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Existing research has found that home visiting programs for families with young children can improve children's development and strengthen caregivers' and families' well-being. However, the pandemic created numerous challenges for home visiting programs, forcing them to deliver services online or in a hybrid format and to adapt the content of their program models to respond to pandemic-related challenges. Questions remain about the impacts of these programs when delivered at scale during this uniquely challenging time. The current study reports 12-month impacts from a randomized controlled trial of Child First--an evidence-based home visiting program that provides a psychotherapeutic, parent-child intervention embedded in a coordinated system of care--implemented across two states. After randomly assigning a racially and ethnically diverse sample of families (N = 226) from predominantly low-income backgrounds to receive the Child First services or typical community services, the research team surveyed caregivers (N = 183) about a year after program enrollment. Results from regression models with site fixed effects revealed that Child First reduced caregivers' job losses, residential mobility, and self-reported substance abuse, and increased receipt of virtual services during the pandemic. Child First also reduced parenting dysfunction (the name of the subscale within the Parenting Stress Index) among caregivers who reported clinical depression at enrollment. There were null impacts on caregivers' psychological well-being, families' involvement with the child welfare system, children's behaviors, and other indicators of economic well-being. Implications for future research and policy are discussed.

The prevalence of school-based healthcare has increased markedly over the past decade. We study a modern mode of school-based healthcare, telemedicine, that offers the potential to reach places and populations with historically low access to such care. School-based telemedicine clinics (SBTCs) provide students with access to healthcare during the regular school day through private videoconferencing with a healthcare provider. We exploit variation over time in SBTC openings across schools in three rural districts in North Carolina. We find that school-level SBTC access reduces the likelihood that a student is chronically absent by 2.5 percentage points (29 percent) and reduces the number of days absent by about 0.8 days (10 percent). Relatedly, access to an SBTC increases the likelihood of math and reading test-taking by between 1.8-2.0 percentage points (about 2 percent). Heterogeneity analyses suggest that these effects are driven by male students. Finally, we see suggestive evidence that SBTC access reduces violent or weapons-related disciplinary infractions among students but has little influence on other forms of misbehavior.

This report presents a snapshot of selected features of the condition of education in Wisconsin in 2019. With support from the U.S. Department of Education's Institute for Education Sciences, and in collaboration with colleagues at the Wisconsin Department of Public Instruction (DPI), the authors set out to measure practices in PK-12 education that they considered especially important for educational equity and success for children in Wisconsin. Public school teachers and administrators in Wisconsin are responsible for educating about 855,000 students between four-year-old kindergarten and twelfth grade. State report cards produced annually by the Wisconsin DPI show how well we are doing as a school system with respect to student outcomes. In this paper, we focus on what principals and teachers in the state are doing. How do kindergarten teachers at both the four-year-old and five-year-old levels engage in play in their classrooms? How do elementary teachers group students for instruction and how frequently do they reconsider these groupings? What sorts of educational opportunities do teachers and schools offer their English language learners and their students with special needs? How supported do teachers feel in their early years in the profession? These are just a few of the questions we asked a representative sample of almost 700 principals and 2,200 teachers in the state. This paper offers a big picture view of instructional practice and educational opportunity in Wisconsin. It makes no claims about what schools and teachers should do to increase equity and success for students in Wisconsin. Instead, it shines a light on the many ways our educators work to support students in the state and, we hope, offers insights into where we might do better.

The COVID-19 pandemic has been intensely disruptive to education all around the world. With children in many countries continuing to face prolonged absences from the classroom, innovative solutions are needed to maintain education continuity, especially for the most vulnerable students. Such crises require solutions that go beyond the resources of the 'traditional' education workforce, with local communities and inputs from other sectors playing a potentially important role in ensuring continuity of learning. Throughout the COVID-19 pandemic, Education Development Trust has sought to be highly responsive to the changing needs of educators, system leaders and partners around the world. In doing so, Education Development Trust has developed an evidence base from which new thinking has been developed, called 'Learning Renewed', which reimagines what more effective, equitable and resilient education systems might look like, and how they might better withstand future shocks. This report, the second in the Learning Renewed series, explores the solutions adopted by a team in Kenya, where the roles of community health volunteers (CHVs) have been redesigned to support continuity of learning for the vulnerable girls, and identifies key lessons which may prove valuable both during and beyond the current crisis. To do so, Education Development Trust commissioned a research study to explore, in detail, CHV activities during school closure. Data was collected remotely through surveys, diaries written by CHVs and interviews with stakeholders. The research covered CHVs operating in both rural Arid and Semi-Arid Lands (ASAL) and urban areas. The research highlighted both many positive outcomes for girls and significant challenges. [Foreword is written by Tony McAleavy. For "Learning Renewed: A Safe Way to Reopen Schools in the Global South. Paper 1 of the Learning Renewed Series," see ED614318.]

