<p> Advocacy for the counseling profession necessitates a thorough understanding of the factors influencing the hiring and reimbursement of licensed professional counselors. The Patient Protection and Affordable Care Act (ACA) enacted several health care reforms that may influence the utilization of mental health services and the employment of mental health professionals. These reforms included the option for states to expand their Medicaid population (effective January 1, 2014), mental health parity requirements for most insurance plans including Medicaid plans, and increased funding for Federally Qualified Health Centers (FQHCs or health centers). FQHCs, created by Congress in 1989, provide primary care services, including mental health services, to approximately 24 million Americans annually and function as a vital safety net for medically underserved communities and populations. </p><p> The largest source of revenue for FQHCs is Medicaid, and FQHCs receive enhanced reimbursement for services provided to Medicaid patients, known as the Medicaid Prospective Payment System (PPS) rate. Federal law, however, explicitly approves only certain health care professions as billable PPS providers. Licensed clinical social workers (LCSWs), along with psychologists and psychiatrists, are included as billable PPS providers under federal law, but not licensed professional counselors (LPCs). Some states have expanded the list of health care professions able to generate billable PPS encounters at FQHCs to include licensed professional counselors. It is vital for the counseling profession to understand the impact of these reforms and the interplay of federal and state policies related to reimbursement upon the mental health industry. </p><p> The optional Medicaid expansion provision of the ACA created an opportunity for a natural experiment to compare mental health service utilization and employment at FQHCs in Medicaid expansion states versus non-Medicaid expansion states. This quasi-experimental study first tested the causal impact of Medicaid expansion on the number of mental health visits and full-time equivalent (FTE) mental health staff at FQHCs, using state-level data gathered from FQHC reports submitted annually to the Uniform Data System. A count model difference-in-differences analysis strategy compared utilization and employment numbers in 2012-2013 (pre-Medicaid expansion) and 2014-2015 (post-Medicaid expansion) between Medicaid expansion states and non-Medicaid expansion states. Then, a two-sample test of proportions utilizing data from a research-developed employment survey examined the relationship between states approving counselors and states not approving counselors as billable FQHC mental health providers under the enhanced PPS reimbursement and the proportion of LPCs at FQHCs (of the total number of LPCs and LCSWs). </p><p> In both groups of states (Medicaid expansion states and non-Medicaid expansion states), it was evident that there was a substantial increase in the number of mental health visits and FTE mental health staff at FQHCs from 2012 to 2015. Contrary to prediction, the first count model difference-in-differences analysis indicated that non-Medicaid expansion states had a significantly <i> higher</i> rate of change in the number of mental health visits from pre-Medicaid expansion (2012-2013) to post-Medicaid expansion (2014-2015), as compared to Medicaid expansion states (&alpha; = .05, <i>p</i> = .01). Then, contrary to prediction, the second count model difference-in-differences analysis indicated that there was not a significant difference in the rate of change for the number of FTE mental health staff between Medicaid expansion states and non-Medicaid expansion states from pre-Medicaid expansion (2012-2013) to post-Medicaid expansion (2014-2015; &alpha; = .05, <i>p</i> = .13). As predicted, the two-sample test of proportions resulting from the survey responses of 138 FQHCs (60% response rate) indicated that there was a significantly higher proportion of LPCs employed at FQHCs in states approving LPCs as billable FQHC mental health providers under PPS as compared to states not approving LPCs (<i>Z</i> = 4.24, <i>p</i> &lt; .001, Cohen&rsquo;s <i>h</i> = .76). Thus, counselor employment at FQHCs was significantly improved in those states approving counselors as billable PPS providers. It is essential for counselors to understand the impact of federal and state health care policies, such as Medicaid expansion, increased funding of FQHCs, and various Medicaid reimbursement methodologies, to successfully advocate for the profession in the dynamic health care landscape. Counselor educators have a responsibility to convey information to students related to the potential repercussions of billable mental health provider status on their employment opportunities following graduation</p>

