two SBMS-AR youths were expelled in the term before entering the program, and only one in the term after program entry. In addition, pro- gram participants had significantly lower mean barrier scores (3.7) six months after program entry than at prog


mple comparison of rates, the two cohorts did not differ significantly in arrest rates in the difference-in-differences analysis. We could not compute the odds ratio for incarceration because the follow-up for the FY 2015–2016 cohort was 0.
Current J


.27 0.68 0.14 0.00
Diff – Diff Percentage
–0.58 –0.28
Odds Ratio
0.872 —
95% CI
0.129–5.884 —
    NOTE: Because there were no incarcerations in the follow-up period for the previous year, we could not compute the odds ratio for incarceration. “Diff –


hree comparison-group youths completed community service and only two SBMS-PROB youths had probation violations. For big six outcomes, see Figure 2.15, with details in Table D.14.
Cluster data were available for all participants in the SBMS-PROB prog


ation Supervision for Middle School Probationers, by Cluster, FY 2016–2017: Arrest, Incarceration, and Completion of Probation
NOTE: A missing bar for a cluster indicates that no one in the cluster had the indicated outcome.
barrier scores significan


ngs.
We note also that, by definition, at-risk youths are likely to have virtually no preprogram juvenile justice costs. Probationers, by contrast, might have been under supervision prior to program entry and might have also incurred other juvenile j


s that could be used for one-time costs. These were spent on a New Directions program, BOS contracts, and expanded (non-JJCPA) programs. These funds totaled $2,926,705, so the total expenditure of JJCPA funds in FY 2016–2017 was $30,718,002.
Estimate


 allow compari- sons for program participants in the six months after entering JJCPA programs versus the prior six months.
The people for whom we calculated costs are the same ones we used in reporting out- comes in the previous chapter, except for t


 the estimated court cost ($3,255.25) yields a total estimate of $5,616.51 per court appearance in 2016 dollars.
Probation Costs for Routine Supervision, Camp Stays, and Hall Stays
The Probation Department’s Budget Department provided the estimated c


m, we counted the number of arrests, the number of days in camp, the number of court appearances, the number of days in juvenile hall, the number of days in the program, and the number of days of probation supervision. For the school-based programs,


estimated costs that such a phenomenon might skew. A median that differs substantially from its corresponding mean indicates skewness, while a similar mean and median for a given cost estimate indicate that the cost is more evenly distributed among


1.07
Program 20.67 0.00
Supervision 8.37 103.27
Total 24,392 8,483
1,452 0 6,391 0 6,292 5,617 9,392 0
0 0 864 1,322
   NOTE: A positive number in a difference column indicates that the cost was lower in the six months after beginning the program tha


25 SNC participants, so high costs for a small number of youths could easily skew the mean cost.
Cost Comparisons for Programs in the Enhanced Services to High-Risk/High- Need Youths Initiative
For this initiative, we again estimated the costs of the


entering the program than before entering. All units are days except for arrests, which are measured by the number of arrests, and court, which is measured by the number of appearances. Because of rounding, some data groups do not necessarily sum pre


d by the number of appearances. Because of rounding, some data groups do not necessarily sum precisely.
Table 3.7
Estimated Juvenile Justice Costs for Youth Substance Abuse Intervention
    Baseline
Mean, Median, in 2016 in 2016 Dollars Dollars
989 0


 0 3
Follow-Up
Difference, in 2016 Dollars
   Juvenile Unit Cost,
Justice in 2016
Cost Dollars Units
Median,
in 2016
Dollars Units
0 0.00 0 0.00 0 0.00 0 0.02
0 178.48 0 0.07 0
Mean, Median,
in 2016 in 2016
Dollars Dollars Mean
3 0 –1 0 0 0 2 0 –1
16


0 0
0 0 0
Difference, in 2016 Follow-Up Dollars
   Juvenile Unit Cost,
Justice in 2016
Cost Dollars Units
Median,
in 2016
Dollars Units
0 0.00 0 0.00 0 0.00 0 0.00
0 179.47 0 0.00 0
Mean, Median,
in 2016 in 2016
Dollars Dollars Mean
0 0 0 0 0 0 0 0 0


rest 2,121.10 Camp 895.04 Court 5,616.51
0.00 0.00 0.00 0.00
0.00 0.00
Juvenile hall
Program Supervision Total
848.18
19.41 8.37
   NOTE: A positive number in a difference column indicates that the
beginning the program than in the six months before


ffset cost increases in juvenile hall ($81), program administration ($758), and supervision ($565). As a result, total mean costs were lower in the follow-up period ($8,384) than during the baseline period ($9,504).
Estimated Total Cost of Programs a


ttendance, targets only at-risk youths who have virtually no involvement with the juvenile justice system.
Ten of the JJCPA programs produced average cost savings in arrests, and HB participants had no arrests in either the baseline or follow-up peri


program and the six months after entering). As one might expect, mean costs differ noticeably among the three initiatives. The Enhanced Mental Health Services ini- tiative, whose participants are almost all probationers, showed lower arrest costs, b


3 106 13,280
3
  NOTE: A positive number in the “Difference of Means, in 2016 Dollars” column indicates that the mean
was lower in the six months after beginning the program than in the six months before beginning. A negative number indicates that th


 this document.
This report presents outcome measures for 14 programs in the Los Angeles County JJCPA for FY 2016–2017. Outcomes are reported for 17,503 program youths and 17,588 comparison- group youths. The county’s 14 programs are grouped into thr


on
and successful completion of community service. There was no significant difference
between the two groups in the other four big six outcome measures. Thevastmajorityofparticipantsinprogramsthatusedpre–postevaluationswereat-risk youths. These prog


Mental Health Services initiative for whom Probation reported big six outcomes, the results for that program significantly influence the results for the initiative as a whole. Echoing the results for MH participants is the finding that program partic


ant differences between baseline and follow-up measurements.
The Enhanced School- and Community-Based Services Initiative
Taken as a whole, participants in the Enhanced School- and Community-Based Services ini- tiative had significantly more-positive


pants had significantly lower arrest rates and higher rates of completion of probation, restitution, and community service than those of comparison-group youths. Rates of incarceration and violations of probation for the two groups did not differ sig


 Justice Crime Prevention Act: Fiscal Year 2016–2017 Report
Difference-in-Differences Analyses
A difference-in-differences analysis compares the change in the current year’s cohort and the change in the previous year’s cohort—in this case, comparing


cohorts, which, by definition, is considered a positive outcome.
From year to year, a particular big six outcome might not always be more positive for program participants, but, overall, there is a consistent pattern of program participants meet- ing


our programs—HRHN, MST, SBHS-PROB, and SBMS-PROB—had lower total juvenile justice costs in the follow-up period than at baseline.
Summary and Conclusions 89
90 Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal Year 2016–2017 Report
Fut


comparison groups, we identified youths who quali- fied for the program but whom the program did not accept because of program limitations or who were “near misses” in terms of eligibility. For the two school-based probationer pro- grams (SBHS-PROB a


SCC outcomes is as follows:
1. successful completion of probation. The Probation Department considers this the most definitive outcome measure. It captures the issues that brought the youth to Pro- bation’s attention (risk, criminogenic needs, and pr


nce abuse treatment Gang intervention Gender-specific services Gender-specific services HRHN employment services
Cluster
5
2, 3, 4 2, 4 1, 2, 5 5
5
1, 5 3
3
1, 2, 3 1, 4 3
3
1, 2, 3 3
2
3
4
4 1,4 3
1
3 3, 5
  95
96
Los Angeles County Juvenile Justice


ustice Crime Prevention Act: Fiscal Year 2016–2017 Report
Table D.2
Outcomes for Multisystemic Therapy, FY 2016–2017
   BSCC-
Mandated
Outcome Number
Arrest 19
Incarceration 7
Completion of 10 probation
Completion of 10 restitution
Completion 7 of co


nity
service
Probation 5 violation
BSCC Supplemental Outcome
Self-efficacy for girls
Program
Percentage
2.21
0.46 28.89
32.26 31.03
11.11
Baseline
Mean
26.96
Sample Size
861 861 45
31 29
45
Sample Size
436
Number
18 5 8
9 6
5
Comparison
Percentage
2.


umber
71 24 117 14
Comparison
Percentage
31.00 5.50 10.00
21.10 10.34
18.50
Follow-Up
Mean
38.71 11.97
Sample Size
200 200 150
109 116
150
Sample Size
62 117
        BSCC Supplemental Outcome
Percentage of positive tests
Percentage testing positive
N


SCC-
Mandated
Outcome Number
Arrest 531
Incarceration 245
Completion of 196 probation
Completion of 170 restitution
Completion 119 of community
service
Probation 159 violation
BSCC Supplemental Outcome
Juvenile hall behavioral violations— SIRs
Progra


h score 9.42 Barrier score 7.40
Program
Percentage
3.80
0.71
n.a. n.a.
n.a. n.a. n.a. n.a.
n.a. n.a.
  Sample Size
2,525
Comparison
Number Percentage
66 3.74
Sample Size
1,765 1,765
   2,525
15 0.85
   Baseline
Follow-Up
Mean
93.24a 4.77a 0.32a
16.39


ion for Middle School At-Risk Youths, FY 2016–2017
   BSCC- Mandated Outcome
Arrest Incarceration
Completion of probation
Completion of restitution
Completion of community service
Probation violation
Number
13 3
Program
Percentage
1.83 0.42 n.a.
n.a.


program or when the youth exited the program, whichever came first.
a Difference is statistically significant (p < 0.05). Statistical testing is not possible if one of the measures is 0.
APPENDIX E
Board of State and Community Corrections–Mandated Ou


175 23.24 55 7.30 254 33.73
175 36.61 89 19.31
46 6.11
Sample Size
753 753 753
478 461
753
       114 Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal Year 2016–2017 Report
Table E.6
Outcomes for School-Based Probation Supervision for


a.
service
violation
  118 Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal Year 2016–2017 Report
     Cluster 12345
Table F.3
32.60
21.03
Sample Size
Percentage
Sample Size
Percentage
Sample Size
Percentage
Sample Size
Percentage
Sam


 Year 2016–2017 Report
Figure H.1
Los Angeles County Probation Department Form for Probationers’ Strengths and Risks
Revised 2/6/07
Program Name/Csld No.
Minor’s First Name:
Mother’s First Name:
LOS ANGLES COUNTY PROBATION DEPARTMENT
STRENGTHS AND RI


oor Relationship Skills
Deviant
Alcohol Use
Drug Use
Low Self-Esteem
Previous Placement (relatives, DCFS, etc.,) Runaway
Access to Firearms
TOTAL CHECKS
Poor Classroom Behaviors Low Commitment to Education Academic Failures
Truancies
Conflict w/Schoo


