Capstone Project Archive

Evaluating the effects of the Double Up Food Bucks program on nutrition security in Texas

In collaboration with the American Heart Association, our capstone project is focused on addressing nutrition insecurity, or access to nutritious foods, through the expansion of the Double Up Food Bucks program in Texas. Our research question is: What are the effects of the implementation of the Double Up Food Bucks program on nutrition security and how can its impact be maximized statewide? Our research design uses farmers' market and county level data to compare fruit and vegetable consumption between counties with DUFB and counties without DUFB for three main subgroups: all Texas counties, rural Texas counties, and urban Texas counties. Our main finding is that DUFB specifically affects fruit and vegetable consumption in rural counties, but not in urban counties or all counties. This finding is important for understanding the impact that DUFB has had on fruit and vegetable consumption since 2019 and for providing insight into the greater effect that the program could have on mitigating nutrition insecurity if it were to be expanded into additional Texas counties, with a particular emphasis on rural counties.

The Effects of the Healthy Texas Women Application Change on Program Enrollment and Patient and Provider User Experience Among Adolescents and Young Adult

Texas has some of the lowest rates of healthcare coverage in the nation, especially among women and people of color— 1 in 4 women in Texas are uninsured (Whitener & Park, 2019). This statistic disproportionately affects women of color— 36.1% of Hispanic women are uninsured, the highest rate among any ethnic group in Texas (Urban Institute, 2019). Texan women have lower rates of health care coverage and subsequently, poorer health outcomes than their counterparts across the nation (Texas Medical Association). The Healthy Texas Women (HTW) program was established by the Texas State Legislature in 2016 to provide preventative care and family planning services to eligible, uninsured women (Delgado, 2017). Clinics, like Baylor Teen Health Clinics (BTHC) system, receive reimbursements from HTW when patients fill out the application form and are approved based on HTW criteria. In 2021, the HTW application form changed from 2-pages to 13-pages— BTHC noticed this change coincided with a drop in patients enrolling in the program. Investigators researched how this form change affected user experience and enrollment outcomes through a mixed-methods study— this paper reflects the qualitative findings. Qualitative researchers conducted interviews with patients and staff— with a total of 5 patient interviews and 4 staff interviews. Investigators then conducted thematic and relational analyses of interview transcripts. Analyses reflected that staff assistance played a critical role in helping patients fill out the 13-page form; additionally, staff identified length and language of the form as confusing for patients. Staff also associated the previous 2-page form with higher enrollment outcomes. While patients reported feeling fairly confident with the 13-page form, this was highly related to staff assistance they received. These findings reflect how the HTW program accessibility could be improved through clarification of confusing language on the application, reducing the application length, increasing the transparency of the approval/denial process, and training staff on assisting with the form. Implementing some or all of these recommendations would increase healthcare accessibility in Texas, thus improving the state’s subpar healthcare outcomes.

Quantitative Analysis of Healthy Texas Women Enrollment Rates Amidst an Application Change

Healthy Texas Women is a Texas Medicaid program that provides funding to cover reproductive health care and family planning services among eligible women. In March 2021, the HTW form increased from 2 pages to 13 pages. The purpose of this study is to determine how the lengthening of the HTW program application has impacted HTW enrollment, specifically in a clinic that serves adolescents and young adults. There are three driving research questions for this study: did enrollment rates significantly change after the implementation of the 13-page form, are there significant differences between approved and denied 13-page HTW applications, and how does the 13-page form place additional burdens on patients? To answer these questions, a mixed-methods approach was designed. First, a quantitative analysis of 597 HTW applications was completed to capture HTW enrollment trends between January 2020 and December 2022 and the relationship between 13-page form completion behaviors and HTW enrollment status. All applications came from patients between the ages of 18-24 who were clients of Baylor Teen Health Clinic (BTHC) locations in Houston, TX. Second, we recruited 11 volunteers aged 19-22 to participate in a usability assessment of the longer application, in which we observed participants fill out the application and asked participants to rate the usability of the application. We found that the HTW enrollment rate at BTHC was 56% for those who completed the 2-page form, but dropped to 36% for those who completed the 13-page form. After running a multivariate regression model, we found that being unemployed significantly increases the likelihood of HTW approval, whereas not reporting one’s Social Security number and applying multiple times to HTW significantly decreases the odds of approval. Surprisingly, the number of incomplete fields and fields with errors on the longer application did not significantly affect enrollment outcomes. Through usability assessments, we determined that participants found the form somewhat burdensome to complete, but the level of difficulty was expected. There were particular parts of the application that were especially confusing or difficult to fill out. We believe our research has important policy implications and can be used by key stakeholders to advocate for changes that make Healthy Texas Women more accessible for eligible patients.