<p> Bill Clinton proffered a plan for student loans as he was running for president: a direct loan system with repayments tied to income and collected by the Internal Revenue Service. Since that time, student loan policy continued to struggle with the dichotomy of the bank based lending system and the direct loan system, until President Obama ended new federal student loan originations in the bank based system entirely in 2010. The actions of President George W Bush&rsquo;s administration in between these two Democratic administrations also played a role in this evolution of student lending. How and why did these Presidents take these policy actions and what does that tell us about student loan policymaking within the executive branch? This dissertation employs a case study methodology to explore whether frameworks of policymaking theory may offer insights into student loan policymaking across these three administrations. </p>

<p> Freshmen at baccalaureate-granting institutions cite being able to secure a more attractive job and earn a higher income among the most important factors that influenced their decision to pursue a college or university education. Indeed, higher education has been cast as a reliable on-ramp to the American Dream, a mechanism for reducing income inequality, and a key to enhancing economic competitiveness and growth of states and the nation. These benefits have been emphasized by a chorus of individuals calling for dramatically increasing college degree attainment levels in the United States (U.S.). Yet to what extent and how consistently has higher education delivered these trumpeted outcomes for individuals, states, and the nation? </p><p> U.S. Census American Community Survey microdata and typical education requirements of occupations published by the U.S. Bureau of Labor Statistics were utilized to quantitatively analyze employment outcomes of college graduates. A special focus was placed on the incidence of malemployment (the phenomenon of college graduates working in occupations that do not require a college degree), relationships between undergraduate degree fields and labor market outcomes, and variations across states in the employment outcomes of college graduates. </p><p> The benefits of higher education for individuals and states were found to be highly uneven. Analyses revealed that approximately 31% of adults in the labor force with a bachelor&rsquo;s degree or higher are malemployed, a rate that varies by undergraduate degree field, educational attainment, race/ethnicity, and age. College earnings premiums generally are far lower for malemployed individuals than for graduates who have secured college-level occupations, and they vary dramatically by undergraduate degree field and state. </p><p> Myths about higher education and the labor market were dispelled, such as the notion that malemployment affects only recent graduates and that there generally is an insufficient supply of STEM graduates. The principal propositions of the national attainment agenda were evaluated in light of the study&rsquo;s findings, and a new framework for that agenda was offered, including a greater focus on the traded sector of the economy, a shift from state leadership to a state/federal partnership, and a suggestion for attainment agenda proponents to embrace a learning quality agenda.</p>

En Côte d’Ivoire, les problèmes de sécurité liés à la criminalité ont été portés sur l’agenda politique pour faire l’objet de politiques publiques à partir des années 1980. En effet, la criminalité liée au banditisme qui avait commencé à se structurer au début des années 70 corrélativement à la période dite du « miracle économique », a connu un boom à la faveur de la crise économique sous les effets conjugués, d’un chômage endémique, d’une immigration et d’une croissance démographique mal maitrisées, d’une urbanisation galopante et d’un exode rural sans précédent. Depuis 1983, l’État tente de maitriser la recrudescence du phénomène criminel à travers divers programmes d’actions gouvernementales sans véritablement y parvenir. C’est donc aux raisons de la contre- performance de l’action publique dans le domaine de la sécurité intérieure qu’est dédiée cette thèse. L’hypothèse défendue ici postule que l’inefficacité des politiques de sécurité publique est imputable aux dysfonctionnements inhérents à l’organisation et au fonctionnement de l’ordre politique ivoirien. En effet, l’exercice d’un pouvoir d’État autoritaire qui privilégie la défense instrumentale de l’ordre public dans les politiques policières et pénales afin d’exercer un contrôle strict sur la compétition politique a contribué à structurer l’action publique principalement autour des motivations électoralistes au détriment des besoins sociétaux en matière de sécurité, notamment en matière de criminalité. / In Ivory Coast, the crime-related security problems were brought on the political agenda to be public policy from the 1980s because crime related to banditry that had begun to take shape in the early 70 correspondingly to the period known as the "economic miracle", boomed thanks to the economic crisis due to the combined effects of rampant unemployment, immigration and a poorly mastered population growth, of rapid urbanization and an unprecedented rural exodus. Since 1983, the state is attempting to master the resurgence of criminal phenomenon through various programs of government action without actually achieving it. So the reasons for the poor performance of public action in the field of internal security that is dedicated this thesis. The hypothesis put forward here postulates that the inefficiency of public security policies is due to malfunctions related to the organization and functioning of the Ivorian political. Indeed, the exercise of an authoritarian state power that favors instrumental defense of public order in the police and criminal justice policies to exercise strict control over political competition has helped to structure public action mainly around electoral motives at the expense of social needs security, in particular on crime.

