<p> From 2017 to 2019, the primary strategy to improve public schools in the U.S. was increasing competition through the expansion of charter schools and the promotion of vouchers to send public school students to private schools. The problem this presented was that key education leaders had not provided adequate input and feedback into this strategy. The purpose of this qualitative study was to gather the perspectives of accomplished education leaders on how Tiebout&rsquo;s theory of competition and the concept of the Ontario K-12 School Effectiveness Framework impacted quality, trust, and capacity. Data were collected using semistructured interviews with a purposeful sample of 15 accomplished education leaders from the charter/school choice community and traditional public schools. Data were analyzed using Bernauer&rsquo;s modified three-phase method. School and classroom leadership, meaningful and informative assessment that guides instruction, substantive student engagement, and a focus on a strong curriculum and effective teaching were the key themes that aligned with quality, trust, and capacity. Education leaders did not see Tiebout education as a key driver that would alone improve the quality of public education. Leaders believed that some schools improved in response to Tiebout competition but also shared cautions on the diminishing returns, collateral damage, and equity concerns because Tiebout competition created winners and losers. Social change may be impacted by the results of this study in that the results define and share examples of healthy and unhealthy competition in public education. The results of this study can help inform policy makers and educators as they create opportunities that will enhance the long term personal and economic success of all U.S. students.</p><p>

<p> Starting in late 2013, new direct-acting antiviral medicines (DAAs) offered the chance of a cure for chronic hepatitis C virus (HCV) infection. In clinical trials, DAAs helped more than 90% of patients achieve sustained viral response (SVR), commonly considered to be a cure that will stop progression of related liver disease and prevent transmission of the virus to others. Prices for these medicines are now around $20,000 per treatment after discounts from manufacturers, due to competition. </p><p> In late 2016, the medical director for D.C. Medicaid asked what it would take to eradicate hepatitis C in the city. This dissertation focused on that question for Medicaid alone, to inform policy discussions and identify next steps. I profiled beneficiaries with chronic HCV infection based on medical claims from 2014-2016; interviewed medical providers and policymakers to learn more about their decision-making processes and to identify opportunities to expand treatment, as well as potential barriers; and created an Excel-based Markov model that estimates outcomes and costs under different scenarios. </p><p> Only 799 individuals, about 10% of the D.C. Medicaid beneficiaries identified as having chronic HCV infection, received treatment with DAAs in 2014-2016. Providers and policymakers are committed to treating this population, but treatment rates remained low through 2018. I estimate that roughly 80% of Medicaid beneficiaries with chronic HCV had not been treated at the start of 2019. </p><p> Beneficiaries with chronic HCV infection often have other physical, mental, and behavioral health conditions that might keep them from seeking treatment for an often-asymptomatic HCV infection. They often miss scheduled appointments and/or are lost to follow-up. Most live east of the Anacostia River, where there are fewer providers. Even if they engage in care, government or health plan policies might discourage or prevent individuals with low levels of liver damage from getting prior authorization for treatment. </p><p> Broader use of DAAs in D.C. Medicaid will allow more people to achieve SVR, potentially decreasing future healthcare costs for some and saving lives. A moderate (50%) increase in treatment rates among those with low liver damage could enable about 300 additional patients to achieve SVR over 10 years, at a net cost of $6.1 million. A 50% increase in treatment rates among those with moderate liver damage could enable more than 500 additional patients to achieve SVR over 10 years, keep more than 160 from severe liver damage, and avoid 19 early deaths. The net cost of the second scenario is $6.5 million, a smaller increase per person achieving SVR because curing those with moderate liver damage is more likely to avoid high healthcare costs. </p><p> The District must weigh the upfront costs of expanding use of DAAs against uncertain long-term benefits and inherent budget limitations. I recommend that D.C. develop a more complete profile of Medicaid beneficiaries with HCV infection; work toward universal screening and sustained monitoring of at-risk populations; collaborate with key stakeholders to develop policies, practices, and tools to engage beneficiaries in care; and reduce prior authorization requirements that might deter or prevent treatment when beneficiaries and health care providers are ready.</p><p>

<p> Several researchers have identified social capital as a means to improve the social sustainability of communities. While there have been many studies investigating the benefits of social capital in homogeneous White communities, few have examined it in Black homogeneous communities. Also, there has been limited research on the influence of racism on social capital in African American communities. In this dissertation a comparative case study was used within a critical race theory framework. The purpose was to explore the role of racial oppression in shaping social capital in majority African American communities. Data were collected from 2 majority Black communities in Florida. The collected data included reviews of local news reports, voter turnout reports, and community health assessments, along with focus groups and semi structured interviews with a purposive sample of 20 of the communities&rsquo; African American residents. Benet&rsquo;s polarities of democracy model was employed to analyze the relationship between racism and social capital. Analysis included inductive coding followed by pattern matching to identify overarching themes between the selected cases. One key theme was that perceived racial disparity inhibited bridging and linking social capital in the selected communities. Another key theme was that racism created social capital deficiencies and a dysfunctional community culture, which limited the capacity to address collective issues. Social change implications include specific policy recommendations to state and local leaders to increase the participation of Black community members in democratic processes. Additionally, this research has potential to improve understanding of the various ways that racism may affect Black Communities.</p>

