Welfare-to-Work Program Benefits and Costs: A Synthesis of Research

Most welfare programs seek to ensure that poor families have adequate income while at the same time encouraging self-sufficiency. Based on studies of 28 programs involving more than 100,000 sample members, this synthesis compares the costs, benefits, and returns on investment of six welfare program strategies -- from the perspectives of participants, government budgets, and society as a whole

Gaining Ground: Findings From the Dana Center Mathematics Pathways Impact Study

Many college students are required to take at least one developmental math course, but as many as half of them fail to complete their developmental math requirements and never matriculate into college-level courses. To address this issue, the Charles A. Dana Center at the University of Texas at Austin created the Dana Center Mathematics Pathways (DCMP) to help colleges implement math pathways aligned with students’ programs of study in both developmental and college-level courses, accelerate students’ progress to and through college-level math, develop strategies to support students as learners, and integrate evidence-based practices in instruction. The Dana Center also created curricula the colleges used for three course pathways (focused on statistical reasoning, quantitative reasoning, and algebra/calculus). This CAPR study looks at how four Texas community colleges implemented DCMP and how instruction in DCMP courses compares with traditional developmental and college-level math courses. Through a randomized controlled trial involving 1,422 students who entered the study from fall 2015 through spring 2017, the researchers examined the impact of DCMP on student outcomes for up to four semesters. The study also considers student perspectives on the reforms and the start-up and ongoing costs of DCMP to the colleges. Researchers found that the colleges were successful in revising pre-existing policies, curricula, and pedagogy in order to launch and then scale DCMP courses to reach more students. They also found that instruction in DCMP courses looked very different from that in colleges’ standard developmental course offerings and college-level algebra courses. Finally, researchers found that DCMP students enrolled in and passed college-level math at higher rates than non-DCMP students, indicating that DCMP played a part in helping them overcome some of the pitfalls of developmental education and reach a crucial milestone. Key Findings: DCMP had a positive impact on students’ completion of the developmental math sequence and their likelihood of taking and passing college-level math. The impacts of DCMP appear to be greater for part-time students and students assessed as needing multiple developmental courses. Start-up and net ongoing direct costs to the colleges to implement and maintain DCMP were fairly low

“Provide care for everyone please”: Engaging Community Leaders as Sexual and Reproductive Health Advocates in North and South Kivu, Democratic Republic of Congo

Background: Inadequate infrastructure, security threats from ongoing armed conflict, and conservative socio-cultural and gender norms that favour large families and patriarchal power structures contribute to poor sexual and reproductive health (SRH) outcomes in North and South Kivu provinces, Democratic Republic of the Congo (DRC). In order to expand contraceptive and post-abortion care (PAC) access in North and South Kivu, CARE, the International Rescue Committee and Save the Children provided technical support to the Ministry of Health and health facilities in these regions. Partners acknowledged that community leaders, given their power to influence local customs, could play a critical role as agents of change in addressing inequitable gender norms, stigma surrounding SRH service utilization, and topics traditionally considered taboo within Congolese society. As such, partners actively engaged with community leaders through a variety of activities such as community mapping exercises, values clarification and transformation (VCAT) activities, situational analyses, and education. Methods: This manuscript presents findings from 12 key informant interviews (KIIs) with male political and non-political community leaders conducted in six rural health zones of North and South Kivu, DRC. Transcripts were analysed thematically to explore community leaders’ perceptions of their role in addressing the issue of unintended pregnancy in their communities. Results: While community leaders in this study expressed overall positive impressions of contraception and strong support for ensuring access to PAC services following spontaneous and induced abortions, the vast majority held negative beliefs concerning women who had induced abortion. Contrasting with their professed opposition to induced abortion, leaders’ commitment to mediating interpersonal conflict arising between community members and women who had abortions was overwhelming. Conclusion: Results from this study suggest that when thoughtfully engaged by health interventions, community leaders can be empowered to become advocates for SRH. While study participants were strong supporters of contraception and PAC, they expressed negative perceptions of induced abortion. Given the hypothesized link between the presence of induced abortion stigma and care-avoidance behavior, further engagement and values clarification exercises with leaders must be integrated into community mobilization and engagement activities in order to increase PAC utilization

“You must first save her life”: community perceptions towards induced abortion and postabortion care in North and South Kivu, Democratic Republic of the Congo