This study investigated the extent and scope of citizen voice in public decision-making in the Gauteng Provincial Legislature (GPL) from two theoretical perspectives. It is structured around three components; an in-depth exposition of the literature on citizen participation, application of two theoretical frameworks applied to the scope of citizen voice in the GPL and an applied case study approach. This study found that the literature ascribes multiple meanings to citizen participation and that there are incongruities in the manner in which the literature conceptualises, describes the mechanisms, and outlines the intentions, and outcomes of citizen participation. Citizen voice in the GPL is deemed to be contextual to and influenced by the interplay of the socio-political environment, multiple interests, values and sub-systems. The case study approach allows for an expanded analysis of the implicit power dynamics in the GPL and the institutional political processes on the nature and extent of citizen voice. In this study citizen voice is regarded as an opportunity for direct, representational and/or institutional expression of citizen interests in public decisions consolidating democracy, citizenship and legitimate government.The GPL’s policy documents point to a stated intent of democratic public participation conceived and pursued as citizen control, empowerment and partnership. However the conclusion is that this participation vacillates between information sharing and consultations, but not decisionmaking control. The study asserts that the theory on citizen voice in public decision-making is under-developed and there is a disconnection between the literature and citizen experiences.

According to Lombard and Kruger (2009), the status of older persons has not changed considerably despite the promulgation of the Older Persons Act in 2005 and the adoption of the South African Policy for Older Persons in 2006. The researcher attempted to contribute to a better understanding of the problematic status of older persons through an exploratory study of institutional arrangements involved in the implementation of the policy using a case study approach. The network theory was used as a guiding theoretical framework. Findings from the study indicate a randomly related network affected by lack of robust, efficient and effective leadership and co-ordination. Formalization of network membership through written rules and a constitution that spells out the roles and responsibilities of network members, and continued interaction amongst network members is suggested to strengthen the network and the leadership. It is the conviction of the researcher that strengthening of the network will improve the implementation of the South African Policy on Older Persons, thereby improving the lives of older people.

Following Hilhorst (2004), this study posits that, as communities become more populous they also become more complex. As they become more complex, communities develop institutions and social structures to help coordinate social activities. Among these institutions are forms of government which ensure management of resources and public safety. As part of public safety, citizens in vulnerable areas expect their government to provide disaster shelters during hurricanes. In response to this expectation, government forms policies and creates plans for disaster/evacuation shelters. These shelters become an arena for both disaster shelter policy implementation and organizational behavior. This study examines the relationships between disaster shelter policy implementation and the organizational behavior of the government staff and nonprofit volunteers who implement disaster/evacuation shelter policy as well as the citizens who receive services and who may themselves be volunteers. This study reviews the social complexity and structure of these relationships within Hilhorst’s (2004) proposed social domains of science and disaster management, disaster governance, and local response, as demonstrated in Florida’s Division of Emergency Management Region 5 (henceforward referred to as Region 5) during the 2004 hurricane season. This hurricane season was selected because nearly every county in Florida was affected by a hurricane (Charley, Frances, Ivan, or Jeanne) within a span of 44 days. Orange County was chosen because it was directly affected by three of the four storms (Charley, Frances, and Jeanne) and served as a regional disaster shelter during the fourth (Ivan). Region 5 was chosen for comparison because it was directly affected by three of the four storms and because Orange County served as a regional disaster shelter during the fourth (Ivan). / A Dissertation submitted to the Askew School of Public Administration and Policy in partial fulfillment of the Doctor of Philosophy. / Summer Semester 2017. / July 19, 2017. / EMERGENCY MANAGEMENT, ORGANIZATIONAL BEHAVIOR, PUBLIC POLICY, SOCIAL DOMAIN THEORY / Includes bibliographical references. / Ralph Brower, Professor Directing Dissertation; Petra Doan, University Representative; Kaifeng Yang, Committee Member; David Berlan, Committee Member.

