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Reducing Black Infant Mortality in Alabama

Infant mortality, defined as the death of a baby after birth up to one year of age, is a national indicator of population-level health. The United States has an average infant mortality rate (IMR) of 6 deaths per 1,000 live births, a rate that is more than 70% higher than other comparable, high-resource nations. Within the last decade, Alabama’s IMR has consistently been one of the top three highest in the nation, with rates that are far worse among Black infants—in 2019, the infant mortality rate in Alabama was over two times higher for Black infants than that of White infants.  

This study will examine the state's pilot program to reduce infant mortality, specifically asking how the Alabama pilot program affects infant mortality among the Black community. This research will provide valuable evidence to the Office of the Governor, state agencies, state legislative members, the Alabama Hospital Association, the Alabama Primary Health Care Association, and the Alabama Congressional Delegation as they evaluate the efficacy of the pilot program, and has the potential to impact Alabama's infant mortality reduction policy moving forward. 

Honoring Indigenous Families: Evaluating the Impact of Nebraska's Indian Child Welfare Act

The removal and placement of Indian children away from their families and communities is a central component of historical trauma. Indian child welfare practice must contend with both the restoration of balance at the level of the individual the family and the community while negotiating with a system which has been an instrument of community disruption in the past. The 1978 Indian Child Welfare Act (ICWA) was designed to address the race equity issues in the child welfare system that historically and disproportionately harm Indigenous youth and families. 

With direct guidance from and collaboration with tribal citizens at every stage of the process, this team will engage in an in-depth exploration of whether:  

  1. changes made to Nebraska's ICWA in 2015 result in fewer Indigenous youth entering the foster care system; 

  1. whether the changes lead to provision of more culturally competent services and improved permanency outcomes for Indigenous youth and families in the foster care system; and 

  1. what is working well with the law's implementation and where improvements are needed. 

This research will provide critical insight into the effectiveness of ICWA policy changes that can be replicated in other states and at the federal level, as well as identify barriers to practice and lessons learned through Nebraska's five years of implementation.  

Date Funded

Evaluating "Ban and Replace" Policies for Reduction of Racial Disparities in School Discipline

Most states in the US allow the use of exclusionary discipline for pre-k and primary school students, despite concerns about the effectiveness and fairness of these strategies. Long-standing disparities in its application exist, in the form of exclusion of African-American children, particularly boys, who are suspended at many times the rates of other children. Because of these disparities, suspensions, expulsions, and other forms of exclusionary discipline may weaken otherwise effective programs to reduce racial achievement gaps.     

In collaboration with the HighScope Educational Research Foundation the project will a) examine  national and state data to document the extent of racial disparities; b) summarize published studies of  effective programs c) conduct case studies of exemplary school districts that have banned exclusionary discipline and reduced disparities; and d) provide technical assistance to school districts seeking to replace suspension and expulsion with an effective disciplinary alternative. 

This project will also evaluate the extent and impact of exclusionary discipline in primary schools, asking:   

  1. How prevalent are "Ban and Replace" policies in the US and how are they implemented?  

  1. Do "Ban and Replace" policies result in lowering reliance on exclusionary discipline practices and a reduction of racial inequalities in school discipline? 

  1. How prevalent are the use of Positive Behavioral Interventions and Supports, Restorative Practices, Socio-emotional Learning, or diversion programs, and is their use associated with reductions in disparities? 

  1. Can information dissemination and technical assistance improve school adoption and teacher acceptance of bans on suspensions and expulsions? 

This research will generate key evidence needed to understand the effects of exclusionary discipline on equitable access to education and potential alternative strategies that address or prevent the behavioral and emotional difficulties that have given rise to exclusion.  


Date Funded

Implementing and Evaluating Structural Interventions in Medicaid to Promote Racial Equity in Pregnancy and Child Health

The burdens of racist policies have produced vastly worse pregnancy and birth outcomes for Black and Native populations relative to White populations in the United States. Because state Medicaid programs are the largest single payer for pregnancy care in the country, changes to Medicaid policies are an important way to implement structural interventions to promote racial equity.  

This project will investigate the implementation of and effects of 3 equity-focused policies in Pennsylvania's Medicaid program: a payment incentive available to Medicaid health plans that achieve excellent outcomes for Black pregnant persons and young children; bundled payment model for pregnancy care that rewards providers who reduce racial inequities; and implementation of Regional Accountable Health Councils to design equity-focused community interventions. The results will inform discussion around how state Medicaid programs can use structural interventions to promote racial equity and justice.