Developmental Disabilities Service Coordination in Nebraska

At the request of the LR 42 Service Coordination Workgroup, coordinated by the office of State Senator Dennis Byars, the University of Nebraska Public Policy Center conducted a study of developmental disabilities service coordination in Nebraska. The Public Policy Center explored the perceptions and experiences of a variety of stakeholders involved in the service coordination system for people with developmental disabilities. Analysis of the quantitative and qualitative data gathered from consumers of developmental disabilities services, consumers’ family members or guardians, Service Coordinators, and Service Provider Employees resulted in the following general observations. Stakeholder satisfaction with service coordination: • Many respondents make a distinction between satisfaction with service coordination in general and Service Coordinators. • Families and consumers generally are pleased and feel Service Coordinators try hard and are helpful and available. • Families, consumers, and Service Coordinators believe more strongly than do Provider Employees that Service Coordination is beneficial. • Families of consumers believe Nebraska does not provide the range of service options that many other states provide to consumers of developmental disabilities services. • Consumers’ family members expressed concerns about supervision and the types of activities offered to consumers at day services. • Consumers’ family members expressed concerns about frequent turnover in day service employees. The roles and responsibilities service coordinators currently are fulfilling, and the importance of various aspects of service coordination: • Consumers and their families generally believe that Service Coordinators help consumers and families in a wide range of ways. • Both Service Coordinators and Provider staff feel they advocate, ask what is important to consumers, and are familiar with the rights of consumers and their families. • Both Service Coordinators and Provider staff feel they support consumer self-determination. • Service Coordinators and Provider Employees indicate that Interdisciplinary Teams function well, but Provider Employees are slightly less positive about Teams. • Service Coordinators rank tasks associated with their job differently when comparing percent of time spent on the task and importance of the task. The working relationship between Service Coordinators and Service Provider Employees: • The relationship between Service Coordinators and Service Provider Employees is tenuous, particularly from the perspective of Provider Employees. • Service Coordinators believe there is a lack of Provider accountability. • There is ambiguity between the roles of Service Coordinators and Provider staff. • Overall, Provider Employees don’t agree as strongly as Service Coordinators that consumers know their Service Coordinator and can talk with their Service Coordinator whenever they want. How service coordination may be improved: • Stakeholders want to see increased funding to add more Service Coordinators and reduce caseloads. • Increase funding for services for people with developmental disabilities. • Families, consumers, and Service Coordinators believe changes are needed in the process for determining eligibility for hours and types of services. • Service Coordinators want processes to improve Provider accountability. • Greater communication and teamwork is needed between Service Coordinators and Provider Staff. • Service Coordinators and Provider staff may benefit from additional training opportunities

Developmental Disabilities Service Coordination in Nebraska

At the request of the LR 42 Service Coordination Workgroup, coordinated by the office of State Senator Dennis Byars, the University of Nebraska Public Policy Center conducted a study of developmental disabilities service coordination in Nebraska. The Public Policy Center explored the perceptions and experiences of a variety of stakeholders involved in the service coordination system for people with developmental disabilities. Analysis of the quantitative and qualitative data gathered from consumers of developmental disabilities services, consumers’ family members or guardians, Service Coordinators, and Service Provider Employees resulted in the following general observations. Stakeholder satisfaction with service coordination: • Many respondents make a distinction between satisfaction with service coordination in general and Service Coordinators. • Families and consumers generally are pleased and feel Service Coordinators try hard and are helpful and available. • Families, consumers, and Service Coordinators believe more strongly than do Provider Employees that Service Coordination is beneficial. • Families of consumers believe Nebraska does not provide the range of service options that many other states provide to consumers of developmental disabilities services. • Consumers’ family members expressed concerns about supervision and the types of activities offered to consumers at day services. • Consumers’ family members expressed concerns about frequent turnover in day service employees. The roles and responsibilities service coordinators currently are fulfilling, and the importance of various aspects of service coordination: • Consumers and their families generally believe that Service Coordinators help consumers and families in a wide range of ways. • Both Service Coordinators and Provider staff feel they advocate, ask what is important to consumers, and are familiar with the rights of consumers and their families. • Both Service Coordinators and Provider staff feel they support consumer self-determination. • Service Coordinators and Provider Employees indicate that Interdisciplinary Teams function well, but Provider Employees are slightly less positive about Teams. • Service Coordinators rank tasks associated with their job differently when comparing percent of time spent on the task and importance of the task. The working relationship between Service Coordinators and Service Provider Employees: • The relationship between Service Coordinators and Service Provider Employees is tenuous, particularly from the perspective of Provider Employees. • Service Coordinators believe there is a lack of Provider accountability. • There is ambiguity between the roles of Service Coordinators and Provider staff. • Overall, Provider Employees don’t agree as strongly as Service Coordinators that consumers know their Service Coordinator and can talk with their Service Coordinator whenever they want. How service coordination may be improved: • Stakeholders want to see increased funding to add more Service Coordinators and reduce caseloads. • Increase funding for services for people with developmental disabilities. • Families, consumers, and Service Coordinators believe changes are needed in the process for determining eligibility for hours and types of services. • Service Coordinators want processes to improve Provider accountability. • Greater communication and teamwork is needed between Service Coordinators and Provider Staff. • Service Coordinators and Provider staff may benefit from additional training opportunities

Behavioral Health Providers and Electronic Health Records: An Exploratory Beliefs Elicitation and Segmentation Study

