shortages
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Improve earnings potential
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Recommended by WCCF
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              2 5
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Environmental Quality: Agricultural programs to reduce environmental contamination
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentGroundwater Stewardship Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Provides information and tools for pesticide and nitrogen fertilizer users to help identify risks to groundwater and to coordinate resources to limit water contamination
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                MI, related programs in WI, IL, MN
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Agricultural Chemical Cleanup Program provides partial reimbursement for agricultural lands that require cleanup of pesticide and fertilizer spills before reaching groundwater.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                annual pesticide, nitrogen, phosphorus and other fertilizer loading in groundwater. Limits the risk of toxic algae blooms in surface water, ‘blue baby syndrome,’ as well as potential birth defects and some cancers.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Strong evidence. Peer reviewed literature supports practices used in groundwater management, including landspreading, riparian buffers, filter strips, nutrient best management and IPM. Koul 2004, American Farmland Trust., WI DoATCP, Laboski 2006, NCSU Extension 2006
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                4 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentConservation Reserve Enhancement Program (CREP)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Part of the Conservation Reserve Program (CRP), federally supported program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Implemented in 30 other states, but level of implementation varies
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Land owners in identified “sensitive areas” agree to use conservation procedures, incl. riparian buffers, filter strips, wetlands restoration, & grassland restoration on agricultural land for a minimum of 15 years. They receive fed and state reimbursement for conservation projects, plus state incentive payments. Eligible areas are in the south, western border, and peninsula of WI.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  annual nitrogen and phosphorus contamination of watersheds near agricultural land limits the risk of toxic algae blooms in surface water, ‘blue baby syndrome,’ as well as potential birth defects and some cancers.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Strong evidence for CRP. National Research Council finds that effectiveness of CREP has not been assessed. Independent evaluations of CRP by National Resources Inventory, FAPRI, & USGS demonstrate decrease in nitrogen and phosphorus contamination. OMB-CRPA, Allen 2005
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  4 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentPesticide Environmental Stewardship Program (Integrated Pest Management)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Federal grants distributed through EPA
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    States with projects funded with EPA grants in 2007 including UT, OR, CO, MO, OK, MI, NC, PA, NJ, CT
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    WI has participating organizations and businesses in a PESP that voluntarily incorporate or assist with IPM. WI also has School Integrated Pest Management Program that provides tools and technical resources to K-12 schools to reduce pesticide use.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    pesticide exposure (direct & via air or water contamination). Pesticide exposure can contribute to nervous system & endocrine disorders, cancer, eye and skin irritation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Strong evidence. Proper IPM implementation can drastically reduce use of pesticides dangerous to non-targeted species. Koul 2004
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    3 5
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentNutrient Best Management and Conservation Tillage
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Conservation tillage keeps at least 1/3 of cultivable soil covered with previous year’s crop residue. This protects soil from erosion and infiltration of pesticide and fertilizer into water sources. Nutrient management includes practices that increase the effectiveness of fertilizers so that less needs to be applied.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Colleges & universities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      The American Farmland Trust (AFT) is a national organization that helps farmers improve conservation efforts. The organization produces a package of best practices for purchase, so details are limited.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      T-by-2000 Program to reduce soil erosion (program unclear)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Nutrient Management Performance Standards implemented in 2003, which requires all farmers applying nutrients to develop a management plan
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      soil erosion/ sedimentation in water
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      leaching of nitrogen and other fertilizers into ground and surface waters
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      fertilizer runoff limits the risk of toxic algae blooms in surface water, ‘blue baby syndrome,’ as well as potential birth defects and some cancers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      contaminated sedimentation also reduces these risks.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Some evidence. American Farmland Trust (AFT) program reduces nutrient use an average of 24%, conservation tillage program reduced erosion by 78%. Koul 2004, American Farmland Trust., WI DoATCP, Laboski 2006, NCSU Extension 2006
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      2 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Environmental Quality: Reduce transportation emissions
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentCongestion Mitigation & Air Quality Program (CMAQ)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Federally supported program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        All states have at least 1 program funded by CMAQ. Funds are only available for zones with non-attainment or maintenance for criteria pollutants.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        As of 2006, ~2.3 million WI residents live within a project area. In 2007, none of the CMAQ projects involved improved pedestrian/ bicycle infrastructure. Only Southern WI and the Door County Peninsula are eligible for project funding under CMAQ.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        automobile traffic & in criteria emissions limits risk of some cancers and cardiopulmonary conditions. Also promotes physical activity through healthier transportation behaviors.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Mixed evidence. GAO report recommends better control of non-point source pollution. Fuel alternatives reduced emissions per VMT, but Increase in overall VMT offsets benefits. Design & transportation alternatives that reduce VMT improves emissions. GAO 2002
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        1 0 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentLocal Transportation Enhancement Grants/ Bicycle and Pedestrian Facilities Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Federally supported, the programs were designed to create or improve multi-modal transportation options, especially bike and pedestrian transportation
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          All states are eligible for Local Transportation Enhancement Grants from the federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          WI channels both state-based and federal LTE funds to communities for local improvements. {GAO 2002}
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          automobile traffic and criteria emissions limits risk of some cancers and cardiopulmonary conditions. Also promotes physical activity through healthier transportation behaviors.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Mixed evidence GAO 2002
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentSafe Routes to Schools