1, updated September 17, 2004. As of February 7, 2017:
h t t p : // w w w.w s i p p .w a . g o v / R e p o r t s / 0 4 - 0 7- 3 9 01
Baldwin, Scott A., Sarah Christian, Arjan Berkeljon, and William R. Shadish, “The Effects of Family Therapies for Ado


uary 5, 2017: http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1998
Campbell, Donald T., and Julian T. Stanley, “Experimental and Quasi-Experimental Designs for Research,” Handbook of Research on Teaching, Boston, Mass.:


 Recidivism in Juveniles: A Meta-Analysis,” Criminal Justice and Behavior, Vol. 28, No. 3, June 2001, pp. 367–394.
County of Los Angeles, 2016–17 Final Budget, Los Angeles, c. 2016. As of July 3, 2018: http://ceo.lacounty.gov/pdf/budget/2016-17/Final


ion, RR-1023-LACPD, 2015. As of February 7, 2017: http://www.rand.org/pubs/research_reports/RR1023.html
Fain, Terry, Susan Turner, and Mauri Matsuda, Los Angeles County Juvenile Justice Crime Prevention Act: Fiscal Year 2014–2015 Report, Santa Monica


 Prevention, December 1999. As of February 7, 2017: http://purl.access.gpo.gov/GPO/LPS41069
Greene, Peters and Associates and Northwest Regional Educational Laboratory, Guiding Principles for Promising Female Programming: An Inventory of Best Practic


Heilbrun, Kirk, David DeMatteo, Ralph Fretz, Jacey Erickson, Douglas Gerardi, and Catherine Halper, “Criminal Recidivism of Female Offenders: The Importance of Structured Community-Based Aftercare,” Corrections Compendium, Vol. 33, No. 2, March–April


atessa, Edward J., and Christopher Lowenkamp, “What Works in Reducing Recidivism,” St. Thomas Law Journal, Vol. 3, No. 3, 2006, pp. 521–535. As of June 24, 2018:
https://ir.stthomas.edu/ustlj/vol3/iss3/7/
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 . g o v / A p p / P u b l i c a t i o n s / a b s t r a c t . a s p x ? I D = 15 5 2 8 2
Mitchell, Ojmarrh, David B. Wilson, Amy Eggers, and Doris L. MacKenzie, “Drug Courts’ Effects on Criminal Offending for Juveniles and Adults,” Campbell Systemat


Relapse Prevention: A Volume in Practical Resources for the Mental Health Professional, Academic Press, 2007, pp. 293–311.
Reiss, Albert J., Jr, Klaus A. Miczek, and Jeffrey A. Roth, eds., Understanding and Preventing Violence, Vol. 1, Washington, D.


an, Patrick H., and Nancy Guerra, What Works in Reducing Adolescent Violence: An Empirical Review of the Field, Boulder, Colo.: Center for the Study and Prevention of Violence, Institute for Behavioral Sciences, University of Colorado, Boulder, 1994.


Elizabeth Cauffman, and Thomas Grisso, “Mental Health Assessments in Juvenile Justice: Report on the Consensus Conference,” Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 42, No. 7, July 2003, pp. 752–761.
Westermark, Pia Ky


   CORPORATION
Building a High-Quality Correctional Workforce
Identifying Challenges and Needs
Joe Russo, Dulani Woods, George B. Drake, Brian A. Jackson
On behalf of the National Institute of Justice (NIJ), the RAND Corporation manages the Priority


andards are required to ensure that training curricula are adequate, consistent, relevant, realistic, and delivered in an effective manner.
• There is a need for standards to control excessive workloads, which can lead to both staff turnover and inad


or 34 percent of the workforce and change jobs at a rate more than three times that of nonmillen- nials (Adkins, 2016). Turnover is expensive, and it is estimated that millennial turnover alone costs the U.S. economy more than $30 billion annually. T


ool of quality candidates, the realities of corrections work (e.g., work hours, environment, com- pensation), and the strategies required to find candidates who meet the existing and future needs of the organization
 • selection: standards and proces


arding, retention, and leadership development. The panelists addressed the misconduct theme last. Misconduct is markedly different from the other themes because it is not a distinct stage of the workforce process; rather, it is a behavior that can be


, project staff used a variant of the Delphi Method (RAND Corporation, undated), an approach in which members of the group provide rankings on the needs individually, then discuss the results as a group, and then have the opportunity to individually


lted in 64 final needs. (See Figure 2 for a breakdown of these needs by theme and Table 1 for the top-tier needs across all themes.)
We acknowledge that the needs identified and the priorities assigned to them are—as with any subjective assessment in


pushing decisionmaking authority
 Problem or Opportunity
Associated Need
The role of corrections staff, particularly in institutions, is generally viewed to be custodial or surveillance-oriented, which limits the sector’s ability to attract new talen


ent.
The sector lacks a coherent vision. Because agencies operate in a rapidly shifting environment, they are struggling to keep pace both in general and with respect to their workforces in particular.
Develop a national vision and strategy for corre


with the public. The panelists reported that, to begin to change perceptions, the sector must actively communicate with both the media and the public. For many decades, agencies have adopted a “no news is good news” stance with respect to the media.


panelists reported that the perpetuation of these negative stereotypes undermines the sector and its ability to recruit new talent. They therefore identified a need for the development of best practices for such stakeholders as the major professional


ed with work experience or military service (“Cor- rectional Officer Education and Training,” 2013). Interestingly, some states have modified educational requirements based, in part, on the labor market. For example, in 1987, the Colorado Department


-based programming and recognize and leverage the potential of corrections officers as key components of the behavioral change process could be more attractive to a wider group of candidates, allowing agen- cies to enforce competency standards. The p


’s family for food stamps (Mitch- ell, 2014). Similarly, new parole officers in New Jersey receive $57,000 annually, whereas their counterparts in Louisiana earn just over $30,000 (New Jersey Civil Service Commission, 2016; Rico, 2017). Compensation


 agency, and geographic area and proposed the establishment of a federal minimum wage for correctional occupations that organizations can exceed, as appropriate.
Retirement benefits are another important aspect of compensation. Historically, relative


ensation. The
High school students with college aspirations (and considering eventual repayment of student loans) could be dissuaded from careers in corrections.
11
 12
Figure 5. Median Base Salaries of the Lowest-Paying U.S. College Majors in 2017


 employment.
Influence of Organized Labor
Organized labor can inadvertently impede the sector’s abil- ity to recruit new talent, according to the panelists. Many employees have joined national unions or state associations to negotiate compensation, b


plications that a human-services approach and culture would have on recruitment.
Develop best practices for pushing decisionmaking authority down to the lowest level.
Reevaluate or create competency standards for various correctional positions.
Devel


s stressed that agencies should consider hiring professional recruiters rather than using existing corrections staff, as is common practice. Professional recruiters have the skills and knowledge to perform the task, and they understand how to leverag


 to ensure appropriate hiring decisions. The panelists discussed a variety of challenges and identified four needs that would help improve the effectiveness and efficiency of the selection process (Table 5).
Screening Processes
Every organization use


tions, 2017). Although this represents great improvement, the timeline is still longer than for other occupations. Some of the challenges identified are information technology–related because many agencies struggle with outdated systems. Panelists no


n process.
Traditional selection criteria could unnecessarily eliminate interested candidates from consideration for correctional positions.
Associated Need
Conduct research to identify the factors that have predictive value in determining success on


the amount and qual- ity of training that correctional staff receive prior to their first assignment. This is perhaps not surprising, given that each state generally sets its own standards and each agency must operate within its unique resource cons


 then quickly exit the field) and benefit the individuals involved.
The panelists recognized that training new staff is a signifi- cant expense. For example, the Ohio Department of Reha- bilitation and Corrections has estimated that the cost to train


 will face.
Younger generations typically value self-improvement through relevant training opportunities.
Traditional training models are inflexible and consume resources unnecessarily.
High turnover rates are a burden to correctional agencies in man


he preparation that more-realistic training could provide. For example, new corrections officers are instructed to
 1
 2
 3
            (Goldstein, 2017), but are not yet applied in corrections. The panelists recommended assessments of the costs and


ure of a correctional facility can be as important as know- ing how to do the job itself. The panelists reported that new hires need better preparation for these challenges and called on agencies to examine and improve their organizational cultures w


esources or attention to retaining staff that they do for recruitment. The most-effective recruiting efforts can bring talented individuals to the agency, and many of these
19
 20
strategies have a role in preventing turnover, but maintaining
a high-


, including self-defense training and situational awareness and personal protection technologies.
Workload Implications
Staff perceptions of workload can also be a stressor that negatively affects job satisfaction and ultimately retention, according


isionmaking has on job stress in corrections. For example, Stohr, Lovrich, and Wilson (1994) found that lack of participa- tion in decisionmaking increased the stress levels of jail staff. Conversely, employee participation in decisionmaking was link


n and, therefore, retention. For example, studies have linked inadequate supervisory support (Maahs and Pratt, 2001) and dissatisfaction with supervisors (Stohr, Self, and Lovrich, 1992) with negative attitudes and turnover intention. Furthermore, co


r intention.
Assess and validate existing standards for staffing ratios, and examine such strategies as capped caseloads to allow agencies to meet these standards.
Develop best practices for “participatory councils,” and evaluate the impact that thes


ight be outdated and should be reevaluated. Rather than using a fixed age, “fit-for-duty” assessments might be a better way to determine whether staff can continue to perform the requisite duties. This issue will become increasingly salient as the ge


when they first join the organization. This approach does have risks, however: The panelists recognized that selecting individuals for groom- ing opportunities could create tension in the workplace among those who are not selected. To combat this, st


e panelists identified the need for an assess- ment of the adequacy of training for new supervisors and the
[Panelists suggested establishing] a national correctional academy that would provide high-quality, standardized management- level training to


 that, as officers are promoted
 Table 8. Needs Identified Related to Leadership Development
Tier
Problem or Opportunity
Correctional agencies do not place sufficient emphasis on leadership and management training.
Existing resources that support lea


emy for management-level training.
Assess the prevalence of this organizational characteristic, and develop best practices to support continuous readiness activities well before they are needed.
Investigate the efficacy of relatively quick and access


practices for ethics and related training, which would prepare staff to protect themselves from criminal and civil liability. Panelists also discussed the wide variation in how agencies respond to incidents of misconduct and identified the need for


hat, if introduced and implemented effectively, could enhance transparency and positively influence staff behavior. Panelists also discussed strategies to improve the detection of misconduct, if only after the fact. They identified the need to develo


er Data
  Tier
Problem or Opportunity
Statistics on the correctional workforce (e.g., salary data, vacancy rates, turnover rates) are stored in separate silos and are difficult to locate and perform comparative analyses on because of the lack of stan


ong with a corresponding change in the competencies sought, would help the sector recruit a broader base of new talent.
Improve Staff Competencies
The corrections sector currently suffers from low levels of professionalism, according to the panelists


