Measuring the Effects of a Demonstration to Reduce Childhood Food Insecurity: A Randomized Controlled Trial of the Nevada Healthy, Hunger Free Kids Project.

BACKGROUND: To reduce childhood hunger, the US Department of Agriculture funded a set of demonstration projects, including the Nevada Healthy, Hunger-Free Kids (HHFK) project. OBJECTIVE: The study objective was to test whether the Nevada HHFK project reduced child food insecurity (FI-C) among low-income households with young children. DESIGN: Households were randomly assigned to treatment and control groups, with outcomes measured using household surveys and administrative data. Survey data were collected at baseline (n=3,088) and follow-up (n=2,074) 8 to 12 months into the project. PARTICIPANTS/SETTING: Eligible households in Las Vegas, NV, had children under age 5 years, received Supplemental Nutrition Assistance Program (SNAP) benefits, and had incomes below 75% of the federal poverty level. INTERVENTION: Between June 2016 and May 2017, treatment households on SNAP received an additional $40 in monthly SNAP benefits per child under age 5 years. MAIN OUTCOME MEASURES: Key outcomes included FI-C (primary), food security among adults and households, and food expenditures (secondary). STATISTICAL ANALYSES PERFORMED: Differences between the treatment and control groups were estimated by a logistic regression model and controlling for baseline characteristics. Analyses were also performed on socioeconomic subgroups. RESULTS: The Nevada HHFK project did not reduce FI-C (treatment=31.2%, control=30.6%; P=0.620), very low food security among children (P=0.915), or food insecurity among adults (P=0.925). The project increased households' monthly food expenditures (including SNAP and out-of-pocket food purchases) by $23 (P<0.001). CONCLUSIONS: A demonstration project to reduce FI-C by increasing SNAP benefits to Las Vegas households with young children and very low income did not reduce FI-C or other food-insecurity measures. This finding runs counter to prior research showing that SNAP and similar forms of food assistance have reduced food insecurity. This project was implemented during a period of substantial economic growth in Las Vegas. Future research should explore the role of the economic context, children's ages, and household income in determining how increases in SNAP benefits affect food insecurity. CLINICALTRIALS. GOV IDENTIFIER: NCT04253743 (http://www.clinicaltrials.gov) FUNDING/SUPPORT: This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

A Cluster Randomized Controlled Trial of a Home-Delivered Food Box on Food Security in Chickasaw Nation.

BACKGROUND: The 2010 Child Nutrition reauthorization called for the independent evaluation of innovative strategies to reduce the risk of childhood hunger or improve the food security status of households with children. OBJECTIVE: The research question was whether the Packed Promise intervention reduces child food insecurity (FI-C) among low-income households with children. DESIGN: This study was a cluster randomized controlled trial of 40 school districts and 4,750 eligible, consented households within treatment and control schools. PARTICIPANTS/SETTING: Data were collected at baseline (n = 2,859) and 2 follow-ups (n = 2,852; n = 2,790) from households with children eligible for free school meals in participating schools in 12 rural counties within the Chickasaw Nation territory in south central Oklahoma in 2016 to 2018. INTERVENTION: Each month of the 25-month intervention, for each eligible child, enrolled households could choose from 5 types of food boxes that contained shelf-stable, nutritious foods ($38 food value) and a $15 check for purchasing fruits and vegetables. MAIN OUTCOME MEASURES: The primary outcome was FI-C. Other outcomes included household and adult food security, very low food security among children, and food expenditures. STATISTICAL ANALYSES PERFORMED: Differences between the treatment and control groups were estimated by a regression model controlling for baseline characteristics. RESULTS: The Packed Promise project did not significantly reduce FI-C at 12 months (29.3% prevalence in the treatment group compared with 30.1% in the control group; P = 0.123) or at 18 months (28.2% vs 28.7%; P = 0.276), but reduced food insecurity for adults by 3 percentage points at 12 months (P = 0.002) but not at 18 months (P = 0.354). The intervention led to a $27 and a $16 decline in median household monthly out-of-pocket food expenditures at 12 and 18 months, respectively. CONCLUSIONS: An innovative intervention successfully delivered nutritious food boxes to low-income households with children in rural Oklahoma, but did not significantly reduce FI-C. Improving economic conditions in the demonstration area and participation in other nutrition assistance programs among treatment and control groups might explain the lack of impact.ClinicalTrials.gov ID: NCT04316819 (http://www.clinicaltrials.gov). FUNDING/SUPPORT: This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

State strategies for coordinating Medicaid and housing services.

