Housing & Community Development

Efforts to Improve Public Policy and Programs Through Improved "Data Practice": Experiences in Fifteen Distressed American Cities"

Efforts to Improve Public Policy and Programs Through Improved "Data Practice": Experiences in Fifteen Distressed American Cities"
Public Administration Review Vol. 66 No. 3

Weitzman, B.C., Silver, D. & Brazill, C.
01/01/2006

Philanthropies and government agencies interested in children's issues are encouraging localities to improve the process of collecting, linking, and sharing microdata and aggregated summary statistics. An implicit assumption of these efforts is that outcomes will improve as a result of the new approaches. However, there has been little systematic study of these efforts. In this article, we examine efforts to improve data practice in 15 distressed American cities. Interviews conducted in these cities revealed variation in the types of information collected, dissemination, and intended audiences. We identify significant challenges to these efforts, including adequate resources, turf battles, technical problems, access to information sources, inconsistent leadership, and absence of political will. We find that little is known about the impact of these initiatives on decision making. Assumptions that improved data practice will lead to improved policy making have not yet been realized in these cities.

Financing Pro-poor Governance in Africa

Financing Pro-poor Governance in Africa
in Karen Millet, Dele Olowu and Robert Cameron (eds), Local Governance and Poverty Reduction in Africa (Tunis: Joint Africa Institute of the African Development Bank)

Smoke, P.
01/01/2006

Defines key lessons on financing pro-poor governance based on cases from Latin America, Asia and Africa (Colombia, Indonesia, Kenya and Uganda). The starting point for pro-poor fiscal decentralisation is that its major goals should be improved governance and performance, specifically, higher efficiency and equity in service delivery, economic development, and poverty alleviation. The enabling environment for fiscal decentralisation involves first the functions and the resources that might normally be allocated to local governments. Second, it can include alternative models and mechanisms to finance local governments, including intergovernmental transfers, markets, capital and donor financing.

Fostering Organizational Change Through a Community-Based Initiative

Fostering Organizational Change Through a Community-Based Initiative
Health Promotion Practice 2006; 7:1-10.

Kaplan S.A., Calman N.S., Golub M., Ruddock C. & Billings J.
01/01/2006

Program funders and managers are increasingly interested in fostering changes in the policies, practices, and procedures of organizations participating in community-based initiatives. But little is know about what factors contribute to the institutionalization of change. In this study, we assess whether the organizational members of the Bronx Health REACH Coalition have begun to change their functioning and role with regard to their clients, their staff, and in the broader community, apart from their implementation of the funded programs for which they are responsible. The study identifies factors that seemed to contribute to or hinder such institutional change, and suggests several strategies for coalitions and funders that are seeking to promote and sustain organizational change.

Racial and Ethnic Disparities in Health: A View from the South Bronx

Racial and Ethnic Disparities in Health: A View from the South Bronx
Journal of Health Care for the Poor and Underserved 2006; 17:116-127.

Kaplan S.A., Calman N.S., Golub M., Davis J.H. & Billings J.
01/01/2006

This study seeks to understand the perspective of Black and Hispanic/Latino residents of the South Bronx, New York, on the causes of persistent racial and ethnic disparities in health outcomes. In particular, it focuses on how people who live in this community perceive and interact with the health care system. Findings from 9 focus groups with 110 participants revealed a deep and pervasive distrust of the health care system and a sense of being disrespected, exacerbated by difficulties that patients experience in communicating with their providers. The paper suggests how health care institutions might respond to these perceptions.

Separate and Unequal Care in New York City

Separate and Unequal Care in New York City
Journal of Health Care Law & Policy, Vol. 9, Number 1. 

Calman, N.S., Golub, M., Ruddock, C., Le, L. & Kaplan, S.A.
01/01/2006

Bronx Health REACH, a coalition of community- and faith-based groups, health care providers, and an academic institution, recently examined the causes of racial and ethnic health disparities in the southwest Bronx and identified separate systems of care for uninsured and publicly insured patients, who are predominantly people of color, and those with private insurance. We found evidence that patients are sorted into segregated pathways of care, a system of medical apartheid in which differential care contributes to disparities in health care and health outcomes.

The Role of Faith-Based Institutions in Providing Health Education and Promoting Equal Access to Care: A Case Study of an Initiative in the Southwest Bronx

The Role of Faith-Based Institutions in Providing Health Education and Promoting Equal Access to Care: A Case Study of an Initiative in the Southwest Bronx
Journal of Health Care for the Poor and Underserved 2006; 17.2: 9-19.