Undies for Everyone

How prevalent is the issue of underwear insecurity among low-income children and what are the associated impacts? Our research set out to quantify the number of low-income children with a shortage of clean underwear by conducting a nationally-representative survey of low-income households with children between the ages of five to fourteen, inquiring into how many pairs of underwear their children owned, how often they were washed, and a number of educational and emotional impacts we identified as potentially connected to not having enough underwear. We find evidence that the issue of underwear insecurity is present in a substantial number of low-income households, with different risk factors including race, geographic location, and location of laundry services. Additionally, we find support for the assertion that children facing underwear insecurity are more likely to report experiencing a number of indicators for worse emotional wellbeing and educational development.

Examining Legislation as it Affects Co-Occurring Disorder Treatment: A Quantitative Study

The prevalence of co-occurring substance use and mental health disorders in Texas coupled with low treatment rates has exposed the need for legislative action. This study examines existing state legislation from across the U.S. To determine what factors of a bill increase its rate of passage, we use a representative sample of state bills to run a logit regression. To determine if a specific bill can significantly impact patient outcomes, we analyze two enacted state bills introduced in 2017, one from Colorado and one from Minnesota, to assess through a difference-in-difference statistical analysis if co-occurring disorder treatment numbers increase using Texas as our control. Our research identifies which elements of a bill are correlated with an increased likelihood of passage in a state legislature as well some of the patient demographics that saw increased treatment rates following legislation in Colorado and Minnesota. Using these findings, we hope that our community partner, The Council on Recovery, can best move forward with legislation and legislative recommendations in Texas to better the treatment outcomes of co-occurring disorder patients.

Gender Disparities in Drug-Related Sentencings in Harris County District Courts

Demographic disparities in representation in prisons and courtroom benches in Texas may suggest that not all individuals are treated equally by the criminal justice system. Establishing a relationship between sex and the severity of one’s sentencing outcome for a drug crime will allow researchers, policy makers, and advocates to better understand how and where injustice is being perpetuated in Harris County. If the research project establishes that men and women in Harris County receive significantly different punishments for the same drug crimes, it 4 opens the door to further research and advances evidence of a dysfunctional judicial and legal system. We seek to explore the relationship between sex and sentencing outcomes in order to further understand how social constructions like race, sex and implicit biases impact how the law interacts with individuals. With more research, data, and attention to this issue area, more sustainable and equitable policy solutions can be proposed to lessen injustice in the criminal justice system.

Analyzing the drivers of rural food insecurity and policy interventions in Texas

The food insecurity rate in Texas is 13.7%, which surpasses the national average of 9.7% (Coleman-Jensen et al., 2021; Guerrero et al., 2014). This problem is most pronounced in rural Texas, yet this population is overlooked both in research and public and private aid. This paper examines the drivers of food insecurity and the policies meant to address it in rural communities in Texas, filling a large gap in the literature. Through quantitatively conducting OLS regressions and matching regressions with 2010 U.S. Department of Agriculture Food Access Research Atlas and 2016-2020 American Community Survey census tract level data, we identified the most significant drivers and mitigators of food insecurity, such as the share of seniors and SNAP enrollment, respectively. Qualitative analysis of interviews with food assistance organization employees and clients yielded a variety of social, physical, and economic barriers as well as government and non-profit programming as important factors that influence food insecurity. The majority of the quantitative analysis results did not align with the drivers of food insecurity identified in our qualitative analysis and literature review. In our rural census tract models, we found lower median household income, greater share of seniors, and greater share of households without a vehicle to be significantly associated with an increase in food insecurity rate, which aligned with the literature. However, urban and statewide census tract models alongside the matching regression model only showed a lower share of college educated residents as a significant predictor of food insecurity. Other variables, such as vehicle ownership, children, racial and ethnic minority population, women, single mothers, and SNAP enrollment had an unexpected positive effect on food insecurity in both the OLS models and matching regressions for urban and statewide census tracts. As one of the few studies focusing on rural food insecurity, our results show a difference in the nature of food insecurity in rural areas as compared to the rest of the state and contradict existing literature, which suggests that further quantitative and qualitative exploration of rural food insecurity is necessary to fully understand and solve this issue.

