Public Affairs: Professional Papers

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Improving Transparency and Oversight of Emergency Medical Services in Minnesota
(2021-08) Ostlie, Kaitlin E.; Beecham, Maya; Bolduc, Ander; Kabaso, Dieudonne
During the project, the scope of consideration was broadened to include the findings of interviews with EMS professionals stating desired reforms and challenges. Desired reforms included the establishment of performance standards for EMS delivery, recalibration of the Emergency Medical Services Regulatory Board (EMSRB) composition to increase more diverse professional representation, increased opportunities for local input in EMS management, the need for connection and engagement between EMS professional and the communities they serve, and increases in pay and professional acknowledgement commensurate with the services provided to the community and equivalent medical professionals in other settings. A number of challenges were also identified. This included the ongoing shortage of paramedics and EMS professionals to provide EMS coverage, exacerbated by the increasing pressure on EMS to support the needs of an aging population. Other challenges also include a lack of local control in EMS decision making; inequitable payment and reimbursement systems that do not compensate for services provided by onscene and non-transporting EMS ; little to no quality measurement indicators (QMIs) leading to lack of performance improvements; low volunteerism; low Medicare/Medicaid reimbursement rates; and the diversion of ambulances for use as non-emergency medical transportation. . The Research Policy Team found that there are multiple factors that need to be addressed in order to address the ongoing challenges and necessary reforms. Complicating factors include the complexity of the policy space; a lack of consensus on problems and priorities; the need for more work to engage community & stakeholders in decisions making; and the lack of diversity on the EMSRB. The reality is that as the need for EMS continues to grow so will the complexity of the challenges.
Co-creating Space for Self-Care and Community-Care in Cook County, Minnesota
(2022-05) McIntyre, Alison
Cook County is in the northeast corner of Minnesota’s arrowhead region, bordered to the north by Ontario, Canada to the south and east by Lake Superior and the south and west by rural Lake County and the Boundary Waters Canoe Area Wilderness. Its remote location and sparse population qualify Cook County as one of Minnesota’s few frontier-status counties. With an estimated population of 5,393, Cook County is among the least populous counties in the State of Minnesota (US Census Bureau, 2018). The year-round population of the county’s only city, Grand Marais, is just 1,351 (MNCompass, 2017). As a popular tourist destination, the number of people in the county varies greatly, reaching upwards of 75,000 during the busy summer months (Cook County, 2019). The racial and ethnic breakdown of county residents is 85% White, 1% Black/African American, 8% American Indian/Alaska Native, 3% two or more races, and 3% Hispanic/Latino. 40% of jobs are in leisure and hospitality and 13% of residents live below the poverty line (compared to 9.5% statewide average) (MNCompass, 2017). The Cook County Public Health and Human Services department recently completed a community health assessment which included two-year engagement process of reviewing local heath indicators, community surveys and meetings with citizen advisory council members, healthcare and other service providers. The resulting community health improvement plan identifies goals to improve health outcomes within the priority areas of behavioral health and healthy living access. Behavioral health care access is a priority issue within the community, particularly following the closure of the county’s only community mental health care clinic in late 2018. Rates of depression and anxiety are higher than state averages, nearly one in four adults (24%) in Cook County are diagnosed with depression, while 22% report a diagnosis of anxiety or panic attacks (Kjos, S.A., Kinney, A.M., Finch, M.D., Peterson, 2016). Among Cook County students, 43% of 8th graders, 52% of 9th graders, and 50% of 11th graders report feeling down, depressed or hopeless for several days or more (MN Department of Education, et.al., 2019). The ratio mental health providers in Cook County to residents (1:1,080) is significantly lower than the statewide average (1:430) (University of Wisconsin Population Health Institute, 2019).
Breaking Down Barriers: An Evaluation of Hennepin County's Homeless to Housing Program
(2022-05) Carlson, Lyndon; Rohrer, Katlyn; Steiner, Rachel
This report summarizing findings from an evaluation of Hennepin County Homeless to Housing program, which began taking client referrals in November 2021. The program provides housing-focused case management services to reach vulnerable single adults who are homeless. The purpose of our evaluation at this stage was to compare the program to other models, identify any service inefficiencies or disparities in early implementation, and present recommendations for improvement. The primary methods included a literature review, an internal document review, quantitative analysis of anonymous client referral data, and qualitative interviews with staff. Our literature review examined the best practices of case management and the efficacy of case management as a tool to increase housing placements for hard-to-reach and vulnerable populations. There are a variety of models for case management programs, but the most frequently cited were Brokerage, Strengths-Based, Assertive Community Treatment (ACT), and Intensive Case Management or (ICM). The literature also discussed the importance of determining case management models to decide other program characteristics, like caseload size. In general, the literature review found that the most effective housing outcomes came from 1) the use of Housing First principles and provision of rapid rehousing. These outcomes improved when paired with either 2) financial supports like housing vouchers or 3) case management services. The best outcomes combined all three (See for example page 17 for a case study of a similar Indianapolis program, Brown et al., 2018).