OBJECTIVE: This article reports findings from case studies of 4 states (Illinois, Louisiana, Massachusetts, and Tennessee) that used different approaches to coordinate Medicaid services with temporary or permanent housing supports for individuals with psychiatric disabilities. METHOD: Data were collected through document review, telephone interviews with state officials and managed care organizations, and site visits to behavioral health and housing providers, and consumer organizations. Qualitative analyses focused on identifying key features of each state's approach, including the strengths and limitations from multiple perspectives. RESULTS: All 4 states facilitated partnerships between behavioral health and housing providers. Each state used managed care strategies to some degree and identified opportunities to use Medicaid to finance the coordination of services with housing providers. These financing strategies included using flexible case rates to fund community support workers; using a 1915(i) state plan amendment to fund intensive Medicaid behavioral health services for those in permanent supportive housing; funding new local entities to support local partnerships between health and housing organizations; and creating a Medicaid supportive housing benefit. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These 4 states took advantage of the flexibility that Medicaid offers to implement different service models in an effort to improve the coordination of behavioral health services and housing. The strategies used in these states may be useful to other states and communities seeking to strengthen coordination of care for individuals who require housing support. (PsycINFO Database Record

Preventing unemployment and disability benefit receipt among people with mental illness: Evidence review and policy significance.

OBJECTIVE: We identify effective services to assist 3 groups of people with mental illnesses become or remain employed and prevent dependence on disability cash benefits: (a) individuals, including youth, who are experiencing an initial episode of psychosis; (b) employed individuals at risk of losing jobs due to mental illness; and (c) individuals who are or may become long-term clients of mental health services and are likely to apply for disability benefits. METHOD: We searched for articles published between 1992 and 2015 using key word terminology related to employment support services and each subgroup, and prioritized articles by study design. RESULTS: The individual placement and support model of supported employment is more effective than traditional vocational programs in helping people with serious mental illnesses who are engaged in treatment or receiving disability benefits obtain competitive employment. Some early intervention programs effectively serve people who experience a first episode of mental illness, but more research is needed to demonstrate long-term outcomes. Less is known about the effectiveness of employment interventions in preventing unemployment and use of disability benefits among individuals at risk for job loss or long-term mental illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: States can fund employment supports to help prevent the need for disability benefit receipt by creatively combining federal sources, but the funding picture is imperfect. Medicaid expansion and other provisions of the Affordable Care Act may fund employment supports and assist in reducing dependence on disability benefits. (PsycINFO Database Record

External Validity: The Next Step for Systematic Reviews?

BACKGROUND: Systematic reviews-which identify, assess, and summarize existing research-are usually designed to determine whether research shows that an intervention has evidence of effectiveness, rather than whether an intervention will work under different circumstances. The reviews typically focus on the internal validity of the research and do not consistently incorporate information on external validity into their conclusions. OBJECTIVES: In this article, we focus on how systematic reviews address external validity. METHODS: We conducted a brief scan of 19 systematic reviews and a more in-depth examination of information presented in a systematic review of home visiting research. RESULTS: We found that many reviews do not provide information on generalizability, such as statistical representativeness, but focus on factors likely to increase heterogeneity (e.g., numbers of studies or settings) and report on context. The latter may help users decide whether the research characteristics-such as sample demographics or settings-are similar to their own. However, we found that differences in reporting, such as which variables are included and how they are measured, make it difficult to summarize across studies or make basic determinations of sample characteristics, such as whether the majority of a sample was unemployed or married. CONCLUSION: Evaluation research and systematic reviews would benefit from reporting guidelines for external validity to ensure that key information is reported across studies.