Enhanced Role for Nursing in Milwaukee County's Redesigned Mental Health System

Few would dispute the idea that effective mental health care relies on the quality and accessibility of health care professionals, especially nurses. As stakeholders in Milwaukee County work to redesign the county’s mental health system, one of the crucial issues they face is how to build an effective and efficient mental health nursing workforce in light of anticipated changes under the new system.

The Nursing’s Voice project is a collaborative effort of local and national foundations, higher education institutions, and other interested parties to enhance the supply of mental health nurses in Milwaukee.  As part of the project, the Forum surveyed 120 mental health nurses and 34 employers to illuminate the state of the county’s current mental health workforce and to gather insights to inform the redesign planning process and the work of Nursing's Voice.  

Survey responses identified three broad categories of need that an effective redesign effort must address – the need for training and professional development of nurses, specifically in mental health care; the need for a larger mental health nursing workforce today and in the future; and the need for nurses and employers to clarify their respective expectations about what constitutes effective mental health nursing skills and practices. In the research brief that summarizes the survey findings, the Forum describes key policy implications:

• Because of a perceived need for nurses with an interest in mental health both now and in the future, incentives for increasing the mental health workforce might be necessary. The redesign process should also anticipate the need for more nurses. 
• Although employers are satisfied with the mental health nurse applicant pool, very few nurses are nationally certified or advanced practice nurses. This suggests that while schools of nursing provide a basic foundation of mental health training, planners should explore possible reasons for the apparent lack of deeper knowledge and discern how this deficit will affect future service provision.
• Employers envision a larger role for mental health nurses in outpatient/community settings. However, today most nurses work in inpatient settings. Planners should explicitly consider the optimal roles of nurses in community health settings.
• Turnover among mental health nurses is relatively low (less than 10%) with the greatest source of job satisfaction deriving from patient care. Sources of job dissatisfaction are related to pay and advancement. If nurses’ responsibilities become more administrative or policy-oriented under a redesigned system, the reduction in patient contact may cause nurse job satisfaction to suffer (and attrition to rise), particularly if wages do not change.
• Employers and nurses lack consensus about which skills are most important for patients’ recovery. This suggests either a lack of clear communication or differing expectations as to the job objectives. Employers and nurses should work toward greater clarity about these differences if the role of nurses is to change under a redesigned system.
• Employers and nurses find more common ground regarding their views of the specific skills that need strengthening. Planners should therefore focus future professional development resources in these areas.
• Both nurses and employers placed specific importance on the ability of nurses to understand the treatment needs of patients diagnosed with dual/co-occurring disorders in which mental illness coincides with substance abuse. As the county shifts its focus to dual/co-occurring disorder treatment, the need for improved training for nurses will be imperative. 

These findings could serve as guideposts to planners, employers, and nurses themselves as they navigate the uncharted territory of a redesigned mental health care system in Milwaukee County. In addition, Nursing’s Voice will play an active role over the next two years to bring the perspective of mental health nurses to both the redesign and implementation of the new system. To do this, the collaborative partnership will undertake three key activities: 1) conduct research and data collection, such as this survey, to document the current and future need for mental health nurses in the new system; 2) develop strategies to encourage nursing students to pursue a career in mental health service and to provide them with the essential skills to be successful; and 3) provide a platform for the voice of nurses so that the new mental health delivery system can make optimal use of their skills and ideas.

New standards and tough goals for region's school districts.

Public school districts in southeast Wisconsin are likely to be hard-pressed to meet new annual performance objectives adopted by the state in connection with its No Child Left Behind Act waiver.  The new objectives are quite ambitious, requiring significant annual improvement by all demographic subgroups of students.  In the latest edition of our annual report, "Public Schooling in Southeast Wisconsin," we find that of all the subgroups and across all subjects, in only one instance – white students in math – does past performance indicate the six-year goal is readily achievable.  All other subgroups in all other subjects would need to dramatically improve proficiency if the goals are to be met.  