Young adults face enormous economic, social and psychological challenges when they transition into adulthood. This transition can be especially overwhelming and daunting for young adults with disabilities. Among the challenges young adults with disabilities are faced with are greater risk of low food security and barriers to healthcare. This study examines how the transition to adulthood may affect food security, health, and access to healthcare for youth with disabilities, and estimates the effects that SNAP has on this group in those turbulent years. The study used five years of data (2011-2015) from the National Health Interview Survey (NHIS). We combined the public and restricted NHIS data with the state SNAP policy variables. The sample included low-income individuals ages 13-25 (and their families) to reflect the life stage from pre-transition, to transition, and then to post-transition. Analyses were conducted at the Census Research Data Center in Columbia, MO. A difference-in-difference (DID) approach in linear models was applied to compare individuals with and without disabilities regarding changes in food security status and their health-related outcomes in the transition to adulthood. State SNAP policy variables were used as exogenous instruments to estimate the effects of SNAP participation on food security and health/healthcare use for youth and young adults with disabilities in the models of instrumental variables. Below is a summary of the main findings in which youth are referred to as individuals under 18, and young adults are referred to as individuals ages 18 to 25. (1) Compared to those without disabilities, individuals with disabilities have a greater risk of low food security in both childhood and young adulthood; (2) Transition into adulthood results in greater food security for individuals without disabilities but an increased risk of low food security for individuals with disabilities. The increased risk for young adults with disabilities may well put them at very low food security, the most severe category on the food security scale; (3) Food security status is associated with health and access to healthcare for all the four groups, youth and young adults, with or without disabilities. However, the associations between low food security and health-related outcomes do not seem to vary by disability status for young adults, indicating the additional risk of low food security that young adults with disabilities experience does not correlate with their health-related outcomes; (4) Contrary to our expectation, SNAP participation does not seem to have statistically significant effects on food security and health-related outcomes for individuals with disabilities. These impacts, although insignificant, show expected directions (i.e., improving food security and health) that are different from those often found in the OLS estimation that does not address the selection bias; and (5) SNAP participation is a statistically significant predictor of youth's food security status measured by the food security raw score only, but not the other three food security measures. SNAP participation appears to have greater impacts for youth than for young adults. In other words, the protective effects of SNAP decrease for young adults perhaps because they encounter greater barriers accessing SNAP than when they were young. The study's limitations are closely examined with a focus on the constraints that we had in the DID analysis and the IV analysis. We also suggested directions for future research. Since food security likely has a profound impact on the long-term development, economic independence, and self-sufficiency, we discussed a few policy strategies that may help individuals with disabilities in their transition to adulthood. These include special outreach services to improve SNAP accessibility, an embedded alert system that serves to bring awareness of a SNAP participant's upcoming transition to adulthood, incorporation of nutrition assistance in transition planning for youth, and better coordination of multiple public programs.

In April 2021, New America's Open Technology Institute (OTI) and the Philanthropication thru Privatization Project (PtP) released a joint proposal that the federal government should invest a substantial portion of the windfall proceeds from future auctions of public airwaves (spectrum) to seed a new Digital Equity Foundation dedicated to addressing equity gaps in broadband adoption and affordability, education, telehealth, access to government services, and other critical areas. The next step in realizing this vision is now in the hands of Congress and other federal policymakers, as allocation of spectrum auction proceeds to support the creation of a Digital Equity Foundation requires legislation. Policymakers will also play a critical role in establishing the guidelines for the creation of an initial foundation board and mission. This paper serves to help flesh out the options for how that could be accomplished, drawing on a review of existing foundations created with public and nonprofit assets to identify best practices for how to start a foundation with public, quasi-public, or nonprofit funds. This paper is structured in five parts. Part I provides a brief overview of the proposed Digital Equity Foundation; Part II, examines some key examples of existing U.S. foundations that illustrate the use of public or quasi-public funds to support priority public needs; Part III, explores ways the proposed Digital Equity Foundation might be structured and organized to achieve its programmatic goals to advance digital equity and inclusion, while operating with appropriate transparency and public accountability; Part IV, considers additional legal considerations that surfaced in a review of foundations previously established under federal legislation; and Part V, provides a summary of concrete recommendations for the proposed foundation. [This report is a joint product of the Open Technology Institute at New America and the Philanthropication thru Privation Project.]

