Health Behaviors |
|
Nutrition: Nutrition education & information
|
 Label 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 |
 Provide 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 |
 Provide 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 |
 Breastfeeding 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 |
|
Nutrition: Nutrition standards
|
 School 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 |
 Nutritional 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 |
 Limited 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 |
 Policy 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 |
|
Nutrition: Access to healthy food options
|
 Make 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 |
 Increase 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 |
 Modify 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 |
 School/ 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 |
 Ensure 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 |
 Offer 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 |
 Allocate 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 |
 Tax 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 |
 Farm-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 |
 Allocate 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 |
 Institute 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 |
 Prohibit 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 |
|
Nutrition: Incentives to improve nutrition
|
 Snack 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 |
 Use 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 |
 Use 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 |
 Provide 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 |
 Teach 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 |
 Identify 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 |
 Reduce 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 |
 Provide 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 |
|
Nutrition: Comprehensive programs that promote nutrition
|
 Comprehensive, 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 |
 School 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 |
|
Physical Activity: Access to opportunities/facilities that promote physical activity
|
 Increased 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 |
 Offer 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 |
 Increase green space/ parks, esp. those accessible by foot/ bike
|
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 |
 Extracurricular 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 |
 Recreational 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 |
 Neighborhood 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 |
|
Physical Activity: Physical activity information & education
|
 Expand 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 |
|
Physical Activity: Physical activity standards
|
 Minimum 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 |
 School policies to increase activity
|
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 |
|
Physical Activity: Incentives to increase physical activity
|
 Community 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 |
 Implement 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 |
 Workplace 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 |
 Subsidized 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 |
 Point-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 |
 Reduced 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 |
|
Physical Activity: Comprehensive programs that promote physical activity
|
 Multi-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 |
|
Physical Activity: Initiatives to reduce unnecessary driving
|
 Developing 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 |
 Zoning 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 |
 Improved 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 |
|
Risky Sexual Behavior
|
 Comprehensive, 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 |
 Condom 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 |
 Individual-, 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 |
 Multi-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 |
 Partner 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 |
 Service-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 |
|
Smoking
|
 Increase 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 |
 Ban 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 |
 Increase 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 |
 Quitline
|
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 |
 Mass 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 |
 Education 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 |
|
Substance Misuse or Dependency: Policies and informational campaigns for those who might be providers of alcohol
|
 State-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 |
 Minimum 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 |
 RBS (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 |
 Keg 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 |
 Policies 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 |
 Vigorous 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 |
|
Substance Misuse or Dependency: Policies that raise the price of alcohol
|
 Increase 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 |
 Restrict 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 |
|
Substance Misuse or Dependency: Policies that restrict the places and times in which alcohol can be consumed or purchased
|
 Reduce 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 |
 Campus 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 |
 Alcohol 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 |
 Restrict 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 |
 Limitations 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 |
|
Substance Misuse or Dependency: Policies punishing suppliers of alcohol to minors or those who are already intoxicated
|
 Non-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 |
 Dram 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 |
|
Substance Misuse or Dependency: Effective school and community based prevention programs
|
 Specific 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 |
 Broad-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 |
|
Substance Misuse or Dependency: Other programs and policies to reduce alcohol consumption
|
 Restrict 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 |
 Alcohol 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 |
|
Substance Misuse or Dependency: Reduce alcohol-impaired driving
|
 Sobriety 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 |
 School-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 |
 Increase 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 |
 Multicomponent 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 |
 License 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 |
 Unrestricted (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 |
 Impaired 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 |
 State Driver Education Program
|
State government
|
|
|
|
No evidence of effectiveness in reducing novice driver crashes TRB 2007
|
1 |
↓ |
4 |
 Mass media campaigns
|
Community organizations State government
|
|
|
|
Little supporting evidence Anderson 2006
|
1 |
0 |
4 |
 School-based peer organization and social norming programs
|
School boards
|
|
|
|
Insufficient evidence found by the Community Guide CG-MVOI
|
1 |
↓ |
3 |
 Designated driver programs – population-based and incentive programs
|
Community organizations
|
|
|
|
Insufficient evidence found by the Community Guide CG-MVOI
|
1 |
0 |
4 |
|
Injury Prevention: Falls prevention/reduction of injury from falls
|
 Screening 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 |
 Home 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 |
 Muscle 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 |
 Group 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 |
 Distribution (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 |
 Mandated installation of releasable (not fixed) window guards/ locks
|
State government
|
|
|
↓falls
|
Recommended by American Academy of Pediatrics AAP 2001
|
2 |
↓ |
2 |
 Parent 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 |
|
Injury Prevention: Poison prevention
|
 Poison 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 |
 Parent 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 |
|
Injury Prevention: Prevention of burns and scalds
|
 Parent 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 |
 Smoke 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 |