- ship development. Finally, the panelists noted that, although resources exist, such as the Correctional Leadership Competen- cies for the 21st Century report (Campbell et al., 2006), there is a need for publishers to review and revise these documen


hem. Once the group had compiled and refined its list of issues and needs, the issues and needs were converted into a web-based Delphi instrument (using the Qualtrics online survey service).
Each panelist was asked to use the instrument to individu-


together, and the median of that product rep- resented the overall priority for that item. Then, the resulting prioritization scores were clustered using a hierarchical clus- tering algorithm. The algorithm was the “ward.D” spherical algorithm from


ns-face-acute-staffing- shortage-fueling-violence-1496401200
BLS—See Bureau of Labor Statistics.
Bonner, Heidi S., North Carolina Department of Public Safety, Division of Adult Correction and Juvenile Justice, Adult Institutional Corrections: Recruit


orrectional Officer Education and Training: Survey Summary,” Corrections Compendium, Vol. 37, No. 3, Fall 2013.
Cullen, Francis T., Bruce G. Link, Nancy T. Wolfe, and James Frank, “The Social Dimensions of Correctional Officer Stress,” Justice Quarte


s, Richard Silberglitt, George B. Drake, John S. Shaffer, Mikhail Zaydman, and Brian G. Chow, Fostering Innovation in Community and Institutional Corrections, Santa Monica, Calif.: RAND Corporation, RR-820-NIJ, 2015. As of June 26, 2018: https://www.


cent/95762920/
33
34
Maahs, Jeff, and Travis Pratt, “Uncovering the Predictors of Correctional Officers’ Attitudes and Behaviors: A Meta-Analysis,” Corrections Management Quarterly, Vol. 5, No. 2, Spring 2001.
Massachusetts Public Employee Retirement


tions Management Quarterly, Vol. 5, No. 2, Spring 2001, pp. 68–78.
Smith, Tom W., and Jaesok Son, “Measuring Occupational Prestige on the 2012 General Social Survey,” Chicago, Ill.: National Opinion Research Center at the University of Chicago, Octob


Content Analysis,” Criminal Justice Studies, Vol. 26, No. 4, 2013.
Wareham, Jennifer, Brad W. Smith, and Eric G. Lambert, “Rates and Patterns of Law Enforcement Turnover: A Research Note,” Criminal Justice Policy Review, Vol. 26, No. 4, June 1, 2015,


master’s thesis was an economic analysis of organic and conventional agriculture using the Rodale Institute’s Farming Systems Trial. He began his career as a Coast Guard officer on afloat and ashore assignments in Miami, Florida; New London, Connect


l use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in anoth


 CORPORATION
How Can Workers’
Compensation Systems
Promote Occupational
Safety and Health?
Stakeholders Views on Policy and Research Priorities
 Michael Dworsky, Nicholas Broten
For more information on this publication, visit www.rand.org/t/RR2566
 P


he well-being of workers. RAND conducted a literature scan to identify published criticisms of current workers’ compensation systems, focusing on the implications of workers’ compensation for worker safety, health, and economic well-being. After prod


s.............................. 18 Focus on Compliance Leads to Complexity and Distracts from Other Objectives .............. 19
 v
Data Management and Claim Tracking Problems Within Employers.................................. 19 Occupational Health


ted policymakers from resolving these challenges.
The National Institute for Occupational Safety and Health (NIOSH) requested that RAND explore the beliefs and priorities of key workers’ compensation stakeholder groups about system challenges and res


njury prevention than, in our view, some of the published critiques had.
Stakeholders identified promising policy interventions in need of rigorous evaluation and also suggested research on questions of epidemiology and system organization that could


um of critical perspectives that resulted from our literature review is included as Appendix C to this report.
Stakeholders Identified Many Shortcomings of Workers’ Compensation Policy as Important Challenges to Worker Outcomes
In general, stakeholde


fficult to monitor. Meanwhile, workers are often unable to navigate current systems without attorney representation, while system complexity can also deter workers from filing claims in the first place. Stakeholders felt that current approaches to di


 New Models and Interventions for Health Care Delivery, Injury Prevention, Dispute Resolution, and Disability Prevention
Stakeholders identified examples of promising state-level innovations for injury prevention, return to work and disability preven


practices for relatively narrow but consequential aspects of system administration, such as rules governing claim initiation, attorney fees, and so on, with the relevant expertise often concentrated in interested parties (for example, the insurance i


at several stages of this research. We also wish to thank Philip Armour at RAND and Gregory Warner at the Harvard T. H. Chan School of Public Health for their insightful and remarkably thorough work as this study’s quality assurance reviewers. We al


ompensation coverage mirror debates from the origins of the system in the early twentieth century. Nonetheless, several recent governmental and journalistic accounts have focused attention on current points of disagreement and tension in the system t


kers
• employers
• claims administrators
• state agency leaders
• occupational health care providers.
RAND convened separate conference calls with each of these groups between February and April 2018. This report provides a synthesis of these discuss


oyers, particularly because damages sought in a lawsuit could include noneconomic costs related to pain, suffering, and wrongful death.
The establishment of workers’ compensation systems represented a compromise, or “grand bargain,” that provided par


e were driven primarily by variation in state rules regarding which classes of workers could be left out of the workers’ compensation system and the tradition of voluntary coverage in many states. The commission highlighted coverage gaps for low-wage


tinuing review of the statute and recommending changes to it and related policies, (3) informing employees of their rights and responsibilities under the law, (4) informing employers and carriers of their rights and responsibilities under the law, (5


equacy, and Cost Spillovers
• Coverage remains less than universal. Observers noted that many of the coverage restrictions identified in the national commission report are still in place, such as exclusions for small employers and agricultural worker


mplexity is a drag on performance. Several observers noted that the administration of workers’ compensation is often too complex, which can lead to confusion, uncertainty, a slow claims process, a focus on compliance rather than outcomes, and dispari


9,634 in Nevada (Groeger, Grabell, and Cotts, 2015).
• Disability determination reference guides have limitations. The evidence base for impairment-rating guides is incomplete across editions of the guides, injury types, injury severity, and individu


opt-out clause was ruled unconstitutional by the Oklahoma Supreme Court because it created radically different legal treatment for otherwise similar individuals in the same class of workers (Szymendera, 2017). A more widely adopted and less radical a


o many workers’ compensation policymakers and system observers. However, some stakeholder groups may be more vocal or better coordinated than others. For instance, the International Association of Industrial Accident Boards and Commissions (IAIABC) h


ng policymaking.
Overview of Challenges Identified as Major Priorities
Different stakeholder groups raised a wide range of concerns about current workers’ compensation system design and performance. The distribution of concerns across stakeholder gro


actions taken by employers and claims administrators. Claim management processes refers to policies, procedures, and norms within workers’ compensation systems that affect the path from injury to closing a claim. These are affected by decisions acros


have been neglected because the relevant agencies were not represented in our discussions.
Prevention of Injury and Disability
Workers, health care providers, and state agency leaders generally agreed that prevention of injury and prevention of disab


me product with essentially the same production process: one factory has numerous workers’ compensation claims for soft-tissue injuries, while the other typically has no compensable injuries. The union representative viewed this pattern as an illustr


ves based directly on safety records may not even be applicable to the smallest employers. Stakeholders, including both occupational health care providers and worker representatives, identified several examples of successful programs in which workers


nd orientating contract employees but that such efforts were costly and were unlikely to be pursued by smaller host employers.
Coverage of Conditions: Work-Relatedness and Causation
Participants cited many examples where work-related injuries were un


it, “[T]hese big employers . . . really do feel the work-related injuries are the workers’ fault as opposed to unsafe conditions.” Speaking about apportionment, another worker advocate viewed legislative debates as being driven by a desire to “build


 dispute resolution mechanisms were deleterious not only to system efficiency and cost control but to the health and economic outcomes of workers themselves.
Some state agency leaders pointed out that litigation and complex disputes are concentrated


re provider. And in general, they don’t have training to deal with this. . . . [T]he worker advocacy part is being done by people who don’t know the system and are discouraged from really working well in the system. The system is so stacked against w


nd the fragmentation of health records between occupational and nonoccupational health care providers harmed patients.
Confusion about privacy and information sharing may amplify the consequences of care fragmentation between group health and workers


isease management.
Claims administrators also raised concerns about the extent to which worker health (including comorbidities and poor health behaviors, such as smoking) made injuries more difficult to treat once they occurred. Self-insured firms ha


o remove providers who are bad apples, and an adjudication process that is capable of applying the guidelines with confidence is also necessary. In the absence of such understanding, the claims management process is heavily dependent on an ecosystem


eform
As noted by Rick Victor, a system feature that has helped to make workers’ compensation politically viable for over a century is the functioning of the political system to reach effective compromises between the interests of workers and employe


e it unconstructive to even discuss federal standards, let alone a federal role in benefit financing. Some worker advocates, however, did argue that greater federal oversight would be necessary to stop the race to the bottom. One suggestion was for t


esolution
Cost Shifting to Social Programs and X Families
X X X X X X X X X
 X
X
X
  Removing Barriers to Claiming and System Navigation
Claims administrators suggested that evidence on best practices for the rules of a workers’ compensation system s