Asthma is the leading chronic health condition among children in the United States and a major cause of childhood disability. It also disproportionately affects low-income and racial and ethnic minorities. Although a wide range of interventions have been implemented to improve asthma-related outcomes among socioeconomically disadvantaged and minority children, disparities persist. This paper, which was commissioned by the JPB Foundation and conducted by MDRC in partnership with the National Academy for State Health Policy, standardizes and compares effects from rigorous evaluations across three main types of interventions: those that focus on improving education and self-management, those that focus on addressing remediation of the conditions that trigger asthma in the home environment, and those that focus on improving health care provider practice. While prior reviews have summarized findings for each intervention type, this review systematically compares findings across a range of outcomes and a spectrum of different approaches to addressing childhood asthma, drawing from about 30 independent studies and earlier published reviews. In addition, the paper includes case studies of various local programs and state-level policy initiatives to illuminate current efforts to address childhood asthma in low-income communities and barriers faced in sustaining asthma programs. Key findings include: (1) Providing education on how to manage asthma is fundamental to improving outcomes, but it may not be enough to alleviate disparities in asthma management; (2) Some local programs are clearly bridging informational gaps among low-income families and are helping them maintain a safe home environment for their children with asthma; (3) The health care benefits of interventions that go beyond education are unclear; (4) Barriers to medication management are complex and medication adherence is difficult to influence; and (5) The role of the state, and the Medicaid program in particular, is relevant for the financing and sustainability of asthma programs for low-income children. Although the long-run sustainability of some of the programs highlighted in this report is uncertain, what is clear is that combating the disparities in the prevalence of asthma among different populations will require more than an agreement on standard asthma management practices within the medical community. The following are appended: (1) Methodology for Literature Review; (2) Summaries of Asthma Studies; (3) Detailed Case Studies of Local Asthma Programs; and (4) Detailed State-Based Case Studies. [This working paper was written with Felicia Heider, Carrie Hanlon, and Taylor Kniffin.]

We know that responsive relationships and language-rich experiences for young children help build a strong foundation for later success in school. The rapidly advancing frontiers of 21st-century biological sciences now provide compelling evidence that the foundations of lifelong health are also built early, with increasing evidence of the importance of the prenatal period and first few years after birth. This Working Paper examines how developing biological systems in the body interact with each other and adapt to the contexts in which a child is developing--for better or for worse--with lifelong consequences for physical and mental health. It explains in clear language how these systems are affected by adversity early in life, and shows how those adaptations can result in costly, common chronic illnesses. The paper encourages us to think beyond early learning in policy and practice. It explores how policymakers, leaders of human services systems, intervention developers, and practitioners can also reduce disparities in preventable diseases and premature deaths and lower the high costs of health care for chronic illnesses that have their origins in early childhood adversity. Sections include: (1) What 21st-Century Science Is Teaching Us; (2) How Early Adversity Affects Developing Biological Systems; (3) Common Illnesses in Adults Have Roots in Early Childhood Adversity; (4) Facts About Health That Are Often Misunderstood; (5) Future Directions for Policy and Practice: Implementing Practical Strategies; Overcoming Longstanding Barriers; and (6) Final Reflections in a COVID-19 World.