Kaplan S.A., Calman, N.S., Golub M., Davis J.H. & Billings, J.
01/01/2006

Although many public health initiatives have been implemented through collaborations with faith-based institutions, little is known about best practices for developing such programs. Using a community-based participatory approach, this case study examines the implementation of an initiative in the Bronx, New York, that is designed to educate community members about health promotion and disease management and to mobilize church members to seek equal access to health care services. The study used qualitative methods, including the collaborative development of a logic model for the initiative, focus groups, interviews, analysis of program reports, and participant observation. The paper examines three key aspects of the initiative’s implementation: (1) the engagement of the church leadership; (2) the use of church structures as venues for education and intervention; and (3) changes in church policies. Key findings include the importance of pre-existing relationships within the community and the prominent agenda-setting role played by key pastors, and the strength of the Coalition’s dual focus on health behaviors and health disparities. Given the churches’ demonstrated ability to pull people together, to motivate and to inspire, there is great potential for faith-based interventions, and models developed through such interventions, to address health disparities.

The Tides of Reform Revisited: Making Government Word, 1945-2002

The Tides of Reform Revisited: Making Government Word, 1945-2002
Public Administration Review 2006, Vol. 66, No. 1, pp. 6-19.

Light, P.C.
01/01/2006

The past six decades have witnessed acceleration in both the number and variety of major administrative reform statutes enacted by Congress. This increase can be explained partly by the increased involvement of Congress, a parallel decrease in activity and resistance by the presidency, and heightened public distrust toward government. At least part of the variation in the tides or philosophies of reform involves a "field of dreams" effect in which the creation of new governmental structure during the 1940s, 1950s, and 1960s generated increased interest in process reforms. However, part of the acceleration and variety of reform appears to be related to the lack of hard evidence of what actually works in improving government performance. Measured by federal employees' perceptions of organizational performance, what matters most is not whether organizations were reformed in the past, but whether organizations need reform in the future and can provide essential resources for achieving their mission.

Multiple Pathways to Community Level Impacts in HIV Prevention: Implications for Conceptualization, Implementation, and Evaluation of Interventions

Multiple Pathways to Community Level Impacts in HIV Prevention: Implications for Conceptualization, Implementation, and Evaluation of Interventions
In E.J. Trickett & W. Pequegnat (Eds.), Community Interventions and AIDS. New York: Oxford University Press,

Yoshikawa, H., Wilson, P.A., Shinn, M. & Peterson, J.L.
09/01/2005

Interventions with individuals who are at risk for HIV/AIDS have been shown to have a positive short-term impact. This book provides an overarching framework based on an ecological approach for designing and implementing HIV/AIDS intervention with longer-term, community impact. It explains the basic aspects of this ecological perspective and provides examples of how it works. It is specifically concerned with the question of the degree to which individuals behavior change can be sustained and whether interventions adequately respond to environmental risk factors.

Multiple Pathways to Community-Level Impacts in HIV Prevention: Implications for Conceptualization, Implementation, and Evaluation of Interventions

Multiple Pathways to Community-Level Impacts in HIV Prevention: Implications for Conceptualization, Implementation, and Evaluation of Interventions
In E. J. Trickett & W. Pequegnat (Eds.) Community Interventions and AIDS (pp. 28-55). New York: Oxford University Press,

Yoshikawa, H., Wilson, P.A., Peterson, J. L. & Shinn, M.
09/01/2005

Interventions with individuals who are at risk for HIV/AIDS have been shown to have a positive short-term impact. This book provides an overarching framework based on an ecological approach for designing and implementing HIV/AIDS intervention with longer-term, community impact. It explains the basic aspects of this ecological perspective and provides examples of how it works. It is specifically concerned with the question of the degree to which individuals behavior change can be sustained and whether interventions adequately respond to environmental risk factors.

The Impact of Medicaid Managed Care on Primary Care Physician Participation in Medicaid

The Impact of Medicaid Managed Care on Primary Care Physician Participation in Medicaid
Medical Care, Vol. 43, No. 9, pp 911-920, September

Greene, J., Blustein, J. & Remler, D.
09/01/2005

Objectives: Medicaid managed care has been touted as an important vehicle for increasing physician participation in Medicaid. Although there is anecdotal evidence that the opportunity to participate in Medicaid via managed care increases physician participation, no empirical study has validated the claim. This study explores the relationship between Medicaid managed care penetration at the county-level and the likelihood that a physician practicing in that county will participate in Medicaid.

Research Design: We used 3 waves of a large, nationally representative sample of primary care physicians from the Community Tracking Study followed across time (1996-2001) to estimate the impact of changing Medicaid managed care penetration levels on physician participation in the program. County-level Medicaid managed care penetration rates were collected directly from state Medicaid agencies for the study.

Findings: In cross-sectional bivariate and multivariate analyses, Medicaid managed care penetration is significantly associated with physician participation in Medicaid; however, the relationship is nonmonotonic, of small magnitude and generally not in the anticipated direction. Our analyses indicate that a 10 percentage point increase in managed care penetration would reduce the likelihood that physicians participate in Medicaid on average by 2.9 percentage points. Although commercial MCO penetration exhibited a small positive, linear relationship with physician participation, this was not sufficient to offset the effects of Medicaid-dominant MCO penetration. Panel data analysis supported these findings.

Conclusions: This study failed to find that increases in Medicaid managed care lead to increased primary care physician participation in Medicaid during the period 1996-2001.

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