ert panel on needs for law enforcement broadband (Hollywood et al., 2016) and a prior NIJ-funded technology assessment of law enforcement information exchange issues and needs (Hollywood and Winkelman, 2015).
 28
Governance and Operational Requiremen


and network
  Preemption activated
Preemption for first responders is critical
  Interconnect (LMR)
Data Voice
   IP network (backhaul, commercial, agency net)
  PSAP/operations center/station
To mobile devices
• CAD—data
• RMS
• Databases about peop


 car)
 COWS/ COLTs
LMR— LMR— P25 legacy
Mobile base station
SATCOM radio
     Wireless broadband network
SATCOM
LMR
 Preemption activated
 Interconnect (broadband—agency)
 Interconnect (SATCOM)
 Interconnect (LMR)
 IP network (backhaul, commercial, a


ecause of the disaster. Whereas, in the major event case, the portable communications systems are supplemental, in this case they form the bulk of the communications network. This case requires being able to provide sufficient portable communications


cy)
 Interconnect (SATCOM)
 Interconnect (LMR)
 IP network (backhaul, commercial, agency net)
  PSAP/operations center/station
To mobile devices
• CAD—data
• RMS
• Databases about people and items: criminal history, NCIC, warrants, license plates
• I


ewed department in the southwestern United States—other concerns, such as cost and redundancy, began to dominate decisionmaking. Rather than voicing specific concerns about Band 14 avail- ability, fire department users described the end-user goals of


 purchase or purchases?
Does the agency use grants to fund IT/communications needs? 7 Does the agency use private donations to fund IT/communications needs? 1
   NOTE: Respondents could indicate more than one funding mechanism.
35
Broadband Communica


grants to help with needs (Gallagher, 2018; FEMA Grant Programs Directorate, 2021; FEMA Grant Programs Directorate, 2022). This is con- sistent with what we heard from the chief of police for a police department in Southern California in an interview


 police budget. The source of funds really depends on what money is available.”
“Have used grants in the past—purchased about four or five tablets and associated applications with that. Certain grants [are] only eligible every so many years—we got ma


, ‘I need this.’ Being small lets us pull the trigger faster. We say, as a command staff, ‘That seems like a good idea’; we can just go out and get it. Replacing all in-car trunked systems. If something goes out to bid, the city council will be invol


20
Chief of police, PD in MA, February 2020
Chief of police, PD in MA, February 2020
IT personnel, sheriff’s department in Southern CA, April 2020
Comment
“[We] talk to the surrounding communities; this is my go-to. [A local city police agency] is on


people have the tools to get the job done. We also do extensive proof-of-concept tests.”
Broadband Communications Prioritization and Interoperability Guidance for Law Enforcement
 Market Research
After the discussions on needs identification, we soug


1, the following departments had open RFPs for communica- tions technology or IT consultants:
• East Windsor, Connecticut: “The Town of East Windsor is seeking proposals for Professional Consult- ing Services for an analysis of our current radio syst


nto decisionmaking are how technologies are implemented in departments and what maintenance consists of. While our interviews did not yield a great deal of information about implementing systems or technology, one participant noted that training is a


CI Systems, a regional radio network provider] is going to be a monthly fee per radio. Everyone around us is either already on ICI or going to ICI, so that’s why we are going that direction. ICI transition will be in the next year.”
“For big projects


 try to use state contracts; [it’s] more efficient for us because we’re small.”
“This is the red tape; [we] have to go through the purchasing department and get it approved by auditing. Then we can order it. It’s time consuming. We use the state cont


 = police department. City and agency names are withheld to protect interviewees’ anonymity.
44
CHAPTER SIX
Broadband Communications Costs for Law Enforcement Agencies
As a follow-up to the discussion of funding and acquisition in the previous chapte


tent is to inform decisionmakers about the types of activities and costs that their organizations must consider when adopting broadband communications.
2 Cradlepoint (owned by Ericsson), Sierra Wireless, and Peplink routers are examples of available


’s specific range of anticipated uses.
Dual-Service Option
In the second scenario, agencies might wish to operate on more than one network, perhaps because of cov- erage issues associated with a single provider or for redundancy capability in the eve


nd replacement of lost or stolen devices (Harris and Romesburg, 2002; Imel and Hart, 2003; Salmensuu, 2019). These management services can be conducted in house by the agency (i.e., using its own dedicated staff), or the work can be outsourced to a t


vision and configure Wi-Fi access; install and manage enterprise applications, such as email; and address any problems that arise on a device. It also allows IT to enforce device security, such as locking a device and wiping data if the device is los


9.00 per device each month for MDM and MAM services (Oxford Economics, 2018). Our research into publicly available pricing on vendor websites suggests that this range is a reasonable estimate, although we found some vendors that offer very basic plan


eir services. For organizations that are unsure of the best MDM, MAM, or UEM solution, it might be worth testing various vendors on a trial basis before committing to a vendor, especially on an annual or perpetual basis. Another observation was that


roid) (Lastovetska, 2022). Some of the key cost drivers in app development are vendor type and location, app complexity and number of features, back-end infrastructure and connected application programming inter- faces, complexity of user experience


integrate mobile apps and back-end databases. In addition to the nonrecurring cost to develop the interface, there will be a need to maintain it as required by the vendor to update apps or the databases with which they interface. This report does no


build and operate that network under the management of the FirstNet Authority Board. As states agreed to join FirstNet and cooperate with the development and deployment of the network, other broadband provid- ers created similar networks and infrast


alized policing approach; it is also a hindrance when the ultimate goal is interconnecting police resources and deploy- ing a seamless interoperable network of communications that can talk and share data across agencies and platforms.
To resolve issu


nteracts with LMR; the system’s interop- erability with other segments of government, both within a jurisdiction and for interjurisdictional needs; planned additions to coverage and capabilities, as articulated in a contract for services; the presenc


capabilities, both present and future, is more difficult; commercial provid- ers, including AT&T/FirstNet.com, do not publicly state the specifics of their coverage or capabilities because of those data being a source from which their competitors co


eholders working to create the future of mobile broadband for their law enforcement and first responder organizations, there were many comments that are relevant to the themes and issues being experienced nationally. We include them in this section s


urrently, only detective or sergeant and above get department-issued phones. If CAD/RMS was more
friendly on the phones, we would give all officers phones.”7
• “[We’re] not going to go to mobile CAD-RMS given Cal-DOJ compliance. It’s too hard to get


 for training?’”15
“[It] will probably be easier for younger, tech-savvy officers to acclimate to and a struggle for older offi- cers to learn a new system.”16
Broadband Communications Prioritization and Interoperability Guidance for Law Enforcement


and chief of innovation for a police department in Southern California on January 31, 2020.
 58
Barriers and Issues
 • “In a perfect world, everything would be done on a single device—doesn’t have to be a phone, but should be able to access all syste


chnology for a police department in Massachusetts on February 7, 2020.
21 Interview with the head of technology for a police department in Massachusetts on February 7, 2020.
22 Interview with the business services administrator for a police departmen


hes are the best technology and configuration to ensure usefulness and survivability, yet different technologies might present differing advantages.
A critical aspect of reliability is the ability of a communications systems to interoperate smoothly


bandwidth. It is therefore important that agencies acquire broadband communications systems in ways that allow for relatively easy and inexpensive upgrading later, as technologies and demands advance, as opposed to having to pay the expensive, long-


and scan social media and offender registries to advise the police of crime and suspect data.2
Key Questions
When considering a transition to the NPSBN or another broadband platform, it is essential that deci- sionmakers choose their path forward kno


we envision policing and the impact of broadband tech- nologies in 20 years. It is important to understand that this story is not a prediction of what will happen, but it does rely on current trends, events, and developments as a foundation for a pos


eo from UAVs or other personnel, or incident command informa- tion to report or receive critical data almost an intuitive activity.
The devices in the hands of law enforcement, firefighters, and other first responders are individually authenticated v


ht come next. They know what their contemporaries in 2022 knew—that it was not as important to know the future as it is to make good decisions today to enable it to emerge.
65
APPENDIX A
Current and Emerging Broadband Technologies
Generations of Broa


es per second (MBps) (Ghosh et al., 2011). Although 3G technologies afforded users much faster data speeds and more-reliable voice communications, the inability of CDMA and GSM technology platforms to support mobile devices (as evidenced by Verizon’s


oadband, which means that transfer speeds would be an order of magnitude faster than 3G download and upload speeds
1 The specific dates on which various 2G and 3G systems will be turned off vary from country to country, and the announced dates of dec


Phone in 2007 integrated data and voice functions through a touchscreen display, web browsing, time and geoloca- tion services via GPS, cameras, and motion sensors, and the iPhone remains the standard against which all other portable communications d


d Clark, 2014). Phase II began even as the more advanced LTE standard in commercial mobile phone networks encouraged the development of hybrid radio devices for first responders that have both smartphone capabilities (LTE) and P25-compliant LMR funct


radio resources (GSMA, 2017).
5G
To sum up the current state and probable future of broadband communications, 1G is analog cellular. 2G technologies, such as CDMA, GSM, and Time Division Multiple Access (TDMA), were the first generation of digital ce


logy (or combination of technologies) is deployed by law enforce- ment for public safety broadband, there are applications that have already come online that will affect not
71
Broadband Communications Prioritization and Interoperability Guidance for