Rowing A Boat in a Hurricane: Nonprofit Strategic Leadership During Community Crises
(2022-05) Quanrud, Julia
The COVID-19 pandemic dramatically disrupted the communities served by nonprofit human service organizations while also throwing the organizations themselves into incredibly challenging conditions. This study examines how organizations’ and their leaders in particular responded and adapted to these crises, drawing from the insights of nonprofit executives interviewed in the spring of 2022. Society relies on nonprofit human service organizations to continue providing critical services in a crisis, even as the organizations themselves reel from the crisis. They must be able to withstand the stress of a crisis and rapidly adapt the services they provide to the community. Community crises are unpredictable events, but when they do arrive, strategic and adaptive leaders can turn them into transformational opportunities for the organization. Leaders must strategically assess, mitigate, and react to the danger of the crisis, using their mission as a compass for their response.
Planning for Essential Destinations: An analysis for the future arterial bus rapid transit F Line
(2022-05) Brokl, Grant; Greteman, Laura; Lubben, Dan; Randle, Hana
Metro Transit’s Transit Oriented Development (TOD) office requested that the capstone team evaluate essential destinations along the future arterial bus rapid transit F Line. The F Line is scheduled to replace route 10 and run along the Central Avenue corridor from downtown Minneapolis to the Northtown Mall in Blaine. While providing transit service for essential destinations has been a long-term goal of Metro Transit, the COVID-19 pandemic exacerbated the need to shift from a commuter centric system to an all-day service model. Metro Transit’s own 2021 Rider Survey clearly showed a shift in travel patterns as a result of the pandemic. The share of commuter trips on the bus rapid transit (BRT) system dropped to 17% in 2021, down from 22% in 2016. Similarly, the survey showed a marked increase in BRT trips taken for running errands, comprising 34% of trips in 2021, up from 20% in 2016.1 Providing transit for non-work trips is more challenging than serving commuter trips. Work destinations tend to be clustered together, typically around a central business district. However, non-work destinations are more spread out, and are located across the entire region. This increases the need for effective accessibility analyses when determining the suitability of a planned route. An additional consideration when evaluating the project context is the impact of socioeconomic status on the travel behavior of riders. Riders below 100% of the poverty level are more likely to need transit service outside of the traditional peak hours than their wealthier counterparts.
Keeping Families Together: A Policy Report on the American Families United Act
(2022-05) Ofori-Atta, Eric; Ryu, Eric; Urueta, Brenda
Since the enactment of the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) in 1996, 270,000 spouses of United States (U.S.) citizens have been deported and an additional 340,000 legal immigration applications for spouses of U.S. citizens have been refused (National Immigration Forum, 2021). Nearly 1.7 million U.S. citizens have a spouse who is undocumented (Connor, 2021). American Families United began their work in 2013 to pass the American Families United Act and provide much-needed relief to families, specifically for noncitizen spouses of U.S. citizens. Over the course of the last nine years, this volunteer-led organization has advocated on behalf of the thousands of families affected by a number of immigration policies that criminalize migration. Currently 65 Democrat representatives and 3 Republican representatives are co-sponsoring the American Families United Act. This report aims to aid American Families United in its advocacy by illuminating the policy landscape surrounding immigration at the federal level, informing strategies to build bipartisanship support for the American Families United Act, and providing information that may help build the organization and align with similar organizations in the migrant advocacy space.
Rowing A Boat in a Hurricane: Nonprofit Strategic Leadership During Community Crises
(2022-05-04) Quanrud, Julia
The COVID-19 pandemic dramatically disrupted the communities served by nonprofit human service organizations while also throwing the organizations themselves into incredibly challenging conditions. This study examines how organizations’ and their leaders in particular responded and adapted to these crises, drawing from the insights of nonprofit executives interviewed in the spring of 2022. Society relies on nonprofit human service organizations to continue providing critical services in a crisis, even as the organizations themselves reel from the crisis. They must be able to withstand the stress of a crisis and rapidly adapt the services they provide to the community.
