Children with the lowest oral language and early literacy skills at entry to kindergarten are the most vulnerable to poor literacy outcomes. This article describes the programmatic development of a Tier 3 early literacy intervention for preschool children who are most in need of intensive support to achieve early literacy outcomes. The intervention consists of carefully sequenced activities and games to promote early literacy development and is designed to be implemented by an early childhood educator with small groups of one to two children during center time or small-group instruction time in the classroom. Development of, and research on, the intervention followed an iterative process leading to a sequence of studies demonstrating moderate to strong effect sizes for children who qualified for Tier 3 support. Children who received intervention were a diverse group who presented an array of challenging characteristics that required individualization of the intervention. Children progressed at different rates, and some children clearly needed more opportunities to receive the intervention. Further research is needed to investigate factors related to effectiveness of Tier 3 interventions, including characteristics of the intervention, such as duration, time, and group size, as well as the characteristics of children who respond/do not respond.
Background Increasing athletic trainer (AT) services in high schools has attracted widespread interest across the nation as an effective instrument to manage injuries and improve children’s health, but there is a lack of evidence on potential medical savings. Our study aimed to address this knowledge gap and provide evidence of AT impacts on medical payments and utilizations to inform public policy decision. Methods We obtained medical claims of patients aged 14 to 18 years from the 2011–2014 Oregon All Payer All Claims limited dataset. We calculated payer payments and utilizations for medical claims under AT’s scope of practice. We used zip codes to link patients with the enrollment boundaries of Oregon public high schools, which were classified as either “AT group” or “non-AT group”. We implemented an innovative microsimulation analysis to address the uncertainty of linkage between children and schools. Results Our analysis included 64,115 and 84,968 eligible children with Medicaid and commercial insurance, respectively. Associated with high school AT services, Medicaid saved an average of $64 per patient during the study period, while commercial insurance payment rarely changed. AT services may reduce emergency visits for both insurance types but increase total visits for commercially insured patients. Conclusions Our study provides evidence for the differential impacts of AT services on medical payments and utilizations. The legislators should consider to allocate funds for high schools to directly employ ATs. This will encourage ATs to work to their highest ability to improve children’s wellbeing while containing avoidable medical cost.
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