Scholarship & Research
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Item Narratives and the Policy Process: Applications of the Narrative Policy Framework. Chapter 6: Speaking from Experience: Medicaid Consumers as Policy Storytellers(Pressbooks, 2022) Colville, Kathleen; Merry, Melissa K.Kentucky’s proposed Medicaid reforms, initiated in 2016 and blocked in federal court in 2018 and again in 2019, elicited an extraordinary volume of public input on the value of Medicaid (publicly-funded health insurance for low-income individuals). Personal statements from current and former Medicaid consumers, through written comments submitted to the Centers for Medicare and Medicaid Services, offer insights into the strategies employed by a segment of the public that contributes infrequently to policy debates. Through a combination of manual and automated content analysis of a random sample of 1100 public comments, we analyze the policy narratives of participants, examining how narrative and non-narrative elements varied depending on commenters’ relationship to Medicaid consumers. Nearly all comments met (and most exceeded) the threshold for a policy narrative, while relatively few comments drew on research-based content typically considered privileged in the rule-making process. Further, these narrative elements cohered in distinct storylines from current and past Medicaid consumers and from those who identified as service providers. This research underscores the importance of narratives as sources of evidence in regulatory processes and suggests that public comments are fertile ground for research using the Narrative Policy Framework. This work also illuminates bottom-up narrative construction, a process thus far overlooked in micro-level research presuming that citizens are passive recipients of narratives, rather than producers themselves. For future work examining micro-level narrative production, we identify important considerations, including the role of narrator trust, audience, forms of evidence, setting, and the interaction between the meso and micro levels.Item Integrating pediatric oral health into a rural, public-health setting(Montana State University - Bozeman, College of Nursing, 2020) Bowden, Janelle Marie; Chairperson, Graduate Committee: Laura LarssonRural, low-income families in Montana experience individual and environmental barriers to oral healthcare access. In addition to knowledge deficits regarding pediatric milestones in oral health care, families in rural areas also have few, if any, pediatric dentists who accept Medicaid clients. The Centers for Disease Control and Prevention reported 2- to 5-year-olds are the only age group where the incidence of tooth decay is on the rise. This evidence-based demonstration research documents the baseline oral-health status of Park County Women, Infants, and Children (WIC) participants as well as the longitudinal efficacy of a bundled intervention to improve oral-health status in this high-priority population. Anticipatory guidance, caries risk assessment, repeated fluoride varnish application, and referrals for establishing a dental home and completing referrals for untreated decay are the bundled interventions under investigation in this project. Each level of intervention was documented in terms of state and national goals for the prevention of early childhood caries. The rate of signed forms consenting to treatment was used as a proxy measure that educating pregnant moms, parents, and caregivers about caring for baby teeth was effective. The long-term goal is to improve oral-health status in the Park County WIC population. The results of this research illustrated that performing oral-health assessments in a public-health setting provides an opportunity for nurses to promote sound oral-health practices, educate families on oral hygiene, and provide interventions aimed at preventing early childhood caries. Integrating oral health into public health as well as primary-care settings is a feasible and imperative practice in order to decrease the rates of ECC. A collaborative and integrative effort will ensure more children are screened for and educated on ECC. Introducing the intervention bundle at the WIC office in Park County proved to be a successful way of performing oral-health screenings, applying preventative FV, educating families on oral hygiene practices, and referring children to a dental home.Item Medicaid expansion and child maltreatment(Montana State University - Bozeman, College of Agriculture, 2019) Holom, Nicholas George; Chairperson, Graduate Committee: Wendy A. StockWith the recent major changes to the Medicaid program through the Affordable Care Act (ACA) and through individual states' expansions to Medicaid, more effort has been applied to understanding the effects of the Medicaid program beyond health. The prevalence of child maltreatment among families of low-income and poor health motivates the question of how expansions to Medicaid may affect child maltreatment. This study contributes to the literature by examining the contemporaneous effects of changes to Medicaid on child maltreatment. I find that increased Medicaid eligibility reduces the incidence of both reported and substantiated child neglect and child sex abuse.Item Judging poverty : institutional poverty relief in Gallatin County during the late nineteenth century(Montana State University - Bozeman, College of Letters & Science, 1999) Jenks, James William; Chairperson, Graduate Committee: Robert W. RydellCounty or locally administrated poor farms were one of the principle means of poverty relief in the United States during the nineteenth century. How financially prepared were localities to effectively carry out poverty relief? Questions regarding the gender, class and ethnicity of local poor farm inmates also remain unanswered. Further, how did citizens respond to the influx of the wandering, able-bodied poor, created by nineteenth century economic dislocation. Gallatin County citizens encountered the two general classes of poor which existed nationwide--the able-bodied poor and the aged and infirm. Various social histories provided the national context for nineteenth century poor relief, while identifying the local poor, the attitudes toward the able-bodied poor, and growth of the poor farm was pursued by studying local newspapers, county directories, census data, county commissioner journals, probate court documents, cemetery information, and local correspondence. What emerged from these documents was a picture of county citizens cognizant of their responsibility to care for the local aged and infirm, yet engaged in coordinated efforts to drive the able-bodied poor out of Bozeman. The poor farm became the final destination for the county’s elderly and infirm, who were overwhelmingly composed of single, laboring class immigrant males. That the poor farm was only able to aid the elderly and infirm indicates the inablity of localities to deal effectively with the immense costs of poor relief. Only with the New Deal were policies initiated at the federal level to finance poor relief created by unemployment and age.Item Factors affecting the education of Montana Indians(Montana State University - Bozeman, 1968) Barnett, James FranklinItem Child abuse potential of a low income population in rural southwestern Montana(Montana State University - Bozeman, College of Education, Health & Human Development, 1990) Seibel, Donnie MarieItem Participation and persistence in postsecondary vocational education : disadvantaged adults served through a Carl D. Perkins project(Montana State University - Bozeman, College of Education, Health & Human Development, 1996) Kercher, Patricia Peressini