Equity in Banking and Lending - Project Findings and Next Steps
(2021-08) Mbali, John; Williamson, Aaron S.; Arika, Jessica; Martinez Gavina, Blanca
The community is poised to address issues related to disparities in access and quality of banking & lending options and solutions for African Americans in North Minneapolis in particular. This project seeks to understand the dynamics of barriers, assets, and potential solutions related to banking and lending specifically for African American-owned small businesses in North Minneapolis. In assessing this issue, the Capstone team and community partners hope this will be the starting point in a collaborative effort including the banking & business community to address some of the issues raised in this research project.
Lessons from a Hurricane: Supply Chain Resilience in a Disaster, An Analysis of the US Disaster Response to Hurricane Maria
(2020-09-09) Kunkel, Matthew
This paper examines the US response to Hurricane Maria in Puerto Rico. It takes a specific look at how the supply chains failed, focusing on the three key aspects of (1) essential workers, (2) medical supply chain fragility, and (3) food availability. It goes on to identify potential causes of those failures and then identifies lessons that might have mitigated the supply chain breakdowns. Finally, the paper reviews how similar supply chain challenges are being faced in the current COVID-19 pandemic and explores how lessons observed during Hurricane Maria may be applicable in the present-day. Maria struck Puerto Rico as a category 4 hurricane on 20 September 2017 and caused widespread damage. The electrical grid was completely destroyed, communications were knocked out, roads were blocked, and access to clean water was limited. Supply chains were severely disrupted. Key failures of the supply chain included the following: 1) A lack of essential workers prevented key goods from being distributed. A shortage of logistical personnel, contracts personnel, translators, debris removal workers, and truck drivers severely compromised the ability to track and distribute important emergency goods on the island. 2) Fragility in the medical supply chain led to national and localized shortages. A shortage of saline, saline bags, and medical drugs disrupted the medical supply chain at a national level and uncovered the US’s reliance on the large medical industry in Puerto Rico. At the local level, most hospitals were completely inoperable following the storm. Without access to doctors, dialysis machines, oxygen, and ventilators, mortality in Puerto Rico increased. 3) Damage to key infrastructure and low food security restricted access to food. Ahead of the hurricane, levels of food insecurity in Puerto Rico were much higher than the rest of the US. The island depended on imports for 85% of its food supply. After the storm, distribution networks were severely compromised, and both local and relief supply chains struggled to meet the need. The result was an island-wide food shortage. During a disaster, the ability of a supply chain to function relies on characteristics of the chain itself, as well as factors external to the supply chain (e.g. infrastructure, emergency preparedness, leadership, and coordination). The cascading effects of failed infrastructure or unprepared leadership will severely compromise the ability of a supply chain to deliver the right supplies at the right time.
Affordable Care Act: It’s Effect on Health Care Utilization and the Health of Minnesotans
(2020-08-18) Uhde, Tamara
In the United States, there are several different types of health care, including the Veteran’s Health care system, Medicare/Medicaid systems and private health care systems. The introduction of the Affordable Care Act sparked an additional type of health care option and further empowerment of citizens to engage in their health outside of their employment status. My interest in this area was started from previous employment and interactions within these systems and the complex nature of how they affect health care outcomes; both positively and negatively. This paper focuses on a small portion of this complicated subject and how it interacts with individuals and their health. There is a large body of evidence showing that access to medical care improves health outcomes. Patients who see the doctor regularly are more likely to receive consistent preventative care, have conditions like cancer and diabetes detected early, and have a higher quality of life (Christopher, 2015). Coverage of preventative care services aims to reduce the amount of undiagnosed or untreated conditions. This is expected to reduce costs through less invasive or complex treatment options (Dixon, 2014).
Disability Access to Sexual & Reproductive Health Care Post-Affordable Care Act (ACA) in Minnesota & the U.S.
(2020-08-03) Kimmet, Haley
With the Patient Protection and Affordable Care Act (ACA) passed in 2010, U.S. women with disabilities stand to benefit from several key provisions intended to enhance access to a system that has historically struggled to meet their needs. However, recent quantitative and qualitative studies suggest that women with disabilities continue to experience gaps in accessing and utilizing sexual & reproductive health (SRH) care (Armour et al., 2009; Becker et al., 1997; Iezzoni et al., 2016; Mosher et al., 2017) despite advances in the health care coverage of this population (Gavin et al., 2006). Here in Minnesota, even less is known about SRH experiences and outcomes for women with disabilities because few large-scale studies gather detailed information about both disability status and access to/utilization of SRH. Even when data is collected, a full picture of women with disabilities’ experiences is obfuscated by discrepancies in disability definitions as well as data collection limitations. Without knowing the full picture of how Minnesota women with disabilities access SRH, inequities are likely to persist for this population across the state. This paper focuses on assembling a comprehensive picture of quantitative SRH data emerging from Minnesota and across the U.S., including a systematic literature review of SRH experiences of women with disabilities and a review of Minnesota health disparities reports released following passage of the ACA. This review was conducted with specific attention to the definitions and data collection methodologies that influence our understanding of SRH access for women with disabilities. The paper concludes with a series of recommendations for data collection on the SRH needs of Minnesota women with disabilities with the hope of developing more effective policy recommendations in the future.