This year’s report highlights the host of other new state and federal education policies that will greatly impact local schools, as well, such as the adoption of the Common Core State Standards, new school report cards, changes in state standardized testing, and implementation of teacher effectiveness measures.

Major findings include:

• A continued five-year gap between southeast Wisconsin students and students in the rest of the state in reading, math, and science proficiency, as measured by the state’s standardized assessment, the Wisconsin Knowledge and Concepts Exam.
• Overall declines in state aid, federal aid, and local property taxes when comparing 2010-11 actual amounts to  2011-12 budgets, coupled with cuts in expenditures.  The 2011-12 budgets for the region’s school districts averaged $665 less per pupil in total expenses and $525 less per pupil in instructional expenses than the previous year.
• Mostly positive trends in college readiness.  The percentage of students in the region taking the ACT increased 1.1 percentage points, while the region’s composite score declined slightly from 22.8 in 2010 to 22.7 in 2011.  The percentage of AP exams passed by southeast Wisconsin students increased by 1.3 points, and the region’s high school completion rate increased by 0.8 percentage points over the past year.
• Improved student engagement.  Southeast Wisconsin attendance rates rose slightly over the last year, outpacing a statewide increase. Truancy rates in the region dropped, but remain higher than the statewide average. Dropout rates in the region fell more in the region than across the state as a whole.
• A 0.8% decline in enrollment in southeast Wisconsin during the past year, representing the largest one-year decline in enrollment in the region in the past five years.  
• Another year of growing poverty rates.  Almost half of all students in southeast Wisconsin (46%) received free or reduced-price lunch during the 2011-2012 school year, up 11.6  percentage points from 2005-06.

The report is sponsored by Alverno College, Children’s Hospital of Wisconsin, Multiple Listing Service, Northwestern Mutual Foundation, Southeastern Wisconsin Schools Alliance, and Waukesha County Technical College.   

A spreadsheet of schooling data for all districts in the 7-county region is also available.      

PPF Pearls: Wisconsin and the Internet sales tax

Yesterday the Wall Street Journal reported that tight state budgets have resulted in several governors adopting Internet sales tax agreements with online retailers that require these sellers to collect state sales taxes at the time of purchase, even if they do not have a “brick-and-mortar” presence in the state.

Such agreements ensure these states receive the sales tax they are due; relying on each consumer to report and pay the sales tax owed often leaves state coffers short. For example, self-reported taxes on online purchases (use taxes) were collected from just 29,200 Wisconsin tax filers in 2009, totaling $1.72 million. This represents less than one percent of the total sales and use tax paid in that year. A 2009 University of Tennessee study projected Wisconsin would lose $126.1 million in state and local sales taxes in 2011 and $142.1 million this year from unpaid sales taxes on Internet purchases. Wisconsin’s 5% state sales tax totaled $4.1 billion in 2011, making up one-third of the state’s general purpose revenues, second only to the personal income tax.

While the recent agreements forged by governors help bolster the revenues of individual states, they result in a patchwork of policies across the country. This patchwork complicates business practices for online retailers and puts them in a different competitive stance with physically-present retailers in each state. The result is that a Wisconsin customer of Amazon.com, for example, would not have the state sales tax added to the cost of his or her purchase, but a resident of Kansas, Kentucky, Texas, or any other state with a collection agreement would. In addition, it means an item sold in a physical store in Wisconsin costs more at the time of purchase than the same item sold online, even if they are priced the same.

Instead of seeking tax collection agreements with individual Internet retailers, Wisconsin has joined several other states in looking to Congress to pass legislation allowing states to require online sellers to collect state sales tax. In 1992, the Supreme Court ruled in Quill Corporation v. North Dakota that retailers must have some sort of physical presence in a state before they can be required to collect state sales tax on behalf of that state. Three bills currently under consideration in Congress would tackle Quill’s prohibition by voiding the requirement of a physical nexus.