<p> This study investigates parental health literacy and parental health seeking behavior for pediatric primary care utilization as a response to childhood obesity among 220 parents from 12 Head Start and Non Head Start preschools in New Castle County, Delaware. Four paper surveys collected data with the Newest Vital Sign, STOFHL-A, a Parent Survey, and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Green and Kreuter's 2005 Precede-Proceed model is applied to an original logical model for determining a need for a preschool health literacy intervention to inform better child health outcomes. Results indicate that low-income, minority families, have fewer health books at home, which is associated with lower parental health literacy, higher child BMI, and more health care referrals for managing childhood obesity. Nutritional health literacy scores are lower among Hispanic parents who are Head Start participants. Black parents who are Head Start participants had significantly lower parent functional health literacy. Head Start programs offer more parent health education and twice the rate of referrals for the same level of health seeking behavior as Non Head Start parents. Health seeking behavior was lower overall for Black parents from the Head Start program. Further study should explore cultural notions and family characteristics associated with lower pediatric health care utilization in relation to both health literacy scores and health care referrals. </p><p>

<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>

The purpose of this study was to conduct a formal program evaluation of the New York State newborn screening for Krabbe disease (KD), a rare neurological disease with variable onset of symptoms to assess 1) the perceptions of stakeholders 2) KD test characteristics, and 3) actual program costs. Using the CDC Framework for Program Evaluation in Public Health, integration of qualitative and quantitative techniques was used to provide a comprehensive evaluation. Stakeholder input was elicited using semi-structured interviews of medical professionals and parents and content analysis of the interview transcripts identified five themes: Legislative/Political, Unintended Consequences, Knowledge and Science, Communication, and Moral Issues. Finally, cost and charge data were used to calculate the cost of the KD screening program from the perspective of the State. Triangulation of the results provided the conclusions for practice and policy recommendations. Using the data from the State annual reports of 9 positive KD screening results, sensitivity was calculated at 100%, specificity was 99%, positive predictive value was 5%, negative predictive value was 100% and prevalence was 1/100,000 births. However, the State reports did not include the 19 infants with low enzyme activity and mutations that could develop into later onset forms of KD. When these 19 infants were included, sensitivity, specificity, and negative predictive value remained unchanged; however, positive predictive value rose to 15%, and prevalence increased to 3/100,000 births. The total annual cost of the program from the perspective of the State was calculated at $750,652. For parents, the cost calculated from initial newborn screen to neurodiagnostic testing was $2669/family. Since 2006, there have been more than 1,000,000 infants screened for KD in New York State. While the screening has identified four infants with the early infantile form of the disease, there have been 24 others identified with low enzyme activity and mutations that may cause later onset forms of the disease, which are poorly understood. This unexpected finding suggests that newborns may be diagnosed with a disease that may not present symptomatically until adulthood. Unfortunately, the current confirmatory enzyme test and neurodiagnostic tests cannot predict onset of disease or severity of symptoms. In addition, the only available treatment, a cord blood transplant, is irreversible, has a high risk of morbidity and mortality, and long term outcomes have not been studied. While the cost of the program from the perspective of the state is not excessive, cost-effectiveness studies are needed to determine the cost of KD screening from the societal perspective, and should include treatment and follow up costs.