Objective: To determine whether the disparities in access to care observed within pediatric populations along the lines of race/ethnicity, socio-economic status, and geography are mirrored in student access to school nursing services. Method: Using school district employment records we linked 1,346 nurses to 1,141,495 students working in 296 districts within Washington state in the 2019-2020 school year. We constructed a measure of access (the student-to-nurse ratio) as the log transform of the total number of nursing full time equivalents divided by the total student enrollment within the district, and regressed these against a district's racial/ethnic composition, a measure of socio-economic status (percent eligible for Free-or-Reduced-Price-Lunch), and geography i.e. how urban vs rural. Results: A 1% percent increase in the student population that is Black is associated with a 3.7% reduction in the student-to-nurse ratio, while a 1% increase in the percent of students eligible for Free-or-Reduced-Price-Lunch is associated with a 1.1% increase in the student-to-nurse ratio. Relative to urban districts, rural districts have higher student-to-nurse ratios, but due to the sorting of students to districts by race/ethnicity, when controlling for race/ethnicity results are insignificant. Conclusions: Disparities in access to school nursing services mirror access gaps for pediatric care along socio-economic status and geography. The increased number of nurses working in school districts with more racial/ethnic minority students may play a protective role and partially ameliorate access gaps for these students observed in pediatric primary care. Policy Implications: We provide a framework for how states, absent of centralized data collection on the school nursing workforce, can use existing employment and licensing data to understand where school nurses work, and who has access to them. States should develop their school nurse workforce data in order to aid in resource allocation decisions. To address disparities in access for poorer districts, a reconsideration of state funding formulas that overly rely on local education dollars for school health services may be warranted.

Efforts to establish, test and analyse hypotheses regarding cross-country variations in women's economic status are hampered by the lack of a readily accessible and easily used information resource on the various dimensions of gender inequality. Addressing this gap, this paper introduces the Gender, Institutions and Development data base (GID) www.oecd.org/dev/institutions/GIDdatabase of the OECD Development Centre. The GID constitutes an important improvement upon existing sources, notably because it incorporates institutional variables related to norms, laws, codes of conduct, customs, and family traditions that heretofore have been neglected in quantitative comparative studies. To illustrate the utility of the GID, the paper models the determinants of women's participation in the labour force -- an indicator of gender equality as well as an important ingredient for long-run economic growth -- and demonstrates that the economic role of women hinges critically on variations in discriminatory social institutions. (A bibliography is included. Contains 4 footnotes, 6 figures and 6 tables.)

The National Assembly on School-Based Health Care (NASBHC) convened a meeting of 23 stakeholders representing a national cross-section of experts in the fields of health and education on April 30, 2004. Among the participants were school health practitioners, educators, researchers, and funders. The meeting's purpose was to clarify and document the relationship between school-based health centers (SBHCs) and student academic performance. The diverse backgrounds, experiences, and viewpoints among participants contributed to a vigorous discussion of pertinent issues. The meeting included a discussion of the educational policy context that is increasing pressures on SBHCs to document the impact of their services on academic performance. This paper aims to: (1) summarize the meeting proceedings and recommendations; (2) provide a stimulus for further discussion and research on the connection between SBHCs and academic performance; and (3) provide guidance to those currently working with SBHCs, including staff, researchers, evaluators, advocates and their educational partners on strategies to document and enhance the collaboration between SBHCs and educators to improve student success and sustain the viability of the SBHC initiative. (Contains 4 figures and 1 footnote.) [Funding for this paper was provided by The Health Foundation of Greater Cincinnati.]

