Providing Foster Care for Young Adults: Early Implementation of California's Fostering Connections Act

This report examines the planning process for implementing California's Fostering Connections to Success Act, as well as the new law's early implementation. It is based on data collected from in-depth interviews with key informants who played a critical role in passage of the law, in implementation planning, or in early implementation at the county and state level and from focus groups with young people who stood to benefit directly from the legislation. Although extended foster care is likely to look different in different states, California's experience offers many lessons from which other states might learn

Extending Foster Care to Age 21: Weighing the Costs to Government against the Benefits to Youth

The Fostering Connections to Success and Increasing Adoptions Act of 2008 allows states to claim federal reimbursement for the costs of caring for and supervising Title IV-E eligible foster youth until their 21st birthday. This issue brief provides preliminary estimates of what the potential costs to government and the benefits to young people would be if states extend foster care to age 21. The analysis focuses on the increase in postsecondary educational attainment associated with allowing foster youth to remain in care until they are 21 years old and the resulting increase in lifetime earnings associated with postsecondary education. Researchers estimate that lifetime earnings would increase an average of two dollars for every dollar spent on keeping foster youth in care beyond age 18

Mixed-method study of a conceptual model of evidence-based intervention sustainment across multiple public-sector service settings.

BackgroundThis study examines sustainment of an EBI implemented in 11 United States service systems across two states, and delivered in 87 counties. The aims are to 1) determine the impact of state and county policies and contracting on EBI provision and sustainment; 2) investigate the role of public, private, and academic relationships and collaboration in long-term EBI sustainment; 3) assess organizational and provider factors that affect EBI reach/penetration, fidelity, and organizational sustainment climate; and 4) integrate findings through a collaborative process involving the investigative team, consultants, and system and community-based organization (CBO) stakeholders in order to further develop and refine a conceptual model of sustainment to guide future research and provide a resource for service systems to prepare for sustainment as the ultimate goal of the implementation process.MethodsA mixed-method prospective and retrospective design will be used. Semi-structured individual and group interviews will be used to collect information regarding influences on EBI sustainment including policies, attitudes, and practices; organizational factors and external policies affecting model implementation; involvement of or collaboration with other stakeholders; and outer- and inner-contextual supports that facilitate ongoing EBI sustainment. Document review (e.g., legislation, executive orders, regulations, monitoring data, annual reports, agendas and meeting minutes) will be used to examine the roles of state, county, and local policies in EBI sustainment. Quantitative measures will be collected via administrative data and web surveys to assess EBI reach/penetration, staff turnover, EBI model fidelity, organizational culture and climate, work attitudes, implementation leadership, sustainment climate, attitudes toward EBIs, program sustainment, and level of institutionalization. Hierarchical linear modeling will be used for quantitative analyses. Qualitative analyses will be tailored to each of the qualitative methods (e.g., document review, interviews). Qualitative and quantitative approaches will be integrated through an inclusive process that values stakeholder perspectives.DiscussionThe study of sustainment is critical to capitalizing on and benefiting from the time and fiscal investments in EBI implementation. Sustainment is also critical to realizing broad public health impact of EBI implementation. The present study takes a comprehensive mixed-method approach to understanding sustainment and refining a conceptual model of sustainment

Computationally Modelling Cholesterol Metabolism and Atherosclerosis

Cardiovascular disease (CVD) is the leading cause of death globally. The underlying pathological driver of CVD is atherosclerosis. The primary risk factor for atherosclerosis is elevated low-density lipoprotein cholesterol (LDL-C). Dysregulation of cholesterol metabolism is synonymous with a rise in LDL-C. Due to the complexity of cholesterol metabolism and atherosclerosis mathematical models are routinely used to explore their non-trivial dynamics. Mathematical modelling has generated a wealth of useful biological insights, which have deepened our understanding of these processes. To date however, no model has been developed which fully captures how whole-body cholesterol metabolism intersects with atherosclerosis. The main reason for this is one of scale. Whole body cholesterol metabolism is defined by macroscale physiological processes, while atherosclerosis operates mainly at a microscale. This work describes how a model of cholesterol metabolism was combined with a model of atherosclerotic plaque formation. This new model is capable of reproducing the output from its parent models. Using the new model, we demonstrate how this system can be utilized to identify interventions that lower LDL-C and abrogate plaque formation

Cost-effectiveness analysis of the management of distal ureteral stones in children

Objective To determine the most cost-effective approach to the management of distal ureteral stones in children given the potential for recurrent renal colic during a trial of passage versus potential stent discomfort and complications of ureteroscopy. Methods We developed a decision tree to project costs and clinical outcomes associated with observation, medical explusive therapy (MET), and ureteroscopy for the management of an index patient with a 4mm distal ureteral stone. We determined which strategy would be least costly and offer the most pain-free days within 30 days of diagnosis. We performed a one-way sensitivity analysis on the probability of successful stone passage with MET. We obtained probabilities from the literature and costs from the 2016 Pediatric Health Information System Database. Results Ureteroscopywas the costliest strategy but maximized the number of pain-free days within 30 days of diagnosis ($5,282/29 pain-free days). MET was less costly than ureteroscopybut also less effective ($615/21.8 pain-free days). Observation cost more than MET and was also less effective ($2,139/15.5 pain-free days). The one-way sensitivity analysis on the probability of successful stone passage with MET demonstrated that ureteroscopyalways has the highest net monetary benefits value and is therefore the recommended strategy given a fixed WTP. Discussion Using a rigorous decision-science approach, we found that ureteroscopy is the recommended strategy in children with small distal ureteral stones. Although it cost more than MET, it resulted in more pain-free days in the first 30 days following diagnosis given the faster resolution of the stone episode

Gauging Residential Knowledge and Behavior to Inform Stormwater Outreach Efforts across South Carolina

Public outreach and education are important components of local stormwater management efforts aimed at protecting water quality and reducing pollutants of concern. Increasingly, educators recognize that creating effective outreach material depends on an understanding of the target audience, their current behavior, and their barriers and motivations to adopting pro-environmental behaviors. Clemson Extension’s Carolina Clear program partners with 39 communities across South Carolina to provide compliance-based stormwater education and outreach. On behalf of these community partners, Carolina Clear conducted the third iteration of a telephone survey to gauge local knowledge, perceptions, and behaviors of residents related to stormwater and watershed health. Results presented here will highlight key knowledge gaps (e.g., the misconception that stormwater runoff is treated) and behaviors (e.g., dumping down storm drains) that could potentially be targeted through education and removal of barriers (e.g., storm drain markings). Survey results showed ongoing misperceptions about the major sources of stormwater pollution, whether stormwater is treated, and what behaviors generate pollution. However, results also show a high level of concern about water quality, as well as a desire to practice pro-environmental behavior. Highlighting the connection between potential sources of pollution, such as pet waste and septic systems, and impacts, such as shellfish bed closures and swimming restrictions, could provide stronger awareness and motivation, particularly among the large number of residents who enjoy visiting beaches and who swim, fish, and boat in local waterways. Ultimately, the survey results can be used by a variety of educators and practitioners statewide to better understand and identify target audiences and to guide the development of stormwater programming that addresses these knowledge gaps. Conducting focus groups with subpopulations of residents is recommended as a next step to further identify specific motivations within subpopulations of residents. Combining the survey results with focus-group data can help educators remove barriers to taking action and further motivate behavior change