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Promotes walking and biking to school through education and incentives. Also targets city planning and legislation to make walking and biking safer. A federally supported program.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            All states have SRTS coordinators as part of their state DOT. Level of SRTS implementation by state varies.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            In 2007, 47 WI communities received SRTS support from the state, only half planned for immediate changes to school environment.{SRSNP 2007}
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            traffic and emissions near schools, improved student health through reduced exposure to emissions and physical activity through healthier transportation behaviors.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Mostly anecdotal evidence. Evidence supports increased number of children walking and biking to school. Little evidence regarding decreased emissions near schools. SRSNP 2007
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            2 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentAlternative Fuels Initiatives (State and City Fleets)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Transition of state and city vehicle fleets to biofuels
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              ~20 states have enacted some form of Alternative Fuel Use mandate, including MN, WA, OR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              S. 16.045 (5) Wis. Stats. requires use of 10% ethanol-90% petroleum blends where feasible in state fleet; UW-Madison began using 20% biodiesel-80% diesel blends in 2005 for its diesel fleet. Decrease petrol fuel by 20% in 2010, 50% by 2015, promote use of flex fuel vehicles in state fleet
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              emissions of CO, ozone, total hydrocarbons, VOCs, PAH and nitro-PAH compounds, and fine particulate matter, which can contribute to some cancers and aggravate cardiopulmonary conditions. Biofuel use can also lessen environmental risks of fuel spills and non-point source water pollution.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Mixed evidence. Change in emissions with biodiesel blends < B20 is negligible. Benefits depend on extent of transition to biofuel, source of feedstocks, & cultivation practices on fuel crops. Wang 1998, Humburg 2006, Hill 2006, Haller 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentClean Cities Coalitions
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Transportation sector and private vehicles are targeted. Goals are to replace petrol fuels with biofuels, increase energy efficiency & mass transit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                90 coalitions across the U.S. 17 states have coalitions that cover the entire state.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                WI SE-Area is the only site covered by a coalition. Current projects: (1) Clean Airport Partnership Program at General Mitchell Airport & (2) Expanding E85 refueling infrastructure in central and SE WI.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                emissions of CO, ozone, total hydrocarbons, VOCs, PAH and nitro-PAH compounds, and fine particulate matter, which can contribute to some cancers and aggravate cardiopulmonary conditions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Mixed evidence. Transition to biofuels can reduce criteria emissions depending on implementation strategy, shift to alternative transportation (mass transit, bike & pedestrian) also contribute to reduced emissions. Wang 1998, Hill 2006, Haller 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentCarpooling and rideshare programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Commuters share transportation to work, reducing number of vehicles on the road and total vehicle miles traveled
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Regional rideshare and carpooling programs are common in most states. Ex: Bay area (CA) 511 rideshare, NH statewide carpooling policy.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  SE WI RIDESHARE program is a database of rideshare/ carpool opportunities; Vanpool program for Madison area commuters
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  traffic and emissions
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  There is some evidence that a shift to alternative transportation (mass transit, bike & pedestrian) also contribute to reduced emissions. GAO 2002, CCAP
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentBus pass incentive programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Bus passes offered free or discounted to employees, students, elderly and disabled.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Several municipalities offer bus pass programs for employers, students (primary and secondary), and state or city employees.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Madison Metro has a service agreement with the UW to provide bus passes to students, faculty, and staff. Others may purchase a monthly transit pass and some companies purchase passes for employees. Milwaukee County Transit offers discount Commuter Value Passes for employers with more than 20 employees.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    emissions of CO, ozone, total hydrocarbons, VOCs, PAH and nitro-PAH compounds, and fine particulate matter, which can contribute to some cancers and aggravate cardiopulmonary conditions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    There is some evidence that a shift to alternative transportation (mass transit, bike & pedestrian) also contribute to reduced emissions. GAO 2002, CCAP
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentSmart Commute Initiative
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Federal, Fannie Mae program. Participating lenders add a portion of transportation savings to borrowers’ qualifying income, which increases home-buying power; requires down-payment of only 3% of purchase price.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      WA, NJ, Cleveland, OH, Clay County, MN, Baltimore, MD, Lincoln, NE, Nashville, TN
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Madison and Milwaukee both participate in this program.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      emissions of CO, ozone, total hydrocarbons, VOCs, PAH and nitro-PAH compounds, and fine particulate matter, which can contribute to some cancers and aggravate cardiopulmonary conditions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      There is some evidence that a shift to alternative transportation (mass transit, bike & pedestrian) also contribute to reduced emissions. GAO 2002, CCAP
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentVehicle Inspection and Maintenance (I/M) Programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Federally mandated programs under the Clean Air Act that require emission testing of vehicles in 8-hour ozone nonattainment regions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        All states with regions that exhibit excessive ozone and VOCs levels must have this program implemented within those areas; MA is the only state that requires emissions testing throughout the state
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Currently 7 SE Wisconsin counties require testing every two years, with license plate registration renewal. If the car fails any part of the test, the owner must repair the car in order to bring emissions within
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        approved limits, or cannot renew the car's registration. Emission standards are set by the DNR.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Reduction of carbon monoxide &VOCs (hydrocarbons) emissions; lower ambient ozone levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Research overall supports the value of I/M programs, but finds that costs of inspection are higher than anticipated. Some researchers recommend a centralized inspection policy in which vehicles are examined in high-volume inspection centers versus private garages. Harrington 2000
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentRetrofitting buses to reduce emissions
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Installing diesel oxidation catalysts, a combination of a muffler and catalytic converter-type device that reduces emissions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Federally supported “Clean School Bus” program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Bus companies
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Eighteen bus companies and school districts are currently participating in the WI Diesel School Bus Retrofit Project, supported by the DNR and federal funds