The Main Street Fairness Act, proposed by Democrats, would allow states that have joined the Streamlined Sales and Use Tax Agreement (SSUTA) to require online retailers to collect state sales tax at the time of purchase. The SSUTA, which seeks uniformity among states by standardizing the definitions of products and taxable items, as well as standardizing and simplifying tax calculations and collection procedures, has a long history in Wisconsin. In our 2000 white paper on tax policy for the new economy, the Forum noted that Wisconsin served as a co-chair of the effort, which began in 1999 with the help of the National Governors’ Association and the National Conference of State Legislators. It wasn’t until 2009, however, that Wisconsin passed the state legislation adopting the standardized definitions required to become a SSUTA member.

The second bill, the Marketplace Equity Act, will be the subject of a hearing in the House Judiciary Committee on July 24. It has been introduced in both the House and Senate with bi-partisan support and appears to be gaining momentum. This act proposes that states wishing to require online tax collection adopt a set of simplified tax rules that are somewhat similar to the SSUTA standards. Some online business groups are worried, however, that by not aligning directly with the SSUTA, the standardization and simplification goals will not be met, as the 22 SSUTA states will be reluctant to pass new and different standards. These states could choose to continue to seek agreements with individual retailers, causing big headaches for national online retailers who would be subject to many differing state tax rules if the act were to pass.

In response to these critiques, a third bill, the Marketplace Fairness Act, has been introduced in the Senate with bi-partisan sponsors. This bill would allow states who are members of the SSUTA to require online sales tax collection, but would also allow non-member states to do so as well, as long as they adopt an alternative set of simplified taxation standards.

Opponents of all three bills argue that by eliminating the nexus requirement for sales and use taxes, Congress would be at the precipice of a slippery slope that could result in all types of new taxes far removed from the activities being taxed. There is also an argument that the requiring sales tax collection by online retailers, even if simplified and standardized, would be so burdensome that it would stifle Internet entrepreneurship.

A May survey by the International Council of Shopping Centers found that 62% of Wisconsin residents polled understand they are supposed to pay a tax on items purchased online, even if the tax was not collected by the retailer at the time of purchase, and that 72% feel having the retailer collect the tax would be easier. In addition, 65% of respondents say they would support a federal law allowing retailers to collect the tax. Until Congress acts, count on Wisconsin’s Department of Revenue to continue to aggressively remind taxpayers that their online shopping sprees are not duty-free.

UPDATE 7/24: More coverage of this issue in the Milwaukee Journal Sentinel http://www.jsonline.com/business/online-retailers-might-have-to-collect-sales-tax-a766ati-163483146.html

Should we be concerned about the decline in family child care providers?

During the debates over Wisconsin's new child care quality improvement initiative, the YoungStar quality rating system, it became clear that an anticipated trade-off for quality improvement was likely to be a reduction in the number of child care providers.  The providers predicted to most likely be negatively impacted were family child care providers (who care for small numbers of children in their own home), as the new quality standards would differ dramatically from the current certification and licensing requirements for these providers. In addition, the Forum's own survey work found family child care providers to be less likely to have the financial and organizational resources needed to make significant investments in quality.  Finally, many observers felt there could be an over-abundance of family child care providers, particularly in Milwaukee County, and that increased parental demand for higher quality care might expose that reality.

In fact, according to a recent analysis by the Wisconsin Council on Children and Families (WCCF), there has been a significant decline in the number of family child care providers, as compared to years prior to YoungStar.  Statewide, there has been an 28% decrease in the number of family providers over the past seven years, including a 63% decrease in the number of certified providers, who had the least rigorous regulatory requirements prior to YoungStar.  WCCF finds the drop in family child care providers in Milwaukee County to be even more dramatic, with a 33% decline in just the past four years.

Should these results be troubling?  It's hard to say.  While there is a need to monitor whether this reduced supply in the family child care market negatively impacts child care access, to date there is no indication that parents have less access to quality care despite the reduced number of slots.  The changes may simply mean the supply has adjusted to match demand.

