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North Carolina's Smart Start and More at Four (MAF) early childhood programs were evaluated through the end of elementary school (age 11) by estimating the impact of state funding allocations to programs in each of 100 counties across 13 consecutive years on outcomes for all children in each county-year group (n = 1,004,571; 49% female; 61% non-Latinx White, 30% African American, 4% Latinx, 5% other). Student-level regression models with county and year fixed effects indicated significant positive impacts of each program on reading and math test scores and reductions in special education and grade retention in each grade. Effect sizes grew or held steady across years. Positive effects held for both high- and low-poverty families, suggesting spillover of effects to nonparticipating peers.

Theory suggests that policy benefits delivered directly by government are most likely to affect the voting behavior of beneficiaries. Nearly every empirical study, however, analyzes a policy or program that meets this criterion. To address this limitation, I compare the electoral impacts of two New Deal-era employment programs—the Works Progress Administration (WPA) and the Public Works Administration (PWA)—which differed primarily in their traceability to government. Though both programs provided employment, the WPA directly hired and paid employees. In contrast, the PWA subsidized private sector employment. Across two datasets, I find that the WPA increased support for the enacting Democratic Party. As expected, however, the PWA had no discernible causal effect on voting patterns. These results offer the strongest evidence to date that whether policy beneficiaries can easily see government as responsible for their benefits shapes the development of mass policy feedback effects.

The North Carolina Regional Abuse and Medical Specialist (RAMS) program is the first proactive supervisory consultation program prioritizing child safety and improved interdisciplinary communication. This study describes the program and staff experiences. From July 1, 2023, to June 30, 2024, RAMS completed 930 consultations primarily involving young children, injuries, and reports from medical professionals. Staff increased their knowledge of child abuse evaluations and collaborating with medical professionals, despite challenges like county inconsistencies and concern for state oversight, showing promise as a state-level case consultation program.

Classroom teaching led to more professional success and personal satisfaction than working within the constraints of district rules, which she didn't believe benefited the students she taught. [...]another mentee, who also left the classroom to become a county-level leader, discovered that leading was more challenging than she had anticipated. Each school had its own \"rules\" that had to be considered when developing events and programs to support the county guidelines.

Population-based efforts to prevent child abuse and neglect are challenging because annual incidence rates are relatively low. Even among families that meet eligibility and risk criteria for intensive home-visiting programs, the baseline rate of maltreatment tends to be low because we use simple criteria. This creates both service (i.e., cost) and evaluation (i.e., power) challenges because a large number of families need to receive the preventive intervention to produce detectable changes in subsequent maltreatment. The increase in the availability of administrative data has made it possible to use predictive risk models (PRMs) to risk-stratify whole birth cohorts and identify children at the highest risk of maltreatment and other early childhood adversities. The current paper describes the development and validation of a PRM implemented in Allegheny County, Pennsylvania, to stratify families and newborn infants into three levels of prioritized services based on the predicted risk of child removal due to maltreatment by age 3. Using a research dataset of anonymized records for children born in Allegheny County between 2012 and 2015, predictive features were coded using data available in the county’s administrative data systems. This spine was linked to child removal outcomes between 2012 and 2018, so we had a 3-year follow-up for each child. A PRM was trained to predict removals in the first 3 years of life using the least absolute shrinkage and selection operator. Predictive accuracy was measured for the highest 5% of risk scores in a holdout dataset. The model was validated using nontraining outcomes such as maternal mortality, infant mortality, and maltreatment-related fatalities and near-fatalities. The model achieved an area under the receiver operating characteristic curve of .93 (95% CI [0.92, 0.95]), recall of 19.93%, and precision of 54.10%. Children identified for the top tier of services had a relative risk ratio of maltreatment-related fatality or near-fatality of 5.54 (95% CI [3.41, 9.00]). Using alternative eligibility approaches (e.g., poverty, teen maternal age) proved far inferior to using PRM in targeting services for children at high baseline risk of maltreatment.