The delivery of an appropriate quantity and quality of health care in an efficient way requires, among other things, matching the supply with the demand for the services of physicians, over time. Such matching has led to very different levels of physicians per million population across OECD countries--because of variations, among other things, in: morbidity and mortality, health expenditure as a share of GDP and the design of health systems. In addition, there are signs that a higher density of physicians is found in countries which have left the supply of physicians mainly to the market whereas lower density is found in countries which have planned the intake to medical schools centrally over many years. Shortages of physicians have now appeared in a number of OECD countries. It seems likely that these shortages could worsen in some countries over the next two decades, as a result of rising demand for, and falling supply of, physicians, unless countermeasures are taken quickly. The countermeasures may involve recruiting into medicine a higher proportion of dwindling cohorts of young people which is likely, in turn, to require raising the relative pay of physicians and/or improving their conditions of service. Countries have at their disposal a variety of additional policy instruments to influence the supply of physicians including education and training policies, migration policies and policies affecting retention and retirement. A number of countries are now raising their intake to medical schools, or discussing raising it. Immigration of doctors can ease physician shortages in countries where numbers are lacking but it raises difficult questions about international equity when there are net, long-term flows of physicians from poorer countries with low average health status to richer countries with high health status. As a result, many OECD countries aim for self-sufficiency in physician supply. Against expectations of a wave of retirement of physicians in many OECD countries, several countries are trying to tempt physicians into delaying their retirement by making retirement arrangements more flexible and staying longer in practice more rewarding, financially. Most OECD countries experience inequities in the geographical distribution of their physician workforce. To tackle this difficulty, a mix of educational policies, regulatory policies and financial policies has been used with some success in a number of countries. Against increasing trends towards specialisation, some countries are trying to raise the relative attractiveness of careers in primary care. There is some evidence to suggest that giving students experience of primary care practice and appointing primary-care role models to academic positions, can influence students' choices towards a career in primary care. The services delivered by physicians depend on their productivity as well as on their numbers. There is good evidence that activity-related methods of payment will raise the activity rates of physicians, but this is also likely to raise costs and little is known about the effect that raised activity has on quality of care. There is growing interest in devising payment systems for physicians which reward the quality of care directly--where that is feasible. (Contains 12 footnotes, 13 figures, 6 boxes and 5 tables.)

Dental disease is one of the most prevalent illnesses facing children in the United States today. Eighty percent of untreated dental disease in permanent teeth is found in roughly 25 percent of 5- to 17-year old children, most of whom come from low-income and other vulnerable populations. The State Children's Health Insurance Program (SCHIP) offers states an opportunity to expand health insurance and, by extension, financial access to dental care. This paper analyzes whether and how the coverage and delivery of dental services is changing under SCHIP, examining key differences between new separate SCHIP initiatives and traditional and expanded Medicaid programs. Data from telephone interviews and site visits with 18 states indicated that states did not focus particular attention on dental issues during SCHIP program development, though dental health coverage constituted a fundamentally important component of child health programs. All but one state elected to cover dental benefits. The extent of dental coverage under SCHIP was quite broad, although not as comprehensive as Medicaid dental coverage. Copayments on dental services were nominal in most separate SCHIP programs. Under separate SCHIP programs, some states raised dental payment levels above Medicaid's in an effort to raise dental provider participation, while other states paid about the same for dental services. In two states, early SCHIP dental program successes hastened reform efforts under Medicaid dental programs. Results suggest that improvements in access may be occurring under separate SCHIP programs that are paying dental providers at market rates when compared with Medicaid. (Contains 15 references.) (SM)

Noting that health benefits for children should be one of the principal goals of comprehensive early childhood initiatives, this Smart Start brochure provides information on "medical homes" and their importance to the overall health of children; the brochure also describes community strategies to help promote a medical home for all children. The medical home, the practice of enhancing access to a regular source of health care, with coordinated referrals to specialized care when needed, is one of three major practices considered necessary to enhance children's health. Among the benefits of a medical home are minimized delay of needed medical or dental care, and decreased visits to the emergency room. The medical home approach to care is described as accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent. Because the medical home has been formally adopted by the American Academy of Pediatrics and the Federal Maternal and Child Health Bureau, the concept is receiving greater awareness in the medical community. Progress in improving children's access to a medical home in North Carolina is being made. Local Smart Start initiatives, as are other community-based early childhood initiatives, are well-positioned to promote the medical home concept. Community efforts in promoting a medical home may use numerous strategies, among them gathering data to measure young children's access to a medical home in their community, contacting active health care providers to determine the progress of young children's access to a medical home, assisting with outreach efforts for publicly funded child health insurance programs, and assisting families in building their capacity to promote the medical home. (KB)

One of higher education's crowning achievements is that colleges and universities are currently educating many groups of people who have been denied access to this resource in the past. A growing percentage of the new population of students arrives on campus with unique mental health needs, which until now campuses have been largely unprepared to accommodate. This new student profile may be more familiar to Student Affairs' offices, but the educational implications extend to the whole campus. Members of NERCHE's (New England Resource Center for Higher Education) Student Affairs Think Tank discussed this topic at one of their meetings and offer the following insights.