 Regulations 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 |
 Zoning 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 |
 Lower 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 |
|
Injury Prevention: Back injury prevention and treatment
|
 Exercise 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 |
 Work-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 |
|
Injury Prevention: Sports and recreation safety
|
 SAFE 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 |
 Use 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 |
 Education 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 |
 Zoning 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 |
 Legislation 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 |
|
Injury Prevention: Farm injuries
|
 Occupational health and safety regulations
|
State government
|
Children are exempt from most regulatory policies
|
|
|
Effective DeRoo 2000
|
3 |
↓ |
2 |
 Modifications 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 |
 Education 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 |
|
Injury Prevention: Increase use of safety seats, seatbelts and helmets
|
 Community-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 |
 Distribution 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 |
 Incentive & 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 |
 Education programs for use of child safety seats when used alone
|
Community organizations Healthcare providers
|
|
|
|
Insufficient evidence from the Community Guide CG-MVOI
|
1 |
|
|
 Primary 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 |
 Enhanced 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 |
 Motorcycle 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 |
 Education 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 |
 Mandated 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 |
|
Injury Prevention: Pedestrian and bicycle safety
|
 Pedestrian 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 |
 Bicycle 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 |
 Engineering 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 |
|
Injury Prevention: Environmental interventions to reduce motor vehicle crashes
|
 Construction 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 |
 Speed 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 |
 Engineering 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 |
|
Violent Behavior
|
 Classroom- 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 |
 Early 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 |
 Early 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 |
 Functional 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 |
 Mentoring 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 |
 Multisystemic 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 |
 Therapeutic (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 |
 Universal 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 |
 Environmental 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 |
 Firearm 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 |
 Homicide 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 |
 Wraparound 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 |
|
Quality of Public Health Services: Strong foundation for state and local health departments
(Sources of Information on Implementation)
|
 Adequate 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 |
 Recruit 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 |
 Integrated 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 |
 Increase 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 |
 Community 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 |
 Increasing 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 |
|
Health Care Access: Comprehensive health coverage reform
(Sources of Information on Implementation)
|
 Employer 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 |
 Individual 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 |
 Connector/ 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 |
|
Health Care Access: Incremental health coverage reform
(Sources of Information on Implementation)
|
 Extend 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 |
 Encourage 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 |
 Small 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 |
 Programs 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 |
 State 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 |
 State 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 |
 Mental 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 |
 Implement 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 |
 Expand 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 |
|
Health Care Access: Health care workforce: recruitment and retention
(Sources of Information on Implementation)
|
 Public-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 |
 Increased 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 |
 Increase 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 |
 Offer 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 |
 Expand 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 |
 Nurse 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 |
 Expand 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 |
 Implement 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 |
 Bonus 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 |
 Health 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 |
 Incentives 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 |
|
Health Care Access: Health care workforce: scope of practice within and across professions
(Sources of Information on Implementation)
|
 Expand 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 |
 Extend 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 |
 Allow 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 |
 Expand 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 |
 Physician-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 |
|
Health Care Access: Cultural competency
(Sources of Information on Implementation)
|
 Expand 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 |
 Require 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 |
 Authorize 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 |
 Implement 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 |
|
Health Care Access: Other programs and policies to improve access to care
(Sources of Information on Implementation)
|
 Increase 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 |
 Medical 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 |
 Mobile 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 |
 Kinship 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 |
 Increase 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 |
 Expand 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 |
 Removal of structural impairments that limit access to care for patients with disabilities
|
Healthcare providers
|
|
|
|
|
0 |
↓ |
2 |
 License organizations instead of individuals
|
State government
|
|
|
↑availability of services
|
|
0 |
0 |
6 |
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
|
Health Care Quality and Costs: Health information technology
(Sources of Information on Implementation)
|
 Adoption 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 |
 Electronic 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 |
 Clinical 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 |
|
Health Care Quality and Costs: Care management & effectiveness
(Sources of Information on Implementation)
|
 CHI 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 |
 Linguistically 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 |
 Aligning 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 |
 Green House Project
|
Healthcare providers
|
31 Projects in 21 States
|
None
|
–Improve quality of life
|
A little evidence of effectiveness Kane 2007
|
2 |
0 |
2 |
 Standardized 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 |
 National 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
|
2 |
0 |
2 |
 Collaborative 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 |
 Preferred 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
|
0 |
0 |
3 |
 Disease 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
|
4 |
0 |
5 |
 Case 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
|
4 |
↓ |
5 |
 POLST (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 |
 Pay 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
|
3 |
0 |
6 |
|
Health Care Quality and Costs: Patient safety
(Sources of Information on Implementation)
|
 Mandatory 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.
