Child Care Quality

“Strategies for Supporting Quality in Kith and Kin Child Care: Findings from the Early Head Start Enhanced Home Visiting Pilot Evaluation.” Diane Paulsell, Debra Mekos, Patricia Del Grosso, Cassandra Rowand, and Patti Banghart, July 2006. Families with infants and toddlers, especially low-income families, rely heavily on child care that is provided by family, friends, and neighbors (“kith and kin” caregivers). The national evaluation of Early Head Start found that a large proportion of program families used kith and kin care. In 2004, the Office of Head Start funded 24 Early Head Start programs to implement the Enhanced Home Visiting Pilot Project, designed to support the quality of care that kith and kin caregivers provide to children enrolled in Early Head Start. Mathematica’s two-year evaluation identified program models, documented implementation strategies and challenges, explored promising practices, and assessed the quality of these child care settings. Researchers note that more than two-thirds of caregivers in the pilot were related to the children in their care, with nearly half being the children’s grandparents. Nearly all programs implemented strategies to improve communication and increase consistency between parents and caregivers in caregiving practices. The results suggest that initiatives for improving the quality of kith and kin child care settings can be implemented in Early Head Start with modest additional resources.

Children's Mental Health

"Parent and Teacher Mental Health Ratings of Children Using Primary-Care Services: Interrater Agreement and Implications for Mental Health Screening." Jonathan Brown, Lawrence Wissow, Anne Gadomski, Clara Zachary, Edward Bartlett, and Ivor Horn, Ambulatory Pediatrics, November 2006. Mental health screening in pediatric primary care settings has become a more common practice to improve the identification and treatment of child mental health problems. This article examines agreement between parents and teachers in their ratings of the mental health of children using primary care. Parents and teachers rarely identified the same child as having mental health problems, and parents failed to detect 52 percent of children the teacher identified as seriously disturbed. The results suggest that screening in primary care may require the development of algorithms to help providers judge when to solicit information from teachers, and that providers need skills to interpret conflicting information from parents and teachers.

Employment for People with Disabilities

Economic and Social Costs and Benefits to Employers of Retaining, Recruiting and Employing Disabled People and/or People with Health Conditions or an Injury: A Review of the Evidence. Edited by Karen Needels and Robert Schmitz, 2006. During the past 20 years, the United Kingdom has promoted fuller inclusion of people with disabilities into the workplace and, more broadly, into all aspects of public life. This volume identifies and synthesizes the best available evidence on the benefits and costs to UK employers of recruiting and retaining workers with disabilities. It addresses the following issues: (1) employers' understanding of disability and the Disability Discrimination Act 1995 (DDA), (2) costs and benefits associated with employing people with disabilities, and (3) the extent to which public policy can alter the labor market outcomes of this population.

Mathematica staff authored the following chapters:

"Overview of the Legislative and Labour Market Context for Disabled Workers." Debra Brucker and Robert Schmitz. The authors summarize the DDA and describe employer responsibilities, noting that 6.9 million working-age people in the UK were disabled under the DDA definition in 2005. Of this group, about half were employed during the year, compared with 78 percent of nondisabled people. As the population ages, the number of working-age individuals with disabilities will also grow, so policies encouraging employment are important to sustain economic growth.

"Framework for Employer Decision-Making." Karen Needels. This chapter provides a theoretical context for categorizing the economic forces that determine recruiting and retention of disabled and nondisabled workers. The model makes three important points: (1) employers want to find the right workers and retain them as long as possible, since recruiting is costly, (2) it is not possible to predict a candidate's productivity with certainty, and (3) some traits related to productivity are easy to assess, but others, such as self-assurance, appearance, and demeanor, may put candidates with disabilities at a disadvantage.

"Evidence-Based Recommendations for Policy and Research." Karen Needels. This chapter synthesizes the arguments and evidence presented in the entire volume. The author notes that policies must be developed with an eye toward distinctions among employers and people with disabilities, in particular, differences between small and large employers, public and voluntary entities, and mental and physical impairments. The chapter concludes with recommendations for future research.

"Guide to Employers for the Recruitment and Retention of Disabled People." Clara Williams and Craig Thornton. This appendix reviews factors and questions employers can consider in employment decisions.

Changing Times for General Hospitals

“A Report on Medical Specialty Centers in Wyoming.” Cheryl Fahlman, Laurie Felland, Michelle Banker, Allison Liebhaber, Deborah Chollet, Gilbert Gimm, and Lynn Taylor, November 2006. The proliferation of medical specialty centers (MSCs) has raised concern about their potential impact on full-service general hospitals. This report for the Wyoming Health Care Commission provides a snapshot of the status and financial performance of for-profit and not-for-profit general hospitals in Wyoming, estimates likelihood of an MSC locating in a particular market based on the characteristics of that market, and summarizes policy implications. Researchers found that the strongest predictors of the likelihood that an MSC would emerge in a market area are population level and the number of for-profit hospitals. MSCs tend to emerge in areas with greater populations because the patient base and demand for services is likely to be greater.

“The Impact of Niche Hospitals on General Hospitals: A Review of the Literature.” Cheryl Fahlman and Deborah Chollet, March 2006. The recent, rapid proliferation of specialty hospitals, or “niche hospitals,” has captured the attention of both the federal government and a variety of states—especially Texas. This report reviews the literature that has addressed the motivations and effects of niche hospitals in their communities. The researchers find that the literature offers mixed evidence about the impacts of niche hospitals on general hospitals, patient selection, and quality of care.

“Analysis of Niche Hospitals in Texas and the Financial Impact on General Hospitals.” Deborah Chollet, Su Liu, Gilbert Gimm, Cheryl Fahlman, Laurie Felland, Anneliese Gerland, Michelle Banker, and Allison Liebhaber, December 2006. In Texas, as in other states, the proliferation of niche hospitals has raised concern about the potential financial impact of these hospitals on full-service general hospitals. This report compares the financial status of physician-owned niche hospitals and general hospitals in Texas, analyzes the impact of niche hospitals on general hospital financial margins and levels of uncompensated care, analyzes potential bias in physician-owners' referral patterns, investigates stakeholders’ perceptions about the impacts of niche and other physician-owned hospitals in Texas, and presents stakeholder recommendations for policy change.