SIG matching funds is an assessment on workers’ compensation premiums (Ohio Bureau of Workers’ Compensation, 2017). A peer-reviewed evaluation of the SIG program by researchers from NIOSH and BWC found that participating employers experienced dramati


s. The target population consists of workers’ compensation claimants with work restrictions that interfere with their regular jobs. The intervention consists of wage subsidies, funding for worksite modification or equipment purchases up to $5,000, or


nover) was cited by one state agency representative as a barrier to socially efficient levels of accommodation. One might observe a similar pattern if these businesses faced high borrowing costs or sharp liquidity constraints. It is also worth noting


t, NIOSH may be uniquely well suited among federal agencies to provide detailed guidance focused on workers’ compensation and occupational health, particularly when it comes to issues of health care delivery and injury prevention.
Incentives to Impro


vement and occupational health delivery.
Alternative Models for Occupational Health Care Delivery and Disability Management
The COHE system in Washington State is recognized as a national leader in improving the quality of occupational health care an


 treatment for symptomatic diseases are largely paid by workers’ compensation, while group screenings are overwhelmingly financed by employers (NYS OHCN, 2017).
Unfortunately, challenges with funding appear to have constrained NYS OHCN from realizing


overall system.
One suggestion from a health care provider, however, was that a promising starting point for efforts to improve coordination between occupational health care and broader health systems is the prevention of chronic pain and transition


some U.S. states, a clearer understanding of the potential consequences for and necessary modifications to workers’ compensation laws will be important for state policymakers. A recent issue brief from the California Workers’ Compensation Institute


tional safety and health, preventing many treating physicians from helping workers engage productively with the workers’ compensation system or coordinating with employers. Nonoccupational physicians may also fail to recognize the contribution of wor


ermine the no-fault character of the workers’ compensation system by shifting the burden of proof to workers.
A potential role for NIOSH and, perhaps, other federal research sponsors would be the creation of large research data sets combining data on


 suggested that the overall effects of these arrangements deserved more careful study.
Carve-out arrangements, in which employers work with labor unions to integrate occupational and nonoccupational benefits, frequently involve alternative dispute re


not file injury claims) fare under the opt-out arrangements developed in Texas, it will be difficult to judge whether the Texas model provides net social benefits or, as suggested by workers, simply saves money for employers by reducing workers’ acc


 and Illinois that clarified the sharing of responsibility between agencies and host employers.6 Worker advocates indicated that right-to-know laws should not be viewed as a panacea, however, and suggested that OSHA or
6 For additional details, see C


ons that would improve their own systems. Stakeholders generally agreed that policy evaluation, identification of system best practices, and continued investment in the basic science of epidemiology and applied or translational work on prevention cou


 spillovers and long- term disability prevention
Cost spillovers and improving medical delivery/integration with occupational health care; payment reforms to incentivize functional improvement
Employment of people with disabilities, including stay- a


ers include philanthropic foundations with topic areas related to the social determinants of health or health systems. National research programs (e.g., the Robert Wood Johnson Foundation’s Culture of Health initiative) and regional foundations (e.g.


r social-scientific evidence on questions pertaining to epidemiology, system performance, and financing. Many important questions, particularly those related to causation, apportionment, and occupational disease presumptions, will generally require o


em designs from Washington will generalize to Texas becoming as contentious as arguments about whether an education program from urban India will work in rural Brazil.
43
Economic theory, fortunately, provides numerous frameworks for optimal policy d


he inherent tradeoffs and contextual factors that will determine which workers’ compensation policies will be best for workers in their state.
Finally, we note that the research priorities highlighted in this report were, to some extent, circumscribe


uld also be an occasion for policy analysts to develop more detailed policy proposals. The narrowing coverage of occupational diseases and conditions with complex causation or high latency might create a need for compensation mechanisms to be finance


 International Union (SEIU) Alliance for the American Temporary Workforce United Auto Workers
Washington L&I
California Department of Industrial Relations Michigan Workers’ Compensation Agency Pennsylvania Department of Labor and Industry Oregon Work


es were covered by workers’ compensation, accounting for approximately 97 percent of jobs covered by unemployment insurance and 86 percent of all jobs (McLaren and Baldwin, 2017). Since the inception of workers’ compensation programs in the early twe


e laws regulating these benefits vary considerably across states, but some features are consistent across all workers’ compensation systems: cash payments for lost earnings are tax-free, medical services are provided at no cost to the injured worker,


rk (depending on the state), the worker may be eligible for permanent disability payments. If the injury prevents the claimant from performing any kind of work, he or she will be eligible for permanent total disability (PTD) benefits. If the claimant


andard vary by state. Workers’ compensation also interacts with Medicare as a second payer for work-related health care expenses. Some workers’ compensation settlement agreements include Medicare set-asides, in which a portion of the settlement is al


aining, including general job-search training, such as a skills evaluation, resume building, or career counseling; and coordination between injured workers and other stakeholders, including potential employers and the health care system. Vocational r


on or rating bureau (Utterback, Meyers, and Wurzelbacher, 2014). Experience modification factors are determined by the firm’s historical injury record relative to its industry risk classification. Experience modification rates tend to be driven more


of workers’ compensation coverage is proportional to the product of injury rates and average costs. Firms that self-insure may be protected from some systemwide shocks (such as the insurance underwriting cycle) that may raise average premiums above


ons.
55
Appendix C: Compendium of Critical Perspectives on Current Workers’ Compensation Policy
Background
NIOSH has requested support from RAND to develop, with stakeholder input, a characterization of the most important possible ways to improve wor


protection against interruption of income
3. provision of sufficient medical care and rehabilitation services
4. encouragement of safety.
A fifth goal that might be viewed as instrumental to promotion of these four goals was also articulated:
5. an e


nderstanding the diversity of viewpoints about current system performance.
Overview of Key Workers’ Compensation Policy Issues
Workers’ Compensation Strengths
• Workers’ compensation has made a strong contribution to economic growth and has promoted


ers communication between stakeholders during the return-to-work process, has been shown to reduce disability days, labor force exits, total workers’ compensation costs, and entry to SSDI (Stapleton and Christian, 2016, p. 10). Washington state’s Sta


option of current protocol terminology (CPT) coding methodology, consistency in medical billing processes, and adoption of formularies and treatment guidelines (IAIABC, 2016b, p. 6).
• Increase use of alternative dispute resolution and mediation mech


ruly evidence-based and can reduce benefit adequacy (Swedlow, 2010, p. 206–207; Spieler, 2016, p. 43).
• Loss of fringe benefits and noneconomic losses can be significant but are
generally not compensated (Barth, 2010, p. 19).
• Shifting cost burdens


tem; reinstate federal tracking of changes in the workers’ compensation system; establish standards that would trigger federal oversight if states fail to meet standards (DOL, 2016, p. 24).
• Develop an online dashboard allowing stakeholders to exami


h source of information to identify the causes of past injuries and develop ways to prevent future cases. In addition to data analysis by the National Council on Compensation Insurance and the Workers Compensation Research Institute, private insurers


ime limits diminish adequacy in less visible ways (DOL, 2016, p. 22; IAIABC, 2016b, p. 3).
• Compensation for occupational diseases is often not adequate (Spieler, 2016, p. 99).
64
Suggestions for Improvement
Return to Work
• Strengthen antidiscrimin


oor integration with the medical system strain resources and hurt outcomes.
• According to 2014 NASI estimates, medical benefits account for approximately half of workers’ compensation (WC) costs nationally. Despite medical cost increases, the worker


ntives will provide a clear value proposition that aligns quality standards with cost- saving activities.
• For claims payors, care systems based on accurately measured outcomes are more inherently logical and easier to protect from manipulation than


ompensation reserves are essentially adequate. Reforms in several states have been enacted. (Lipton and Ayres, 2010, p. 37)
Coverage is provided to most employees.
With the exception of Texas, workers’ compensation insurance coverage is mandatory for


or survivors of those disabled or killed by occupational diseases, the state systems in general are more cognizant of such diseases and prepared to compensate for them. (Barth, 2010, p. 14)
Insurer-based prevention programs have demonstrated some suc


rs are embracing the biopsychosocial model, understanding return to work and recovery is influenced by more than just a physical injury. Occupational health research informs safety practices, medical treatment, and return to work best practices which


tc.) as more focused on compliance with little or no benefit to employers and employees. (IAIABC, 2016a, p. 2)
The state should ensure compliance by all parties; educate all parties; maintain equitable playing field for all. (IAIABC, 2016c, p. 3)
Var


-percent agreement that system should reduce disputes and be less adversarial (IAIABC, 2016b, p. 1)
The state should ensure there is a balanced approach to resolving disputes. (IAIABC, 2016c, p. 3)
The state needs to provide a neutral forum for adjud


. Casual inspection of workers’ compensation data reveals that cash benefits tend to be higher in cases in which attorneys are involved, and there is a natural tendency to assume that attorneys are therefore responsible for the higher benefits. Howev


s employee differently, and often there are different definitions within a state for workers’ compensation, unemployment, and taxation purposes. Some felt “employee” should be defined nationally but others believed it should stay a state-by-state iss


 an injury occurring, employees have an incentive to report it as work related, potentially leading to overreporting.
Given an injury, the injured or ill person has an incentive to claim the malady is work-related. A work injury requires no out-of-po


led as a result of occupationally-caused injuries or illnesses—who are most likely to turn to other social benefit programs, particularly SSDI. (DOL, 2016, pp. 15–16)
Most persons familiar with workers’ compensation recognize the difficulties associa


er deems the claim to be compensable . . . If the employee’s claim is denied . . . her economic situation is likely to deteriorate far more rapidly than would that of a similarly-situated worker in a comparator country [Canada, Australasia, Europe],


ry” rather than the welfare of injured workers and their families. (Davoli, 2016, p. 2)
Legislative challenges in some states, including opt-out and coverage restrictions, threaten the viability of the system and adequacy of benefits.
Opting out of w


ination against people with disabilities. In several states, these funds were closed out except for injuries or claims prior to a specified date . . . The combination of elimination of these funds and the exclusion of conditions with multiple causes


ing or temporary work agencies often are unsure about their rights—to the point that new “right to know” laws for temporary workers have been enacted, and specifically require that a worker be told who the workers’ compensation carrier is, in case th


centives to reduce premiums]. For example, “behavior-based” incentive programs that reward workers for reporting no injuries or that penalize workers who do report them are commonplace in the US. Although they are typically justified as a means to re


ensive protective measures have been available and well recognized for hundreds, and in some cases thousands, of years. For example, every week one or more workers are killed in trench cave-ins despite the fact that nearly 2,500 years ago Herodotus d


particular, the percent of prime-age men who report that they are ill or disabled has grown from less than two percent in the late 1960s to about three percent in 1983 and to nearly five percent by 2003. Is it possible that workers’ compensation cas


and Return to Work Committee, 2016, p. 16)
Trust in the workplace is one of the most important predictors of return to work. (IAIABC Disability Management and Return to Work Committee, 2016, pp. 17– 18)
Some insurers may see a conflict in return to w


igation for dollars? (Steggert, 2010, p. 75)
Any jurisdiction’s ability to deliver benefits depends on the choice of disability rating system as well as the method of implementation and administration—all of which flow from underlying social policy d


es that develop over time, then these diseases should be removed from the “bargain” and employers should, when appropriate, be liable in tort. (Spieler, 2017, p. 99)
Medical Management
Rising medical costs and poor integration with the medical system


l payer health care system would change workers’ comp into an indemnity program only . . . needs to be consideration of the consequences of delinking medical benefits and indemnity. (IAIABC, 2016b, p. 2)
Medical cost-control efforts often use blunt t


me state programs has been undermined by a combination of complex design and/or regulatory scope issues. Additionally, some payors’ have, in my opinion, missed the boat by making “black-and-white” UR decisions based on strict adherence to guidelines.


ts to the changing workplace, workforce, and kind of work. Employers need to make sure their workplaces are safe and have a responsibility to report injuries . . . Employees need to know what their benefits [sic] under workers’ compensation. They hav


s’ compensation plays in supporting economic growth. (IAIABC, 2016a, p. 1)
There were many who felt that the grand bargain was an “illusion” and that there is no single bargain. In many ways the grand bargain is really more about the “spirit” of empl