<p> In recent years, emergency managers have recognized the importance of building and sustaining resilience in communities. U.S. disaster preparedness has long been centered at the local and state municipality level. However, there has been an increase in federal policy and grant funding to better prepare communities. These federal initiatives may actually be prohibitive when the money runs out. This funding discontinuity can impede progress toward creating resilient and prepared communities. The relationship between existing hazards and dynamic issues showcase the need for refining future approaches to mitigation. One piece of this forward movement includes the evaluation of mitigation grants that embraces concepts of sustainability. A good practice in this area is already underway in the State of California. It utilizes an evaluative process termed SMART and has shown possibility for adapting to a wider use. Semi-structured interviews were conducted with mitigation experts to further inform the adaptation of the instrument. Concepts from the Strategic Foresight Initiative (SFI) were infused together to build community resilience. The adapted mitigation evaluation instrument has been designed to follow current mitigation practices and includes concepts of sustainability, resiliency, and foresight to choose grants that will improve communities. The aim is to better inform the way mitigation project grants are chosen and applied, and to reduce expenditure. Finally, the assessment tool has been adapted to encompass a wider geography.</p>

<p> Humanitarian aid, while useful in the short run, sometimes has the effect of contributing to poverty and poor economic conditions in the long run. This occurs when recipients of relief aid lose their initiative to fend for themselves and become reliant on external aid. The purpose of this mixed method study was to evaluate the degree to which dependency on long term aid has contributed to chronic poverty in the Moroto district of Uganda. This study was grounded on Harvey &amp; Lind&rsquo;s conceptualization of the dependency syndrome. The research questions addressed the relationship between household production and investment pattern with number of year as aid beneficiary, while exploring the beneficiaries&rsquo; perceptions on the roles of relief aid in their livelihood. Survey data were acquired from 75 participants from five sampled villages in Moroto District; qualitative data were acquired from the same villages involving five focus group discussions with 15 key informants per village. Quantitative data were analyzed using multivariate regression analysis and resulted in a finding of a statistically significant negative relationship between household production and investment with number of years spent as aid beneficiary. Qualitative data were inductively coded, and then organized around key themes. These findings suggest that many rural Ugandans believe that if aid were to cease, they would either migrate to an area where aid was available, or die of starvation. Implications for positive social change are connected to a recommendation to organizations offering humanitarian aid to package relief aid with other programs that support the recipients&rsquo; resilience building capacity in order to save lives and reduce chronic poverty that is common in disaster-prone areas around the world. </p>

<p> In the United States, 397,000 children received foster care services in 2012. Some states successfully achieved permanent homes for children with diagnosed disabilities who exited care while others were less successful. Using change theory and social ecological theory as the foundations, the purpose of this study was to determine the impact that diagnosed disabilities had on permanent home placements among Pennsylvania&rsquo;s foster care children who were discharged and were between ages of 0 to 6 years in 2012. Hernandez&rsquo;s and Hodges&rsquo;s theory of change was used to evaluate the 1982 standards that license foster care agencies, while Stokol&rsquo;s ecological theory provided the framework to assess whether there were measurable increases in child welfare outcomes for permanent placements among children with diagnosed disabilities. Following a retrospective, nonexperimental, quantitative design, data were acquired from a purposive sample of 344 archived foster care files across the state. These data were analyzed using bivariate correlation procedures to evaluate the strength of the relationship between medically diagnosed conditions and permanent placement. The findings indicated a statistically significant association between medically diagnosed conditions and permanent placements (p=0.01). Additionally, length of stay in care was also found to be statistically associated with permanent placement (p=0.019). The theoretical constructs evaluation with a theory of change found the 1982 standards were outdated to authorize the licensing of foster care agencies; the social ecological theory identified evidence for change to achieve the intended goal. Findings of this study may provide guidance to policymakers in term of improving standards related to oversight and licensing foster care agencies in order to better support permanent placement of children with disabilities.</p><p>