Conversely, at least a few child care providers feel the new regulations, coupled with the state Department of Children and Families' focus on fraud reduction, are having an unconstitutional disparate impact on African-American child care providers in Milwaukee and several have filed a federal law suit.  Although the claim does not provide statistics, it does seem possible that most of the suspended licenses and certifications were held by African-American providers.  As of March 2012, of the 281 providers listed on the website of the Department of Children and Families as suspended, the vast majority (90%) are located in Milwaukee. The state does not report the race of these providers, but the Forum's 2010 survey of child care providers found that while 10% of Wisconsin's providers are African-American, the rate increases to 48% in Milwaukee County. Thus, to the extent Milwaukee providers make up most of the suspended providers, it is likely that African-American providers are over-represented among them.  Whether this is a disparate impact and, if so, whether it is intentional will likely be difficult to prove.  However, even if no intent is found, if the perception that the state is targeting Milwaukee's African-American providers is widespread in the city, it may prove to be a significant hindrance to the state's efforts to reach out to Milwaukee parents about the importance of choosing a high-quality provider.

Another concern may arise if the family child care providers who have left the market stay unemployed or leave the labor force altogether.  The Forum found in our 2010 report, "Moving the Goal Posts: The shift from child care supply to child care quality," that the state's restructuring of the subsidy program was likely to have unintended consequences for child care providers.  We cautioned that "if this system reform is to be effective, then it is important to understand that the child care system we have today is the result of policy goals originally designed to impact the supply of care..."  Reforming welfare and creating a new child care subsidy program enabled low-income parents to join the workforce, including thousands who found new jobs as family child care providers.  The subsidy program was designed to emphasize child care supply over child care quality in order to effectuate the goals of welfare reform. It is important to recognize that these supply-oriented actions created jobs in the child care market; dramatic quality-oriented changes in the market will now affect those same jobs.  


Finally, given the fact that family child care is less expensive than center-based care, any decrease in the supply may negatively affect families who cannot afford to utilize a child care center.  YoungStar is designed to make higher quality care more affordable to low-income families by increasing the subsidy rate for higher quality care.  Whether the increase is enough to neutralize the impacts of the decreased supply in the low end of the market over the long term is yet to be seen.  For now, families appear to be able to remain the in the regulated market.  However, there remains a potential for growth in cheap, unregulated care, which should be monitored.  

Fighting an uphill battle

It always feels a bit discomforting to say, "Race and economic status are highly correlated to academic achievement." Children can change neither their race nor their income; a statement like the one above can feel like saying these children also cannot improve their academic achievement. But when confronted with the lackluster-to-dismal achievement data of many Milwaukee schools, where the race and income patterns are so stark, its hard to avoid making that statement.

As the Forum's recent report on the Milwaukee Parental Choice Program found, these patterns appear among private school students as well as public school students. In both the public and private sectors in Milwaukee, there are very few schools enrolling predominantly minority and low-income students producing high test scores. (Even among the suburban public schools with fewer minority or low-income children, we've found that as those populations have grown, aggregate test scores have declined.) And while the private school data are new, are they really news, considering how entrenched the pattern has been in the public schools?

What is news is the fact that, while the nation's schools have made some progress in closing the racial achievement gap, the income achievement gap has grown significantly. A recent New York Times story highlights the research of Sean F. Reardon, a Stanford University sociologist, who analyzed data from 12 national studies starting in 1960 and ending in 2007 and found that while the average black-white racial achievement gap has shrunk in half since the 1960s, the gap between children from the wealthiest and poorest families has grown 40% in that time, and is now twice the size of the racial achievement gap.

Schools with low-income students in their charge, whether public or private, are fighting against a nationwide, decades-long trend. While several of these schools, on an individual level, have stellar outcomes, educators are still hunting for the best strategy to improve outcomes system-wide. The hunt requires even more urgency now--the recession is creating more, not fewer, poor families.

Most new voucher users already were enrolled in private schools

The Forum's 14th annual census of schools participating in the Milwaukee Parental Choice Program (MPCP) finds that voucher use by Milwaukee students grew 10% in 2011-12 to 23,198 voucher students, reversing last year’s enrollment decline. In addition, the data indicate that most voucher students are attending hyper-segregated schools that have low reading and math proficiency rates.

