Browsing by Author "Rosch, Joel B"

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    ItemOpen Access
    A Case Study of Transit Demand Modeling and Transportation Planning at North Carolina State University
    (2012-04-20) Bream, Baird
    EXECUTIVE SUMMARY: Policy Questions: How should a large urban university make short-term trade-offs in its provision of transit service to a new, multi-use library that is expected to shift demand towards new transit policies? How should the goals of transportation and campus planning fit into a larger decision-making process for university development? Recommendations: Based on the emerging preference among the NCSU community for rapid, direct bus services between major trip generators and in particular between Main Campus and Centennial Campus, these recommendations focus on short-term route adjustments and long-term changes in service delivery. The short-term route changes to the Wolfline system can meet demand at the Hunt Library without incurring substantial changes in existing service patterns or increases in transit resources. The long-term route changes impact the larger issues of campus planning and community engagement that NC State Transportation must address as Centennial Campus becomes a larger and more multi-use part of the campus. Short-term transit demand analysis at Hunt Library: 2012—2013 • Re-route 3A Centennial Express and 8 Southeast Loop to stop at Hunt Library via Main Campus Drive and Partners Way • Do not change frequencies on 8 Southeast Loop • Move one bus from 3 Engineering to 3A Centennial Express to improve frequencies • Increase daily end of 3A Centennial Express service from 6:30 PM to 9:54 PM Long-term campus development planning and transit planning: 2015—2022 • Wolfline service o Shift focus on Wolfline service from circulating loops to prioritize rapid, high-frequency service between campus precincts via major transit hubs and trip generators with limited stops o Develop express bus service between Hunt Library and D.H. Hill Library with limited stops along North and Central Campus precincts o Shift express bus service to corridor between Hunt Library and Talley Student Center following completion of renovations • Development of parking decks for parking supply o Ensure that each campus precinct has sufficient parking for people traveling to precinct o Maintain sufficient surface parking around campus buildings to permit access for facilities vehicles and emergency service vehicles • Pedestrian and bicycle infrastructure o Implement reductions in automobile access on Dan Allen Drive to improve pedestrian safety o Increase bike and pedestrian safety at Avent Ferry and Western intersection • NCSU community outreach o Communicate clear service standards for Wolfline operations to NCSU community to set expectations about public transportation services  Stress the use of the TransLoc app to make wait times more predictable o Communicate the Wolfline system upgrades and benefits that students, faculty, staff and corporate partners receive from their student fee and parking fee contributions o Communicate all restrictions in automobile access as early and as directly as possible to give opportunities for community feedback and travel behavior adjustment o Update Office of University Architect and Centennial Campus Development Office on transit technologies and infrastructures at all levels: NCSU; City of Raleigh; North Carolina Context for Case Study: This project uses North Carolina State University as a case study for transit planning at large urban university campuses and focuses on a new capital project, a large, multi-use library called the James B. Hunt Jr. Library located on the Centennial Campus of NCSU, a newer satellite campus precinct that is currently undergoing expansion. The NCSU Transportation Department will be responsible for providing public transit service (the Wolfline) for students, faculty and staff who want to travel to and from the Hunt Library, which is scheduled to open in the winter of 2013. Many departments attached to the Hunt Library and Centennial Campus view the Library as a flagship building that will raise the profile of NCSU and will transform the Centennial Campus from “an office park environment” to a “campus environment,” with greater student and pedestrian activity. Since the building will likely have a significant impact on a rapidly developing campus precinct, NC State Transportation must evaluate the potential demand for traveling to and from the Hunt Library that students, faculty and staff demonstrate to determine the impact that the Library will have on the Wolfline system. This expansion of transit service is one of several changes in transit operations that NC State Transportation is evaluating in its Campus Mobility Plan. The goal of the Campus Mobility Plan is to outline the changes in funding, service provision and streetscape infrastructure