The widespread adoption of electronic health records (EHRs) is a public policy strategy to improve healthcare quality and reduce accelerating health care costs. Much research has focused on medical providers’ perceptions of EHRs, but little is known about those of behavioral health providers. This research was informed by the theory of reasoned action, and the technology acceptance model. This mixed methods research was conducted in two studies. The first study interviewed behavioral health providers (n = 32) to elicit beliefs about EHRs. Using the elicited beliefs from the first study, a survey of 38 Likert-scaled belief statements was administered to all behavioral health providers in Nebraska (N = 2,010). Using data from the sample (n = 667) the belief statements were reduced to four factors. The factors were used as a basis for a cluster analysis to create two market segments. In the first study, most providers (81%) identified themselves as having positive overall opinions about EHRs and three themes emerged: (a) safety and quality of care, (b) security and privacy, and (c) delivery of services. Benefits and barriers were mentioned for each of these three areas, with the most frequently mentioned being benefits to client safety and quality of care (100%), privacy and security barriers (100%), delivery of services barriers (97%), and benefits to delivery of care in their practices (66%). 667 providers participated in the statewide survey to identify salient beliefs, reduced to four factors, that EHRs would (a) improve care and communication, (b) add cost and time burdens, (c) present access and vulnerability concerns, and (d) improve workflow and control. Using the factors as clustering variables returned a two-cluster solution: providers who had overall positive beliefs about EHRs (67%) and providers who had overall negative beliefs about EHRs (33%). Based on the research, five key areas are highlighted that will likely impact behavioral health providers’ perceptions of EHRs: (1) usability, (2) ease of use, (3) privacy and confidentiality, (4) cost, and (5) marketing

Show Me the Money!

Table of Contents: What Are Expanded Learning Opportunities? Identifying resources available to support expanded learning opportunity programs in Nebraska Some Key Findings of the Fund Mapping Projec

A Case Study in Data Sharing: 211 Helplink and the AIRS XSD

The Coordinated Assistance Network (CAN) helps communities prepare for and respond to disasters. The ability to exchange up‐to‐date information about resources and clients is central to effective response. To facilitate the exchange of resource data, CAN has been working with information & referral organizations, namely 2‐1‐1s, to ensure that their existing data about community services may be easily and quickly shared with CAN in the event of disaster. CAN has been working with 211 Helplink (San Francisco, California) to develop an exchange using the data standard developed by the Alliance of Information and Referral Systems, AIRS XSD 2.07. The data exchange has failed. The University of Nebraska Public Policy Center and the University of Nebraska‐Lincoln Department of Computer Science and Engineering agreed to analyze the exports, determine the failure points, and make recommendations for this and future data exchanges

A Framework for Tracing Social–Ecological Trajectories and Traps in Intensive Agricultural Landscapes

Charting trajectories toward sustainable agricultural development is an important goal at the food–energy–water–ecosystem services (FEWES) nexus of agricultural landscapes. Social–ecological adaptation and transformation are two broad strategies for adjusting and resetting the trajectories of productive FEWES nexuses toward sustainable futures. In some cases, financial incentives, technological innovations, and/or subsidies associated with the short-term optimization of a small number of resources create and strengthen unsustainable feedbacks between social and ecological entities at the FEWES nexus. These feedbacks form the basis of rigidity traps, which impede adaptation and transformation by locking FEWES nexuses into unsustainable trajectories characterized by control, stability, and efficiency, but also an inability to adapt to disturbances or changing conditions. To escape and avoid rigidity traps and enable sustainability-focused adaptation and transformation, a foundational understanding of FEWES nexuses and their unique trajectories and traps is required. We present a framework for tracing trajectories and traps at the FEWES nexuses of intensive agricultural landscapes. Framework implementation in a case study reveals feedbacks characteristic of rigidity traps, as well as opportunities for modifying and dissolving them. Such place-based understanding could inform sustainable agricultural development at the FEWES nexus of intensive agricultural landscapes worldwide

Public Input for City Budgeting Using E-Input, Face-to-Face Discussions, and Random Sample Surveys: The Willingness of an American Community to Increase Taxes

Regular public input into a city\u27s budget is frequently associated with municipal budgeting in Brazilian cities, successes in public engagement that have been emulated around the world. American communities are adopting the practice to varying degrees. This paper will report on a five-year old public input program that is taking place in Lincoln, Nebraska, the capital city of a politically conservative state in the U.S. We discuss the processes we use to engage the public about the City\u27s budget. The process includes regular online input as well as face-to-face, deliberative discussions. On occasions, random sample surveys also have been used. The public\u27s input has been helpful to City Hall in budget prioritization, and has even resulted, pursuant to residents\u27 recommendations, in raising taxes to preserve programs rather than eliminating them to balance the City\u27s budget. In an era of concern that the American public will not endorse tax increases, the recommendation was surprising. Our work to date indicates the public welcomes the invitation to participate in governance and responds positively to the opportunity to provide input and is willing to endorse policy options that have been thought to be unpopular by a majority of Americans

Climate Change Implications for Irrigation and Groundwater in the Republican River Basin, USA

This study investigates the influence of climate change on groundwater availability, and thereby, irrigation across political boundaries within the US High Plains aquifer. A regression model is developed to predict changes in irrigation according to predicted changes in precipitation and temperature from a downscaled dataset of 32 general circulation models (GCMs). Precipitation recharge changes are calculated with precipitation recharge curves developed for prognostic representations of precipitation across the Nebraska-Colorado-Kansas area and within the Republican River Basin focal landscape. Irrigation-recharge changes are scaled with changes in irrigation. The groundwater responses to climate forcings are then simulated under new pumping and recharge rates using a MODFLOW groundwater flow model. Results show that groundwater pumping and recharge both will increase and that the effects of groundwater pumping will overshadow those from natural fluctuations. Groundwater levels will decline more in areas with irrigation-driven decreasing trends in the baseline. The methodologies and predictions of this study can inform long-term water planning and the design of management strategies that help avoid and resolve water-related conflicts, enabling irrigation sustainability