The dramatic increase in voucher use is likely due to changes to the program in the most recent state budget, which allowed schools outside Milwaukee to join MPCP and expanded eligibility to include families at higher income levels. As a result, more than 2,200 additional students are using vouchers worth $6,442 each, increasing the program’s cost by $14.2 million.

Most of the new voucher users appear to have already been enrolled in private school. In 56 schools, the number of new voucher users exceed the growth in total enrollment in the school, while in 13 schools voucher growth and enrollment growth were equal. Over the past 10 years, total enrollment in the schools participating in the program has grown by roughly 5,300 students, while the number of voucher users has increased over twice as much.

More students are eligible for vouchers because the income limits for voucher were raised to 300% of the Federal Poverty Level, which means that a family of four earning up to $67,050 per year is now eligible. The median household income in Milwaukee is $35,921 per year. Under the new rules, once a student qualifies for a voucher, he or she remains eligible for all subsequent years, even if the family’s income grows.

The report also includes an analysis of the 2010-2011 state standardized test results of the participating schools, finding that performance among the MPCP schools varies widely. There are a few patterns in the data, however. Reading proficiency rates are higher, on the whole, than math proficiency rates. In addition, schools with fewer voucher users and fewer minority students tend to produce higher proficiency in both reading and math, as do the Catholic and Lutheran schools.

The poor test scores are likely related to the socio-economic and racial demographic make-up of the schools, which mirror the Milwaukee Public Schools, in the aggregate. Nearly half of all MPCP schools have student bodies that are at least 90% minority and/or 90% low income; 65% of all voucher users attend one of these schools.

The report also includes updated data on enrollment trends, schools gaining and losing the most MPCP students, and the aggregate high school drop-out rate. Schools participating in Racine’s new Parental Private School Choice Program are included as well.

The full report and an interactive database of school information are available on the Forum's website.

Paradigm shifts in state budgeting

In 2003, California could have laid off every one of its state employees and still had a deficit, according to Alan Greenblatt of Governing Magazine. He explains, "Most of what states do, after all, is simply write checks to schools, hospitals and other entities that actually provide services." Which helps explain why, traditionally, attempts to reign in state costs have focused less on state personnel, overhead and administrative costs and more on programmatic and service cuts. Not anymore—with employee pension and health care costs soaring, across the nation states are now engaging in a cost-cutting paradigm shift and are focusing on getting state internal costs down in order to preserve services as much as possible.

Wisconsin appears to be leading the charge, at least so far as personnel cost-cutting goes. The most recent data from the U.S. Bureau of Labor Statistics show the number of state employees declined faster in Wisconsin in the second quarter of 2011 than in any other state. With a 10.1% decrease in the number of state employees compared to the second quarter of 2010, Wisconsin's state job-cutting surpassed every other state's over that year.

In addition, the recent final report from the governor's Commission on Waste, Fraud, and Abuse identifies other, mostly administrative, savings to the state. Suggestions in the report aimed at internal savings include changes to overtime policies, better uses of technology in order to improve efficiency, and greater use of quality assurance systems for infrastructure projects.

Balancing the state budget with significant internal cost-cutting, as opposed merely to passing the cuts along to local governments, is a laudable goal. If it rights the state's financial house, it has the potential to benefit taxpayers today and tomorrow. What remains to be seen, however, is the extent to which a balanced budget will empower state policymakers to invest in service quality and/or access.

What if Wisconsin were to be at the forefront of a new wave of policymaking: one where policy and budget decisions were made based on citizens' needs and desires, programs' efficacy and outcomes, and statewide strategic goals?

Metro Milwaukee nonprofit organizations rate the region's philanthropic efforts

In each of the past 15 years, the Public Policy Forum has surveyed nonprofit leaders in southeast Wisconsin to gain insight into the financial health of their organizations and their success in generating support from philanthropic and government entities in Greater Milwaukee. This year’s 15th annual Report Card on Charitable Giving is based on the November 2011 survey responses of 95 nonprofit leaders and finds the responding organizations report greater fiscal stability and more optimism about the future than in the previous two years.