that are necessary to create an “enhanced multimodal campus transportation system” over the next ten years. Because the Campus Mobility Plan has far-reaching impact on the physical design of the campus, NC State Transportation will be communicating with and working with numerous departments across the NCSU Administration. Representatives from these departments serve as Advisory Stakeholders to the CMP and have the opportunity to share their visions for the Hunt Library and NCSU transportation in general with the Department at planning meetings. Methodology: This report bases its analysis on three evaluations. The first evaluation is an estimation of ridership and transit demand at the Hunt Library based on trip generation rates at the Library as a function of the Library’s net assignable square footage. This report compares these estimates to trip generation rates at the D.H. Hill Library and distributes the number of daily trips that each building generates into trips in to the library and trips out of the library and into low-demand morning hours and high-demand afternoon and evening hours. This analysis takes this system of trip generation and distribution from the Institute of Transportation Engineers’ Trip Generation Report and applies the system to both libraries. The second and third evaluations are both qualitative. The second evaluation extrapolates trends in stated preferences from two surveys that NC State Transportation conducted in the Fall of 2011: a Customer Satisfaction Survey that the Department distributed to a sample of students, faculty and staff; and an Engineering Student Survey that the Department distributed to a sample of first-years, sophomores and juniors who have a major in the College of Engineering. Both surveys evaluate student preferences for Wolfline services and ask students to predict their interest in using the Hunt Library and their travel behaviors to and from the Library. The third evaluation is a series of interviews with members of the NCSU community who are serving as Advisory Stakeholders for the Campus Mobility Plan. The author interviews each stakeholder to obtain the stakeholder’s perspective on the current services that NC State Transportation offers to the larger community and those that the Department plans on providing. Specifically, these interviews focus on Wolfline services, parking services, the design and planning of campus transportation infrastructure, and the Hunt Library. Findings: 1. Assuming a seven-percent mode share for Wolfline services, estimated levels of demand for Wolfline services at the Hunt Library are within the system’s current capacity and NC State Transportation can meet this demand with small changes to existing services. 2. The Customer Satisfaction Survey and the Engineering Student Survey reflect that the Wolfline service plays an important role in students’ mobility on a daily basis and that students show a high level of familiarity with the information technologies that NC State Transportation uses to promote its services and notify riders about changes and updates. 3. Students’ priorities for service improvements focus on greater frequency, longer evening service hours, and more connections between Main Campus and Centennial Campus. 4. The Customer Satisfaction Survey and the Engineering Student Survey show high levels of interest in the Hunt Library and high levels of demand for travel between Main Campus and Centennial Campus. 5. The results of the stakeholder analysis show substantial support for an increase in public transportation services and for greater connectivity between Main Campus and Centennial Campus. Many stakeholders express significant concern for reducing automobile access on Main Campus and promoting the development of parking decks over surface parking. Stakeholders also express opposition for increasing parking fees or transportation fees to fund an increase in Wolfline services. Support for greater pedestrian and bicycle infrastructure is present, but opinions are more muted. 6. Many stakeholders state a preference for direct, limited-stop services between major trip generators with low travel times and high frequencies and believe that the growth of Centennial Campus will create greater demand for these services. They assert that NC State Transportation should prioritize these services in its future route planning. 7. Many stakeholders stress that the Department should engage with the NCSU community more directly and openly about the opportunities and limitations of a public transit system and its ability to enhance mobility and connectivity across the campus. 8. Several stakeholders believe that NC State Transportation should increase its investments in transportation infrastructure and develop high-speed, high-frequency transit services that are more capital-intensive than the current Wolfline system, including light rail transit and bus-only corridors.