PSBN (FirstNet) is now offering tethered UAVs as part of its emergency response fleet. These are “flying COWs” that relay Band 14 communications. Their flying height is 400 ft; in contrast, cell towers are typically below 350 ft. As of 2019, FirstNet


 built.
Public safety agencies and their LMR-LTE providers might want to assess the cell capacities of their sys- tems in normal and emergency operations and plan for ways that COW and COLT deployment can support communications during natural disaste


mmunications Prioritization and Interoperability Guidance for Law Enforcement
 geographic reach and is faster than low band. To enable 10-gigabyte-per-second (GBps) speeds, however, net- works must use mmWave (mid band is 1 GBps) (Finley and Pearlste


 ecosystem to deploy
robots, have devices interact, and enhance safety measures for workers
• smart cities, which will become the norm, with 5G speeds tracking traffic conditions, parking availabil-
ity, refuse pickup, and guidance to smart vehicles


ercial infrastructure (instead of mission-critical, public safety–grade broadband sites, which are only loosely defined), it is unknown whether the planned system would remain functional in the case of a significant seismic event, another large-scale


et still poor; and green indicates a reliable signal strength, one that an end user would see as a “3- to 5-bar” connection on their device. The figures in this appendix depict repeater coverage at four cell frequencies (778 MHz, 850 MHz, 1,900 MHz,


equal to –90 dBm but less than –70 dBm is considered weak but potentially usable and shown as yellow; and greater than or equal to –70 dBm is considered a good
connection and shown as green. Areas with none of these colors have no reception.
We chose


 the mission, then the two handsets are roughly comparable.
For our LMP/P25 examples, we considered any received signal strength of greater than –110 dBm (DAQ [data acquisition] 3.4 or better) to be a good signal and colored the area green. We consid


d web browsing.
The fourth generation of mobile broadband, also known as Native internet protocol.
The first iteration of 4G. LTE leveraged the dependability of data-optimized 3G broadband and delivered performance roughly equivalent to wired broadba


eroperability and enhance public safety communications. A component of the Cybersecurity and Infrastructure Security Agency.
These can also be referred to as drones, unpiloted aerial systems, unpiloted aerial vehicles, unpiloted ground systems, or ro


 More to Boost Gameday Look and Feel,” TechRepublic, February 5, 2021.
Alleven, Monica, “T-Mobile Makes Public Safety a 3-Way Race—Sort Of,” Fierce Wireless, May 22, 2020. ———, “Verizon Beefs Up C-Band Deployment to 175M by End of 2022,” Fierce Wirel


rporation, February 2014.
CISA—See Cybersecurity and Infrastructure Security Agency.
91
Broadband Communications Prioritization and Interoperability Guidance for Law Enforcement
 City of Albany, New York, “Request for Proposals for the Provision of C


ent Agency, February 2021. As of July 11, 2022: https://www.fema.gov/sites/default/files/documents/FEMA_2021-Preparedness-Grants-Manual_02-19-2021.pdf
———, FEMA Preparedness Grants Manual, version 3, Federal Emergency Management Agency, May 2022. As


. As of April 26, 2021:
https://www.androidcentral.com/how-much-data-does-streaming-media-use
Hill, Kelly, “Key Takeaways from FirstNet’s Annual Report,” RCR Wireless News, March 3, 2021.
Hill, Simon, Simon Chandler, and Paula Beaton, “4G vs. LTE: Th


-lte-in-depth-guide-to-its-differences/
Kozlowski, Jonathan, “Spotlight On: Verizon,” Officer.com, July 10, 2020. As of July 11, 2022: https://www.officer.com/command-hq/technology/communications/article/21143122/ spotlight-on-the-verizon-public-safe


Forbes, March 6, 2019.
Nilsson, Jeff, “Albert Einstein: ‘Imagination Is More Important Than Knowledge,’” Saturday Evening Post,
March 20, 2010.
NIST—See National Institute of Standards and Technology.
NPSTC—See National Public Safety Telecommunicatio


ves Committee on Energy and Commerce Subcommittee on Communications and Technology on November 1, 2017, Washington, D.C., 2017. As of June 27, 2022: https://energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/ Testimony-


df
U.S. Government Accountability Office, “Decision,” T-Mobile USA, Inc., File B-418394, April 8, 2020. As of June 28, 2022:
https://www.gao.gov/assets/b-418394.pdf
———, Public-Safety Broadband Network: Congressional Action Required to Ensure Network


bility. For various reasons, this has not happened. Every law enforcement and first responder agency has legacy systems and equipment for mobile broadband uses and is faced with a complex set of decisions about its broadband communications infrastruc


   Research Report
JULIA ROLLISON, JULIA BANDINI, KATIE FEISTEL, ALLYSON D. GITTENS, MEGAN KEY, ISABELLE GONZÁLEZ, WEILONG KONG, TEAGUE RUDER, JASON MICHEL ETCHEGARAY
An Evaluation of a Multisite, Health Systems– Based Direct Care Worker Retention P


raining, and one-on-one coaching. RAND exam- ined the THRIVE program in light of its targeted outcomes and also identified areas for program improve- ment. This report is intended for stakeholders interested in supports for direct care workers and wa


Foundation funded three health systems (hereafter referred to as “sites”) to support the implementation of a new program: Transformational Healthcare Readiness through Innovative Vocational Education (THRIVE). This one-year program was designed to h


and race emerged as significant predictors of retention in both program years;
those in the lowest pay category and individuals who identified as black had a higher likelihood of termination (voluntary or involuntary) than those in the highest pay ca


ears 1 and 2, given program costs; in other words, it would not have been possible to break even,
given the observed program average expenditures per caregiver.
• What lessons learned would other sites need to leverage when implementing an interventi


require both technical and interpersonal skills for providing physical and emotional support to care recipients and communicating with other members of the care team and family members. Direct care workers are predominantly women and people of color


s related to decisionmaking, problem-solving, communication, and relationship-building as well as tar-
1 The health systems also provided some funding support to cover expenses such as fringe benefits for participating caregivers.
  1
Multisite Healt


provided resources (e.g., information on tuition reimbursement or scholarships) to caregivers to supplement their experience and address certain identified needs (e.g., transportation, uniforms).
The foundation and the implementing health systems eng


?
• What are the strengths and opportunities for improvement of the THRIVE intervention, including the intervention content, modality, and skill and knowledge of those delivering the content?
• Can THRIVE break even or generate a positive return on i


ts helped demonstrate the potential influencing factors on THRIVE from the beginning of the program and were used to guide the development of data collection instruments as well as analyses. While we attempted to include as many variables as pos- sib


en found to be drivers of engagement and retention, particularly among young employees (Gilsdorf, Hanleybrown, and Laryea, 2017). In terms of benefits and compensation, higher wages, work schedule flexibility, health insur- ance, overtime pay, and pa


he time of hire
– Part-timeversusfull-timeposition
– Workload in number of hours, night shifts
• Termination status (voluntary or involuntary) and reason
• Organizational-levelcharacteristics
– Direct care worker staffing level (e.g., number of worke


reas for improvement following each round of observations.
Interviews. RAND conducted three rounds of interviews with staff members in the spring of 2020, the fall of 2020, and the spring of 2021 (see Appendix C for sample staff interview guide). Sta


nclud- ing worker type, shift (day/night shift), and hours worked (full time, part time). Participants were primarily women. Both job and demographic characteristics largely aligned with the characteristics of the overall pop- ulation served by THRIV


btaining approvals and the early program pause, the survey was administered only once (i.e., in February, March, and July 2021 at the different sites).
The survey could be sent only to active caregivers (i.e., enrolled in THRIVE at the time, not thos


ng each round of obser- vations. The observational data were integrated with the interview data to formulate key findings across sites and data type.
We analyzed interview and observational data simultaneously throughout data collection during the co


 selection of a survival model, plus we complete a sub-analysis for the subset of employment episodes for which we have 12 months of data.
Our analysis was limited to hires who were eligible for THRIVE, whether they actually completed the training. T


for all factors (burnout α = .84; teamwork climate α = .78; perceived supervisor support α = .94; perceived organizational support α = .94; core training; α = .84; Bring Back Day sessions; α = .83; coaching α = .97). For outcomes (e.g., caregiver in


predictor variable and the outcome variable might be different (i.e., nega- tive) because of the presence of the other predictor variable.
 11
Multisite Health Systems–Based Retention Program
 expenses, and other materials and expenses) and benefits


on, absenteeism, or recruiting many years beyond the hiring date that could be estimated but this would require data collection beyond the grant period.
The evaluation’s interviews and surveys were limited by the sampling universe. Although we employ


ic approach given available data, it does not provide insight into the effects of COVID-19 on THRIVE.
13
CHAPTER THREE
Evaluation Findings
To provide some context for the findings of this report, we begin this chapter with descriptive information reg


ing Caregiver Job Characteristics
 Characteristic
Role
Nurse assistant (PCNA, CNA, NA)
Patient care technician or aide (PCT, PCA)
Other Job status
Full-time Part-time PRN
Shift
Work involves night shift
Work does not involve night shift
Year 1 Percen


ose scoring less than –4 are assigned a “high” risk category, those scoring between –4 and +4 are assigned a “medium” risk category, and those scoring +4 are assigned a “low” risk category.4
• Coaching assessment. During their initial meeting with ea


 Caregivers’ Risk Levels as Identified by SuccessGPS Versus Those Assessed by Coaches
      SuccessGPS Risk Level
Low Medium High Total
Coach Risk Level Rating
Low Medium High
429 542 252 388 646 366 30 107 104 849 1,296 726
Total
1,224 1,403 241 2,8


eliminating certain group activities that required participants to be in close proximity).5 In the interviews, some caregivers and staff expressed challenges with the curricu- lum activities that were restricted due to COVID-19 because they were not


oughout the year, the ability to complete the offered sessions beyond the one-year program period. Because of the COVID-19 pandemic, much of the content of Bring Back Days moved from in person to virtual or computer-based learning and was delivered i


l. These check-ins were intended to be interspersed throughout the year with other activities such as Bring Back Days (see Table 3.7).
Actual caregiver participation in coaching ranged from zero to 12 sessions over the program year and did not always


. . . It’s the speed-bump meetings with the nurse managers: “Hi, I was just here to see so and so. Any questions or concerns that I should know about?” It takes two minutes of the time but builds the relationships with the nurse managers.—Staff
Unfor


Thus, one of the core objec- tives of this evaluation was to assess whether caregiver retention improved during THRIVE implementa- tion. RAND used administrative data for the comparison year (Year 0) and intervention years (Years 1 and 2) to describ


 Year 2 for 12 months). This analysis revealed results similar to those of the main analysis, but with a significant difference between Year 1 and Year 0 (p < 0.05) in retention, with retention worse in Year 1 than in Year 0.
rates (accounting for 9.