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        hydrocarbons, CO, and PM in diesel exhaust by 20-50%.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        A review of 11 studies indicates that emission-reducing techniques can eliminate most self-pollution in school bus cabins Borak 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Environmental Quality: Renewable or reduced energy use
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentGreen pricing utility programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Utility companies offer their customers the option of purchasing some or all of their power from renewable energy sources at a higher rate
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          More than 700 of the nations 3000 utilities offer these programs in more than 75% of states
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Eight Wisconsin companies offer their customers green pricing options
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          the use of renewable energy
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          There is some evidence regarding the characteristics of successful green pricing programs. The largest program sells a yearly average of over 500 million kWh of renewable energy NREL 2004
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentCredit or rebates for using solar energy
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Customers are provided with tax credit or rebates from utility for installing solar energy systems in their homes or businesses.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Home owners
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Examples include rebate programs in NC, ME, CA, FL, Austin, TX
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            MGE offers provides credit to residential and company energy consumers that operate solar voltaic systems.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            the use of renewable energy
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Some evidence suggests that solar power systems are often too expensive for the average consumer, so the cost rebate is an ineffective incentive. NREL 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentEnergy Star Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            This federal program promotes energy efficiency in commercial, public, and residential settings.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Available to some degree in all 50 states; coordinated with 12,000 organizations in 2007 to promote reduction in energy use among individuals and businesses
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Wisconsin offers Focus on Energy program, which promotes the purchase and use of Energy Star certified products and services. It also offers a limited number of free energy efficiency upgrades for homes if owners are at or below a set income.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              energy use and emissions; increased use of renewable energy in some instances
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Evidence suggests that energy efficiency programs can be an important part of a low-cost emissions reduction policy. Gillingham 2004
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Environmental Quality: Comprehensive programs with an environmental component
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentHealthy Sustainable Schools
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                School boards
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Related programs in MN, WI, IL, OR; other states incorporating on a district or school-by-school basis.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                WI Green & Healthy Schools Program requires assessment phase then activities in energy conservation, waste and recycling, and water plus 2 additional areas (mercury, indoor air quality, integrated pest management, chemical management, transportation, facilities & grounds, comm. involvement). Schools eligible for grants, awards, & other recognition. Only 11 schools have completed certification. More than 70 schools are at some stage of implementation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                pollution
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                student health
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                conservation and recycling behaviors
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                performance & attendance, which may result in better health at later life stages.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Weak evidence. Anecdotal evidence, little-to-no peer reviewed literature to support extensive health or educational outcomes. BICE 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentSmart Growth (Comprehensive Planning) Grants
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Provides grants to local municipalities to implement comprehensive planning, that includes 9 elements: issues & opportunities; housing; transportation; utilities & community facilities; economic development; agricultural, natural and cultural resources; economic development; intergovernmental cooperation; implementation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  OR, MD, CA
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  WI Comprehensive Planning Grants: Since the program began in 2000, 964 communities have participated. In 2007, 12 grantees were awarded funds, covering over 350,000 WI residents.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Improvement in environmental quality, economic development, improved community cohesion and services. These shifts can reduce risk of health problems due to air and water pollution. Long term health improvement may result from improved economy & social service provision.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Mixed evidence. EPA Web site lists publications (not peer-reviewed) that identify the water and air quality improvements that result from Smart Growth principles. Benefits vary according to context and degree of implementation. US EPA
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Housing: Housing cost
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentLow Income Home Energy Assistance Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Energy providers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Federal program; all states and territories are eligible to apply for block grants. Grants are awarded based on low-income population and climate.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Wisconsin Home Energy Assistance Program offers financial assistance for heating and electricity bills, In addition to regular heating and electric assistance services include: (1) Emergency fuel assistance; (2) Counseling for energy conservation and budgeting; (3) co payment plans; (4) Emergency furnace repair and replacement. However, under the program, non-eligible residents may be in need of assistance.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Energy assistance to reduce financial burden among low-income households, freeing resources for other expenditures, incl. food and health care. Health outcomes expected to improve especially among vulnerable populations (youth, disabled, elderly).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Several authors critique the administration of LIHEAP programs, but support the importance of energy assistance to low-income households. Poor administration of the federal program limits the (cost) effectiveness of LIHEAP. Frank 2006, Kaiser 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentHousing trust funds