In fact, it appears the nonprofit sector may have seen the bottom of the recession’s impacts, with a greater number of nonprofit leaders reporting they are financially healthy – and fewer reporting chronic financial problems – than in 2009 or 2010. It is also clear, however, that nonprofit organizations have yet to bounce back to their pre-recession status, and that most continue to be challenged to meet increasing demands for their services within the context of their budget constraints.

Major Findings
• While about half of respondents feel the state of philanthropy in the metro Milwaukee area in 2011 did not change from the previous year, the percentage of those feeling it is getting worse decreased sharply from two years ago.

• The majority of respondents continue to feel the U.S. economic downturn has caused giving to be less generous than usual, yet the proportion of respondents feeling that way has declined in each of the past two years.

• A majority of respondents say the outlook for the long-term sustainability of their organization is high or very high. Very few have low expectations for long-term sustainability.

• Recession-driven demand for direct services continues to grow, but most respondents this year say they are at least somewhat confident they will be able to meet the demand. More respondents this year say they have been able to increase their staffing levels in response to increased demand and more say they feel donations are increasing relative to the increased demand for services than in the previous two years.

• Budget constraints continue to challenge nonprofit organizations, with many continuing to freeze salaries or take other steps to reduce expenses.

• More respondents in 2011 report overall revenue growth and growth in donations as compared to 2010.

In rating child care provider quality, Wisconsin can learn from other states

In June 2010, Wisconsin’s Joint Committee on Finance approved YoungStar, a new quality rating and improvement system (QRIS) for the state’s nearly 8,500 child care providers. YoungStar supporters believe the new system will improve the overall quality of childcare in Wisconsin by motivating and supporting providers to make quality improvements and by providing parents with the information they need to choose high-quality child care options.

In the Forum's latest Research Brief, we examine several issues and challenges that have arisen in other states or jurisdictions with QRIS policies, how those entities have tackled those challenges, and the lessons their experiences might yield for Wisconsin. We found five common implementation challenges that have confronted other states and that have the potential to occur in Wisconsin, as well.

1. Bridging the disconnect between theory and policy: QRIS policies are partly based on a theory that greater demand for quality child care will cause quality to improve. Yet, the QRIS policy provides incentives to child care suppliers, not those in demand of care. This disconnect can be bridged via extensive outreach to parents to educate them about the rating system and its benefits, or by creating financial incentives for parents to choose higher-quality care. Wisconsin is planning an outreach effort, but may also wish to explore demand-side incentives should it become clear that demand for higher-quality care is lacking even after YoungStar is fully implemented.

2. Establishing meaningful differences in quality across tiers: QRIS policies assume that there are real differences in quality across the ratings tiers—meaning higher-rated providers benefit child outcomes more than lower-rated providers. If tiers are poorly defined, or if the cut-points between tiers are arbitrary, there may not be meaningful difference in quality between providers with different ratings. Wisconsin will not know if this is a problem until all providers have been rated and have had time to make improvements needed to move up along the tiers.

3. Coordinating QRIS policy with existing quality improvement policies: Wisconsin already has several policies and funding streams in place aimed at improving child care quality. Coordinating these efforts with QRIS so as to maximize the positive outcomes of these many investments could potentially be a challenge. Provisions regarding technical assistance and improvement grants appear to be reinforcing QRIS goals; however, professional development scholarship and stipend programs have yet to be tied to YoungStar.

4. Promoting higher quality systemwide without causing higher costs systemwide: Increasing the state reimbursement to child care providers serving low-income families as their quality ratings increase, otherwise known as tiered reimbursement, is a common incentive used in many states. Wisconsin’s tiered reimbursement strategy is unique, however, in that it not only increases reimbursement for highly-rated providers, but also reduces reimbursement for low-quality providers. As no other state has implemented a carrot and stick approach, Wisconsin cannot use other states’ experiences to predict the effect the tiered reimbursement will have on costs to private pay parents.