(p < 0.05). There were no significant differences between Year 0 and Year 1 for either voluntary or involuntary reasons. Overall, voluntary terminations account for a larger proportion of dropouts (i.e., lower retention rates), as reflected in Figur


ager)
Non-return or -reinstatement after leave of absence All other reasons
Missing
101
 54
 38
 43
 33
 14
10 0
2 14 1 9 2 5 0 5 3 29
131 812
52 283 16 127
Evaluation Findings
 TABLE 3.9
Reasons for Termination Through December 31, 2021
Year 1 Reaso


a lot of managers are hiring people who aren’t qualified just because they need a body on the unit. Just to try to get that help on the unit because they’re so short. And then when they get on the unit, they are so freaked out about everything that’


 2 were significantly higher than in Year 0.
• There were no significant differences in retention between the nine months prior to COVID-19 in Year 1
and the same nine months in Year 0.
• Several staff members perceived THRIVE to positively affect re


ated with a higher likeli- hood of terminating involuntarily in both Years 1 and 2. Specifically, individuals identifying as black had a relative risk ratio (RR) of 3.2 (p < 0.01) in Year 1 and 2.9 in Year 2, while caregivers identifying as other had


ec- ognized this possibility, too. Caregivers also mentioned that scheduling and location of the health system could affect their decision to stay or go; this was especially the case for caregivers who had other personal responsibilities including ch


as possible because it’s completely toxic. My boss is probably a great person, but when it comes to me and my issues, it seems he is turning a blind eye and places the blame on me and thinking it’s all my fault, even though it could not be.
Similarly


 system. For example, a caregiver mentioned considering leaving the health system if staffing ratios were to worsen:
That does bother me. I went in one day and I had had 34 patients [in] one day. How can I give my attention to my patients if I have 3


cated that THRIVE helped them improve, on a scale from none to a great deal, in areas ranging from attendance to relationships with colleagues and managers to the quality of their work (see Figure 3.6).
The findings in this section focus on potential


 ing, respectively).
To explore potential factors predicting intent to leave, we examined job-related factors (i.e., measures of caregiver burnout, teamwork climate, supervisor support, and organizational support) and program factors—i.e., measures o


gram factors were examined as predictors of relationships in two separate models (i.e., one with managers and one with other colleagues), Bring Back Day sessions were also the only significant predictor for relationships with managers (β = 0.97,
34
E


a result attributed their perceived improvement in providing care to THRIVE components.
THRIVE staff conceptualized the effectiveness of the THRIVE program as related to outcomes other than retention, including gaining calmness, confidence, and commu


egression indi- cated three significant predictors (F (4, 64 = 31.8, p < 0.05, model R2 = 0.67): core training (β = 2.14, p < .05), Bring Back Day sessions (β = 1.38, p < 0.05), and coaching (β = −0.97, p < 0.05). This finding suggests that caregiver


f the THRIVE curriculum.
We asked specific questions about the components of THRIVE including the core training, Bring Back Days, and coaching on the survey, although the number of questions was limited due to length of the survey (see Appendix E). M


acted to THRIVE either very positively or very negatively:
I can’t thank Ralph Wilson Jr. [Foundation] enough and all the staff who do the leg work for this program because this program was life-changing for me. . . . I learned so much about myself a


ssessment and coaches’ own assessment of risk based on their interactions with caregivers both as they pro- gressed through THRIVE and started working on their floors or units. In some instances, coaches thought that the risk assessment may not accur


 agree side and they accidentally hit strongly disagree.
The accurateness of the tool varies. I have [caregivers] that answer strongly agree to every barrier, and when I am on my call with them, I will say I see that you struggle with childcare, tran


2) the classes provided an opportunity for caregivers to become oriented to the health system and meet other new caregivers.
40
Evaluation Findings
 Core Class Content and Delivery
In the interviews, many caregivers and THRIVE staff shared that the c


d in the interviews that by interacting with and getting to know other caregiv- ers in the core classes, caregivers were able to create a support network during their time at the health system. Caregivers found this support from interacting with thei


n a scenario that we didn’t need to be in. We could have just had a simple conversation about it and moved on. . . . It was a little dragged out with the implementation of arts and crafts. Which I understand for engagement purposes, textbook-wise it’


VE staff described strengths of the Bring Back Days in terms of their (1) content and (2) delivery and facilitation.
Content
THRIVE caregivers appreciated that Bring Back Days provided an opportunity to revisit curriculum topics from the core classes


ng and atten- dance, (2) content, and (3) delivery and facilitation.
Scheduling and Attendance
Caregivers and staff mentioned logistical challenges around scheduling and attendance for Bring Back Days that were offered virtually in a synchronous or a


s also
44
Evaluation Findings
 suggest that time management could be improved in reviewing topics previously covered in the core classes. Caregivers stated that they would have preferred the topics presented in the Bring Back Days to be more rel- eva


sessions, both for asynchronous and synchronous learning.
Honestly, I felt like the virtual conference is pointless because we were set at one hour or two hours and the other participants—there was no cut off for them. They were just talking and talk


 caregivers, responding to texts and phone calls when needed in addition to their regular check-in outreach.
Coaching Support
Some caregivers described how their coaches provided support related to their jobs and work environment. Coaches served as a


just keeping me focused.
I know that [coach] has always been there for me, and she would talk to me if I wanted for hours on end just to see how I’m doing and what it is that she can help me with, and what if there are any improvements or if there is


in the ratio of caregivers to coaches may be needed to improve the coaching. Some THRIVE staff across all three sites noted that coaches may have too many caregivers on their caseload, which affects the quality of their individual coaching. Staff re


vided to THRIVE partici- pants. Some caregivers expressed their appreciation for these connections:
Whatever I need, whether it is personal or work related, they’ll support you in any way. I love the coaches; they text you. It’s so personal. They’ll


s, and gain support for it. Many caregivers also noted that their manager was supportive of their participation in THRIVE, enabling them to attend Bring Back Days or coaching sessions.
Opportunity for Cross-Site Collaboration
THRIVE staff mentioned t


minimal stuff about the program and what the purpose is and the contract. I probably reread the coaching manual like 50 times trying to narrow it down, and then I would go on and research some of the topics on my own too just to get comfortable and


 is critical for the program’s success:
I think we have some difficult personalities on our team that can be very challenging and maybe even toxic sometimes that kind of put their feet in and just won’t do things.
Awareness of THRIVE and Buy-In to th


ioned anything to me about the THRIVE program.
I don’t think my manager knows what THRIVE is. I mean she probably does, but I don’t think we’ve ever spoken about it. My manager is rarely on the unit. I’ve talked to her like five times in the year.
[T


 challenges related to organizational staffing shortages, local requirements, and COVID-19.
• There seems to be an overall indifference to THRIVE among caregivers and a lack of understanding of what THRIVE is when beginning the program.
• Reported st


ime workers would be reduced.13 We con- verted benefits into dollars but there are other potential benefits such as improved satisfaction or morale or productivity that we were not able to monetize. Due to the historical nature of the comparison, the


y $265 in Year 1 and $299 in Year 2), the ROI would reach a breakeven point.
As a reminder, the average costs per caregiver were $1,772 in Year 1 and $2,263 in Year 2.15 When compar- ing these numbers with the majority of costs for the program (i.e.,


allowed them to involve a range of organizational representatives and truly integrate the effort into organizational operations (e.g., alignment with human resources, corporate onboarding). Sites felt this planning time was critical to early successe


rything or they’re not going to. If they don’t, they find ways around and try to get their people out of it. They need to see the benefit of it, with communication with those.
Sites also noted that there may be some resistance from clinical sites and


, others felt that cross-training of these roles would provide staff with additional connection to caregivers on their caseload and alleviate an imbalance in work- loads between educators and coaches. The composition of the THRIVE staff team should a


d tracking systems and ensure technology is in place to sup-
port virtual or web-based options for the program.
58
CHAPTER FOUR
Recommendations
This chapter presents RAND’s recommendations based on findings to date (i.e., largely reflecting program Y


e similar design elements.
Clearly articulate the goals to leadership, managers, and caregivers up front. Successfully implement- ing a program of this magnitude (i.e., mandatory attendance for all newly hired caregivers) requires multiple levels of


her challenges that could inhibit internal quality improvement efforts as well as external evaluation efforts.
Alternative Interventions to Improve Retention
As findings from the outcome evaluation pointed to no change in retention, RAND recommends e


andatory or “one-size-fits-all” approach to the intervention. Caregivers across health systems represent a diverse workforce in terms of age, race and ethnicity, education, work expe- rience, and more. Our findings revealed a fair number of caregiver


gs of being undervalued within the care team. While not an explicit area of a priori focus for our evaluation, we learned about systemic issues that warrant attention moving forward. That is, if systemic issues are not addressed adequately, any inter


omes or performance may be masked or heavily influenced by
TABLE 4.1
Sample Guiding Evaluability Assessment Questions
  Area
Model design
Information availability
Institutional context
Guiding Questions
• Are the long-term outcomes for the model clea


While RAND collected demographic data and controlled for these variables in its analysis, there were no explicit questions around the potential disparities in short- and long-term outcomes among certain segments of the workforce (e.g., women, individ


k had a higher likelihood of termi- nating than those in the highest pay category or those who identified as white. Other predictors included part-time status, identification as “other” race, and gender for certain years or types of terminations (i.e


tion, ensuring strong leadership support, encouraging collaboration and ongoing idea generation among participants, and clarifying THRIVE staff roles and ensuring diversity across staff backgrounds.
Summary of Limitations
The evaluation included seve


also encourage developers to think creatively and comprehensively about potential interventions that may be more effective for the specified goals (i.e., retention). Further, we would suggest considering alter- natives to a mandatory or “one-size-fit


 These data were collected via Excel for program numbers and via SurveyMonkey for other questions.
Site Information
1. Choose your health system:
2. WhatwasthedateofyourfirstTHRIVEtraining?[Askedonlyforfirstadministrationoftracker]
3. How many THRIVE


ling
Flipped Classroom/Modules
Activity: Lessons and Hopes Reflection and Kahoot Review
There Is No “I” in Team
Can We All Get Along
Team of Teams
Developmental Goals Discussion
Reflective Portfolio/Journaling
THRIVE Journey Sharing
THRIVE Wrap Up
7.


on administrative, management, and other tasks noted above, how frequently have you engaged in any of the following activities since THRIVE began?
 Never
Once or twice
At least monthly
At least weekly
Daily
 Held discussions or gave presentations to


components of THRIVE where there is more or less engagement?
[If repeat] Have there been any changes in the level of involvement or engagement of caregivers over the past six months?
9. [If new] What are common issues you see that THRIVE caregivers a


d you recommend THRIVE to a friend or new hire interested in caregiving? Why or why not?
Organizational Culture
15. How has COVID-19 impacted your ability to do your job? 16. What do you like about working at [Facility/Site of Care]?
    79
Multisite