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Publicly funded, trust funds can facilitate affordable housing in multiple ways: create/ maintain low-income housing; homebuyer assistance (down-payment, counseling, interest subsidies); subsidize rental housing; “gap financing”--provide financing when other sources have been secured; support (non-profit) housing developers.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Housing developers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      There are 170 housing trust funds in 34 states to assist low-income residents.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Wisconsin tried passing a statewide Housing Trust Fund in 1986-1989, but it did not pass the legislature. The state instead created the Housing Cost Reduction Initiative (HCRI) to assist low income residents in rental and home-buying. The Local Housing Organization Grant program (LHOG) to provide grants for operating expenses and new program development to local public and nonprofit housing agencies. Both have funds allocated yearly by the legislature. Programs are not stable because funding is not guaranteed. There are local housing trust funds in Madison and Milwaukee.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      access to quality housing, homeownership, and neighborhood choice for lower-income families. Improved housing stability and quality is expected to improve mental health and health conditions related to substandard housing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      The Center for Community Change (CHC) & PolicyLink both endorse the use of housing trust funds for equitable housing development. CHC, the Urban Land Institute, National Council of State Housing Agencies, & American Planning Association have published reviews supporting the effectiveness of trust funds. Brooks 2002, Stegman 1999, Connerly 1993, NCSHA 2008, Policy Link-HTF
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentLand banking
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Land banks acquire property as stand-alone affordable housing sites or combined with larger parcels for development. They typically acquire surplus city-owned land/ buildings, land/ buildings from nonprofits and religious entities, sites owned by private for-proft owners, and other transferred development rights.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Examples in MI, TX, MA, NY
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Greater density of development and housing affordability; Economically and racially integrated communities; increased access to employment, education, and health services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        No studies identified on land banking for affordable housing in U.S., but it is supported by numerous municipal governments. The World Bank used to recommend land banking in the developing world but nows views it as less effective than other redistribution approaches.
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentAffordable Housing Tax Incremental Financing (AHTIF)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        TIF districts are created to generate revenue to eliminate blight and stimulate economic development. The tax “base” is set according the district’s property values prior to improvements. As properties are improved, the increase in their values raises taxes; the tax revenue in excess of the base rate is reinvested into affordable housing options in the district.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          ME (MaineHousing); possible in 49 states and DC; AZ does not allow for TIF districts; UT requires 20% of TIF funds be allocated to affordable housing; MA makes TIF funds available for low-cost housing in urban areas; Austin, TX and Sacramento, CA also have AHTIF
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Tax Increment Financing for affordable housing has been considered in Madison; may also be underway elsewhere in the state. Legislation to offer incentives to local governments to use some borrowing for affordable housing was proposed by the Wisconsin Partnership for Housing Development to legislative sponsors of a TIF bill in 2003, but the sponsors declined to include the provisions in the bill.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          access to quality housing, homeownership, and neighborhood choice. Improved housing stability and quality is expected to improve mental health and health conditions related to substandard housing. Neighborhood choice expected to reduce risky health behavior, violence, and chronic health conditions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Recommended by Center for Housing Policy (Housing Policy), PolicyLink (PolicyLink-AHD), National Council of State Housing Agencies (NCSHA 2008). Limited systematic research of AHTIF impact, but reviews of TIF districts demonstrate their effectiveness in economic development.
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentCommunity Land Trusts
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Private, non-profit organization that purchases land to lease to low- and middle-income residents for housing use. Home owners on CLT land are required to sell the home back to CLT or to another low-income resident at an affordable price.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Examples: Albuquerque, NM; Portland, OR; Burlington, VT; Madison, WI
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            WI has three CLTs: Bayfield Community Land Trust, Community Land Development Association (Waukesha) and Madison Area Community Land Trust. Madison Area CLT provides homeownership opportunities as well as community gardens and a community-supported agriculture farm to provide food.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Improved housing stability and quality for lower-income families. Expected to improve mental health and health conditions related to substandard housing. Community gardens as part of a local food system can improve nutrition among participants.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Rec. by the Inst for Community Economics & PolicyLink (Policy Link-CLT). Experience from the Burlington VT Community Land Trust demonstrates that use of CLTs can maintain housing affordability and neighborhood diversity. Peterson 1996
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Housing: Housing location and mobility
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentMoving to Opportunity
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            This policy experiment randomizes participants to 3 groups: (1) housing vouchers that can only be used in low-poverty neighborhoods, (2) housing vouchers with no restrictions, (3) no housing voucher but eligible for public housing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Demonstration program in Baltimore, Boston, Chicago, Los Angeles and New York City
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Racially, socially, and economically diverse neighborhoods; reduction in risky health behaviors, improvements in mental health/depression, less exposure to violence, improvement in rates of childhood chronic illness (e.g. asthma).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Evidence from housing mobility studies supports health improvements from greater housing/neighborhood choice, though some evidence is mixed Acevedo-Garcia 2004. Success of MTO outside the policy experiment is unclear. Cubbin 2005, Von Hoffman 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentInclusionary or incentive zoning
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Inclusionary zoning requires developers to reserve a proportion of housing units for low-income residents; incentive zoning often provides density “bonuses” to developers for including low-income housing units.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                The only state requiring inclusionary zoning is MA; otherwise on municipality-by-municipality basis
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                The provisions of the Madison, WI inclusionary zoning ordinance related to rental housing were struck down by the 4th Circuit Court of Appeals, because it was considered a form of rent control, which is prohibited by state statute. Incentive zoning is a permissible land use management technique.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Economically/racially integrated communities; increased access to employment, education, health services, and reduced criminal activities. Expected health outcomes include: reduction in risky health behaviors, improvements in mental health/depression, less exposure to violence, improvement in rates of childhood chronic illness (e.g., asthma).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Reviews conducted by municipalities implementing inclusionary zoning indicate that inclusionary can improve neighborhood diversity. Recommended by Nonprofit Housing Assoc. of CA, Business and Prof. People in the Public Interest, MA Housing Partnership, Innovative Housing Inst. Policy Link-IZ, Burchell 2000, Brown 2001, Iglesias 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentSection 8 Housing Choice Voucher Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Eligible low and very low income families are awarded vouchers to help cover the costs of rental housing. Residents pay 30-40% of their income on rent & a local public housing agency contracts with the landlord to pay the remainder.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Section 8 is a federal program active in all 50 states.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Counties in WI without Public Housing Authorities (37 counties) have their Sec. 8 program administered by WHEDA. Housing authorities in the remaining counties and many municipal housing authorities administer the program individually. The state doesn’t subsidize the program with state funds, but housing authorities can apply for add’l grants when offered by HUD. To increase housing mobility, PHAs can restrict fewer vouchers to low-income housing units