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    ItemOpen Access
    Analysis of Work in Retirement
    (2014-04-24) Brown, Brendan
    Retirement system staff are in the midst of contemplating changes to policies limiting work in retirement for members of the Local Governmental Employees’ Retirement System (LGERS) and the Teachers’ and State Employees’ Retirement System (TSERS). Until recently, the retirement system had no comprehensive data about how many of its retirees return to work, when, for how long, and how much they earn in doing so. The project analyzes a new dataset including that information for all LGERS and TSERS retirees who worked in retirement -- from Jan. 1, 2007 to Dec. 31, 2013 -- for employers in the same systems from which they retired, while continuing to receive their retirement benefits. I try to answer two questions using least-squares regression and survival analysis: 1. Which characteristics, if any, suggest retirees in the dataset were willing to work for less in retirement, holding constant pre-retirement compensation and other factors? 2. Which characteristics influenced how long those retirees worked?
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    Barriers to reporting child maltreatment: do emergency medical services professionals fully understand their role as mandatory reporters?
    (N C Med J, 2015-01) Lynne, Ellen Grace; Gifford, Elizabeth J; Evans, Kelly E; Rosch, Joel B
    BACKGROUND: Child maltreatment is underreported in the United States and in North Carolina. In North Carolina and other states, mandatory reporting laws require various professionals to make reports, thereby helping to reduce underreporting of child maltreatment. This study aims to understand why emergency medical services (EMS) professionals may fail to report suspicions of maltreatment despite mandatory reporting policies. METHODS: A web-based, anonymous, voluntary survey of EMS professionals in North Carolina was used to assess knowledge of their agency's written protocols and potential reasons for underreporting suspicion of maltreatment (n=444). Results were based on descriptive statistics. Responses of line staff and leadership personnel were compared using chi-square analysis. RESULTS: Thirty-eight percent of respondents were unaware of their agency's written protocols regarding reporting of child maltreatment. Additionally, 25% of EMS professionals who knew of their agency's protocol incorrectly believed that the report should be filed by someone other than the person with firsthand knowledge of the suspected maltreatment. Leadership personnel generally understood reporting requirements better than did line staff. Respondents indicated that peers may fail to report maltreatment for several reasons: they believe another authority would file the report, including the hospital (52.3%) or law enforcement (27.7%); they are uncertain whether they had witnessed abuse (47.7%); and they are uncertain about what should be reported (41.4%). LIMITATIONS: This survey may not generalize to all EMS professionals in North Carolina. CONCLUSIONS: Training opportunities for EMS professionals that address proper identification and reporting of child maltreatment, as well as cross-agency information sharing, are warranted.
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    Evidence-Based Policy Reform: Exploring the Role of Evidence in States' Model Selection for the Maternal, Infant, and Early Childhood Home Visiting Program
    (2013-04-19) Kawar, Anna Neal
    Policy Question Did the U.S. Department of Health and Human Services (DHHS) successfully signal to states that the driving factor for model selection for the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) should be strong evidence of effectiveness? o On which factors did states base their selection of models? o Were states rewarded through competitive funding for selecting stronger models? Program Overview Title V of the Social Security Act of 1935 included Federal aid for maternal and child health services (part 1), services for children with disabilities (part 2), and child welfare services (part 3), all to be administered through the Children’s Bureau. Today, Title V remains the only Federal program solely devoted to the health of all mothers and children. In the current political climate, with a strong emphasis on deficit reduction and continued debates over the size and role of government, federal entitlement programs have come under increased scrutiny. It is important to ensure that each dollar is optimally spent and that the programs that are funded are known to be effective. Randomized evaluations have been hailed as the best way to precisely measure impact and gather evidence regarding the true effectiveness of a social program. Policymakers can then use this evidence to make better decisions regarding which programs to fund and also to garner support for social programs that have been proven to be effective. In 2010, Obama signed into law the Patient Protection and Affordable Care Act (ACA), which included authorization for MIECHV, a program designed to strengthen and improve the Title V programs and services. The majority of funding is reserved for evidence-based programs—models developed, evaluated, and proven to show significant improvement in outcomes. DHHS launched the Home Visiting Evidence of Effectiveness (HomVEE) project and created a team to conduct an evaluation of existing home visiting programs and literature. HomVEE’s review of 32 models resulted in a list