16 18.0 30 33.7
5 5.6 35 38.9 50 55.6
 Night shift work
N
%
 Weekend work
N
%
11. In the past 3 months, how many days or shifts did you miss work due to illness, injury, extra rest, etc. (not including approved days off)? (n = 90)
 Missed shifts
N
%


27.0
27.0
31.5
33.7
28.7
         17. To what extent has THRIVE helped you improve in the following areas?
 None
 Little
 Some
 Quite a bit
 A great deal
 Ability to attend work more consistently (n = 89)
Relationship with manager (n = 89)
Relations


ed household income
N
%
Less than $40,000
Between $40,001 and $60,000 Between $60,001 and $80,000 Between $80,001 and $100,000 More than $100,001
53 63.9 18 21.7 4 4.8 4 4.8 4 4.8
30. How many people are living or staying at your home? Include yourse


served as our assurance of compliance with the regulations of 17 federal departments and agencies. According to this assurance, the HSPC is responsible for review of all research, regardless of the source of funding. The HSPC monitors research on an


r- mination reason (if applicable), age, gender, race, ethnicity, full-time status, type of work shifts, setting (i.e., hospital, nursing home, or home health care), and pay rate. Following receipt of data, we held phone discus- sions and corresponde


program was then put on pause and thus Year 3 data were not collected due to this pause and anticipated changes to the intervention.
2 If a site did not provide this information, RAND used termination reasons to exclude such individuals.
  91
Multisi


e the time period before the COVID-19 pandemic began (i.e., the first nine months of the first program year [Year 1]); and (4) an uncensored version of the main analysis following Year 1 hires for a full 12 months after hiring.
92
Survival approach
M


enominator of this equation, for example, limiting to up-front fixed costs, such as computers, furniture, and construction. We chose the most inclusive definition, which will result in lower estimated losses per investment dollar.
   95
Multisite Hea


rganization.
         96
Methods for Assessing Return on Investment
 TABLE H.2
Program Benefit Categories
   Category
Cost saving areas
(Reported to RAND in Excel; rate information from administrative data)
Inputs
Hiring and recruitment
Bringing on b


7, No. 3, 2002, pp. 565–573.
Espinoza, R., 8 Signs the Shortage in Paid Caregivers Is Getting Worse, Bronx, N.Y.: PHI, 2017.
Faul, F., E. Erdfelder, A. Buchner, and A. G. Lang, “Statistical Power Analyses Using G*Power 3.1: Tests for
Correlation and


As of April 22, 2022: https://www.phinational.org/resource/direct-care-workers-in-the-united-states-key-facts-2/
RAND Center to Address Racial Equity Policy, webpage, undated. As of June 30, 2022: https://www.rand.org/well-being/racial-equity-policy.


2020 California Neighborhoods Count
Validation of U.S. Census Population Counts and Housing Characteristic Estimates Within California
LANE F. BURGETTE, BEVERLY A. WEIDMER, ROBERT BOZICK, AARON KOFNER, MICHAEL TZEN, JENNIE E. BRAND,
HIRAM BELTRAN-SAN


al analysis, to determine the efficacy of using administrative records for small-area population and housing estimates, and to help measure the effectiveness of California Complete Count—Census 2020 outreach efforts. This report summarizes the findin


fforts in advance of our in-field activities.
We appreciate the support of several individuals who provided input during the sampling design and the writing of this report: Ethan Sharygin, Fennis Reed, Tom Belin, and Paul Ong. Marc Elliott and Ann Ha


s, conducted by the U.S. Census Bureau, is critical to states because its results are used to reapportion seats in the U.S. House of Representatives; guide state and local redistricting; and form the basis for allocating federal funds, such as those


. In-field address canvassing subsequently verified the remaining 35 percent of addresses that were not able to be updated or verified through in-office address- canvassing operations. In contrast, the CNC team undertook a completely in-person physic


re of
vii
our study relative to the mandatory nature of the decennial census, which has greater outreach efforts, a larger workforce, and other resources.
Our study identified 5 percent more housing units than the census. We 23,929 housing units in t


lity data while facing pressures about costs, a fuller in-field address-canvassing operation, a shorter amount of time between phases, and additional statistical imputation methods could inform future census- related collection and processing efforts


other states, California has a disproportionate number of residents who are
 considered traditionally hard to count; these individuals include foreign-born residents, recent
 migrants, homeless individuals, renters, individuals living in homes withou


l-area population estimates produced from the 2020 Census. The primary sampling unit for the CNC is the census block, which is the lowest level of geography for which the U.S. Census Bureau provides publicly available population counts. Census blocks


o 105 potential strata. However, we identified only 57 unique strata because not all land-use types were present in each region.
To draw from the demographic sampling frame, we first identified five major cities to include alongside the original seve


igure 2.1. Development of Strata for the Geographic and Demographic Sampling Frames
Given the extensive preparation required for data collection, the initial sample was drawn using the 2010 Census block designations because the block boundaries for t


g each block to identify and document every single housing unit and its corresponding address. In the third phase, we attempted to undertake a complete enumeration of all of the residents living in each housing unit identified during the address-list


t between our data collectors and their law enforcement agents. In addition, several agencies posted information about our study on their Facebook pages or requested electronic copies of the study brochure in order to post it on their community virtu


tion, we describe the activities conducted during each phase.
Phase 1: Block Observations
In preparation for the listing of addresses in the sample of blocks selected for the study, the four field supervisors were tasked with driving to each of the b


quired the address lister to confirm or update the address for each structure on the block and code the structure type, the housing unit type, whether the housing unit appeared to be occupied or vacant, other housing unit characteristics (e.g., the p


ries, identifying the starting point for listing, and listing all of the structures on a block (residential, commercial, group quarters, or other). We also reviewed the process by which an interviewer needed to update or add an icon indicating a stru


g units took place between January 14 and March 13, 2020, and was conducted using an electronic form and an iPhone 8. Prior to going into the field, we loaded the most up-to-date block maps available (obtained from the U.S. Census Bureau in 2019) and


e or apartment number on the exterior of the dwelling. Once data collectors finished listing a block, they circled back to each housing unit where they were unable to confirm the address with a resident to see whether there was anyone at home who cou


nia on March 13, 2020, we were forced to send all field staff home and curtail field validation after validating only ten blocks (6 percent of all blocks). No major quality issues were identified in the blocks that were relisted for the purpose of qu


t each residential housing unit, including the dwelling type; any issues related to gaining access (e.g., secured building, gated community, guard dog, an ADU located at the back of a property); and, when available, information collected about the ho


wo forward translations, (2) a review of both translations by a bilingual reviewer, and (3) the resolution of any translation issues or differences between the forward translations by a committee made up of the translators, the reviewer, and a biling


rvey invitation letter and study brochure were printed in English on one side and Spanish on the other and included a note that listed the languages in which the survey was available. The homepage for the web survey included a drop-down menu that all


of people who could be in a room at the same time, we had to adapt our Telephone Survey Center operations to allow telephone interviewers to work remotely. This required the purchase of tablets and software that allowed telephone interviewers to secu


inutes, and most interviews were completed in the first visit to a household. In addition, interviewers provided respondents with brochures with a list of social services and COVID-19 resources in the area.
Field Staff Recruitment and Training
Staff


o keep interviewers and respondents safe (e.g., face masks, face shields, hand sanitizer, gloves, alcohol wipes). Finally, field interviewers were required to be shadowed by one of the field supervisors or a trainer before being allowed to work indep


cash for those who completed the survey in person with a field interviewer. Upon completion of the interview, respondents who participated in person received a postpaid incentive in cash and were required to sign a receipt for the incentive. Incentiv


y staff meetings, we identified and congratulated the highest-producing region and the highest-producing interviewers and field supervisor in each region and provided them with an additional bonus.
Quality Assurance and Control
Throughout the CNC enu


two interviewers drop out before the start of training and another two drop out during training. In addition, over the first eight weeks of data collection, we lost 20 field interviewers. Most of the interviewers quit over COVID-19 concerns or becau


d to conduct the survey outdoors from a distance of at least six feet. The use of protective equipment and the restrictions on where and how interviewers could conduct the survey made it challenging for them to establish rapport with respondents.
Con


tly affected air quality, which affected interviewer productivity and contributed to staff turnover. Two of the field interviewers were forced to leave the project because they had asthma and were not able to work outdoors under the challenging condi


ere is not a one-to-one correspondence between our approaches and those of the federal census. To partially compensate for these differences, we strategically invested in a handful of processes where there were opportunities to improve upon those use


 respondents or other enumeration activities. The U.S. Census Bureau also used administrative records to impute
24
missing data. Because our address-listing process was essentially its own stand-alone survey, we included a question to the resident of


e rates for eligible housing units that reported at least their TNR (partial response). We also report full response rates, which count households that provide demographics for all residents (full response). Some respondents filled out part of the su


tributed to this issue. In addition, housing units in blocks where relatively few households exclusively use English at home were less likely to respond. The CNC was also unable to obtain responses from most group quarters. As mentioned earlier, beca


 674 50 65 28 21 25
Exists in the fringea
Groupquarters 14 0 0 — — —
Resident-Level Characteristics**
        Structure Type
All
ADU
Empty trailer pad/ mobile home site
Hispanic
Race Ethnicity Age Response Response Response
Rate Rate Rate (%) (%) (%)


 residents who completed the respective race, Hispanic ethnicity, and age survey responses.
* The denominator is the total number of eligible housing units. ** The denominator is the estimated total number of residents.
29
Housing Type
All
Apartment:


umber of residents” survey item. Race response rate, Hispanic ethnicity response rate, and age response rate refer to the estimated percentages of total residents who completed the respective race, Hispanic ethnicity, and age survey responses.
* The


eligible housing units.
** The denominator is the estimated total number of residents.
32
provided the total number of household
Table 3.7. Response Rates by Urban Versus Rural Categorization Housing Unit–Level
   Characteristics*
Full TNR
Response R