<p> This dissertation used a mixed-methods approach to investigate both how intergovernmental relationships influence collaboration between regulators and to what extent their regulatory tools affect nursing home regulatory violations. Chapter 1 examines the impact of the five-star quality rating system and market competition on nursing home violations. Chapter 2 explores the intergovernmental relationships between state and federal regulators and whether it is facilitated by collaborative action. Chapter 3 evaluates the impact of two government tools (one direct and one indirect) and their association with regulatory compliance in nursing homes. The findings suggest that the five-star quality rating system has a positive association with nursing home providers&rsquo; regulatory compliance. Meanwhile, communication among regulators appears to be the key to collaboration, and the current structure of their regulatory regime might be inhibiting collaboration. Furthermore, the findings suggest that the direct governance tool leads to improvements in subsequent regulatory compliance as compared to the indirect tool. These three essays on the intergovernmental regulation of nursing homes and the specific regulatory tools contribute to the future policy decisions that affect the well-being of approximately 1.4 million individuals residing in nursing homes and primarily funded by the public.</p><p>

<p> Contenders disputing electoral results in Sub-Saharan African countries often attribute defects in presidential electoral processes to the implementation of rules and procedures. Yet despite the considerable decision-making authority poll workers are entrusted with and the significance of the tasks performed by therm, scholars have not closely investigated poll workers&rsquo;contributions to elections&rsquo; management in Sub-Saharan Africa. Using principal-agent theory as the foundation, the purpose of this case study was to examine the challenges encountered in the organization of the presidential election in Togo, held on April 25, 2015, with a particular emphasis on poll workers&rsquo; job performance. Research questions focused on whether poll workers in Togo have the ability and the resources necessary to carry out quality elections and the perceived effects of poll workers&rsquo; performance on the integrity of the presidential electoral process. Data were obtained from interviews with 11 purposely selected poll workers and review of social media audio and video records of the election. These data were inductively coded and subjected to thematic analysis. A key finding was that deficiencies in poll workers&rsquo; performance reflect a complex interplay of ill-conceived legal framework, lack of infrastructure, poor training, personal ineptitude, underfunding, partisanship, and tribalism. Further findings indicated that poll workers performing poorly resulted in long lines of voters, voter suppression, inaccuracies in vote counts, and delay in results announcement. Implications for positive social change include election practitionners&rsquo; increased awareness that improving the quality of service delivery to voters on election day may foster confidence in and legitimacy of election results, seen as prerequisite to peaceful presidential elections in this part of the world.</p><p>

Previous studies have neglected to focus on the generalized affective satisfaction (diffuse support) to state level courts among Hispanics/Latinos. A western US county was selected for this case study to test a racial and ethnic theory of procedural justice in a region with a large Hispanic/Latino population. Differential experience theory was used as a theoretical foundation and posits that people determine their level of satisfaction with the courts based on their own actual experience with the courts. The main research question was whether Hispanics/Latinos have a different level of satisfaction with their access to, and fairness in, the court when compared to Whites. Data were gathered from 1406 people exiting the courthouse for any reason in 2007 and 2008. The exit survey data were used to test a logistic regression model to empirically investigate whether race or ethnicity is a significant predictor of court user satisfaction. Level of satisfaction was operationalized by assessing responses to questions regarding the accessibility to, and perceived fairness in, the court. Although race/ethnicity proved to be significantly linked to both measures of satisfaction in 2007 these associations were no longer observed in the 2008 data. Mean satisfaction ratings affirmed the findings of other researchers in the field that Hispanics/Latinos have a high level of satisfaction with their access to, and fairness in, the court. This is important because the legitimacy of the judicial branch is dependent upon the good will of the public. This study can directly contribute to social change by informing outreach programs designed to increase voluntary participation in state and local legal systems among members of Hispanic/Latino communities, and thus help to realize more equitable justice for all citizens.

The lack of preparedness by local communities in the event of a biological attack is a predicament that will result in chaos and an increase in casualties. Assessing city preparedness is essential in the event of a biological attack. The potential for an enormous number of casualties is real; it is imperative, therefore, for local communities to be prepared in the event of a biological attack. This descriptive single case study investigated whether one city in the southeastern United States is prepared for a biological attack. System theory provided the theoretical framework for this research, with the unit of analysis being the local Emergency Operations Center, which is responsible for coordination, preparation, and oversight in the event of such a disaster. Data were collected from interviews, documents, public records, and participant observation. Pattern matching and comparative analysis were utilized to analyze data that was collected in this research. This examination of the preparedness of the city for a biological attack is critical because any lack of preparedness would be devastating to the community. The findings of this study revealed that the city is prepared for a biological attack and that the recommendations and best practices identified in this study such as the utilization of virtual technology during a biological attack, the ability to perform random biological exercises, investments in laboratories, bioterrorism training for citizens, and establishing global partnerships in combating bioterrorism, promote social change, and will result in saving lives in the event of a biological attack. This research contributes to social change by promoting security improvements and identifying a model of preparedness for other cities in their own preparation for a biological attack.