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Racially, socially, and economically diverse neighborhoods; reduction in risky health behaviors, improvements in mental health/depression, less exposure to violence, improvement in rates of childhood chronic illness (e.g. asthma).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Sec. 8 users benefit greatly when placed in middle-income/affluent neighborhoods. Restricting sec. 8 users to vulnerable neighborhoods limits benefits. W/out add’l assistance (housing counseling, etc.) sec. 8 does not ensure placement in low-poverty neighborhoods. Cubbin 2005, Deng 2007, Von Hoffman 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Housing: Housing quality
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentHousing Rehabilitation Loan and Grant programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Implemented in all states.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Housing rehabilitation is probably the most common use of Community Development Block Grant and HOME Investment Partnership Program funding provided as block grants by the federal government to the state government and some local governments in WI and in other states.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Improved housing safety
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    utilities costs (heating/cooling)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Greater housing stability
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Berry 1997, Howden-Chapman 2004, Thomson 2002
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentMaster Home Environmentalist program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Housing quality; Volunteers assist residents in assessing and remediating environmental health risks within the home.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      WA, CA, ND, RI, ID, TX, NY and Chicago
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      N/A
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Low cost improvements including improved ventilation, integrated pest management, and other forms of allergen control are expected to alleviate or prevent health conditions due to substandard housing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Evidence from 2 studies indicates that visits from a volunteer could promote behavior change, but did not concretely identify health benefits of the changes made. Krieger 2002, Leung 1997
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentWeatherization Assistance Program (WAP)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Federal program available in all states. Amount of federal funding depends on: (1) Low-income population; (2) Climatic conditions (heating and cooling degree-days); and (3) Residential energy expenditures by low-income households.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        WisWAP offers services to income-eligible homes. Services differ with each home, but common weatherization services include: Insulation; installation of energy efficient lighting; reducing air leakage; repairing/ replacing furnace; testing/replacing refrigerator; general health and safety inspection. However, under the program, non-eligible residents may be in need of assistance.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Improved housing quality, reduced energy expenditures among low-income households. Expected health outcomes include reductions in health conditions related to substandard housing; change in energy costs may also reduce malnutrition because resources for food are not diverted to energy costs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Evidence from a randomized trial in NZ supports the benefits of retrofitting housing with insulation, showing health improvement including health outcomes and measures of well-being. Other studies demonstrate that self-rated health improves. Berry 1997, Howden-Chapman 2004, Thomson 2002
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentRadon mitigation programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Most states have a radon protection program through their Department of Health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          WI Radon Mitigation Program collects data on all radon tests in the state and operates 16 radon information centers in the state. The program also provides information on how to upgrade homes to reduce radon leakage and offers a list of certified contractors to assist in radon abatement. DHFS has provided one-time grants to PHA to do radon detection and mitigation, but does not have a committed program.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          exposure to radon (to levels below 4 pCi/L) reduces the likelihood of developing lung cancer.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Evidence supports the relationship between radon exposure and lung cancer; conflicting evidence on the effectiveness of information-only radon awareness programs. One paper identifies that likelihood of radon mitigation is greater for individuals with higher education (college or more). Riesenfeld 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentLead abatement programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Varies by state
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Lead abatement efforts are focused on Milwaukee and Racine Counties
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            lead exposure resulting in less cognitive disability in children, and neurological and other effects in adults.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Several studies show favorable results of lead hazard control and abatement activities (Wilson 2006, Dixon 2005, Clark 2004, HUD-Lead 1999)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            3 5
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Housing: Housing retention and homelessness prevention
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentHousing mediation services
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Mediation between tenants and landlords to resolve conflict and prevent eviction.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Public housing authorities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Basic mediation services are available in most states; MA offers the Tenancy Preservation Project, which develops a housing plan in case mediation is not successful.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Housing Mediation Services offered through the Tenant Resource Center and the Apartment Assoc. of South Central WI. Outside of Dane County, general mediation services are available through the Wisconsin Assoc. of Mediators.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              housing stability and decreased homelessness.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Research on mediation as part of Housing First, as well as its use individually confirms its use in preventing eviction and housing instability. Gill 2006, Gulcur 2003, Stefancic 2007, Burt 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentHousing First program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              This program offers 4 integrated sets of services: crisis intervention/ short-term stabilization; intake/ needs assessment; provision of permanent housing; case management.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Public housing authorities
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Examples: Rapid Exit program in MN; Project HOME in PA; and other programs in CA, MA, WA, NYC, IL, CO, GA
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Dane County Homeless Services Consortium directs the Housing First program through the United Way of Dane County.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Ref. Housing mediation services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                HF participants w/dual diagnosis obtained housing earlier, remained stably housed, and reported higher perceived choice. Also reduced cost and psychiatric hospitalizations. Gulcur 2003, Cohen 2004, Stefancic 2007, Burt 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentService-enriched housing