Total Eligible Housing Units (n)
Hispanic
Ethnicity Age Response Response
Rate Rate (%) (%)
52 51
58 57 55 54 47 46
Total Estimated Number of Residents (n)
51,304
12,267 16,655 22,382
        23,929 39 54 50
5,548 42 59 54
7,407 40 55 51 10,974 37 5


hbors; and multiple imputation via chained equations, where the conditional models considered include classification and regression trees and random forests. In combination with the imputation model itself, we considered several design choices that a


rmation. However, allowing the number of data elements that need to be imputed to vary by the value of another variable (i.e., having the number of race/ethnicity/age data elements vary according to the number of residents in the housing unit) is a n


algorithm should have relied more heavily on those data. The primary voter registration data elements that we used were voter names, which were translated into race/ethnicity probabilities through BISG. The address match rates for April and November


g unit h, found in a block b, nested in its demographic strata 𝑑# (or geographic strata 𝑔 ), with number of housing units #hu, we computed final weights 𝑤∗∗ as
$%
! ! #huin𝑑 #huin𝑔 #huin𝑑 # # &∈⋃)! &
That is, a block was sampled, 𝑃(𝑏 ∈ 𝑆), if it was


 higher than that of the census. In total, the CNC identified 23,929 housing units, compared with 22,668 housing units identified in the 2020 Census.
Figure 4.2 displays the same data as Figure 4.1 but focuses on differences; we can see that the CNC


g similar estimates in the two data sources.
Figures 4.4 and 4.5 separate the block-level totals by demographic characteristics. Notably, the single-race Asian imputed estimates are generally lower in the CNC, and the single-race White imputed estima


correspondingly imputes many zeroes. Note also that, in the cases in which there is a substantial deviation between the CNC and the census (e.g., block 1224001011 in Santa Cruz County), the difference does not appear to be driven by abnormal shares o


ise, and zero (no difference) is well within the resulting 95-percent confidence intervals. These confidence intervals also ignore uncertainty associated with the differences across imputation approaches shown in Figure 4.8.
Table 4.2. Survey-Weighte


 provide evidence regarding the accuracy of the census counts.
Table 4.4. Number of Housing Units in CNC and Census
       CNC Housing
County Units
CNC CNC Occupied Vacant
Census
Housing Census
Units Occupied
Census Vacant
       Alameda 1,494 1,241


and other complicating factors. Because of these difficulties, the CNC achieved a response rate that was lower than originally planned for.
Nonetheless, the study produced several findings that might be helpful for future enumeration efforts. Regardi


ions support the U.S. Census Bureau and state policymakers in making decisions that result in high- quality data collection in future efforts.
53
Appendix A. CNC Block Observation Form
In preparation for the listing of addresses in the sample of bloc


BLOCKID ABOVE BLANK? IF IT IS BLANK AND THIS IS A NEW STRUCTURE MAKE SURE YOU’VE COPIED FROM A NEARBY STRUCTURE. IF IT IS INCORRECT PLEASE MAKE SURE YOU’VE LAUNCHED FROM THE CORRECT STRUCTURE.
  NAME
  WORKER_NAME
 ANSWER
 Text
  NAME
   block_blank_


THE PROPERTY.
TYPE int
HOW MANY ADDITIONAL HOUSING UNITS IN ADDITION TO THIS [HOUSE/APARTMENT] ARE THERE AT THIS ADDRESS (ON THIS PROPERTY)? IF REFUSED, ENTER 98 ENTER #:
TYPE Int
  NAME
   HU_OCCUPIED
 ANSWER
 Yes 1
 No 0 Could not observe 8
  NAME


/ Sent survey in from 3 different location
 73
Appendix C. CNC Survey and Enumeration Form
This appendix provides the CNC survey and enumeration form.
CNC $15 Survey
  74
 75
 76
 77
 78
 79
 80
 81
 82
 83
 84
 85
 86
 87
 88
 89
 90
 91
CNC $10 Sur


 in California.
Who is doing this study?
The study is being conducted by the RAND Corporation in collaboration with the State of California’s Demographic Research Unit. RANDisanonprofit,nonpartisanresearchorganizationbasedin Santa Monica, CA. For mor


parte.
Este estudio le da la oportunidad de
proporcionar información que ayudará a
mejorar cómo el Estado de California
asigna los fondos para los programas y los servicios, y nos ayudará a evaluar el éxito del Censo de 2020 en California.
¿Quie


HU_RESIDENTS NUMBER_OF_VISITS
STRUCTURE_TYPE
age18ou — hisp_cat —
Used to Impute Demographics
Variable
LC
mos_dem
mos_geo
n_samp_obs_dem
n_samp_obs_geo
pr_dem
pr_fin
pr_geo
pr0_geo
qr_dem
qr_dem_in_geo
REGION
SAMPLE
sampled
strata_unif
w_hu
Data Sour


CNC names (BISG)
CNC names (BISG)
Voter registration (April; BISG)
Voter registration (April; BISG)
Voter registration (April; BISG)
Voter registration (April; BISG)
Voter registration (April; BISG)
Voter registration (April; BISG)
Voter registratio


ample Designs: Sampling with Multiple Overlapping Frames,” Survey Methodology, Vol. 37, No. 2, December 2011, pp. 197–213.
Sperrin, Matthew, and Glen P. Martin, “Multiple Imputation with Missing Indicators as Proxies for Unmeasured Variables: Simulat


Evaluation of the California County Resentencing Pilot Program
Year 1 Findings
LOIS M. DAVIS, LOUIS T. MARIANO, MELISSA M. LABRIOLA, SUSAN TURNER, MATT STRAWN
 Prepared for the California State Legislature
SOCIAL AND ECONOMIC WELL-BEING
 For more inf


tor of the pilot program. The pilot term is September 1, 2021, through Sep- tember 1, 2024; the evaluation term is September 1, 2021, through January 31, 2025. The evaluation comprises three components: a descriptive and outcome analysis of data coll


ion 1170, paragraph (1), subdivision (d) of the California Penal Code to reduce sentences of eligible prisoners. In June 2022, SEC. 8 Section 1170.01 was amended and renumbered to 1172 (California Legislative Information, 2021). Nine Cali- fornia cou


PDs indicated overall support for the program.
• The DA office and PD office staff we interviewed all expressed their commitment to and interest in the opportunities the pilot program afforded their counties to address discrepancies in sentencing for


 a sentence enhancement.
• We caution the reader about drawing firm conclusions at this early stage of the pilot, as the patterns we identify may change over time as we analyze more cases and the counties have the chance to fully develop their pilot


rosecutor-Initiated Review and Resentencing Process Discussed in
ThisReport..................................................................................................... 14
Tables
1.1. Summary of Funding for California County Resentencing Pilo


 20
3.14. Years Added to Original Sentence Length for Enhancements Among Cases Considered
byaCountyDAforResentencing:September1,2021,ThroughFebruary28,2022................. 20
3.15. Years Served by Individuals Considered by a County DA for Resentenci


o programs to help reduce recidivism (Pew Charitable Trusts, 2017, p. 1; Mauer, 2019).
The public is in favor of less punitive options. A 2018 national poll indicated that three-quarters of Ameri- cans feel the justice system needs improvements, with


the county DA office and PD office and may include a CBO within each pilot county.
For the nine counties engaged in the pilot program, the pilot runs from September 1, 2021, through Sep- tember 1, 2024. Table 1.1 summarizes the funding provided to th


uals from the county who are cur- rently incarcerated in state prison. Several of the county DA offices also have indicated that they expect their inclusion criteria to evolve.
AB 2942, 2018, the first prosecutor-initiated resentencing law in the nat


-referral from the incarcer- ated individual or their family, or from a CBO. The county DAs, as discussed in Chapter Four, vary in terms of what sources of referral they will accept.
4
TABLE 1.3
Common Criteria Used to Exclude Cases from Resentencing


 experiences regarding how these cases are handled and processed by the county DA and PD offices.
As shown in Figure 1.2, cases referred to the court for resentencing are eventually heard and a decision rendered. The decision may result in the resent


ds.
Outcomes and Other Measures Study
This component of the study will measure the characteristics and outcomes at each phase of the resentenc- ing process, including characteristics of the incarcerated individuals; offenses and sentences of the revi


e visits will be conducted to the pilot counties.
Cost Study
The legislation requires that the evaluation include a cost study to estimate the resources required to imple- ment the pilot activities, including both new expenditures on personnel and ot


ts discussed in Chapter Three. Appendix D con- tains the implementation interview instrument.
8
CHAPTER TWO
California County Resentencing Pilot Program: Context
This chapter reviews recent resentencing efforts and summarizes other relevant sentencin


islation to reduce the size of the prison population. Table 2.2 shows key legislation and policies related to prison downsizing in California
 9
Evaluation of the California County Resentencing Pilot Program
 TABLE 2.1
Select Resentencing in Californ


ertain individuals convicted of lower-level offenses were to serve their sentences locally rather than be sent to state prison. These individuals were referred to as “non-non-nons”—nonserious, nonviolent, non-sex offenders. Second, certain individual


014 Increased credits certain inmates earn for maintaining good behavior; created release consideration for certain nonviolent inmates with third-strike sentences
2016 Expanded inmate eligibility for release consideration; increased CDCR’s authority


Prop 47. Additional senate bills passed between 2017 and 2019 reduced or made optional the use of certain sentencing enhancements for individuals.
The inmate population has been under the Three Judge Panel cap since 2015—over seven years. As of early


period. Therefore, we focus discus- sion of early results primarily on the DA review portion of the resentencing process.2 Figure 3.1 replicates the illustration of the prosecutor-initiated review and resentencing process first presented in Figure 1


59 cases for which a referral review was initiated by the nine pilot county DA offices. Nearly four out of five cases were identified for review internally within the DA offices. Among other sources of referral, self-identification by the incarcerate


