Assessing the Deployment of Home Visiting: Learning from a State-Wide Survey of Home Visiting Programs.

OBJECTIVES: Large-scale planning for health and human services programming is required to inform effective public policy as well as deliver services to meet community needs. The present study demonstrates the value of collecting data directly from deliverers of home visiting programs across a state. This study was conducted in response to the Patient Protection and Affordable Care Act, which requires states to conduct a needs assessment of home visiting programs for pregnant women and young children to receive federal funding. In this paper, we provide a descriptive analysis of a needs assessment of home visiting programs in Ohio. METHODS: All programs in the state that met the federal definition of home visiting were included in this study. Program staff completed a web-based survey with open- and close-ended questions covering program management, content, goals, and characteristics of the families served. RESULTS: Consistent with the research literature, program representatives reported great diversity with regard to program management, reach, eligibility, goals, content, and services delivered, yet consistently conveyed great need for home visiting services across the state. CONCLUSIONS: Results demonstrate quantitative and qualitative assessments of need have direct implications for public policy. Given the lack of consistency highlighted in Ohio, other states are encouraged to conduct a similar needs assessment to facilitate cross-program and cross-state comparisons. Data could be used to outline a capacity-building and technical assistance agenda to ensure states can effectively meet the need for home visiting in their state.

Taking it to scale: evaluating the scope and reach of a community-wide initiative on early childhood.

In implementing broad community initiatives, the ability to assess the delivery of services is a distinct challenge. Yet, understanding both the magnitude and cross-usage of services by target populations is often a precursor to effective program evaluation, program improvement and additional program planning. This research examines the extent to which a comprehensive early childhood initiative successfully reached young children and their families in a large urban county. By linking birth records and administrative datasets at the level of the individual child, the study tracks the experiences of children in respect to engagement in program services and their receipt of public benefits. The study shows both the rapid growth in programs and the reach of the program elements to the majority of newborns in the target county after 5.5 years. The research highlights the challenges of effectively using individual-level data from a variety of sources for the purposes of documenting program receipt by participants.

Dying for work: The magnitude of US mortality from selected causes of death associated with occupation.

BACKGROUND: Deaths due to occupational disease and injury place a heavy burden on society in terms of economic costs and human suffering. METHODS: We estimate the annual deaths due to selected diseases for which an occupational association is reasonably well established and quantifiable, by calculation of attributable fractions (AFs), with full documentation; the deaths due to occupational injury are then added to derive an estimated number of annual deaths due to occupation. RESULTS: Using 1997 US mortality data, the estimated annual burden of occupational disease mortality resulting from selected respiratory diseases, cancers, cardiovascular disease, chronic renal failure, and hepatitis is 49,000, with a range from 26,000 to 72,000. The Bureau of Labor Statistics estimates there are about 6,200 work-related injury deaths annually. Adding disease and injury data, we estimate that there are a total of 55,200 US deaths annually resulting from occupational disease or injury (range 32,200-78,200). CONCLUSIONS: Our estimate is in the range reported by previous investigators, although we have restricted ourselves more than others to only those diseases with well-established occupational etiology, biasing our estimates conservatively. The underlying assumptions and data used to generate the estimates are well documented, so our estimates may be updated as new data emerges on occupational risks and exposed populations, providing an advantage over previous studies. We estimate that occupational deaths are the 8th leading cause of death in the US, after diabetes (64,751) but ahead of suicide (30,575), and greater than the annual number of motor vehicle deaths per year (43,501).

Proportionate mortality of crop and livestock farmers in the United States, 1984-1993.

BACKGROUND: Livestock farmers are more likely to be exposed to a variety of different farming hazards than crop farmers. An analysis of occupation and industry-coded U.S. death certificate data from 26 states for the years 1984-1993 was conducted to evaluate mortality patterns among crop and livestock farmers. METHODS: Cause-specific proportionate mortality ratios (PMRs) were calculated using a National Institute for Occupational Safety and Health (NIOSH) computer program designed to calculate sex and race specific PMRs for occupations and industries in population-based data. RESULTS: Among white male (WM) livestock farmers, there was a significantly higher mortality from cancer of the pancreas, prostate and brain, non-Hodgkin's lymphoma (NHL), multiple myeloma, acute and chronic lymphoid leukemia, and Parkinson's disease. WM crop farmers showed significantly higher mortality risk for cancer of the lip, skin, multiple myeloma, and chronic lymphoid leukemia. CONCLUSIONS: These disease trends suggested that livestock farmers might be exposed to more carcinogens or agricultural chemicals than crop farmers.

Simple Solutions: Ergonomics for Farm Workers

A educative document from the U.S. Department for Health and Human Services. It describes early intervention practices to reduce and prevent injuries in farm industry. The document offers simple practical solutions to common farm injuries. The ideas introduced can me adapted to many farming situations. Document in PDF format; Acrobat Reader required.