|
2 |
0 |
3 |
 Statewide 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
|
0 |
0 |
3 |
 Accreditation 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
|
0 |
0 |
2 |
 Routinely 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 |
 No 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
|
0 |
0 |
3 |
 Other 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.
|
|
|
|
|
|
|
Health Care Quality and Costs: Other health care quality programs and policies
(Sources of Information on Implementation)
|
 Health 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 |
 Member 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 |
 Continuing 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 |
|
Health Care Quality and Costs: Strategies to reduce amount paid for services
(Sources of Information on Implementation)
|
 Increase 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 |
 Negotiated 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 |
 Tiered 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 |
 Increase 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 |
 Revise 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 |
 All-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
|
0 |
0 |
6 |
|
Health Care Quality and Costs: Strategies to reduce inappropriate or duplicative use of services
(Sources of Information on Implementation)
|
 Regulatory 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 |
 Reduce 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
|
4 |
0 |
6 |
 Reduce 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 |
 Payment reform to eliminate fee-for-service (FFS) incentives
|
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 |
 Payment 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 |
 Tort 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 |
 Adoption 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 |
 Reduce 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.
|
|
|
|
|
|
|
|
|
|
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)
|
 Enhanced 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 |
 Strengthen 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 |
 Chronic 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 |
|
Health Care Quality and Costs: Other strategies to reduce health care spending
(Sources of Information on Implementation)
|
 Incentives 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
|
1 |
0 |
5 |
 Administrative 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 |
 Set 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 |
 Limit 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 |
 Provide 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 |
 Programs 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.
|
2 |
0 |
6 |
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.
Social and Physical Environment |
|
Healthy Child Development and Education: Alternatives for a comprehensive, state-wide system for high quality early child care and education
|
 Comprehensive, 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 |
 Comprehensive, 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 |
 Early 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 |
|
Healthy Child Development and Education: Healthy child development policies
|
 Increase 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 |
 Refundable 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 |
 Statewide 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 |
 Universal 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 |
|
Healthy Child Development and Education: Home visiting or parent education programs
|
 DARE 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 |
 Developmentally 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 |
 HIPPY (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 |
 Incredible 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 |
 Nurse 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 |
 Parents 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 |
 Reach 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 |
|
Healthy Child Development and Education: Other broad focused early care and education programs
|
 Birth 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 |
 Child-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 |
 High/ 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 |
 Families 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 |
|
Healthy Child Development and Education: Improve quality of K-12 education
|
 Comprehensive 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 |
 Policies 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 |
 Reduced 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 |
 Health 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 |
 Embed 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 |
 Teaching 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 |
|
Healthy Child Development and Education: Increase high school graduation rates
|
 Broad 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 |
 Mentorship-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 |
 Alternative 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 |
 Programs 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 |
|
Healthy Child Development and Education: Increase education beyond high school
|
 Adult 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 |
 Targeted 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 |
 College 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 |
 College 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.
|
1 |
↓ |
2 |
 Career 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 |
 College 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 |
 Comprehensive 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 |
|
Environmental Quality: Agricultural programs to reduce environmental contamination
|
 Groundwater 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 |
 Conservation 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 |
 Pesticide 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 |
 Nutrient 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 |
|
Environmental Quality: Reduce transportation emissions
|
 Congestion 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 |
 Local 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
|
1 |
0 |
5 |
 Safe 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 |
 Alternative 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
|
1 |
0 |
2 |
 Clean 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
|
1 |
↓ |
4 |
 Carpooling 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
|
2 |
↓ |
5 |
 Bus 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
|
2 |
↓ |
4 |
 Smart 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
|
2 |
↓ |
3 |
 Vehicle 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
|
3 |
↑ |
4 |
 Retrofitting 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
|
4 |
↓ |
3 |
|
Environmental Quality: Renewable or reduced energy use
|
 Green 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
|
2 |
↑ |
6 |
 Credit 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
|
1 |
↑ |
5 |
 Energy 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
|
2 |
0 |
5 |
|
Environmental Quality: Comprehensive programs with an environmental component
|
 Healthy 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
|
1 |
0 |
3 |
 Smart 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
|
1 |
↓ |
4 |
|
Housing: Housing cost
|
 Low 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
|
1 |
↓ |
3 |
 Housing 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
|
3 |
↓ |
5 |
 Land 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.