–1027. As of July 29, 2018: https://onlinelibrary.wiley.com/doi/pdf/10.1002/ajim.22112
  90
BLS, “Frequently Asked Questions About Data on Contingent and Alternative Employment Arrangements,” 2018. As of June 20, 2018: https://www.bls.gov/cps/conting


rs
Crum, Elizabeth, “Workers’ Compensation Adjudication and Administration,” in R. A. Victor and L. L. Carrubba, eds., Workers’ Compensation: Where Have We Come? Where Are We Going? Cambridge, Mass.: Workers’ Compensation Research Institute, 2010, pp


99.
Galizzi, Monica, Roberto Leombruni, Lia Pacelli, and Antonella Bena, “Injured Workers and Their Return to Work: Beyond Individual Disability and Economic Incentives,” Evidence- Based HRM: A Global Forum for Empirical Scholarship, Vol. 4, No. 1, 2


ational Conversations, 2016b. As of July 26, 2018: https://www.iaiabc.org/iaiabc/National_Conversations1.asp
———, “New Mexico Report,” in IAIABC National Conversations on the Future of Workers’ Compensation, National Conversations, 2016c. As of July


: Where Have We Come? Where Are We Going? Cambridge, Mass.: Workers’ Compensation Research Institute, 2010, pp. 39–57.
Marmot, Michael G., Stephen Stansfeld, Chandra Patel, Fiona North, Jenny Head, Ian White, Eric Brunner, Amanda Feeney, and G. Davey


docs/ssb/v35n10/v35n10p31.pdf
Neuhauser, Frank, “The Myth of Workplace Injuries,” Perspectives (IAIABC), April 2016, pp. 16–21.
New York State Occupational Health Clinics Oversight Committee, “Report to the Governor and Legislature,” 2012. As of July


doi:10.1111/1468-0009.00202.
Savych, Bogdan, and H. Allan Hunt, “Adequacy of Workers’ Compensation Income Benefits in Michigan,” Cambridge, Mass.: Workers Compensation Research Institute, WC-17-20, 2017. As of July 27, 2018: https://www.wcrinet.org/


cine, Vol. 45, No. 4, 2004b, pp. 338–345. http://doi.wiley.com/10.1002/ajim.10356
Swedlow, Alex, “Social Policies of Disability Evaluation,” in R. A. Victor and L. L. Carrubba, eds., Workers’ Compensation: Where Have We Come? Where Are We Going? Camb


ety and Health Through Workers’ Compensation Systems,” Perspectives (IAIABC), July 2017, pp. 6–10.
99
Wurzelbacher, Steven J., Stephen J. Bertke, Michael P. Lampl, P. Timothy Bushnell, Alysha R. Meyers, David C. Robins, and Ibraheem S. Al-Tarawneh, “


 The Cost and Affordability
of Flood Insurance in
New York City
Economic Impacts of Rising Premiums and Policy Options for One- to Four-Family Homes
Lloyd Dixon, Noreen Clancy, Benjamin M. Miller, Sue Hoegberg, Michael M. Lewis, Bruce Bender, Samara


l level. Congress instructed the Federal Emergency Management Agency (FEMA) to develop an affordability framework in light of legislation that directs FEMA to gradually eliminate certain program subsidies and to collect additional program fees. This


lculations ..................................................................35
v
vi The Cost and Affordability of Flood Insurance in New York City
Premiums Using the 2007 Flood Insurance Rate Map. . . . . . . . . . . . . . . . . . . . . . . . . . .


perty Values. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Effect of Flood Insurance Premium Increase on Property Tax Revenue . . . . . . . . . . . . . . . . . . . . . . Effect of Flood Insurance Premium Increase on Probability of Defaul


 for Properties in the
High-Risk Zones of the 2007 FIRM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3.6. Premium Increases for Properties in the High-Risk Zones
of the 2007 FIRM . . . . . . . . . .


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2.5. Comparison of Reported and Actual Flood Insurance Coverage . . . . . ..
2.6. Deductible Amounts for Flood Insurance Policies in Place as of
June 2016 (Percentage of Policies


 Owner-Occupied
Residences Only (2016 Dollars). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3. Impact of Flood Insurance Rate Changes on Property
Tax Revenue (2016 Dollars) . . . . . .


6.15. Cost of Mitigation Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
6.16. Design 4: Mitigation Grants and Low-Interest Loans—Program Outcomes with Full Participation


urance Reform Act of 2012 and the Homeowner Flood Insurance Affordability Act of 2014.
 xv
xvi The Cost and Affordability of Flood Insurance in New York City
Figure S.1 Study Area
  Manhattan
Brooklyn
Queens
Bronx
    Staten Island
NOTE: Purple areas


ures, meaning they were built before the first FIRM for New York City was issued in November
2 The Rockaway Peninsula includes the Rockaway Park and Rockaway Beach communities, which are consid- ered particularly vulnerable to flooding and other nega


e exam- ined the effect of eliminating the current pre-FIRM rate with the 2007 FIRM in place. We also projected premiums if the PFIRM were adopted. This allowed us to examine the effect of a map reflecting greater flood risk on premiums and to analyz


idy for certain policyholders.
xx The Cost and Affordability of Flood Insurance in New York City
tions relative to the BFE—the median premium is only $100 more when pre-FIRM rates are eliminated, as shown in the table.
Outside the high-risk zones, th


ercent of the households in the study area; but these potential premium increases would both increase the number of households for whom flood insurance is burden-
some and increase the burden on those for whom it is already burdensome. With the PFIRM


00
      xxii The Cost and Affordability of Flood Insurance in New York City
Some study areas, such as the Rockaway Peninsula, could be particularly hard hit by increased default rates.
Take-up of insurance is likely to increase for homes outside of


e more modest than in other programs. We have modeled a program in which the household buys a policy with a $10,000 deductible for building losses and a $10,000 deductible for contents coverage,
Table S.3
Flood Insurance Affordability Program Designs


 measures become considerably more attractive assuming risk- based rates based on the PFIRM. For example, the number of households eligible for a structure elevation program rises from 190 to 5,000 (not shown in table) when the
xxiv The Cost and Affo


with the pre- mium subsidy alone. We illustrate that this can indeed be the case, with savings up to hundreds of millions of dollars in certain multiyear scenarios, assuming risk-based rates based on the PFIRM, but only if the low-income households


ecovery helped us understand data collected by the Build It Back program. Jona- than Hayes and Rachel Rosenberg of ideas42 designed an effective final appeal that was mailed out to the property owners who we were attempting to enroll in the study. Ma


e National Academies of Sciences, Engineering, and Medicine on behalf of the Fed- eral Insurance and Mitigation Administration (FIMA) in helping us refine the flood insurance affordability program options considered in this report. The workshops were


he flood maps in New York City to reflect increasing flood risk will likely result in higher flood insurance premiums for many households.
A report by the RAND Corporation developed plausible scenarios for flood insurance premiums for one- to four- f


high risk of flooding according to the Preliminary Flood Insurance Rate Map (PFIRM) that was released in June 2013.2 To collect the data, we selected a stratified random sample of 2,800 of the 48,100 one- to four-family properties in the high- risk


in the study, the property owner received a free elevation certificate (EC) valued at $800 to $1,000, a $50 gift card, and a fact sheet describing flood risk and the information contained in the EC. Having an EC can help property owners qualify for


r various scenarios. To do this, we worked with Torrent Technologies to determine rates per $100 of coverage for a wide range of structure characteristics.8 These include structure type (e.g., basement, crawlspace), flood zone, elevation relative to


holds for which flood insurance is burdensome absent the program assessed. The advantages and disadvantages of the alternative approaches are identified and compared.
Chapter Seven provides concluding comments.
The main body of the report is followed


nd Silver Beach cooperatives. Breezy Point is on the Rockaway peninsula and Edgewater Park and Silver Beach are in the Bronx.
3 A and AE zones are areas with a 1 percent or greater annual chance of flooding. AO zones are areas with a 1 percent or gre


d by property owner in the property-owner survey.
a Based on the study sample of 2,800 properties.
b Based on all 48,100 properties in the study areas. Because all 48,100 properties are represented, confidence intervals are not necessary.
c Based on


omes in the study area, 18,700 are in the high-risk zones of the 2007 FIRM (bottom set of rows in Table 2.1).
An important indicator of flood risk is the elevation of the structure relative to the Base Flood Elevation (BFE).9 These elevation differen


ECs for the 240 structures in the study sample with complete ECs that are in the high-risk zones of the 2007 FIRM. Data on 2007 BFE are interpolated from the 2007 FIRM. Data are weighted to reflect the 22,200 one- to four-family properties in the hi


with household size to classify households by income category. It is also combined with various expenses to determine the proportion of income spent on housing costs, which is another potential metric used to determine eligibility for an affordabili


ome and net worth for households nationwide. It provides a basis for esti- mating how much the number of program beneficiaries would decline if an asset test were imposed on top of an income test.
11 Note that these percentages do not include renters


ch may overstate the take-up rate to some extent.12 In this study, the policies were matched using both geocoded location and address, which we believe provides a more accurate estimate of the take-up rate.
The 2012 take-up rate outside the high-risk


012
2016
    In study areaa
High-risk zones of 2007 FIRM
Outside high-risk zones of 2007 FIRM
For properties with mortgagesb High-risk zones of 2007 FIRM
Outside high-risk zones of 2007 FIRM
For properties without mortgagesb High-risk zones of 2007 F


d not know if they had flood insurance (pen- ultimate column of Table 2.5). For this group, it was much more common not to have flood insurance according to the PMF.
Table 2.5
Comparison of Reported and Actual Flood Insurance Coverage
 Flood Insuranc


 a substantial fraction of one- to four-family structures are
       1–49 50–99 100
101– 150–
200– 250 149 199 249
Coverage (in thousand $)
0 1–49
50–99 100
NOTE: Data are based on properties in the study sample with a flood insurance policy as of Ju


nts coverage as of June 2016 (N = 885). Affordability of Flood Insurance
Flood Insurance Premiums
In this section, we examine the amount paid for NFIP coverage in the study area. Before doing so, we review the rating methods available to structures i


ns are met within a ten-year period regard- less of change of ownership: (1) two flood insurance claim payments for separate losses, each more than $1,000; (2) three or more flood insurance claim payments for separate losses, regardless of amount; (3


igher—averaging $1,650. A few policyholders outside the high-risk zones are using elevation-based rates—but these are likely because of errors in the flood zone provided on the PMF given that FIRMs do not provide a BFE outside the high-risk zones.
Ho


ack to the National Housing Act of 1937. The regulations promulgated pursuant to this act originally offered public housing to families with incomes less than five to six times the rent. This rule was quickly changed to limit maximum rent to 20 perce


that size household (very low income). As can be seen, the PITI ratio exceeds 0.4 for many households, particularly low-income households. Note that the PITI ratio exceeds 0.4 for very few households with incomes
27 These regulations were established


,000 43% 1,500 16% 3,900 41%
Moderate- and middle-income households (income 80–165% of
AMI)
0 to 0.3
> 0.3 and ≤ 0.4
> 0.4 (housing burdened)
11,200 70% 2,700 17% 2,000 12%
Higher-income households (income > 165% of AMI)
0 to 0.3
> 0.3 and ≤ 0.4
> 0.