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Permanent, basic rental housing in which social services are available on-site or by referral. Housing can be nonprofit, private, HUD-assisted, unsubsidized, mixed income or any combination of the above. It is not restricted to homeless or at-risk of homelessness.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Local development organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Examples: Twin Cities Development Corporation; Mercy Housing in CA, CO, ID, IA, KS, MO, NE, GA, NC, SC, AZ, Chicago; New Destiny Housing Corp. in NYC
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Some organizations throughout WI offer service-enriched housing for special needs individuals—AIDS Resource Center of Wisconsin offers such housing to clients
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Ref. Housing mediation services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Multiple studies confirm the effectiveness of service-enriched housing for dual-diagnosis individuals, the elderly, low-income/unemployed households, and other “hard-to-house” individuals/families. Gulcur 2003, Cohen 2004, Burt 2007
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Housing: Federal assistance to state and local governments
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentCommunity Development Block Grants
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  CDBGs fund local community development activities such as affordable housing, anti-poverty programs, and infrastructure development.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    In all states
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Multiple CDBG projects throughout the state.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    slums/blight
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    housing quality and security for low-income people
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Improved infrastructure.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    The Urban Institute 1994 support benefits of CDBG, including local neighborhood stabilization and community revitalization. Galster 2005 found that larger CDBG investments are more likely to improve neighborhood quality.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    4 5
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentHOME Investment Partnership Program
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    HOME provides formula grants to states and localities that communities use-often in partnership with local nonprofit groups-to fund wide range of activities that build, buy, and/or rehabilitate affordable housing for rent or homeownership or provide direct rental assistance to low-income people.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      In all states
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Participating jurisdictions receive funds directly from the federal government, and additional funds are distributed to non-participating jurisdictions via the state.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      access to quality housing, homeownership, and neighborhood choice for lower-middle-income families.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Comprehensive review of HOME Investment Partnership program Turnham 2004
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentLow-Income Housing Tax Credits
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      The LIHTC provides funding for the development costs of low-income housing by allowing a taxpayer to take a federal tax credit equal to a large percentage of the cost incurred for development of the low-income units in a rental housing project.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Housing developers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        In all states
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        LIHTC is commonly used in Wisconsin and appears to work effectively in integrating communities (Green, 2002).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        access to quality housing, homeownership, and neighborhood choice for lower-middle-income families.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Cummings 1999 reviews the first 10 years of LIHTC; Green 2002 find that properties near LIHTC sites do not lose value and some evidence suggests they appreciate more rapidly. The benefits, however, depend on local implementation Deng 2007.
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentSection 202 Program (housing for elders)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        HUD provides capital advances to finance the construction, rehabilitation or acquisition with or without rehabilitation of structures that will serve as supportive housing for very low-income elderly persons, including the frail elderly, and provides rent subsidies for the projects to help make them affordable.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          In all states
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Used in Wisconsin
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Retrofitting improves the accessibility of dwellings, enhances the delivery of community-based services, and helps create elder-friendly communities capable of accommodating the needs of frail older adults as well as younger people with disabilities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Nishita 2006 argues that Sec. 202 housing is a cost effective way of providing supportive environments for aging residents.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          3 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentSection 811 Program (housing for people with disabilities)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          See Section 202
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Local government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            In all states
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Used in Wisconsin
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            See Sec. 202 outcomes.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Harkness 2004, Nishita 2006
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Income and Employment: Programs and policies to increase or supplement income or wages
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentEarnings supplements for the working poor: increase State EITC
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Federal and State Earned Income Tax Credit (EITC): Earnings supplements can be administered in a number of ways, including as part of a welfare-to-work program, with an earned income disregard policy, and providing work expense allowances. Goals of EITC are to 'make work pay' and reward low wage work by reducing the tax burden and supplementing wages with a refundable credit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              EITC is highly complex, which can lead to tax filing errors or the need to have tax forms completed by a professional. Many states offer state EITC, but they differ in eligibility requirements and whether the credit is refundable.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              It is estimated that up to 20% of individuals and families eligible for the federal EITC do not claim it. A number of local groups in WI provide free tax preparation assistance to low-income individuals.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              WI has a state refundable EITC, but it is only available to residents who have at least one qualifying child in addition to qualifying for the federal EITC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              unemployment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              employment among single parents by making low-wage jobs more appealing
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              in receipt of cash welfare assistance;
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              tax burden;
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              poverty
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Greenstein 2005, CBPP 2004
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Recommended by NCCP, CBPP 2004, and others
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              4 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentIncrease minimum wage
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Current federal minimum wage rate increased from $5.85 to $6.55 on July 24, 2008. On July 24, 2009 it will increase to $7.25.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                The current highest state minimum wage is $8.07/hr (WA).