14 21 60 76 reviews initiated
SOURCE: Data provided by county DA offices, March and April 2022.
February
2022 Total Cases
51 259
  included in this reporting) may still have been occupying staff already in place. For example, Los Angeles initiated a


g were overwhelmingly male. As reported in the county DA data, only three of 259 individuals were female.3 Table 3.6 displays the distribution of race and ethnicity of the individuals reviewed by the pilot DA offices over the reporting period. Over 4


ases
259
171 88
 SOURCE: Data provided by county DA offices, March and April 2022, and CDCR, June 2022. NOTE: Percentages might not sum to 100 because of rounding.
TABLE 3.8
Age at Time of DA Review for Resentencing: September 1, 2021, Through Februa


nd-strike cases carry determinate sentences, while third-strike cases carry indeterminate sentences. Percentages might not sum to 100 because of rounding.
reported separately from all other determinate sentences, and sentences of indeterminate length


reporting period. As displayed in Table 3.13, just under 75 percent of reviewed cases had at least one sentence enhancement attached to their sentence, and 36 percent of cases had at least three enhancements. Cases with the greatest number of enhance


among reviewed individuals with indeter- minate sentences until they reach their MEPDs. As parole is not necessarily granted as soon as eligibility is reached, some reviewed individuals with indeterminate sentences were beyond their MEPDs at the tim


for resentencing
Percentage 1 Year or Less Remaining
15.1
17.6 9.1
Percentage 1+ to 3 Years Remaining
23.3
25.5 18.2
Percentage 3+ to 5 Years Remaining
21.9
23.5 18.2
Percentage 5+ to 10 Years Remaining
30.1
25.5 40.9
Percentage Over 10 Years Remaini


on recidivism for individuals who are resentenced and released. We will obtain automated criminal history records from the California Department of Justice (DOJ) and record convictions at one-year post return to the community. We will break down conv


lop a robust application and reentry plan. Still, one county DA felt that it is the job of the individual to develop a strong application packet, includ- ing a reentry plan. This interviewee did not feel that it was necessarily the role of the DA to


ion, we are handicapping these people; we are depriving them of some of the preparation that goes with reentry planning and being on parole.
Current Status of Implementation of the Pilot Program
To conduct the work of resentencing efficiently, counti


he level of PD office involvement, though, varies across the counties; some PD offices meet regularly with the DA office, and others meet rarely. Counties with a history of engaging in resentencing work and DA/PD office collaboration tend to be furth


nsideration. Specifically, the pilot counties obtain from CDCR a list of all individuals incarcerated within the county. The DA office then analyzes the data to identify indi- viduals who fall within their tier of cases for review.
The pilot counties


eir websites with respect to the resentencing guidelines, an application form, and/or FAQs to provide guidance to individuals who would like to be considered for resentencing.
When a case has been identified as eligible for resentencing consideration


o the courts for consideration.
When the DA files a resentencing request, a court date may be set to hear evidence and arguments on whether to reduce an individual’s sentence. The packet of information is presented to the judge. In some instances, th


resentenc- ing but who did not have a strong enough application (e.g., their reentry plan was weak, they had an RVR within the past three years), some DAs will let an individual know what the issues are and that if they address those deficits, then


tiated resentencing, the intent of the legislation was that the participating DA and PD offices would work collaboratively on this initiative as summarized above. Over- all, these two agencies in each of the pilot counties are trying to collaborate a


n the pilot, the PD did not fully understand the DA’s eligibility criteria and instead reached out to a number of their clients and obtained their C-files, bringing forward too many cases to consider. Also, the interviewee noted that there was disagr


of the pilot. The community-based organization shall have experience working with currently or formerly incarcerated individuals and their support networks, and shall have expertise in at least two of the following areas: (1) Supporting and developin


uals to access upon release from prison. These offices have made it a requirement for resentencing consideration that individuals agree to waive any excess credits to increase the likelihood that they will be put on parole and so be able to access re


ew and resentencing process is the amount of time it can take to reach out to victims under Marsy’s law (CDCR, undated-b) to notify them that an individual is being considered for resentencing and to get their input. As stated on the Los Angeles DA’s


hat influences the time it takes to obtain an individual’s C-file is the length of time they have been incarcerated. If an individual has been incarcerated for a long time, some prison facilities may only have paper records that will need to be scann


esentencing
As discussed in Chapter One, CDCR has been sending referrals for resentencing consideration to the courts since 2018. 1170(d) provides the CDCR secretary broad authority to look at various factors, such as type of sentence, enhancements,


 to obtain CDCR data to aid them in selecting candidates for resentencing consideration. Furthermore, the counties had to decide
35
Evaluation of the California County Resentencing Pilot Program
 whether to create new resentencing units or use existi


ple, ‘individual has done a lot of programming while incarcerated, has no rules violations,’ whereas another individual may be struggling to get the programming he or she needs or may have mental health issues.” It takes time to sort this out. Fur- t


the reporting period. Of those initiated, 163 cases (63 percent) were still pending at the end of the reporting period and eight had been referred for resentencing. We presented data summaries of DA sentencing review uptake, characteristics of review


program, it takes time to stand up all the different components of a program and to put into place the processes and procedures for implementing it. We expect to see over time that many of these hurdles will have been addressed and that the pilot co


.
(1) Develop and implement a written policy which, at minimum, outlines the factors, criteria, and processes that shall be used to identify, investigate, and recommend individuals for recall and resentencing. The district attorney’s office may take


o later than October 1, 2021. The measures shall include, but not be limited to, the following:
(1) A summary of expenditures by each entity receiving funds.
(2) A summary of any implementation delays or challenges, as well as steps being taken to ad


allows for comparison between the pilot participant sites. This includes, but is not limited to, collection and reporting of data at the individual case level using the same definitions. Each pilot participant shall provide any information necessary


t shall include a calculation of the total number of days of incarceration avoided, and amount of time by which the person’s earliest possible release date or minimum eligible parole date was advanced due to prosecutor-initiated resentencing for thos


ch stage of the resentencing process?
 3. What is the impact of the resentencing pilot on case outcomes and recidivism?
4. What is the tangible and intangible cost of the pilot program?
TABLE B.1
Evaluation Components and Sources of Data
Data Source


d the case to the court for recall of sentence, the date the court considered the motion for resentencing, the date the court responded to the motion, the date the court resentenced the indi- vidual, the date the individual was released from state pr


ne 2022. Given the timing of this report and the available complete data, results contained in this report cover this first data reporting period, through February 28, 2022. Future data delivery from the DA offices will occur quarterly throughout the


ing process, and will provide description of contem- poraneous variables to help place the time reductions into context. Given the early stage of the pilot term at the time of this report, current analyses will focus on univariate descriptions of var


m analysis—it is too early. However, we anticipate that we will have enough cases for the second and final report. We will report on convictions during a one-year follow-up (longer if enough cases have been released to allow for longer follow-ups). S


lementation assessment interviews with each site, both the DA and PD offices, and supplementing the findings with additional interviews with other county-level stakeholders, CBOs and any technical assistance help, such as FTP.
Recidivism information


nditures for the pilot program, regardless of the funding source.
6 We use project quarters versus the state’s fiscal quarters because the legislation requires that counties report their cost data on a quarterly basis for the pilot program, which beg


 CA Penal Code Section 666 for additional specific details).
TABLE C.3
Drug Crime Cases Considered by Pilot DAs for Resentencing: September 1, 2021, Through February 28, 2022
  Cases considered by DA
By DA review outcome
Pending or referred for resen


et’s get started.
II. Description of Jurisdiction
1. What are the most common local crime problems?
2. Describe the structure of the Prosecutor’s Office.
3. How many felony and misdemeanor cases are prosecuted yearly?
4. Is an annual statistical repo


 interviewed during a prior site visit, ask if their job title and responsibilities have changed since you last spoke, and how long they have been in the new role.
2. How many prosecutors work on the resentencing pilot program? How many paralegals wo


 pilot program in September 2021
57
Evaluation of the California County Resentencing Pilot Program
 2. Please explain the process of working with the court. VIII. Partnerships
1. Are you partnering with any community-based organizations to implement


AND provided?
2. Do you create your own regular performance reports of any kind?
59
Abbreviations
AB Assembly Bill
CBO community-based organization
CDCR California Department of Corrections and Rehabilitation
C-file California Department of Correctio


August 29, 2022: https://www.cdcr.ca.gov/news/2021/12/08/california-department-of-corrections-and-rehabilitation-announces- changes-to-good-conduct-credits-staff-misconduct-and-disciplinary-process/
California Department of Corrections and Rehabilita


s of September 23:
https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=202120220SB483
California Senate Bill 678, Criminal Recidivism, October 11, 2009. As of September 23, 2022: https://leginfo.legislature.ca.gov/faces/billNavClient


isan-approach-to-public-safety-reform
Prison Law Office, “Penal Code 1170(d) CDCR Resentencing Recommendations,” San Quentin, Calif., September 2018. As of August 1, 2022: https://prisonlaw.com/wp-content/uploads/2018/09/PC1170d-CDCR-resentencing-AB-


 Reducing Deaths in Law
Enforcement Custody
Identifying High-Priority Needs for the Criminal Justice System
Duren Banks, Michael G. Planty, Madison Fann, Lynn Langton, Dulani Woods, Michael J. D. Vermeer, Brian A. Jackson
Congress enacted the Death i


tality.
• A taxonomy of deaths or critical incidents that occur in law enforcement custody should be developed to provide necessary context to understand law enforce- ment’s role.
Data and reporting
• Challenges that law enforcement agencies (LEAs) a


create efficiencies and reduce burden on reporting agencies
• clear guidelines to support accurate and timely reporting, including the specification of who is responsible for report- ing, what data elements, and when
• a foundation for translating kn


deaths of (1) any person detained, under arrest, or in the process of being arrested by any officer of law enforcement, or (2) any person incarcerated, detained, or en route to be incarcerated or detained at government facilities. DCRA further requir


ed alternate data collection strategies and DOJ determined what agency should be responsible for collecting the information mandated by DCRA. Supplemen- tary homicide reports, collected through the Federal Bureau
of Investigation’s (FBI’s) Uniform Cr


e data. The officers employed by these agencies represent 54 percent
of federal, state, local, and tribal sworn officers in the United States (FBI, undated). The Office of Management and Budget (OMB) has stipulated that limited data from the National