00 (out of 42,700 owner-occupied one- to four-family properties).30
30 If the properties without flood insurance paid the average premium for flood insurance that other properties do (approximately $1,880 in the high-risk zones and $530 outside the h


s us to characterize the effects of changes in the FIRM, ceteris paribus. Although the advantages of pre-FIRM rates may well be largely elimi- nated by the time a revised map is in place, we calculate how much premiums would change under the PFIRM if


The weighting procedure is explained at the end of Appendix A.
Premiums are generated for the scenarios described in Table 3.1. In all cases, the full premium including all fees is projected. Scenario A characterizes the situation on the eve of Hurri


ew levels at an 18-percent com-
3 Eight inches is the 75th percentile of estimates by the New York City Panel on Climate Change on the amount of SLR by sometime in the 2020s (see Horton et al., 2015, p. 41).
4 It may well be that 8 inches of SLR will


n the right direction.
The deductible assumed reflects the observed deductible chosen by NFIP policy- holders in New York City in 2016 (see Table 2.6).
Figure 3.1 shows the coverage limits assumed in the premium projections for the one- to four-famil


of stories Flood zone Elevation difference Location of contents Location of M&E Building coverage Contents coverage
Example Value
Pre-FIRM
Single family
Has basement
3 (including basement)
A
3 feet below BFE Throughout structure
In basement
$250,000


s from the April 2015 rate schedule for a one- to four-family structure in an AE zone, with two or more floors, contents located throughout the structure, and M&E in the basement.
Somewhat unexpectedly, changes in the NFIP rate schedule between 2012


elevation- based rates. Policyholders may not be taking advantage of elevation-based rates because of lack of information. Most homeowners may not be aware that they are paying pre-FIRM subsidized rates or that an EC would lower their premiums (an E


 structure considered earlier in this chapter (Table 3.2). The elevation difference was –3 feet under the 2007 FIRM and the base premium was $2,500 (Table 3.4). If the PFIRM were adopted, the elevation difference would
Flood Insurance Premium Scenari


an it is in the 2007 FIRM (see first column of Figure 3.6). Premiums fall for less than 5 percent of properties, which results in a $400 decline in the average premium.
Figure 3.4
Difference Between Structure Elevation and PFIRM BFE in the Study Area


y 50 percent from $3,000 to $4,500. Now, 5 percent of property owners face annual premiums of $12,000 or more.
46 The Cost and Affordability of Flood Insurance in New York City
Without grandfathering, pre-FIRM rates are of considerable benefit. It ma


dfathered rates (see Appendix F for details).
Eliminating pre-FIRM rates when grandfathering is allowed does not make any difference for newly mapped properties (scenario E is the same as scenario D in
10 The standard X-zone rate is also referred to


 in sce- nario H by 7 and 13 percent over scenario G, respectively. These percentage increases are similar to those discussed above for the properties already in the high-risk zones.
Housing Burden Under Different Premium Scenarios
Premium increases


hering and without pre-FIRM rates
G. Without grandfathering or pre-FIRM rates
Median
$3,000 $3,100
$3,100 $5,600
Percentage Change from Scenario B
— 3%
3% 7%
Median
$500 $500
$2,700 $4,200
Percentage Change from Scenario B
— 0%
440% 740%
Premium for


mium for the 25,800 newly mapped properties would gradually increase from $500 to $2,700, even with grandfathering.
The removal of grandfathering would have considerable consequences for all one- to four-family properties in the study area. For those


nsurance in New York City
Subarea Risk Profiles
This study focuses on one- to four-family properties. Table 4.1 reports the number of one- to four-family properties in each of these subareas and the estimated number that are owner occupied.
The locat


 in Canarsie have a separate residential unit in the basement (see Figures 4.3 and 4.4).
Building and Typology
Residential areas in Canarsie consist primarily of one- and two-family attached and semidetached buildings. There is also a concentration o


er geography than this neighbor profile repre- sents. The smaller geography was originally selected by DCP for its unique building and land use conditions, but then the area was expanded to include a larger neighborhood context (Alan Zaretsky, person


ring- ing homes, even detached homes, into compliance with current floodplain manage- ment standards would be challenging, as it would mean filling in cellars or basements (NYC Planning, undated[f]). Another constraint with attached homes is that mos


d.
RAND RR1776-4.9
 Flood Insurance Affordability in Five Vulnerable Subareas 63
Building and Typology
Low-density residential, mostly one- and two-family residences (see Figure 4.10), char- acterizes the area. More than 90 percent of residences were


 water interacted with electrical equipment. The flooded streets made it difficult for fire trucks and emergency responders to get through and resulted in fires burning unabated. This destroyed 175 homes and businesses (City of New York, 2013).
 Floo


tal inundation on the East Shore. Floodwater traveled as far as one mile inland, causing damage to homes and businesses in its path.
Building and Typology
Many of the beach bungalows built early in the 19th century have been retrofitted to provide ye


Canarsie again stands out in terms of income and housing burden. An estimated 54 percent of households in owner-occupied one- to four-family homes in Canarsie are low income, very low income, or extremely low income (first column of Table 4.3). More


sing burdened are located in the middle and eastern parts of the peninsula, not the western end, where the Breezy Point cooperative is located.
Premium Scenarios by Study Subarea
We break out premiums by study subarea for two of the premium scenarios


onfidence Percentage Interval
54% 40–68% 25% 13–43%
21% 11–35% 39% 29–50% 31% 21–45% 29% 20–39% 33% 28–39%
   NOTE: These values are based
not add exactly to total because of rounding to nearest 100. Sample weights are described in Appendix A.
a The


e west end of the Rockaways is particularly hard hit.
The premium increases in scenario G cause a substantial increase in the percent- age of households that are housing burdened in all subareas. The percentage that is housing burdened in Canarsie in


ese higher coverage levels because it is desirable for property owners to have the resources available to recover after a flood (subject to the policy limits offered by the NFIP).
This chapter focuses on the implications of shifting from scenario B t


nded to the nearest $1,000.
 Effects of Flood Insurance Premium Increases on Households and Neighborhoods 79
Table 5.1
Market Value of One- to Four-Family Properties in the Study Area, Owner-Occupied Residences Only
  Property Value (2016 $)
$235,000


nt to consider how long the household will purchase insurance. As presented in Chapter Two and Dixon et al. (2013), we know that homeowners who are not required to purchase flood insurance are less likely to purchase flood insurance. We also know tha


s fully paid because of lax enforcement or other factors, then he or she would be willing to pay a higher price for the home.
4 A very small number of properties even increase in value after their flood insurance rates decrease.
 Effects of Flood Ins


venue
Such large changes in property value have several further implications. One is that declines in property value directly map to declines in property tax revenue. Property tax rates in New York City are quite high, and the base rate for most one-


ts are somewhat higher in low-income areas, this simply reflects that low-income households have more limited ability to access other sources of funding if their resources become constrained. As such, the ability-to-pay literature has found that once


ke-up rates for homes without mortgages and homes out- side the current high-risk flood zone are approximately 30 percent. Even absent pre- mium increases, the take-up rate among this latter group is likely to drop over time for two reasons. First, t


ffective FIRM is likely to increase from approxi- mately 30 percent to 70 percent as the flood zones and premiums move from those in scenario B to those in scenario G. That is, these households will now be subject to the mandatory purchase requiremen


se by $22 million. We estimate the mortgage default rate will increase by 50 percent to 1.5 percent of homes with mortgages per year. Most of these defaults will be in the high-risk areas of the current FIRM. Some study areas, such as the Rockaway Pe


rently a member of the CRS, but is investigating whether it would make sense to join.
The first step to evaluating CRS eligibility entails a FEMA Community Assistance Visit (CAV); FEMA ini- tiated a CAV in New York City in 2015, and it is currently i


to a flood insurance affordability strategy in this report. That topic warrants further study.
 individuals or businesses presumably have too many assets to justify assistance
for flood insurance premiums.
2. Coverage levels. The outcomes for each de


ned households estimated in Chapter Two (Table 2.9).
Flood Insurance Affordability Program Options 89
 90 The Cost and Affordability of Flood Insurance in New York City
Table 6.2
Number of One- to Four-Family Households in Owner-Occupied Properties b


f the risk of increasing flood insurance premiums. Incorporating the gradual
4 Other New York City housing assistance programs such as the New Housing Opportunities Program, Mixed- Income Program, Taxable 80/20, and Coop Housing Program provide benef


less than 165 percent of AMI would receive benefits from the program. When flood insurance premiums without the program are equal to those in premium scenario B, households receive $33 million in premium subsidies annually. The average flood insuran


 to $13 million. It then increases as the participation rate rises.
Table 6.4
Design 1: Enrollment and Program Cost Under Different Program Participation Assumptions
Flood Insurance Affordability Program Options 93
 Participation Rate
2016 flood insu


olds in study area that are housing burdened
Without the program
With the program
Annual program cost
Scenario B (2007 FIRM with Pre-FIRM Rates)
31,700 9,700
22,000
23%
22% $33 million
Premium Scenario
Scenario E (PFIRM, with Grandfathering and No Pr