of 13 models that met DHHS’s criteria for an evidence-based home visiting model. The 13 models that HomVEE selected as approved evidence-based home visiting models for MIECHV are: 1) Child FIRST 2) Early Head Start-Home Visiting 3) Early Intervention Program for Adolescent Mothers (EIP) 4) Early Start (New Zealand) 5) Family Check-Up 6) Healthy Families America (HFA) 7) Healthy Steps 8) Home Instruction for Parents of Preschool Youngsters (HIPPY) 9) Nurse Family Partnership (NFP) 10) Oklahoma’s Community-Based Family Resource and Support (CBFRS) Program 11) Parents as Teachers (PAT) 12) Play and Learning Strategies (PALS) Infant 13) SafeCare Augmented The Coalition for Evidence-Based Policy is interested in evaluating the success of the Home Visiting Program to determine how clearly the need for evidence-based programs was signaled to states and also to learn more about the barriers states may have faced in selecting evidence-based models and programs. The Coalition found a wide variety of evidence of effectiveness among the 13 models selected by HomVEE. Only one program, NFP, is ranked as “strong” by the Coalition. This is primarily because effects were significant, strong, and sustained, but most importantly they were replicated. Replication lowers the likelihood that effects are observed by chance and, therefore, increases confidence that the program is delivering real effects. Methodology In order to determine the driving factors in states’ model selection, my research and analysis consisted of both research and conducting telephone interviews with a select number of states. I selected 13 states to conduct telephone interviews with about the process for and driving factors in model selection. Key Findings Findings indicate that, based on interviews, the driving forces behind model selection were: • Models are already existing or established with a strong statewide network o Out of the 13 states interviewed, 11 (85%) of states selected models that already existed in their state; only two states chose to “start over” with brand new models. • Models would have the most impact on federal benchmarks for MIECHV • Models are the best fit for the needs of our target population given our capacity • Cost of implementation • Models target a specific need and/or risk factor identified in our state Only six models out of the 13 listed by HomVEE were chosen across all 38 states. The top three most commonly selected models were: 1) HFA, selected by 28 states; 2) NFP, selected by 25 states; and 3) PAT, selected by 22 states. HFA represents 29% of all models selected, NFP represents 26%, PAT represents 23%, and the remaining three models represent 21%. NFP is the only model selected that ranks as “strong” by the Coalition, and, therefore, only 26% of all models selected under MIECHV are ranked as having strong evidence of effectiveness. A key hypothesis regarding these findings is that NFP restricts enrollment to only the first child, and many states chose other models in parallel to ensure that all at-risk populations could be served. Recommendations Considering Evidence: Add to the definition of evidence-based models and to the selection criteria that effects be “substantial and important” as well as statistically significant. This language will eliminate a loophole allowing weaker models to be selected by not solely focusing on statistical significance. Statistically significant effects can exist for trivial outcomes, can actually be very small in size to where it’s of little practical importance, or can be chance findings if a program studied a large number of outcomes. Model Selection: As MIECHV evolves and as the list of models continues to develop, it may be important to consider selecting models that have strong evidence of effectiveness in varying contexts and for varying outcomes. This process, ideally, would result in a list of models that are all individually strong and designed to target specific populations in specific contexts. Put together, the models would cover everyone. Providing Information and Tools to States: DHHS should provide the states with more materials, toolkits, and matrices that they can use to thoroughly research and compare models and budget estimates. DHHS should also create a feedback loop that can optimize communication, standardization, sharing of best practices, and can create culture conducive to improvement and innovation. Standardization of model selection as well as implementation can assist in creating not just a centralized state system, but also improve data collection, reporting, oversight, and planning at the federal level. Costs, resources, and staff time can be controllable, optimized, and subsidized as needed. Implementation: Implementation is a commonly overlooked aspect of programs in that the assumption is if you design it well, it will work that way. What has become increasingly evident is that, not only due to the varying contexts within which programs are implemented, but also due to varying processes, management styles, and service delivery on the ground, effectiveness of the same program can vary significantly. Innovation and Continuous Improvement: MIECHV was designed with two-tiers of funding to allow for promising models to be evaluated to determine the strength of evidence of effectiveness. A more thorough understanding of improvement science can help ensure continued innovation through learning from failures and allowing small tests of change in understanding and redesigning the system of maternal and child health.