Third World countries have used community health advisors (CHAs) for many years to deliver health services, health education, and linkages to isolated and underserved communities. In 1998 the National Community Health Advisor Study estimated there were at least 600 such programs in the United States using about 12,500 CHAs. Program activities and target populations vary widely; CHAs' work ranges from volunteer service in health education to actual provision of services. The most significant commonalities of CHA programs are a focus on reaching hard-to-reach populations, use of indigenous workers, and CHA expertise in community knowledge rather than formal education. Results of the 1998 national survey of 281 respondents provided data on rural and urban location of programs, racial and ethnic groups targeted, types of health problems encountered, provision of advocacy services, and types of outreach sites. Most CHAs were paid workers but averaged only 20 hours per week. Examples illustrate typical CHA activities: (1) acting as a bridge between underserved people and service providers (explaining the system to clients and gathering information for providers); (2) providing culturally appropriate health education and information; (3) locating cases, making referrals, and providing followup; (4) helping people with basic needs; and (5) building individuals' capacity to help themselves. Only a few evaluations of CHA programs have been carried out, all with positive results. Serious challenges for programs include inadequate and unreliable funding, lack of legitimacy among professionals, the health care system's lack of emphasis on prevention, and varying levels of CHA training. Recommendations focus on formal recognition of the value of CHAs, better funding, a comprehensive evaluation, and advocacy. (SV)

This study reviews evidence that overall within-country inequality, although showing no trends from 1960-80, increased after 1980-85, focusing on developing and transitional countries. It explores trends in rural-urban, intrarural, and intraurban inequality of income, poverty risk, health, and education, and the offsetting trends in inequality hypothesis (OTI). OTI claims that underlying the overall inequality trend has been a tendency for rising intrasectoral inequality to be offset by falling rural-urban inequality. Analysis of the limited available data indicate that there is no such pattern. Different regions and countries experienced different, though substantial, trends and timings of change in different types of rural-urban inequality. For example, rural-urban gaps in mean consumption and poverty incidence have narrowed in Africa and widened in Asia, but they show no global trend, usually moving in the same direction as overall inequality. Such change can be explained in part by two demographic forces affecting almost all developing countries since the 1950s, but at different times and speeds (demographic transition and urbanization). The finding of rising rural-urban odds ratios in education (and to some extent in health) indicators appears to indicate rising urban bias. (Contains 64 references.) (SM)

The institutions of a neighborhood are vital to its health and economic strength, and public schools are one of the most important shared institutions. They function not only as centers for providing education but also as hubs for communities to organize a range of supports and opportunities for children and their families. Reuben Jacobson's addition to the Building Healthy Neighborhoods series explores the potential for community-schools to cultivate healthy neighborhoods through partnerships with educators, families, nonprofits, businesses, faith-based institutions, and community members. Says Jacobson, "Such school-based partnerships provide social services and supports, enriching educational opportunities, healthcare, mental health services, adult education, and nutrition programs, with a strong emphasis on equity and making greatest use of the community's strengths." With an estimated 5,000 community schools now in operation across America, studies have shown positive impacts on attendance, health, school climate, and achievement, while also pointing to challenges faced by these institutions. As attention to this education and community change reform grows, we will continue to learn more about its impact on schools, families, and communities.

This document provides an analysis of key themes, as they relate to the U.S. Latino population, included in the President's 2016 State of the Union Address. Addressing these issues is critical to extend opportunity to more people to help ensure national prosperity and security for generations to come.

Significant mental health problems can and do occur in young children. In some cases, these problems can have serious consequences for early learning, social competence, and lifelong health. Furthermore, the foundations of many mental health problems that endure through adulthood are established early in life through the interaction of genetic predispositions and sustained, stress-inducing experiences. This knowledge should motivate practitioners and policymakers alike to address mental health problems at their origins, rather than only when they become more serious later in life. This report summarizes in clear language the most recent scientific advances regarding the importance of addressing emerging emotional and behavioral problems in the early years, and the implications of those findings for policy. [This report was sponsored by The Pierre and Pamela Omidyar Fund.]