|
1 |
↓ |
5 |
 Affordable 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.
|
3 |
↓ |
5 |
 Community 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
|
3 |
↓ |
5 |
|
Housing: Housing location and mobility
|
 Moving 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
|
2 |
↓ |
3 |
 Inclusionary 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
|
3 |
↓ |
6 |
 Section 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
|
1 |
↓ |
3 |
|
Housing: Housing quality
|
 Housing 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
|
3 |
↓ |
5 |
 Master 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
|
2 |
↓ |
6 |
 Weatherization 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
|
2 |
↓ |
3 |
 Radon 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
|
1 |
↑ |
6 |
 Lead 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 |
|
Housing: Housing retention and homelessness prevention
|
 Housing 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
|
2 |
↓ |
4 |
 Housing 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
|
2 |
↓ |
3 |
 Service-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
|
3 |
↓ |
3 |
|
Housing: Federal assistance to state and local governments
|
 Community 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 |
 HOME 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
|
4 |
↓ |
5 |
 Low-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.
|
4 |
↓ |
5 |
 Section 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 |
 Section 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
|
3 |
↓ |
2 |
|
Income and Employment: Programs and policies to increase or supplement income or wages
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 Earnings 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.
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Federal government State government
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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.
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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.
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↓unemployment ↑employment among single parents by making low-wage jobs more appealing ↓in receipt of cash welfare assistance; ↓tax burden; ↓poverty
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Greenstein 2005, CBPP 2004 Recommended by NCCP, CBPP 2004, and others
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 Increase minimum wage
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State government
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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).
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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.
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↑income
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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.
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 Living 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.
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State government
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A number of communities across the country have adopted living wage ordinances.
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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.
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↑income/ wages ↓poverty
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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.
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 State 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.
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State government
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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.
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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.
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↓in pay discrimination; ↑wages for women and other groups experiencing pay discrimination
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Neumark 2006
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 Expanded 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
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State government Federal government
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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.
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WI does not have a state child tax credit.
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↑income; ↓tax burden
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CBPP 2004 recommends improving and extending the child tax credit to reduce child poverty
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 Child 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.
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State government Federal government
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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.
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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.
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–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.
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Wheaton 2008, Legler 2006, Cancian 2006, Meyer 2001
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 Maintain 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.
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 Supplemental 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.
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Federal government State government
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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.
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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.
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↑income
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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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 Temporary 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
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State government Federal government
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Eligibility and benefit calculations vary by state, as well as work and other requirements.
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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
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–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
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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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 Increased educational attainment
Programs and policies in this area are addressed under Education
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Income and Employment: Programs and policies offering other supports to the poor, working poor and other workers
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 Unemployment insurance: expand insurance
Program is administered by states under federal guidelines. Eligibility and the amount and duration of benefits are determined by each state.
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State government Federal government
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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.
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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.”
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↑income while job seeking
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CBPP 2004; NCCP
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 Paid family and medical leave
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State government Businesses & employers Community organizations
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Paid medical/ maternity leave offered in 6 states (CA, RI, HI, NJ, NY, WA)
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Employers (> 50 workers) subject to the federal Family and Medical Leave Act must provide up to 12 weeks unpaid leave. No paid leave requirement.
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↑return to pre-birth employment ↑paternal leave-taking ↑job retention ↑child health
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Shown to improve child health (Ruhm, Tanaka)
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 Access to affordable and quality child care
Programs and policies in this area are addressed under Healthy Child Development & Education
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 Access to affordable and quality health care
Programs and policies in this area are addressed under Health Care Access and Health Care Quality & Costs
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 Access to safe and affordable housing
Programs and policies in this area are addressed under Housing
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Income and Employment: Community-based and community-focused programs
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 Food buying clubs and co-ops
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Community organizations Community organizations
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Food buying clubs and co-ops exist throughout the country.
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SHARE Wisconsin is an example of a food buying club that allows anyone to join and saves members money on monthly grocery purchases
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↓in money spent on food purchases
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 Community revitalization and economic development
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State government Community organizations
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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.
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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
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↑availability of jobs ↑employment ↑income
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Bloom 2005, Molina 2003
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 Comprehensive, employment, earnings supplement and and/or work support programs
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State government Community organizations
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Minnesota Family Investment Program (welfare program with earnings supplments) (Opportunity NYC & National Work Advancement & Support Center programs in progress)
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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.
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↑employment ↓poverty ↑positive outcomes for children
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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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