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    Improving the Doctor-­Patient Relation in China Through a Three-­Level Framework
    (2017-05-11) Bai, Yifang
    This thesis discusses the controversial doctor-patient relation problem in contemporary China. The key issue it aims to address is how to improve the doctor-patient relation with efforts from multiple levels. This thesis reviews literature on China’s healthcare service as a way to identify the causes of the doctor-patient tension. It then recommends possible interventions drawing on international experiences. The recommendations follow a three-level—macro-, meso- and micro-level—framework. What this thesis found is that the tension between doctors and patients is not only the fault of the frontline health workers. As a result, interventions for its improvement cannot target exclusively doctor’s behavior. Meanwhile, since the doctor-patient relations problem is not unique to China, we should also learn from the successful lessons in the global society. It is not our goal to resolve the problem in China’s healthcare system. With the discussion in this thesis, we hope to show that there is the potential to alleviate doctor-patient tension in China with joint efforts in the society.
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    Medicaid Coverage for Inmates and Reentering Populations in North Carolina
    (2012-04-20) Ellen, WhelanWuest
    As part of the Patient Protection and Affordable Care Act (PPACA), Medicaid will expand in 2014 to extend eligibility for health care coverage to millions more Americans. Included among these will be those prison inmates and ex-offenders who are currently ineligible for Medicaid coverage. Corrections systems are constitutionally mandated to provide adequate health care to all prison and jail inmates for the duration of their incarceration. The expenses associated with providing this care are a leading cost driver for most state correctional systems. As states continue to battle large budget deficits, elected officials and agency leadership are increasingly motivated to reduce high prison costs. North Carolina is no exception, and in 2010 the General Assembly issued a directive compelling the state Department of Correction (DOC) to identify and implement new cost-saving measures. The result was the implementation of a new Inmate Medicaid Enrollment (IME) program that became operational in February 2011. According to internal estimations, this new program was projected to save DOC $14 million by the end of the 2011-2012 fiscal year. IME also represents a uniquely successful cross-collaboration between two large state agencies with no prior working relationship- DOC and the State Department of Medical Assistance (DMA). As more states consider similar inmate Medicaid utilization programs, North Carolina has established itself as a leader that is well poised to take advantage of Medicaid expansion and its increased federal reimbursements scheduled for 2014. In this project I analyze the process by which these North Carolina state agencies created and implemented IME, while also examining the implications of Medicaid expansion for DOC’s costs, inmate populations and reentering prisoners. The following paper offers background information on prisoner health care and medical costs; Medicaid as it currently relates to inmates and as its projected change in 2014; and the public health dynamics of prisoner health and reentry. The second section offers an analysis of IME in North Carolina, from its conception to its current operation. The third section offers projections for IME once Medicaid expansion is implemented and the possible implications for the future. Finally, I offer conclusions based on my analysis and five specific recommendations for how North Carolina can best maximize the potential benefits of IME, whether or not Medicaid expansion progresses. North Carolina’s Inmate Medical Enrollment Program is a model other states may wish to emulate in their own pursuit of cost-savings and innovative solutions to rising incarceration and medical costs. In particular, the cooperation between DOC and DMA on an administrative and personnel level indicate that complicated inter-agency programs can be successfully implemented quickly and efficiently. To build on the success of the IME program’s implementation and expand its positive impacts, I recommend DOC take the following actions: 1) DOC and DMA should educate and train county managers in the process of Medicaid utilization for enrolled inmates. While it may not be feasible to expect all 100 of North Carolina’s counties to implement their own IME program for jail inmates, even a handful of densely populated or high incarceration counties stand to reap financial and public health benefits if they follow the state model. 2) DOC should work with county social service agencies to create and implement their own IME program, whereby arrested individuals are immediately cross-referenced against Medicaid records for possible matches. In particular, NC DOC should model the Colorado Department of Correction’s jail enrollment program. DOC may consider working first with the most populated counties and those with the highest incarceration rates, as they will likely be most motivated and have the greatest staff and infrastructural resources to enact their own successful IME programs. 3) To protect the state from any legal repercussions, DOC should add an additional information search related to inmates’ family participation or ability to pay for medical care. At the very least, DOC should ensure access to contact information for inmates’ families so that those requiring hospital care are screened for any other possible payers of last resort. 4) Finally, in the event Medicaid expansion does move forward, DOC should implement a health care training process for all probation and post-release supervision officers as well as other reentry programs to maximize the potential for improved public health and reduced recidivism. With public confidence in government historically low it is all the more important and valid to analyze and credit IME for its smooth implementation as well as its outcomes. As the country faces a slow and halting economic recovery, state governments may look to the North Carolina Inmate Medicaid Enrollment Program as an example for how government can quickly respond to economic crises and create new programs that may reduce spending and result in long term community benefits.