Student Knowledge and Access to Wraparound Services in Houston Independent School District

Alongside our partner, the Kinder Institute for Urban Research’s Houston Education Research Consortium (HERC), we are looking to better understand students’ experiences with the HISD wraparound program. The HISD website defines wraparound services as connecting “students and their families with community resources that address the non-academic challenges that students face which ultimately impact their ability to learn” (HISD). These services encompass mental health services (stress, anxiety, or depression), essential needs (transportation, housing, clothing or food), and administrative support (school supplies or legal aid). As of the 2021-2022 school year, HISD employs 280 wraparound services specialists to serve 276 4 campuses with a total of over 196,000 students, meaning each specialist serves over 690 students on average (HISD). Each school is typically assigned one specialist and over a million interventions were provided in the 2020-2021 school year (HISD). One thing that remains unclear, despite some existing research conducted by HERC for HISD, is if there exist disparities between campuses in the areas of student knowledge and access to wraparound services. Given the large size of HISD, variations across campuses are expected, however, these differences and their nature are largely unknown by HISD administrators. With this research, the district will be able to better understand if there exists any inequities or barriers to access, and thereby usage. Approximately 79% of students in the district are economically disadvantaged as defined by the Texas Education Agency, indicating a high probability of need for wraparound services. Knowing about any gaps and disparities in wraparound service access and knowledge between campuses and individual-level demographics of students is critical to finding better ways to reach the most underserved students.

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A Criminal Justice Team Studies Re-entry Interventions for Veterans

For incarcerated individuals, reintegration into the community following their release is typically a difficult process, and frequently ex-offenders wind up back in prison. For incarcerated military veterans, reentry comes with additional challenges. The Harris County Sheriff’s Office designed and implemented a new 60-90 day holistic reentry program targeting veterans in Harris County jail that mimics some of the structure of the military, including barrack-style living, plus offers case workers, job skills training, and connections with outside services. We’re working with Texas Policy Lab to conduct a comprehensive review of existing literature on reentry programs, particularly those designed for veterans. TPL is also conducting a rigorous evaluation of the Harris County jail veteran’s program and its effect on post-release employment, recidivism, and psychological well-being. While the bulk of the evaluation data isn’t available until after the school year, we’re performing initial analyses on preliminary data, such as identifying factors that most influence a veteran’s optimism and hope going into the program.

A Veterans’ Support Organization Looks for Help Evaluating Its Service Model

In nearly all other communities, veterans of the U.S. armed services have to seek out multiple different non-profit groups to find help with employment, housing, health care, community involvement, and all of their other needs. Houston, however, is the home of a one-stop agency, Combined Arms, that acts as a "front door" to the city for newly arriving veterans. After an intake survey, agency employees assess the veterans' individualized needs, then refer them to the most appropriate service providers from all over the city. Our Capstone team makes regular visits to the agency and works with their data to help evaluate the effectiveness of this unique model of serving veterans' needs – they hope to use our results to help raise funding and spread the model to other cities. We're also studying the research that's already out there for findings and insights that can improve the agency's work.

Education Researchers Study High School Career and Technical Education

Texas policy makers have recognized the evolving needs of the state’s workforce and identified ways that high schools can fill important educational gaps. One of the critical priorities is improved career and technical education (CTE) programs which prepare students for the workforce by providing career-specific content, hands-on experiences, and a pathway to certifications and licenses. We work closely with researchers at Rice’s Houston Education Research Consortium to evaluate CTE programs in 11 local school districts. We helped collect data on which programs, courses, and course content are available at each district and campus. We are using statistical software to clean and analyze this data so we can create a map that demonstrates how current CTE programs are distributed across the greater Houston area and assess how well they serve the community’s needs. (133)

Evaluating the Roll-Out of an Early Childhood Language Acquisition Program

The first few years of a child's life are critical for language acquisition, and their interactions with parents are particularly important to this development. Our group is working with the Texas Policy Lab to develop a tool to help evaluate how effectively a local school district is rolling out a brand new early-language intervention through group-based parenting classes. Policy makers call this step the fidelity of implementation (FOI). Late in the school year, we're also getting the first rounds of preliminary results of the intervention, and we’ll use that data to evaluate whether our FOI tool effectively identified points of growth. Our goal in creating and studying the FOI tool in this pilot program is to make sure TPL can confidently use it to evaluate implementation as the program gets rolled out over the next three years, and to measure how effectively this school-based intervention improves childhood language acquisition.