Child maltreatment is a pervasive public health problem with well-documented impacts on a child's well-being. The connection between social , determinants , of health and child maltreatment is well established, particularly economic stability and mobility, education, and health care. Prevention and aftercare networks (P&A) use a community-based approach to offer volun tary services to address social determinants of health through collaborative approaches to supporting and strengthening families in their communities. The three core strategies of P&A are to provide economic opportunities and support self-sufficiency, decrease social isolation, and increase access to a broad range of existing community-based resources, supports, and services. The current study leveraged administrative child protection system (CPS) records and P&A program data from Los Angeles County to document the relationship between P&A referrals and CPS involvement following service engagement among families with screened-out CPS reports between January 1, 2016, and December 31, 2019 (N = 52,353). Overall, 6,895 (13.2%) families were referred for P&A services and 748 (1.4%) successfully completed P&A services. Weighted Cox analyses showed families who completed P&A services were less likely to enter foster care compared to families never referred to P&A services (HR = 0.51; 95% CI = 0.33, 0.78). Results suggest that offering voluntary, community-based services may prevent out-of-home placement, especially if families engage in and successfully complete services.

Background This study aims to analyze the demand and supply of these professionals within healthcare institutions at the county level after the Chinese government launched a three-year vocational education program of preventive medicine in 2016. Methods A national cross-sectional design and multistage cluster sampling method were employed for this study. At the county level, a total of 132 Centers for Disease Control and Prevention (CDCs), 346 medical institutions, 20 medical colleges and 1,083 graduate students were selected. Self-designed questionnaires were used to assess the demand and supply of these professionals. Descriptive statistics were applied to describe key data features. Results The county-level CDCs and medical institutions required an average annual total of 15,007 preventive medicine professionals. However, vocational colleges have only enrolled 2,025 of these students per year. Moreover, approximately two-thirds of the provinces continued to face significant demand for preventive medicine professionals, Additionally, medical institutions prioritized clinical skills while the CDCs emphasized preventive expertise as essential qualities for preventive medicine professionals. The requirement for personal qualities were consistently of the utmost importance in healthcare institutions. Furthermore, the self-assessments conducted among graduate students in medical institutions have revealed a relative insufficiency of their professional skills. Conclusions There was a general shortage of professionals in vocational preventive medicine education in China; however, certain provinces exhibited a surplus supply relative to demand, and prospective graduates primarily secure employment within medical institutions. The enhancement and refinement of professional skills are imperative in order to align with the specific demands of the preventive medicine position.

Local-level immigration enforcement generates fear and reduces social service use among Hispanic immigrant families but the health impacts are largely unknown. We examine the consequence of 287(g), the foundational enforcement program, for one critical risk factor of child health—food insecurity. We analyze nationally representative data on households with children from pooled cross-sections of the Current Population Survey Food Supplemental Survey. We identify the influence of 287(g) on food insecurity pre-post-policy accounting for metro-area and year fixed-effects. We find that 287 (g) is associated with a 10 percentage point increase in the food insecurity risk of Mexican non-citizen households with children, the group most vulnerable to 287 (g). We find no evidence of spillover effects on the broader Hispanic community. Our results suggest that local immigration enforcement policies have unintended consequences. Although 287(g) has ended, other federal-local immigration enforcement partnerships persist, which makes these findings highly policy relevant.

Gatekeeper training for suicide prevention was evaluated on a college campus to examine the impact of training on gatekeeper enactment of behaviors in support of suicide prevention and identify predictors of enactment of gatekeeper behaviors. Trained gatekeepers ( N  = 216) displayed greater perceived knowledge and self-efficacy for suicide prevention and reported higher rates of self-reported actual gatekeeper behaviors, including inquiring about suicidal ideation and referring for mental health treatment when they encountered someone in distress, compared to their untrained counterparts ( N  = 169). Consistent with the Theory of Planned Behavior, SEM results indicated that attitudes, self-efficacy, and perceived knowledge explained intentions to engage in gatekeeper behaviors, accounting for 59% of the variance in intentions to inquire about suicidal ideation and supporting the role of attitudes and perceived behavioral control in intentions to act. These intentions explained self-reported actual gatekeeper behaviors among participants who encountered someone in distress, with each one-point increase in intention associated with nearly twice the likelihood of both inquiring about suicidal ideation and referring someone for mental health care. On the other hand, self-reported situational barriers were associated with a decreased likelihood of referral behavior, indicating the role of actual behavioral control over volitional actions. Findings support the value of gatekeeper training for promoting factors that influence the likelihood of action on behalf of suicide prevention.