Structural barriers such as a restrictive legal environment, limited medical resources, and high costs inhibit access to safe abortion in the Democratic Republic of the Congo (DRC); these barriers are exacerbated by two decades of conflict. Socio-normative barriers further complicate access to safe abortion and post-abortion care (PAC) in DRC, where fear of abortion-related stigma may lead women to avoid PAC services. Programme partners support the Ministry of Health to provide good quality contraceptive and PAC services in North and South Kivu, DRC. This paper presents results from focus group discussions that explored community members’ attitudes towards women who induce abortion and their care-seeking behaviour in programme areas. Results indicate that while abortion stigma was widespread, community members’ attitudes towards women who induced abortions were not one-dimensional. Although they initially expressed negative opinions regarding women who induced abortion, beliefs became more nuanced as discussion shifted to the specific situations that could motivate a woman to do so. For example, many considered it understandable that a woman would induce abortion after rape: perhaps unsurprising, given the prevalence of conflict-related sexual violence in this area. While community members believed that fear of stigma or associated negative social consequences dissuaded women from seeking PAC, a majority believed that all women should have access to life-saving PAC. This commitment to ensuring that women who induced abortion have access to PAC, in addition to the professed acceptability of induced abortion in certain situations, indicates that there could be an opening to destigmatise abortion access in this context

A Synthesis of Random Assignment Benefit-Cost Studies of Welfare-to-Work Programs

Over the past two decades, federal and state policymakers have dramatically reshaped the nations system of cash welfare assistance for low-income families. During this period, there has been considerable variation from state to state in approaches to welfare reform, which are often collectively referred to as welfare-to-work programs. This article synthesizes an extraordinary body of evidence: results from 28 benefit-cost studies of welfare-to-work programs based on random assignment evaluation designs. Each of the 28 programs can be viewed as a test of one of six types of welfare reform approaches: mandatory work experience programs, mandatory job-search-first programs, mandatory education-first programs, mandatory mixed-initial-activity programs, earnings supplement programs, and time-limit-mix programs. After describing how benefit-cost studies of welfare-to-work programs are conducted and considering some limitations of these studies, the synthesis addresses such questions as: Which welfare reform program approaches yield a positive return on investments made, from the perspective of program participants and from the perspective of government budgets, and the perspective of society as a whole? Which approaches make program participants better off financially? In which approaches do benefits exceed costs from the governments point of view? The last two of these questions coincide with the trade-off between reducing dependency on government benefits and ensuring adequate incomes for low-income families. Because the benefit-cost studies examined program effects from the distinct perspectives of government budgets and participants incomes separately, they address this trade-off directly. The article thus uses benefit-cost findings to aid in assessing the often complex trade-offs associated with balancing the desire to ensure the poor of adequate incomes and yet encourage self-sufficiency.

Billing at the Milwaukee Health Department Clinics: An Analysis of Potential Revenue Gains

For PA 869: Public Affairs Workshop, Domestic IssuesThe Milwaukee Health Department operates six health clinics to provide services to uninsured and underinsured residents. This paper looks at ways by which the department could increase clinic revenue. At the time of the report, the department only billed Medicaid HMOs. The authors recommend that the health department make changes to its billing process, bill Medicaid for sexually transmitted disease tests and treatments, increase monitoring of the clinics, and investigate billing private insurance companies

Concomitant bacteraemia as a risk factor for diarrhoeal disease mortality in Karachi: a case-control study of hospitalized children

The objective of this study was to evaluate risk factors for death due to diarrhoea among hospitalized children at the Aga Khan University Hospital (AKUH), Karachi. We conducted a retrospective case-control study of all diarrhoea deaths at AKUH over the period 1988-93. For each death, the next two consecutive admissions matched for gender and type of diarrhoea were identified as controls. Data were analysed by univariate methods and logistic regression analysis. A total of 42 deaths and 84 matched controls were identified. Blood cultures at admission were obtained in all deaths and 94% of controls. The rates of isolation of organisms from blood cultures were significantly higher among deaths [38 versus 9%, odds ratio (OR) 6.5, 95% confidence interval (CI) 2.2-19.9], the majority of which were Gram-negative Enterobacteriaceae (94 versus 57%, Fisher\u27s exact test p \u3c 0.02). Conditional logistic regression revealed that several clinical and laboratory features of systemic infection were associated with a significantly increased risk of mortality, such as anorexia (OR 3.9, 95% CI 1.4-10.9), drowsiness (OR 4.4, 95% CI 1.3-15.3), respiratory distress (OR 7.0, 95% CI 1.4 36.6), anaemia (OR 5.8, 95% CI 2.0-16.6) and a positive blood culture (OR 8.7, 95% CI 2.5-30.7). Our data suggest that bacteraemia with Enterobacteriaceae is common among hospitalized malnourished children with diarrhoea and systemic infection may be an important risk factor for mortality