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                WI minimum wage is $6.50/hr, the 24th highest state minimum wage. However, another 20 states will implement minimum wages higher than $6.50 in 2008. Wisconsin has proposed a rule to increase the minimum wage to $7.25 effective July 24, 2009. The proposal to increase the state minimum wage will match the federal rate of $7.25 on July 24, 2009 under the Fair Labor Standards Act. The Wisconsin minimum wage rule, DWD 272, has passed the Senate Committee and is currently in the Assembly Committee.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                income
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Increasing minimum wage to raise incomes of the working poor is recommended by the NCCP, WI Vision 2020 coalition, CBPP 2004, and others. Increasing wage minimums may reduce employment.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                3 2
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentLiving wage law (proposed)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                A living wage is higher than state or federal minimum wage levels and is often set as the wage level needed for a family to meet the federal poverty level. Current living wage ordinances typically only apply to companies under contract with or receiving assistance from the cities the ordinance.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  A number of communities across the country have adopted living wage ordinances.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  A living wage in WI has been estimated at $7.32 for one adult without children. Some cities and counties in WI have living wage ordinances; e.g, the City of Madison has a living wage of $10.92 for 2008 that applies to city employees, and employees associated with many service contracts or groups receiving financial assistance from the city.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  income/ wages
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  poverty
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Living wage has been recommended as a way to raise incomes of the working poor. Whether increasing wage minimums also carries consequences for employment rates is debated. Neumark 2000 and Neumark 2006 found these laws boost wages with limited coverage.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  2 3
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentState equal pay/ comparable worth laws: Enact Equal Pay Act
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Equal Pay Act would strengthen remedies for violation of Fair Employment Law and authorize study of reasons for disparities in pay. Equal pay laws explicitly state that compensation for equal work can not differ based solely on gender, ethnicity, etc. Comparable worth laws seek to equalize pay for work of comparable worth between jobs held predominantly by women and jobs held predominantly by men.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    The federal Equal Pay Act of 1963 requires men and women be paid equally for equal work. 39 states outlaw pay discrimination by sex; a few of these states also outlaw pay discrimination by factors like race, religion, ethnicity.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Comparable worth legislation has also been introduced in several states focusing on state employees.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    The Wisconsin Fair Employment Law at §111.322 (1) states that it is violation of the law to refuse to hire, employ, admit or license any individual, to bar or terminate from employment or labor organization membership any individual, or to discriminate against any individual in promotion, compensation or in terms, conditions or privileges of employment because of age (40+), race, creed, color, disability, marital status, sex, sexual orientation, national origin, ancestry, arrest record, conviction record, military service or use of lawful products.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    in pay discrimination;
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    wages for women and other groups experiencing pay discrimination
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Neumark 2006
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    1 5
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentExpanded child tax credits: Improve access; expand eligibility; expand to 17 & 18 year olds
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    This tax credit is partially refundable and available to families with qualifying children under 17 years of age
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      The federal child tax credit is worth up to $1,000 per child, but only families with earnings well above the poverty line qualify for the full amount. New legislation proposes to extend the federal credit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      New York has a relatively new refundable state child tax credit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      WI does not have a state child tax credit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      income;
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      tax burden
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      CBPP 2004 recommends improving and extending the child tax credit to reduce child poverty
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      2 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentChild support pass-through
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Child support collected on behalf of TANF families may be kept by the government as reimbursement for welfare costs; states may choose to instead “pass through” this collected child support money to the TANF family. Some states also disregard some or all of pass-through amount when determining TANF benefits.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        As of Oct 1, 2008, if a state passes through and disregards some or all of child support payments, the fed. government will waive its share up to $100/mo for families with 1 child and $200/mo for families with 2 or more children.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        WI currently has a partial pass-through, full disregard policy. WI passes through approximately 42% of the support collected and returns the remaining 58% to the federal government for cash benefits received by an individual.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        New pass-through options are yet to be decided.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        If all states increased pass-through and disregard to allowed levels, it would Increaseannual incomes for these families by $500 & reduce dependence on other benefits. Other outcomes include improved child support compliance.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Wheaton 2008, Legler 2006, Cancian 2006, Meyer 2001
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentMaintain Social Security
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        The federal Social Security program provides lifetime monthly income for qualified workers when they reach full retirement age, for surviving spouse and children < 18, and for workers who are disabled and some spouses and children. Social Security pays benefits to 89% of US population aged 65 and over -- it is the major source of income for two-thirds of its beneficiaries. Without Social Security, 40% of those ages 65+ would be in poverty.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentSupplemental Security Income (SSI) Program: raise benefit amounts
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Provides cash to meet basic needs for food, clothing, and shelter for aged, blind or disabled people with little or no income.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Application for SSI disability benefits is a function of health but is also influenced by program rules and benefits. Five states (AR, MS, ND, TN, WV) do not pay SSI supplements. The federal SSA implements SSI supplements for 14 states. Other states implement their own.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Federal need-based program with state supplement. About 5 states provide a larger supplement than WI for SSI recipients living independently but far more states provide more for recipients in group homes or facilities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            income
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Great variation in level of benefits across states so generalized findings are difficult. Evidence shows that recessions lead to increases in applications for SSI. Over 7 million recipients nationally receive an average of $467 per month SSA.