Enhanced autonomy of sub-national governments has spurred innovative management. Spending assignments across levels of government, however, often overlap and/or are not yet fully understood by most citizens. Sub-national governments' accountability is further reduced by the heavy reliance on federal transfers, as opposed to own-revenues (taxes and user fees). In addition, the use of federal transfers as collateral for states' borrowing potentially undermines the role of financial markets in disciplining fiscal behaviour. Getting the most out of decentralisation would thus require a national agreement clarifying responsibilities for each level of government. Improving sub-national governments' incentives in delivering cost-effective public services would further require improving the quality of information on actual spending and outcomes, raising the volume of their own taxes and reforming the grant systems. Decentralisation should also be more consistent with the aim of improving interregional equity in obtaining access to core public services. (A bibliography is included. Contains 40 footnotes, 10 figures, 7 boxes and 3 tables.)

This paper focuses on two important dimensions of Indonesia's development record: education and health. The paper investigates the extent to which the poor benefit from public and private provisioning of these services. Multiple rounds of annual household surveys document a reversal in the rate of decline in poverty and a slowdown in improvements in the social sector as a result of the economic crisis in the late 1990s. Rural and urban analyses of public spending in education and health reveal patterns consistent with experience in other countries: spending on primary education and primary health care tends to be pro-poor, while spending on higher education and hospitals is less obviously beneficial to the poor. These conclusions are tempered once one allows for economies of scale in consumption, which weaken the link between poverty status and household size. An examination of the incidence of changes in government spending finds that the marginal incidence of spending in both junior and senior secondary schooling is more progressive than what static analysis would suggest, consistent with a process of "early capture" by the non-poor of education spending. In the case of health, marginal and average incidence analysis point to the same conclusion: the greatest benefit to the poor would come from an increase in primary health care spending. A table presents data for rural and urban areas of each province on poverty, adult illiteracy, elementary school dropouts, infant mortality, and child malnutrition. Appendices present additional data tables and notes. (Contains 45 references.) (Author/TD)

In this study of 99 countries, representing 2.3 billion women (92 percent of the world's female population), 20 indicators measure women's well-being in the following sectors: (1) health; (2) marriage and children; (3) education; (4) employment; and (5) social equality. Original data for each of the 20 indicators were converted mathematically to 5 point scales, giving a maximum total score of 100 points per country. Countries are ranked for each of the five sectors. General conclusions are provided about the quality of life for women worldwide for each of the five sectors. General findings include the following: (1) women in all countries aspire to have equal opportunities with men in the areas of employment, health care, and social status; (2) in no country surveyed have women achieved overall equality; (3) in over half these countries conditions for women were ranked as poor, very poor, or extremely poor; and (4) North American and Northern European countries ranked highest, while Africa, the Middle East, and South Asia ranked lowest. (BJV)

It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) serves a vital role in the delivery of health care to our nation's students within the healthcare system reshaped by the Patient Protection and Affordable Care Act of 2010, commonly known as the Affordable Care Act (ACA). This law presents an opportunity to transform the healthcare system through three primary goals: expanding access, improving quality and reducing cost (U. S. Government Printing Office, 2010). School nurses stand at the forefront of this system change and continue to provide evidence-based, quality interventions and preventive care that, according to recent studies, actually save healthcare dollars (Wang et al., 2014). NASN supports the concept that school nursing services receive the same financial parity as other healthcare providers to improve overall health outcomes, including insurance reimbursement for services provided to students. [This document replaces the Position Statement "Health Care Reform" (Adopted June 2006, Revised June 2010).]

This paper focuses on the effects of the hurricanes on people with all types of disabilities. The National Council on Disability (NCD) released another report that addressed in detail the specific challenges for people with psychiatric disabilities. Please refer to "The Needs of People with Psychiatric Disabilities During and After Hurricanes Katrina and Rita: Position Paper and Recommendations" for a more detailed report about the population of mental health consumers affected by the hurricanes. Additionally, although the focus is on the emergency preparedness and response to Hurricanes Katrina and Rita, many of the problems addressed in this paper are systemic in nature and were not caused solely by the hurricanes. The challenges faced by people with disabilities during and after the Hurricanes, while unique in scope and proportion, were similar to the challenges people with disabilities face on a day-to-day basis. Therefore, many of the findings and recommendations related to Hurricanes Katrina and Rita echo NCD's previous research on improving the daily quality of life of people with disabilities. When America embraces the twin principles of inclusion and accessibility for everyday programs, policies, and infrastructure, Americans with disabilities surely will be counted among the survivors of the next disasters. NCD made detailed recommendations for disaster preparedness in its 2005 report, "Saving Lives: Including People with Disabilities in Emergency Planning. Since Hurricanes Katrina and Rita," many interested policymakers and emergency planners have used NCD's research to make their emergency plans more inclusive of people with disabilities. Some of the key recommendations from that report, along with recommendations based on lessons learned from Hurricanes Katrina and Rita, are included in this report under the Recommendations for Emergency Preparedness section. A section on Education details the crucial challenges for disaster recovery efforts in continuing the education of student-evacuees while rebuilding educational services on the Gulf Coast. (Contains 89 endnotes.)