00 $62,000
$93,000 $128,000 (50% of AMI) (80% of AMI) (120% of AMI)(165% of AMI)
Household income
(Percentage of AMI for a three-person household)
RAND RR1776-6.4
households. Figure 6.4 shows the PITI ratio for three hypothetical households, first wh


hreshold is 0.4 and the program eligibility cutoff is 165 percent of AMI.
a 95-percent confidence intervals in parentheses.
Table 6.7 reports the costs, enrollment, and impacts of the housing burden–based flood insurance affordability program depicte


would be without the program (not shown in table).
Table 6.10 shows the outcomes for a more narrowly targeted program and a more broadly targeted program. In the more narrowly targeted program, the PITI ratio threshold is increased to 0.5 and program


nts coverage. If instead of buying a policy with a $2,000/$2,000 deductible, the property owner bought a policy with a $10,000/$10,000 deductible, the premium would be 20 to 25 percent lower.9 Figure 6.5 shows the benefit structure when there is a lo


ncial loss.
 Figure 6.5
Subsidy Structure for Deductible Subsidy
Flood Insurance Affordability Program Options 103
 Maximum deductible reimbursement
$16,000
  RAND RR1776-6.5
$62,000 (80% of AMI)
$128,000 (165% of AMI)
Household income
(% of AMI for


utoff is 165 percent of AMI.
a 95-percent confidence intervals in parentheses.
Table 6.12
Design 3: Enrollment and Program Cost Under Different Program Participation Assumptions
 Participation Rate
2016 flood insurance take-up rates (36% and 50%)a
50


ent of AMI) to finance the mitigation measures.13 To ensure that a mitigation measure pays off over time, we require the present value of the premium reductions to exceed the cost of the mitiga- tion measure. We refer to such mitigation measures as c


mine the number of properties for which the mitigation measure is fea- sible and whether the household is eligible for the program. For example, basement infill is only feasible for structures with basements, and households are only eligible for a gr


mitigation measure (further discussed in this section).
We examine the impacts of structure mitigation under two different premium scenarios: scenarios B and G. Pre-FIRM rates and grandfathering have been removed from scenario G, so scenario G is pre


dations do not depend on the location of M&E, so this mitigation measure is not cost-effective for this type of struc- ture. For structures with basements, lower premiums are available if the M&E is raised out of the basement. For enclosures and craw


and allowing pre-FIRM rates. As can be seen from the first row of the table, some type of mitigation is feasible, and the household passes the income test (income less than 165 percent of AMI) for a substantial share of the 42,600 owner-occupied pro


loans depends on the distribution of household income for each structure type. For example, it turns out that grants are provided for all 190 structures that are elevated, which means that income of all these households is less than 80 percent of AM


e Cost and Affordability of Flood Insurance in New York City
Table 6.17
Design 4: Mitigation Grants and Low-Interest Loans—Program Outcomes with Full Participation Using Premium Scenario G (2015 Rate Schedule with No Grandfathering, No Pre-FIRM Rates


nd the flood risk indicated by the PFIRM, is $120 million (see last row of Table 6.5) and is reproduced in the first row of Table 6.18. The second row shows the present value of the subsidy when there is no mitigation. The subsidy continues only as l


higher.
Summary of Findings
This chapter has examined different approaches for providing assistance to households that have difficulty paying flood insurance premiums. Five designs were developed and their performance modeled. Table 6.19 pulls togeth


 Program
a Benefit Cost with Full Participation
mitigation cost; large premium reduction flood risk exceed $600 Benefits of reduced
$10,500
$31 million
0
190
Structure elevation
          Affordable Flood Insurance Beneficiaries Flood Insurance Unaff


cent of AMI.
While moving to risk-based rates under the PFIRM increases the number of structures for which mitigation is attractive, it also increases the number of households that are housing burdened and the costs of the subsidy-based designs (desi


d losses. Replacement cost is greater than building coverage for about 45 percent of the structures with flood insurance.
Using a definition of housing burden based on the PITI ratio, flood insurance is currently burdensome for approximately 11,000 (


e impacts of shifting from premiums that are based on the 2007 FIRM and current FEMA pricing practices to premiums that are based on the PFIRM and the elimination of grandfathering and pre-FIRM rates. We found that newly mapped properties will see th


 for relatively few structures given the 2007 FIRM and the 2015 NFIP rate schedule.
The mitigation measures become considerably more attractive assuming risk- based rates based on the PFIRM. For example, the number of households eligible for a struct


cess that was used to extrapolate from the study sample to all one- to four-family properties in the study area.
Sampling Approach
Sample Frame
The sample frame includes 48,089 one- to four-family structures in the high-risk zones of the PFIRM (the s


first stage, a minimum sample of 200 structures was drawn from each of the six study subareas. The minimum size of 200 structures at the first stage was selected so that, with a 25-percent response rate, a two-sample t-test comparing the mean afford


ing as percentage of income ≤ 25
> 25.1 and ≤ 35
> 35
Water depth in flood that occurs with a 1% annual change (in feet)
≤1
> 1 and ≤ 2 > 2 and ≤ 3
> 3 and ≤ 4 >4
Count Percentage of Total
2,800 100%
358 13% 267 9% 293 10% 578 21% 435 16% 869 31%
1,2


he property owner will be kept strictly confidential and the names of properties owners or the addresses of properties participating in the study will not be shared directly with the city.
Both the website and the invitation letters indicated in mult


nable additional phone- based outreach to encourage participation in the study. The list obtained included phone numbers for 78 percent of the properties in the sample set. Calls were made to property owners who had not responded to the initial two i


s that resulted from the extensive recruitment efforts are shown in Table A.3.
Figure A.3
Flood Insurance Fact Sheet Provided to Study Participants
Survey Methods 133
 RAND RR1776-A.3
134 The Cost and Affordability of Flood Insurance in New York City


ricane Sandy (NYC Build It Back, undated[b]).
As can be seen from Table A.4, properties in the STAR program, with a flood insurance policy, and in the Build It Back program are all more likely to complete the survey as well as to complete the survey


1.0005 for weights for properties with completed surveys and 1.0153 for weights for properties with com- pleted surveys and ECs.
The design effect for the study (mean of squared weights divided by [mean of weights]2) is 1.45.
 For Study Sample
Minimu


sehold
– B25119e3: median income of renter-occupied household.
• FEMA effective FIRM for New York City (2007 FIRM database), with an effec- tive date of September 5, 2007, was downloaded from the FEMA Map Service Center. The database contains informa


the HAG and LAG were assigned to each parcel polygon.
Calculate Maximum Flood Zone and BFE from Preliminary and 2007 FIRMs for Each Parcel
Each parcel was assigned the maximum flood zone from the effective FEMA FIRM database and the preliminary FEMA


to speak English for the popula- tion 5 years and over,” was downloaded at the census-tract level and analyzed. The top three languages besides English were identified per census tract. Then the census tracts with the initial 1,400 study addresses i


as subsequent mailings and telephone outreach, online questionnaire completion, scheduling the EC surveys, gift card mailings, and overall study progress. These fields were maintained throughout the study as specific study activities (e.g., mailings


ally exported into spread- sheets set up for specific additional activities. This included the creation of phone track- ers for use by outreach teams and trackers for door-to-door canvassers.
Door-to-Door Maps
As described in Appendix A, study outrea


Geodatabase 145
146 The Cost and Affordability of Flood Insurance in New York City
program. The Build It Back database contained BBLs, so a first pass match was made using the BBLs. However, because of the presence of multi-address parcels (e.g., coo


d Program Participation (SIPP), 2008 Panel, Wave 10 (U.S. Census Bureau, undated[c]). Net worth is defined as total assets less total liabilities. Annual wages for each income quintile are calculated by the authors using SIPP 2008 Panel, Wave 10. We


argely driven by the principal and interest components, which we exam- ine as total mortgage expenditure. Table D.1 estimates that just more than one-quarter of households have no mortgage. Households in the high-risk flood zone that have a mortgage


ts do vary with income, others do not. Households with more income do tend to purchase more expensive houses, and hence tend to spend more on principal, interest, and property taxes. However, other costs associated with homeownership, such as utiliti


00 43.0% 3,500 8.2% 1,200 2.8% 600 1.4%
Percentage of household income spent on property taxes
0% < x ≤ 3% 3% < x ≤ 6% 6% < x ≤ 10% 10% < x
7,900 18.3% 16,700 38.6% 10,100 23.4%
8,500 19.6% Percentage of household income spent on utilities
0% ≤ x ≤ 5


ble D.2
Fraction of Income Spent on PITI and Utilities by One- to Four-Family Households in Study Area, Owner-Occupied Residences Only
 Number of Percentage of Households Households
95% Confidence Interval
   NOTE: These values are based on a
may not


ilding coverage
33% In 2,800 sample, with < $250,000 166 in building coverage and contents
coverage
 SOURCE: Coverage amounts are taken from the 2016 NFIP policy database. Mortgage balance is taken from the property owner survey and reflects mortgage


Rate Type and Parameters
Non-elevation-based rates NFIP rate table
Flood zone Structure type Occupancy Residency
Elevation-based rates in AE zones NFIP rate table
Flood zone Structure type Number of floors Elevation difference M&E
Elevation-based rat


 premium) for
other policies
1 The NFIP rating schedules always assume that contents are distributed throughout single-family residences.
2 The base premium for PRPs is specified in the NFIP manual for the combination of building and contents
coverag


e used to calculate the premium in scenario D (2015 rate schedule, PFIRM, with grandfathering, and with pre-FIRM rates):
Step 1: Step 2:
Step 3: Step 4:
Step 5:
Assign PR6 to each structure.
Assign PR4 to the structure if the structure is a pre-FIRM


 (see boxed cells). The model predicted well on average for all three different rating methods: PRP, non-elevation-rated, and elevation-rated.
There was more variation in the difference between the projected premium and the PMF premium for the elevat


or VE B, C, and X
Total
Flood Insurance Premium Model 165
     154 0 3 157 0 1 0 1 18 1 114 133 172 2 117 291
 SOURCE: Based on 291 properties in a selected sample with a completed EC and building coverage in 2016.
4 It could also be the case that pr


de crawlspace is misclassi-
7 3 5%
712% 59% 24% 59% 24% 24%
  Table E.6
Comparison of Structure Type
Building Type According to EC Completed for Study
Flood Insurance Premium Model 167
  Structure Type
According to 2016
Policy Master File Basement
Ba


 cumulative loss history will receive an annual 25% rate increase until they reach full- risk (elevation-rated) rates. An insurance agent must make that determination.
All other buildings will have annual rate increases of no less than 5% and no more


ing.
If a post-FIRM policy lapses, it will need to show again that it was built in compliance.
Table F.2—Continued
Rating Option and Scenario
Conversion
On a revised FIRM, property is no longer determined to be in a high-risk flood zone (e.g., its fl


rough several steps to ensure data quality. First, we check to make sure the reported monthly payments, if repeated for 30 years, would pay off the reported mortgage balance. For the small number of households that do not pass this test, as well as o


insurance prices with flood insurance prices from the 2016 NFIP PMF. For households reporting that all insurance pay- ments were included in their mortgage, this value is $0. If other households did not report a value for expenditure on insurance no


chased for 30 years. Under these assumptions, the equation for PV when moving from scenario B to scenario G is
29 scenario G annual price – scenario B annual price
PV = ∑ t=0
.
(1.04 )t where t is time from the present in years.
Economic Effects Mode


the current loan-to-value ratio increases. Gyourko and Tracy (2014) find similar results using more recent FHA insured mortgage data, but we use values from Wong, Fong, and Sze (2004) because they cover a broader range of current loan-to-value (CLTV


 income and housing costs were only asked when the property was the primary residence of the owner. An asterisk at the end of a question indicates that the question was mandatory.
179
180 The Cost and Affordability of Flood Insurance in New York City


et for Residential Properties, Santa Monica, Calif.: RAND Corporation, RTR-468- FEMA, 2007. As of March 15, 2017:
http://www.rand.org/pubs/technical_reports/TR468.html
Dixon, Lloyd, Noreen Clancy, Bruce Bender, Aaron Kofner, David Manheim, and Laura


ortgage Default,” Journal of Urban Economics, Vol. 80, March 2014, pp. 87–96.
Horton, Radley, Christopher Little, Vivien Gornitz, Daniel Bader, and Michael Oppenheimer, “New York City Panel on Climate Change 2015 Report Chapter 2: Sea Level Rise and


lient-neighborhoods/canarsie.page
———, “East Shore Neighborhoods,” nyc.gov, undated(b). As of March 22, 2017: http://w w w1.nyc.gov/site/planning/plans/resilient-neighborhoods/east-shore.page
———, “Gerritsen Beach,” nyc.gov, undated(c). As of March 2


ber 1988. As of April 6, 2017:
https://oig.hhs.gov/oei/reports/oai-04-88-01280.pdf
U.S Department of Housing and Urban Development, “Mortgage Credit Analysis for Mortgage Insurance on One- to Four-Unit Mortgage Loans (4155.1),” hud.gov website, March


 might increase premiums and analyzes the potential consequences of those increases on households and communities.
It also develops and evaluates several different approaches for assisting households that have difficulty affording flood insurance. Th


