Examining the impact of Medicaid payments for immediate postpartum long-acting reversible contraception on the mental health of low-income mothers.

OBJECTIVE: To examine the effect of Medicaid immediate postpartum long-acting reversible contraception (IPP LARC) reforms on self-reported mental health among low-income mothers aged 18-44 years. DATA SOURCES AND STUDY SETTING: We used national secondary data on self-reported mental health status in the past 30 days from the core component (2014-2019) of the Behavioral Risk Factor Surveillance System (BRFSS). STUDY DESIGN: We estimated linear probability models for reporting any days of not good mental health in the past 30 days. We adjusted for individual-level factors, state-level factors, and state and year fixed effects. Our primary independent variable was an indicator for IPP LARC payment reform. We examined the effect of the Medicaid payment reforms on self-reported mental health status in the past 30 days using difference-in-differences and event-study designs. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: State adoption of Medicaid IPP LARC reforms was associated with significant reductions (between 5.7% and 11.5%) in the predicted probability of reporting any days of not good mental health among low-income mothers. Treatment effects appeared to be driven by respondents reporting two or more children (less than 18 years of age) in the household (ATT = -0.028, p = 0.04). Results are robust to a series of sensitivity tests and alternative estimation strategies. CONCLUSIONS: Our findings suggest that contemporary efforts to improve access to contraceptive methods may have important benefits beyond reproductive autonomy. These findings have implications for policymakers as the landscape related to family planning services continues to shift.

State-level education policies: Opportunities for secondary prevention of child maltreatment.

BACKGROUND: Exposure to child maltreatment creates risk for adverse social, health, and economic outcomes across generations. The socioecological model posits the well-being of individuals, including children and youth, is shaped by the larger systems they exist in. Employing state-level policies to position school settings to effectively identify and intervene in instances of child maltreatment is an important secondary prevention opportunity. OBJECTIVE: This study examines the relationship between state-level policies that call for school based trainings to promote the recognition of and response to child maltreatment, and states' annual rates of substantiated child maltreatment reports. METHODS: Relevant policies were identified and abstracted to generate measures of policy presence and comprehensiveness. The National Child Abuse and Neglect Data System was used to derive rates of substantiated child maltreatment reports by state and year. Child maltreatment rates were the dependent variable and policy measures were the primary explanatory variables in a difference-in-differences (DD) model series with state-level clustering and year-fixed effects. RESULTS: The DD model series suggest significant, positive relationships between the presence of policies calling for school-based recognition and response training and child abuse (IRR 1.140, p = 0.04) as well as child physical abuse outcomes (IRR 1.150, p = 0.05). Sensitivity analyses suggest the relationships between policy presence and abuse outcomes were stronger for children than for adolescents. CONCLUSION: These findings suggest that related policies may be effective secondary prevention tools for child maltreatment.

The "Boyfriend Loophole" and Intimate Partner Homicides: A Longitudinal Analysis Using the National Violent Death Reporting System.

Intimate partner homicides (IPHs) often occur in the context of violent relationships, and firearms often facilitate lethal outcomes. Accordingly, policies have been implemented to reduce firearm access among individuals with histories of intimate partner violence (IPV) or violent propensities. There is considerable variation, however, in the enactment and implementation of such state-level firearm protection laws. Some states fail to extend IPV-related firearm related protections to dating partners, creating what has been referred to elsewhere as the "boyfriend loophole", or what will be referred to here as the "partner loophole". The goal of this analysis was to examine trends in National Violent Death Reporting System (NVDRS) data to assess the relationship of IPHs among unmarried victims in association with state partner loopholes. State policies were abstracted to identify partner loopholes. A series of negative binomial generalized estimating equations were performed using lagged policy variables, year fixed-effects, robust standard errors, and errors clustered by state. Model findings suggest that increased firearm access is related to higher rates of unmarried IPH victimization, however, the associations between the presence of a partner loophole and IPH rates amongst unmarried victims varied between racial subgroups. Significant, protective relationships with closed partner loopholes were identified for the IPH rates amongst white unmarried victims, however, not amongst victims of color. The partner loophole policies considered here, and other individual IPV-related and/or firearm-related policies may be an important component of protections, however, our findings suggest they are not independently sufficient to equitably reduce the burden of IPH. Continuing to develop public health and policy evaluation literature will be essential to progressing towards a policy landscape and cultural environment that are equitably protective.

United States' teen dating violence policies: summary of policy element variation.