A work group consisting of representatives of public agencies, education, the health care industry, and unions and professional associations was formed to examine education and training issues related to the shortage of health care workers in Washington state. The group concluded that the shortage of available workers in many health care occupations across Washington is seriously jeopardizing the availability and quality of health care for the state's residents and is undermining the vitality of one of the state's largest industries. The group drafted eight objectives and 30 enabling strategies and submitted them for state and local policymakers' consideration. The identified objectives were as follows: (1) increase the number of students in training for health care occupations; (2) increase opportunities for clinical training; (3) remove barriers to training for current health personnel; (4) recruit diverse populations into the health care profession (including diversity in gender, race, ethnicity, age, and disability); (5) increase the availability and retention of qualified health care faculty; (6) increase young peoples' awareness of opportunities in health care and awareness of the math and science requirements; (7) enable local communities to address health care shortages; and (8) provide innovative leadership for solving health care labor shortages. (Contains 14 endnotes.) (MN)

The purpose of this position statement is to clarify issues and suggest priorities relating to the documentation of the relationship between school-based health centers (SBHCs) and the academic accomplishments of students. Current national educational policies, such as the No Child Left Behind Act, are increasingly exerting pressure upon schools to document improvements in student achievement. With increasing competition for limited school resources, the continued vitality and viability of school programs, such as SBHCs, may depend upon their ability to demonstrate their contribution toward academic success. The National Assembly on School-Based Health Care (NASBHC) is committed to providing health center staff, researchers, educational professionals, and other stakeholders across the nation with comprehensive information and guidance regarding SBHCs and academic outcomes. A bibliography is included. (Contains 1 table and 1 footnote.)

It is the position of the National Association of School Nurses (NASN) that the registered professional school nurse (hereinafter referred to as school nurse) has the educational and clinical background to coordinate the necessary school health services to provide students with the same health, nutrition, and safety needs while attending school-sponsored before, after, and extended school year programs as the students receive during the traditional school day/year. In 2010, the White House Task Force on Obesity called for an increase in access to safe supervised physical activities beyond the school day (White House Task Force on Childhood Obesity Report to the President, 2010); and, as these programs have expanded, the necessity for providing quality, effective healthcare services during these hours has developed. As the expert in school health services delivery models of health care, the school nurse is an essential facilitator for student access to these programs. The school nurse plays a vital role in preparing the school-sponsored before and after school and extended school year program personnel with the necessary resources to respond to a health emergency. [This document replaces the Issue Brief "Care in Extended School Year Before and After School Programs" and the "Responsibilities of the School Nurse. A School Nurse All Day, Every Day" (Adopted June 2003; Revised June 2012).]

One literature documents a significant, black-white gap in average test scores, while another finds a substantial narrowing of the gap during the 1980's, and stagnation in convergence after. We use two data sources -- the Long Term Trends NAEP and AFQT scores for the universe of applicants to the U.S. military between 1976 and 1991 -- to show: 1) the 1980's convergence is due to relative improvements across successive cohorts of blacks born between 1963 and the early 1970's and not a secular narrowing in the gap over time; and 2) the across-cohort gains were concentrated among blacks in the South. We then demonstrate that the timing and variation across states in the AFQT convergence closely tracks racial convergence in measures of health and hospital access in the years immediately following birth. We show that the AFQT convergence is highly correlated with post-neonatal mortality rates and not with neonatal mortality and low birth weight rates, and that this result cannot be explained by schooling desegregation and changes in family background. We conclude that investments in health through increased access at very early ages have large, longterm effects on achievement, and that the integration of hospitals during the 1960's affected the test performance of black teenagers in the 1980's.