Choosing Social Enterprise for Equity and Resilience
(2019-04) Cheng, Fun Fun
Building equity into existing organizational structures that systemically work against equity has become the trend for non-profit, for-profit, and governmental organizations, with varying degrees of progress and success. Instead of adding an equity component into an existing system, is it possible to build a system that centers equity? This paper explores work that has been done in creating an organizational structure that has equity built into its structure from conception so that it systemically works for equity. What mechanisms need to be put in place within a system to make equity its natural setting so that when a structure veers from equity, the mechanisms draw it back into balance? Additionally, a crucial aspect of building an equitable organization is resilience. Once an equitable organization is created, how can it be supported for resilience and scalability? The focus of this paper will be on social enterprise as a promising model for addressing equity and resilience. Social enterprise is a new model that gained legal designation in Minnesota on January 1, 2015. This paper aspires to understand how an equitable organization can be created from conception, then looks at existing organizations to see how it is done. This allows for an analysis of theory and its application through real world practice. This paper also analyzes the promise of social enterprise as a resilient model, looking not only at its promise, but also its challenges and unintended consequences. We will look at the interplay of equity and social enterprise, considering why organizations choose this business model -- whether as a response to equity or as a model for resilience, or both.
Citizenship for Adoptees Project: Implementation in Washington State
(2018-12) Tschida, Rachel K
The United States has been a receiving country of intercountry adoptees since the end of World War II, with the trend increasing dramatically during the aftermath of the Korean War. Since that time, over 500,000 children born overseas have been adopted by American parents, with the promise of being placed in a safe, loving, and permanent home. Unfortunately, when intercountry adoption began, citizenship was not automatically granted to the adopted children of American citizen parents. Adoptive parents needed to ensure the adoption was final, and then complete the naturalization process on behalf of their child. For various reasons, some parents either did not know or did not choose to complete the process, which left tens of thousands intercountry adoptees without U.S. citizenship. The Child Citizenship Act of 2000 granted automatic and retroactive citizenship to some, but not all intercountry adoptees. This excluded an estimated 25,000-49,000 adoptees nationally, with approximately 2,000 adoptees residing in Washington State. As a result, adoptees are denied the equal rights and protections promised through their adoption by U.S. citizen parents, such as the right to vote, obtain a passport, go to school, or legally work. Adoptees without citizenship live in fear, and some are at risk for deportation back to a country where they don’t have the language or cultural skills needed to survive.
Longitudinal study of income and wealth attainment for: Black and White women; 1965 - 2015
(2019-05-02) Green, Tyeastia
Black women earn less income, on average, than White women do. White women earn 81.9% of White men, and Black women earn 67.7% of White men (Reports, 2018). Wealth attainment between Black and White women is even more dismal. According to recent studies, single Black women, ages 20-39 with a bachelor’s degree, have a net worth of -$11,000 - $0, while single White women, ages 20-39 with a bachelor’s degree, have a net worth of $3,400 – $7,500 (Tucker, 2018). Career longevity does not appear to help Black women with wealth attainment, as they remain at a mere $12,000 in net worth at the age of 60, while White women, age 60, soar with wealth attainment averaging $384,400 (Tucker, 2018). The reasons given for these inequalities in the literature are historical disadvantage (e.g., wealth accumulation), segregation (educational quality differences, social network differences), discrimination, and individual differences (educational attainment, single motherhood, labor force participation). It is easy to look back on the past and know that discrimination based on race was the norm. Blacks didn’t have the same rights as Whites so it is conceivable that Blacks wouldn’t have the same wealth or income. But in 2019, we are still having the same conversations about equality between Whites and Blacks in regard to income and wealth attainment. Whites tend to believe that part of America is no longer an issue – that somehow the Civil Rights legislation erased all economic disparities between Blacks and Whites, and abolished racism, but the numbers suggest otherwise.