As teen dating violence (TDV) has gained attention as a public health concern across the United States (US), many efforts to mitigate TDV appear as policies in the 50 states in the form of for programming in K-12 schools. A keyword search identified 61 state-level school-based TDV policies. We developed an abstraction form to conduct a content analysis of these policies and generated descriptive statistics and graphic summaries. Thirty of the policies were original and 31 were additions or revisions of policies enacted by 17 of the 30 states previously. Of a possible score of 63, the minimum, mean, median, and maximum scores of currently active policies were 3.0, 17.7, 18.3, and 33.8, respectively. Results revealed considerable state-to-state variation in the presence and composition of school-based TDV policies. Opportunity for improving policies was universal, even among those with most favorably scores.

Medicaid managed care in Iowa: Experiences of older adults and people with disabilities.

BACKGROUND: A growing number of states are turning to managed care arrangements to provide care to senior and disabled Medicaid beneficiaries. Despite their complex care needs, very little is known about the experience of these individuals in managed care. OBJECTIVE: To document experiences of a sample of aged and disabled Medicaid beneficiaries receiving long-term services and supports through managed care in Iowa and to assess whether these experiences changed over time. METHODS: A purposive sample of 49 aged and disabled beneficiaries enrolled in one of seven HCBS waivers in Iowa was recruited in 2017. Telephone surveys were conducted in 2017 and 2019. A conventional content analysis was used to generate themes, which were then ranked by frequency proportions. Thematic frequencies were compared across waves among repeat respondents. RESULTS: Content analysis yielded seven themes in the following areas: system navigation; service approvals; provider relations; customer service; case management; perception of Iowa's transition to managed care; and oversight. Concerns with service approvals was the most frequently reported theme and within this, issues related to changes in approved services or hours and quality of newly approved services comprised the largest number of references. Beneficiary concerns appeared to grow over time among respondents participating in both survey interview waves. CONCLUSION: The results of this study point to serious and persistent concerns related to access and quality of care under managed care for at least some HCBS waiver participants in Iowa, underscoring the need for a comprehensive evaluation of the program.

COVID-19-related violence trend data challenges & a resource for injury researchers.

Published works have raised concerns that certain violent behaviors and firearm acquisition have encountered dramatic increases since the onset of COVID-19. While these works provide important preliminary insights, they lack the empirical robustness necessary to inform a targeted societal response. Having the ability to perform the research needed to support evidence-based policy requires that data at national, state and local-levels be accessible and of sufficient quality. While related, robust data sources do arguably exist, their availability may come long after the window for effective prevention and intervention efforts has closed or may otherwise present with quality limitations, leaving populations at risk for various forms of violence without the support of protective policies.The University of Iowa Injury Prevention Research Center and the Public Policy Center has compiled a compendium of secondary data sources in an effort to promote exploration of relationships between the COVID-19 pandemic and rates of injury and violence. The forms of violence and firearm-related behavior that were identified as being at risk for amplification given the social stress, economic stress and isolation associated with the public health emergency period included: firearm acquisition, firearm violence, intimate partner violence and family violence.

Two-generational trauma-informed assessment improves documentation and service referral frequency in a child protection program.

BACKGROUND: Two-generational trauma-informed assessment (TIA) helps providers conduct holistic family well-being assessment (FWbA). This tool makes it possible to use families' trauma history in the case-finding process. OBJECTIVE: This study compares the documentation and frequency of adverse childhood experiences (ACEs) and service referral rates for index children and their caretakers in two groups of families evaluated in a child abuse clinic (CAC). PARTICIPANTS AND SETTING: The sample consisted of 364 children stratified into two groups: Group 1 - children seen in the CAC after implementation of FWbA in years 2014, 2015, 2016 and Group 2 - children seen in the CAC prior to implementation of FWbA in years 2011, 2012, 2013. METHODS: Researchers utilized retrospective chart review method and analyzed data regarding ACEs and service referrals for patients and their caregivers. RESULTS: Documentation of ACEs was higher in Group 1 for children (77.7 % vs 26.6 %,p <  0.0001) and caretakers (60.7 % vs 7.3 % p <  0.0001). Caretakers in Group 1 had a higher rate of four or more ACEs (47.0 % vs 5.1 % p <  0.001) while the increase for children was not statistically significant (61.4 % vs 51.1 %, p =  0.110). Both children and caretakers were referred to more services in Group 1 (2.7 + 1.5 vs 1.5 + 1.3, and 3.0 + 1.9 vs 1.2 + 1.2, respectively, p <  0.0001). CONCLUSIONS: In families evaluated for child abuse and neglect, conducting TIA in addition to conventional psychosocial evaluation increased documentation regarding trauma history, which led to increased referral rates.