’s (NIJ’s) Prior-
ity Criminal Justice Needs Initiative (PCJNI), a 2016 panel explored specific needs surrounding mortality in correctional settings (Russo et al., 2017). BJS reports that approximately 1,000 inmates die in U.S. jail facilities each y


ram estimated that each year 1,000 individuals die from a police shooting; 1,200 deaths result from all types of law enforcement use of force (including police shootings and other uses of force); and 1,900 deaths of all manners occur in law enforceme


surrounding these deaths; information needs of practitioners, policymakers, and the public; and opportunities to improve policies and practices that may prevent or reduce deaths occur- ring in law enforcement custody while also ensuring public safety


 enforcement custody, and the public.
As an initial step in the development of the engagement, RTI staff reviewed relevant literature (e.g., scientific studies, technical reports) on the challenges of collecting comprehen- sive, national-level inform


given an opportunity to review the rankings of needs following the workshop and vote to move needs up or down
in terms of importance. For a more detailed description of the prioritization methodology that we employed, including iden- tified limitatio


cidents that could result in fatali- ties, including all incidents in which law enforcement deploy deadly force and deaths occurring in law enforcement custody that meet other inclusionary criteria described in DCRA: accidents, suicides, deaths due t


 engagement (e.g., with other LEAs, advocates, policymakers) to institutionalize LEA reporting.
• Leverage existing reporting platforms and coordinate across providers to create efficiencies and reduce burden.
• Conduct user experience research to un


    a Multiple needs were associated with this issue, but the others did not fall in the top tier. See the technical appendix for a complete list of needs.
ity occurring during an incident involving active law enforce- ment response and (2) any incid


imately, the participants cautioned against expanding the collection beyond nonfatal incidents that were the result of law enforcement use of force. The group felt that including serious injuries of bystanders in an accident would likely create chall


ere was no need to start from scratch with
a new data collection; instead, they recommended focusing on understanding and addressing the challenges to participating
Workshop participants determined that there
was no need to start from scratch with a


ational Use-of-Force Data Collection and the BJA’s deaths in custody program, and they may also be reportable to state and local systems.
LEAs may also find reporting to be challenging because
of their concern about who has access to the information


changes to law enforcement training or policy. Although many train- ing programs and policies designed to prevent fatal incidents are in place, there is no rigorous evidence on whether any of these programs reduce fatalities, serious injuries, or unw


ategies (GAO, 2021). The FBI’s National Use-of-Force Data Collection may be discontinued by December 2022 if participation in the current data collection approach remains insufficient.3 GAO further recommended that “the Attorney General should assign


ssional and social networks (e.g., LinkedIn) and by reviewing literature published on the topic. We then extend an invitation to those individuals and provide a brief description of the workshop’s focus areas.
For this workshop on deaths in law enfor


had not been used before). After identifying and refining the needs, we used a vot- ing process based on the Delphi method to elicit prioritization information from the group about the identified needs (RAND Corporation, undated).
Prior to the COVID-


 slides that were edited in real time to incorporate participant revisions and comments.
Once the group reached consensus on a group of needs, we conducted a real-time voting prioritization exercise using Del- phi techniques. We asked the panel to an


s the group’s collective expected value score for the need.
We clustered the resulting expected value scores into three tiers using a hierarchical clustering algorithm. The algorithm we used was the “ward.D” spherical algorithm from the “stats” libra


nded outsized impact—for example, when some or all of the needs in one tier have the same or very similar expected values—we also set a threshold that at least 25 percent of the workshop participants must
have voted on that need (and then rounded to


ty is responsible for providing the information.
• Define the lead agency for reporting purposes.
• Develop and implement protections that address privacy
concerns. Specify appropriate uses of the data for disclo- sure and research purposes and provi


y for one or more aspects of the data collection(s) that could inform deaths that occur in law enforcement custody or use-of-force incidents, or both. This can create duplicative reporting and additional burden confusion for data providers.
Potential


e incidents result in nonfatal or fatal injuries.
There is a lack of information about policies and practices to recognize and respond to a person experiencing a mental health crisis and general crisis intervention models and programs.
  Table A.1—Co


 law enforcement custody. LEAs and other stakeholders disagree on which manners of death should be reported.
20
Table A.1—Continued
Problem or Opportunity
Data providers or gatekeepers are concerned about disclosing active case information, respectin


n or when an officer discharges a firearm at or in the direction of a person.
3 OMB stipulated that if the FBI did not achieve 60-percent partici- pation by the end of 2022, the FBI was to end the data collection effort and explore alternatives for c


s in United States Vital Statistics and News-Media-Based Data Sources: A Capture-Recapture Analysis,” PLOS Medicine, Vol. 14, No. 10, October 2017.
GAO—See U.S. Government Accountability Office.
GBD 2019 Police Violence US Subnational Collaborators,


dy: Identifying High-Priority Needs to Reduce Mortality in Correctional Facilities, Santa Monica, Calif.: RAND Corporation, RR-1967-NIJ, 2017. As of February 2, 2022: https://www.rand.org/pubs/research_reports/RR1967.html
U.S. Government Accountabili


 multiple national data collection projects on victimization and law enforcement issues. He holds a Ph.D. in justice, law, and society; public administration; and public policy.
Madison Fann is a public health analyst in the Division for Applied Just


quirements & Resources Consortium (RRC) and is intended to support innovation within the criminal justice enterprise. For more information about the RRC and the Priority Criminal Justice Needs Initiative (PCJNI), please see www.rand.org/well-being/ju


 of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.
Limited Print and Electronic Distribution Rights
This document and trademark(s) contained herein are protected by law


 Societal Impact of
Research Funding for
Women’s Health
IN LUNG CANCER
Matthew D. Baird Annie Chen Andrew W. Dick Chloe E. Bird Melanie A. Zaber Molly Waymouth Grace Gahlon Denise D. Quigley Hamad Al-Ibrahim Lori Frank
     CORPORATION
 THE WHAM REPO


ouraged through the generous support and collaboration from the following organizations:
American Heart Association (AHA) is a relentless force for a world of longer,healthier lives dedicated to ensuring equitable health for all—in the United States


ze existing data with sex as a biological variable, to work together to spark new projects, to hire new faculty to build key research areas, to communicate via The WHAM Report, and to establish an ignition point for new leadership in the scientific f


, Neurobiology and Behavior, University of California, Irvine
Robynne Chutkan, MD, Founder and CEO, Digestive Center for Wellness
Richard J. Davidson, PhD, William James and Vilas Research Professor of Psychology and Psychiatry, University of Wiscons


 Epidemiology and Prevention, and Professor of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
Lisa Mosconi, PhD, Director, Women’s Brain Initiative; Director, Alzheimer’s Prevention Clinic; Associate Professor, Neurosci


ith immediate relevance for use by funders, advocacy organizations, researchers, and other stakeholders.
Soo Borson, MD, Professor of Clinical Family Medicine, University of Southern California; Professor Emerita, University of Washington School of M


rms of age incidence, mortality, and quality of life yields the following results:
• For the U.S. population age 25 and older, more than 22,700 years can be saved across 30 years, with substantial gains in health- related quality of life.
• Approxima


s limited. Even today, the value of research investment on women’s health is not widely accepted. The impact of this oversight is far-reaching.
Also unknown is the potential impact of accelerating and increas- ing funding for women’s health research.


Costa, 2021). Research on lung cancer to date has yielded some benefits, but lagging attention to women leaves a knowledge gap.
Quantifying the impact of research funding investment is a rela- tively new area of inquiry (Adam et al., 2018). Microsimu


erminology guidance from the NIH, which states the following:
• “Sex” refers to biological factors and processes (e.g., sex chromo- somes, endogenous hormonal profiles) related to differentiation between males (who generally have XY chromosomes) and


ife years
Decreased lung cancer years
Increased nursing home years
More QALYs
Fewer lost productivity years for patients
Fewer lost productivity years for informal caregivers
Impact of health improvements on costs
More nursing home years
Health care


sing funding for health research on women in terms of economic outcomes. These economic outcomes included the mon-
METHODS 11
  12 SOCIETAL IMPACT OF RESEARCH FUNDING FOR WOMEN’S HEALTH IN LUNG CANCER
etary value of workers being able to stay in the


bstracts in this research portfolio using NIH RePORTER, the publicly available interface
of funded extramural NIH projects (NIH, 2020b). The terms used
to search the retrieved titles and abstracts to determine the total number of women-focused projec


the impact is three times larger for women than men.
Lost Productivity for People with Lung Cancer
Health improvements increase employment and earnings of the lung cancer population in two ways. Fewer years of lung cancer create fewer lost earnings,


)
NOTE: Figure shows a 0.1 percent health impact for mortality and incidence and a 0.01 percent impact for QALYs, which is three times larger for women than men.
RESULTS 17
  18 SOCIETAL IMPACT OF RESEARCH FUNDING FOR WOMEN’S HEALTH IN LUNG CANCER


when modeling using labor force participa- tion and earnings is selection of earnings profiles. We chose to apply earnings of non-Hispanic white males for all races and ethnicities and genders in the informal caregiving population. This has the adva


nagement, in terms of the impact on health and quality of life outcomes, can aid with tracking investment impacts in the future, given the findings here of the potential for impact on health-related quality of life of women with lung cancer. The foll


for- mation, email sbp@rand.org.
   SOCIAL AND BEHAVIORAL POLICY PROGRAM 23
  References
Adam, Paula, Pavel V. Ovseiko, Jonathan Grant, Kathryn E.
A. Graham, Omar F. Boukhris, Anne-Maree Dowd, Gert V. Balling, Rikke N. Christensen, Alexandra Pollitt,


in Lung Carcinogenesis and Lung Cancer Treatment,” Frontiers in Medicine, Vol. 8, 2021.
Scott, Troy J., Alan C. O’Connor, Albert N. Link, and Travis J. Beaulieu, “Economic Analysis of Opportunities to Accelerate Alzheimer’s Disease Research and Devel


Examining Interventions to Address Infant Mortality
in Allegheny County, Pennsylvania
DANA SCHULTZ, SUSAN L. LOVEJOY, EVAN D. PEET
  SOCIAL AND ECONOMIC WELL-BEING
Sponsored by the Richard King Mellon Foundation
For more information on this publicati


re 15. Factors Related to the Maternal and Infant Context in the Infant Mortality Prediction System with Intervention Management Database................................................................. 80 Figure 16. Correlation of Intervention Parti


........................................................................................ 105 Figure 32. Causal Effects of Preconception/Interconception Care on Infant Mortality ............. 107
Figure 33. Causal Effects of Specific Types of Preconce


7
viii
Tables
Table 1. Linkage Between Underlying Factors and Leading Causes of Infant Mortality .............. 8 Table 2. Summary of Data Sources in the Infant Mortality Prediction System with Intervention
Management Database .......................


birth outcomes and infant death. These factors fall into five broad, interrelated categories of risk: maternal health, mental health, stress, risky behaviors, and the context in which the mother lives. Many women, particularly those with low socioec


er’s utilization of publicly funded social services such as Women, Infants, and Children (WIC); housing assistance; Family Support Centers; substance use disorder services; and mental health services from the Allegheny County Department of Human Serv