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    Recruiting and Retaining a Diverse, Culturally Responsive Guardian ad Litem Volunteer Pool in Durham County
    (2011-04-22) Hamilton, Andrea
    EXECUTIVE SUMMARY What steps should the Durham County Guardian ad Litem (GAL) Program take to further improve its recruitment and retention of diverse, culturally responsive volunteers? The Durham County Guardian ad Litem (GAL) Program is part of a larger state system and national network dedicated to ensuring abused and neglected children have advocates in court. In recent years, the National Court Appointed Special Advocate (CASA) Association, a large network of local and state agencies and organizations, has encouraged its members to increase GAL and CASA volunteer diversity. Increasing diversity has become a priority largely because the majority of volunteers nationally are white and female, whereas the majority of children served are African American and male. National CASA encourages offices to recruit more volunteers that reflect “the makeup of the children in the judicial system as well as the local community.” The Durham County GAL Program has been relatively successful in recruiting volunteers that reflect the demographic of the larger Durham population. This has worked because the Durham office takes a holistic approach to assigning volunteers to children, looking at factors that extend beyond race and gender. Nevertheless, because the overall demographics of the volunteers and children are vastly different, the program acknowledges that its recruitment efforts could always be more targeted. The Durham County GAL Program is limited in its ability to make substantial changes to its recruitment and retention efforts, however, because the office lacks the funding and current full-time staff lack the time. METHODOLOGY: To address the Durham County GAL Program’s policy question, I researched best practices for recruiting and retaining diverse and culturally competent volunteers. I performed a literature and resource review on the topic. Additionally, I interviewed staff from National CASA, the North Carolina Guardian ad Litem Program, and local and state programs identified by National CASA as “Inclusion Award” winners. POLICY OPTIONS: My policy options were grouped into two categories: Recruitment and Retention. Altogether, I listed seventeen policy options grouped into different option groups that focused on capacity-building, targeted recruitment, and adopting specific recruitment strategies. Each option group was evaluated against the following three criteria: (1) minimize Durham County GAL Program costs, (2) maximize self-sustainability, and (3) ensure political feasibility. RECOMMENDATIONS: Based on my analysis, I recommend the following policy options under each policy group: Recruitment Option Group #1: Target specific groups  Focus recruitment on a particular group(s) of underrepresented advocate volunteers—i.e. African Americans, Hispanics, males. Recruitment Option Group #2: Capacity-building  Create a volunteer recruitment committee  Recruit more non-advocate volunteers. Recruitment Option Group #3: Specific recruitment strategies  If a volunteer recruitment committee is created or if non-advocate volunteers are recruited: any combination of the policy options could be adopted (other than “do nothing”)  If no volunteer recruitment committee is created or if non-advocate volunteers are not recruited: do nothing/retain current strategies. Retention Option Group #4: Capacity-building  Use non-advocate volunteers to assist with retention efforts.