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentTemporary Assistance for Needy Families (TANF): Improve access; expand eligibility; raise benefit amounts
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Federally funded and state-administered program - Community groups can help eligible parents enroll
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Eligibility and benefit calculations vary by state, as well as work and other requirements.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              WI’s TANF program is called Wisconsin Works (W-2) and is available to parents with minor children and family incomes below 115% of the federal poverty level. W-2 is not an entitlement program, but is based on work participation and personal responsibility. WI’s W-2 program does not include earnings supplements
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Stated goal of W-2 is to provide necessary and appropriate services to prepare individuals to work, and to obtain and maintain viable, self-sustaining employ-ment, which will promote economic growth.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Ideal outcomes:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              employment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              inco
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              CBPP 2004 recommends raising benefits and expanding outreach; programs providing mix of services rather than only mandatory employment services are more effective Bloom 2001; Cancian 2006 found reduced net income.
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentIncreased educational attainment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Programs and policies in this area are addressed under Education
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Income and Employment: Programs and policies offering other supports to the poor, working poor and other workers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Submit a commentUnemployment insurance: expand insurance
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Program is administered by states under federal guidelines. Eligibility and the amount and duration of benefits are determined by each state.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Federal government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  9 states treat part-time workers the same as full-time workers. At least 15 states provide benefits to individuals forced to leave work for some “good cause,” such as child care conflicts, illness, or domestic violence.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  In WI individuals must be seeking full-time work to qualify and are not eligible if seeking part-time work. WI also does not have a provision that recognizes “good cause.”
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  income while job seeking
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  CBPP 2004; NCCP
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  3 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Submit a commentPaid family and medical leave
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Businesses & employers
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Paid medical/ maternity leave offered in 6 states (CA, RI, HI, NJ, NY, WA)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Employers (> 50 workers) subject to the federal Family and Medical Leave Act must provide up to 12 weeks unpaid leave. No paid leave requirement.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    return to pre-birth employment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    paternal leave-taking
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    job retention
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    child health
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Shown to improve child health (Ruhm, Tanaka)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    3 4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Submit a commentAccess to affordable and quality child care
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Programs and policies in this area are addressed under Healthy Child Development & Education
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Submit a commentAccess to affordable and quality health care
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Programs and policies in this area are addressed under Health Care Access and Health Care Quality & Costs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Submit a commentAccess to safe and affordable housing
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        Programs and policies in this area are addressed under Housing
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Income and Employment: Community-based and community-focused programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Submit a commentFood buying clubs and co-ops
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Food buying clubs and co-ops exist throughout the country.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            SHARE Wisconsin is an example of a food buying club that allows anyone to join and saves members money on monthly grocery purchases
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            in money spent on food purchases
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Submit a commentCommunity revitalization and economic development
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Jobs-Plus Community Revitalization Initiative was a multi-component employment program in public housing. The Neighborhood Jobs Initiative had the potential to raise emp. rates in poor communities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Similar programs are in progress.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              A number of WI non-profit groups are interested and involved in state economic development, including Wisconsin Economic Development Association, Forward Wisconsin, and Competitive Wisconsin
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              availability of jobs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              employment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              income
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Bloom 2005, Molina 2003
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              2 6
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              Submit a commentComprehensive, employment, earnings supplement and and/or work support programs
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                State government
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Community organizations
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Minnesota Family Investment Program (welfare program with earnings supplments) (Opportunity NYC & National Work Advancement & Support Center programs in progress)
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Milwaukee-based New Hope Demonstration project – this social contract program operated outside the welfare system, requiring participating adults to work at least 30 hours/wk to remain eligible for a wide variety of services, including earnings supplements, health & child care subsidies, career counseling, & community service employment.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                employment
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                poverty
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                positive outcomes for children
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                An evaluation of the New Hope demonstration project found a number of positive outcomes for the participants in comparison to a control group Duncan 2007. Program in Minnesota also showed positive results Gennetian 2005
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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Policy/Program Decision
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Maker
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Implementation in Other States Wisconsin Specifics Expected Beneficial Outcomes Evidence of Effectiveness SE DI PR