Together, the results of the two components of the project provide information that can help health care and community-based social service providers and policymakers identify those pregnant women most at risk for infant mortality, decipher the appro


ons include legislative or regulatory changes that address social determinants of health or funding decisions for programs such as the Title V Maternal and Child Health Services Block Grant program. Others include efforts such as perinatal regionaliz


mortality prevention, including breastfeeding and safe sleep. The Pennsylvania Perinatal Partnership facilitates efforts of the Healthy Start projects in the state, the maternal and child health programs organized by the Department of Health’s Burea


ting infrastructure and the need for expanding or improving access and engagement with existing interventions, or for introducing new interventions.
Overall, Allegheny County has programs, services, and supports that span medical-setting intervention


dJAtlantic2Mother’s2
Milk2Bank Allegheny2County2
Breastfeeding2 Coalition
 WIC MidJAtlantic2Mother’s2
Milk2Bank Allegheny2County2
Breastfeeding2 Coalition
Behavioral2 health2 services
 Sojourner2House POWER Familylink’s Family2
Treatment2Centers The2


hers, the infant mortality rate was 10.3 per 1,000; it was 13.8 per 1,000 births when the previous birth occurred less than 1.5 years before.
Intervention Participation
• Seventy-five percent of women received one or more prenatal care visits; among


terms of the size of the effect and the degree of accuracy.
xx
Intervention Category
Medical interventions were estimated to have the largest impact. From the causal inference models, the estimated effects of prenatal care were found to be large and


 offerings (e.g., services include prenatal care), or the approach used (e.g., program based on evidence-informed model).
Among behavioral health services, the effects of substance abuse services were large and significant, particularly at higher lev


men with opioid use disorder, which may reflect more about women struggling with substance abuse issues than it does about the interventions. Both WIC and behavioral health services, on the other hand, did reduce the risk of infant mortality for wome


y a key role in whether an intervention is successful.
• Educate health care and community-based social service providers about available and effective interventions. Successful referral to interventions often depends on health care and community-bas


 coordinated, consistent, and targeted efforts that are initiated as early as possible. The
xxiv
earlier health care and community-based service providers can engage with women, particularly those at high risk of poor birth outcomes, the better able


nt evidence is somewhat limited for some of the approaches recommended for expansion (e.g., enhanced prenatal care and doula support) or introduction (e.g., mobile applications). W hen these are implemented, it will be important to examine their effe


h syndrome
UPMC University of Pittsburgh Medical Center WIC Women, Infants, and Children
xxviii
1. Introduction
The rate of infant mortality, calculated as the number of deaths before age one among 1,000 live births, is widely used as a measure of ma


the southwest part of Pennsylvania, with Pittsburgh as its regional hub, Allegheny County has a population of about 1.22 million, with an average age of just over 40; 80 percent of the population is white and 13 percent is black. The median househol


.50 1.00 0.50 0.00
         2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 N a t i o n a l P e n n s y l v a n i a A l l e g h e n y C o u n t y
SOURCE: CDC, n.d.b.
Access to Perinatal Care
The relatively high rate of infant m


rate of 5.93 per 1,000. Only in two years (2014 and 2016) in the span between 2003 and 2016 was Allegheny County’s infant mortality rate below 6.00 (Figure 1). A 10-percent reduction in the disparity between black and white infant mortality would dr


varied maternal factors that increase risk for poor birth outcomes and infant death (CDC, 2019) (Figure 3). These factors fall into five broad, interrelated categories of risk: maternal health, mental health, stress, risk behaviors, and the context i


ence that
6
untreated maternal depression increases the odds of preterm birth and low birth weight (Grigoriadis et al., 2013; Szegda et al., 2014; Jarde et al., 2016). Anxiety and depression are also both risk factors for maternal complications of pr


t. Higher maternal age (34 and older) may increase risk for birth defects and maternal complications of pregnancy (Huang et al., 2008; Bayrampour and Heaman, 2010; de Queiroz Herkrath et al., 2012), whereas lower maternal age (younger than 18 years)


ystem with Intervention Management (IMPreSIv) database. The database includes vital statistics records of all births and infant deaths from ACHD, the social services database from the Allegheny County Department of Human Services (ACDHS), the Magee O


, services, and supports addressing the underlying causes of infant mortality; and the causal inference framework to examine intervention effectiveness.
• Chapter 3 summarizes the evidence base for interventions that address the underlying causes of


ated keywords for the period 2006– 2016. The results from each search were combined into one master EndNote library with results from each underlying cause grouped into individual folders within the library. All duplicates between database and outcom


tion
• eligibility criteria
• areas served
• year started
• referral sources
• annual referrals
• recruitment methods
• annual number served
• capacity
• number and type of staff
• program or service components
• intervention model, measures, or tool


on participation with the data we observe, then we can mitigate the bias caused by selection. So, just as the University of Pittsburgh team built models to predict infant mortality, as the first step in the causal inference framework we built models


s on the causal inference framework and steps in the model development process are provided in Appendix B.
Infant Mortality Prediction System with Intervention Management Database
Our causal inference framework is built on and responsive to the IMPre


f information regarding social, economic, and demographic characteristics of the mother and, in some cases, the father. These include parental education and insurance status. Major maternal and child health risk factors, such as gestational diabetes


a range of health care and community-based social service providers, we divided the data by type and time period. If the models within the framework rely too heavily on information available only to health care providers, such as blood tests and ultr


igure 5 describes the overall data structure by type and time period. Reportable data during the preconception period represent the smallest portion of the overall database, and health care data in the postdelivery period include all of the available


ey identified as important were also included in our models. We then extended this work by developing our own models to predict infant mortality using each type of data at each point in time. We used machine learning algorithms that iteratively impro


participation. Additionally, in order to make the results as relevant as possible for a range of health care and community-based social service providers, we modeled intervention participation using the three data types described. The main results o


rence model enable us to predict who will participate in the interventions, describe the effectiveness of the interventions for different risk factors, and suggest individualized referrals based on the overall risk profile. The main results of this s


y-based organizations, such as Healthy Start.
Preconception Care
Preconception care consists of a group of preventive screenings and services designed to reduce modifiable risk factors before a first pregnancy to improve pregnancy outcomes, as well a


se; weight loss for obese women; and smoking and alcohol use cessation. While interventions for smoking and alcohol use have been shown to be effective among some populations, they have not been as effective for injection drug users and polysubstance


ve life planning, is a vehicle to provide counseling about modifiable preconception health risks at every health care visit and to potentially discuss the prevention of unintended pregnancies. Several approaches to initiating discussions of reproduct


report’s release, national legislation expanded Medicaid eligibility to low-income pregnant women and children, and many states further expanded eligibility and eased the enrollment process for pregnant women. Attention then turned to the content of


ication adopted by the U.S. Preventive Services Task Force to rate the quality of evidence as “good,” “fair,” or “poor.”
 27
receive a comprehensive risk assessment at their first prenatal visit, and that the frequency of visits thereafter should be


baby from 24 weeks of pregnancy to 7 days after birth (13 studies). Women also had higher rates of spontaneous vaginal birth (12 studies). There were no differences in the rate of cesarean births between the intervention and control groups (Sandall


aches, there was a reduction in the rate of elective deliveries between 37 and 39 weeks from 9.6 to 4.3 percent of all deliveries. The “hard stop” approach led to the largest decrease in elective early term delivery.
29
In South Carolina, the Birth O


    Early elective delivery reduction
• Some evidence of successful strategies to reduce early elective deliveries such as strict hospital enforcement of the policy
     Preconception/ interconception care
   • Strong evidence for improved birth outc


nd a reduction in pregnancy-induced hypertension, few studies have demonstrated a positive effect on pregnancy outcomes (Gomby, Culross, and Behrman, 1999; Ciliska et al., 2001; Olds, 2002; Issel, 2011). In a study from Olds and colleagues (1986), pr


omes for families enrolled in Medicaid or the Children’s Health Insurance Program. The 2012 to 2017 evaluation is part of the CMMI’s Strong Start for Mothers and Newborns Initiative.
Safe Sleep Education
Safe sleep education to prevent SIDS and other


ost parents will model the behavior of the hospital staff with their babies at home (National Institute for Children’s Health Quality, 2015).
Another intervention that is increasingly being promoted to prevent SIDS is pairing safe sleep education wit


the group that had home visitors (Roberts, Kramer, and Suissa, 1996). In a subsequent review that included studies of the impact of home visiting and pediatrician-based education on accident prevention, families receiving the interventions had a low


k, Anderko, and Stetzer, 2011; Hillemeier et al., 2015). Results include reductions in low birth weight, preterm delivery, infants transferred to the NICU, infant mortality, and medical costs. Two studies examined the effect of the amount of coordina


ion in maternal stress is not known.
Several cities, including Baltimore and New York, have adopted doula programs to address disparities in infant mortality rates (Ollove, 2017). In Baltimore’s program, doulas are also trained to connect women to ho


e provided through various programs and policies, such as local breastfeeding coalitions, WIC programs, hospital staff interactions with mothers, home visitors, and workplace facilitation (Association of Maternal and Child Health Programs [AMCHP], 20


 have been implemented in a variety of settings to support breastfeeding, with mixed evidence.
• Peer counseling programs have been shown to increase the rate and duration of breastfeeding among low-income women with term and preterm infants (Merewoo


erate- to high-quality evidence on the effectiveness of psychosocial interventions on smoking cessation in pregnancy (Chamberlain et al., 2017). It found that the interventions decreased the number of women smoking late in pregnancy by 35 percent, in


ons may be needed in addition to brief behavioral interventions and medication and may be coupled with case management and assistance with housing, transportation, childcare, and employment services.
• Intensive outpatient treatment provides women 9


Evidence for Support and Referral Interventions
Care coordination • Emerging evidence of the effectiveness of maternity care coordination on birth weight, preterm births, NICU stays, and infant mortality
   Support and Referrals
     Summary of Evide


erritorial Health Officials, 2014). Levels of maternal care have also been proposed by the ACOG and the Society for Maternal- Fetal Medicine. Regionalized systems assign risk-appropriate levels (I through III) to hospitals to ensure that facilities h


nt of the 476 very preterm infants born
43
outside Level III hospitals were transferred within 24 hours of delivery. The Illinois network is focused on educating health care providers and raising patient awareness of nearby hospitals and their design


creased infant mortality risk (Bhatt and Beck-Sagué, 2018).
Income Supplements for Pregnant Women
Low-income women are at high risk for stress, poor nutrition, and smoking or drinking during pregnancy, and they are more likely to have preterm births