  CORPORATION
Injury and Illness
Surveillance of U.S.
Agricultural Workers
Assessment of Recommendations and Actions Ramya Chari, Amii M. Kress, Jaime Madrigano
For more information on this publication, visit www.rand.org/t/RR1500
 Published by the R


ability, and water resource man- agement and coastal protection. Program research is supported by government agencies, foun- dations, and the private sector. This program is part of RAND Justice, Infrastructure, and Environment, a division of the RAN


 . . . . . .
43
44 . 45 . 47
48 . 52
. 52 .58
Summary
Agriculture remains one of America’s oldest and most valued industries, but it is also one of the most hazardous. According to the Bureau of Labor Statistics (BLS) Survey of Occupational Injuries


alth and Safety, “2014 Fact Sheet: Childhood Agricultural Injuries in the U.S.,” Marshfield, Wisc., 2014.
6 NIOSH, “Agriculture, Forestry, and Fishing,” web page, last updated July 11, 2017.
  ix
x Injury and Illness Surveillance of U.S. Agricultural


d information on planned allocation of resources within the AgFF Program, for the costs and resources criterion, we presented general estimates and a descriptive assessment of implications. For each action, we calculated average scores across criteri


ity of the Childhood Agricultural Injury Survey by extending the sample to include labor aggregators.
4.2: Collaborate with the National Agricultural Worker’s Survey to field a supplementary module targeted at children who work as hired farmworkers o


1.1: Develop definitions and taxonomy
5.2: Evaluate sources of surveillance data
3.1: Field the National Agricultural Worker’s Survey and hired worker survey
4.1: Improve validity of the Childhood Agricultural Injury Survey
8.2: Monitor alternative a


al thanks to our reviewers, John Mendeloff (University of Pittsburgh) and Christopher Nelson (RAND), who provided valuable and insightful comments that strengthened the report.
 xiii
Abbreviations
Ag Center AgFF BLS CAIS CDC CIPSEA CWCS DOL EPA
ETA F


f Occupational Injuries and Illnesses (SOII), in 2015, almost 36,000 farmworkers engaged in animal and crop production experienced an injury event (5.8 per 100 full-time workers).5 An estimated 1,900 farmworkers suffered an illness event (31.8 per 10


 of the National Institute for Occupational Safety and Health in Agricultural Injury and Illness Surveillance
Some of the agricultural injury, illness, and fatality statistics cited above are the outputs of large and sophisticated data collection eff


nd Surveillance Activities at NIOSH
The mission of NIOSH, established by the Occupational Safety and Health Act of 1970, is “to develop new knowledge in the field of occupational safety and health and to transfer that knowledge into practice.”15 NIOS


Law 101-517, Departments of Labor, Health and Human Services, and Education, and Related Agencies Appro-
priations Act, 1991, November 5, 1990.
18 Bureau of Economic Analysis, “Regional Data: Annual State Personal Income and Employment; Full-Time and


 on adult farmers and farmworkers (≥20 years) on all farms
Population-based injury survey (NASS) focused on adult farmers and farmworkers (≥20 years old) on minority- operated farms
Population-based injury survey (NASS) focused on nonfatal injuries t


e awareness of farm-related risks to children culminated in NIOSH establish- ing the National Childhood Agricultural Injury Prevention Initiative in 1996.24 Through the initiative, the AgFF Program has supported a wide range of activities to decrease


he National Children’s Center (NCC) for Rural and Agricultural Health and Safety.27 Through the Ag Centers, NIOSH has grown regional capacity to address agricultural safety and health issues. As shown in Table 1.1, given the diver- sity of farming op


ula- tions by the Occupational Safety and Health Administration (OSHA) under the Occupa-
27 NIOSH, “Centers for Agricultural Disease and Injury Research, Education, and Prevention,” web page, last updated October 3, 2017.
28 National Research Council


included inpatient and emergency department records, pre-hospital care reports, and death certificates. In addition, electronic news sources were reviewed for their potential as a supplemental source of agricultural fatality reporting.
Title: Surveil


atest estimates from the 2015 Farm Labor Survey, about 45 percent of the nation’s farms employ fewer than 11 hired workers (this estimate does not include migrant, seasonal, or unpaid workers).32 In addition, 88 percent of U.S. farms are classified a


nomics, the agricultural industry has also witnessed declines in injuries and illnesses across child and adult worker populations. According to data from the Child Agriculture Injury Survey (CAIS), from 1998 to 2012, the rate of childhood agricultura


ultural workforce and decline in injury and illness rates, led NIOSH to
37 NCC, “2014 Fact Sheet: Childhood Agricultural Injuries in the U.S.,” Marshfield, Wisc., 2014.
38 BLS, “Industry Injury and Illness Data,” web page, last updated May 10, 2017 (


mmendations for improvement: (1) establish strategic goals for improvement in lead- ership, administration, and evaluation; (2) develop a cohesive program that provides national leadership in agricultural, forestry, and fishing safety and health; (3)


of this report is to provide NIOSH with a practical assessment of the feasibility and desirability of carrying out actions to meet surveillance-related recommendations given current AgFF Program resources and priorities. Many actions for meeting reco


 This chapter focuses on the identification of recommendations and the development of actions and introduces the final list of actions we considered in the assessment.
The 2012 AgFF Program panel review offered numerous points of guidance for activit


ort
  Theme
Theme 1: Define and characterize agricultural worker populations at risk
Theme 2: Review ongoing or new data sources for injury and illness surveillance among agricultural workers
Theme 3: Analyze, report, and communicate surveillance fin


 in recommendation 5, we added
Press, 2008; National Occupational Research Agenda Agricultural, Forestry, and Fishing Sector Council, National Agricul- ture, Forestry, and Fishing Agenda: For Occupational Safety and Health Research and Practice in th


sources for use in surveillance), which was not included in the panel report, because of (1) overall need for such an assessment, as evidenced by sources beyond the panel report, and (2) as a complement to action 5.1 (evaluation of the NASS sur- veys


ving specific actions.
 17
18 Injury and Illness Surveillance of U.S. Agricultural Workers: Assessment of Recommendations and Actions
Table 3.1
Actions by Implementation Mechanism
Action Description
Actions achievable through extramural funding mecha


creased collaboration between funder and awardee, the principal investigator will still ultimately drive the direction of research based on the objectives defined in the original proposal. A potential solution would be to issue a contract. Contracts


ry. In 2014, NIOSH issued a funding opportunity announcement (FOA) under the U01 cooperative agreement mechanism to conduct research related to agricultural injury and dis- ease.2 The FOA noted that any application that focused on occupational safety


sks and time frames needed to either fully complete the action or ensure that implementation results in meaningful impacts. The satisfactory version refers to our estimation of tasks and time frames that may result in lesser (compared with the ideal)


oyment and migration; earnings, benefits, and worksite characteristics; health, safety, and housing; and income and assets, social services, and legal status. NIOSH has worked with DOL since 1999 to add injury modules to the NAWS.6
Because of the NAS


n an as-needed basis or on request.
Table 3.5
Implementation Plan for Actions Achievable Through Direct NIOSH Action
  Action
Action 6.1 Action 6.2
Overall Mechanism
Direct action Direct action
Partnerships
Possible Resource Capability Partners Partn


the data from the team assessment and the expert input to develop final cost ranges.
 23
24 Injury and Illness Surveillance of U.S. Agricultural Workers: Assessment of Recommendations and Actions
Table 4.1
Summary of Approaches for Estimating Costs
A


 timeline estimates.
Partnerships
The two scales presented in Tables 4.2 and 4.3 were used to rate actions on the partnership criterion for resource and capability partner scenarios. The scales cover a range of partnership scenarios that incorporate


ners, and is avail- able in forms that are relevant and usable is critical for the accomplishment of actions and asso- ciated recommendations. The scale in Table 4.3 was used to rate actions on the information availability and accessibility criterion


thin a reasonable time frame (e.g., zero to two years); see Table 4.5.
Estimates for timelines were developed similarly to cost estimates. For actions achievable through extramural funding mechanisms, we again used similar projects as benchmarks to d


In 2016, after completion of the research phase of this project, NIOSH developed a framework for prioritizing research through an assessment of burden (what is the magnitude and severity of the problem and the societal costs), need (why is it importa


e high quality (e.g., collected regularly, have standardized protocols, have large geographic and population coverage, and allow for subgroup inferences) and are useful for many purposes but do not perfectly address the specific action.
Information c


ome potential for negative impact that could be mitigated through precautionary steps (e.g., robust training and data safeguards).
Action would moderately decrease the utility of existing information or create minor barriers to access.
Action would n


imitations of each associated action using the assessment criteria as a framework (costs and other resources, partnerships, information availability and accessibility, policy, timing, program surveillance goals and priorities, information quality, an


ill vary according to worker characteristics (e.g., age and gender), geographic location of operations, commodity specialization (e.g., fish farm, cereal crops, and type of livestock), and the specific tasks that are performed. Furthermore, the repor


 award. We estimated a
Table 5.1
Action 1.1’s Implementation Plan
 Action
Action 1.1
Extramural Mechanism
Contract
Resource Partner
—
Capability Partner
Ag Centers, research organizations
Resources
$150K–$250K
Timeline
5 months for initiation; 1–1.5-