5. Inadequate financial planning: Improving the quality of the child care market is a costly endeavor. To do so will require adequate and sustainable revenue sources, not only for conducting YoungStar rating and improvement processes, but also for subsidizing the higher program costs that may result from the improvements. Because Wisconsin has a unique tiered reimbursement structure, the financial plans of other states are not useful in helping estimate potential costs here.

Despite the 26 child care quality rating and improvement systems across the country, a robust body of research has yet to develop that can provide insight into the effectiveness of specific state child care regulatory policies. As a result, Wisconsin, like other states, must be prepared to closely monitor the costs and the child outcomes resulting from its QRIS policy, and make policy changes as necessary.

People Speak: Citizens concerned about health care costs and reform

The latest edition of the People Speak poll finds Milwaukee area citizens are concerned about health care costs in general, as well as the costs of the new health care reform law.

Of the 436 residents polled in early November, a majority (62%) agree with Wisconsin joining 25 other states in challenging the constitutionality of the federal health care reform law. Residents do not seem to base their support on uneasiness with the mandate that individuals be required to have at least minimum insurance coverage, however. In fact, 64% say they favor a requirement of this type. Support for the individual mandate drops to 42% when the question is rephrased to include a hypothetical tax increase to cover the costs for those who cannot afford insurance on their own, indicating concerns about the cost of the law may factor into support for the legal challenge.

These concerns about the cost of reform may reflect respondents' personal situations. A majority (64%) say they are very or somewhat worried that they will not be able to pay their medical bills in the event of a serious illness in the future, although just 23% say that cost has prevented them from seeing a doctor for a medical problem in the past 12 months. Of these 101 respondents who have skipped a doctor visit in the past year due to cost, almost half (47%) report having employer-provided insurance.

Other findings:

• The 64% of respondents in favor of requiring all Americans to have at least minimum health insurance includes 80% of Democrats and 55% of Republicans.


• While 67% of respondents overall agree that states should be allowed to opt out of the federal health care reform law and devise their own health care coverage systems, 92% of Republicans and 42% of Democrats agree.


• Almost half (48%) of respondents favor guaranteeing health care for every American, even if it doesn't do much to control health care costs.


• On the whole, however, health care is not at the top of people's minds when asked to name the most important issue facing the Milwaukee region. Just 2% said "health" or "health care" is the top issue, while 47% said "jobs" or "unemployment" is most important.

The People Speak poll is a tracking poll conducted three times per year in partnership with the Center for Urban Initiatives and Research at the University of Milwaukee and The Business Journal Serving Greater Milwaukee. Full results of the November 2011 poll and all previous polls can be found at the People Speak website.

Maxmizing the local economic benefits of academic research

This afternoon the Public Policy Forum takes up the topic of the economic impact of academic research at our Viewpoint luncheon. One specific way in which research leads to job creation and business development is via technology transfer – the legal process in which new discoveries are patented, marketed, and licensed to commercial manufacturers. Southeast Wisconsin is home to several academic research institutions, each of which goes about technology transfer independently, for the most part. A new Forum report to be presented at the luncheon today examines whether greater collaboration among the region’s research institutions is needed to maximize the local economic impacts of technology transfer.

Our analysis finds that there are three models that might be considered by academic leaders to enhance collaboration in technology transfer and potentially augment the effectiveness of existing efforts:

• Joint Office of Technology Transfer
  A joint office of technology transfer could potentially result in greater expertise in economic development practice for the participating institutions, as well as economies of scale. However, a joint office may stretch the resources of technology transfer officers to the point that some institutions may experience reduced levels of service. Equitably funding a joint office to serve public and private institutions also would be challenging.
• Joint Infrastructure for Informal Technology Transfer Activities
  Currently, much of the technology transfer work performed by academic institutions is of the informal variety - building awareness of academic research projects by industrial researchers and investors through networking and partnering. At the federal level, this work is performed by a permanent consortium of the federal research labs. A similar consortium of local institutions could be created and charged with raising the profile of translational research for local industry. Each participating institution would have to trust, however, that its financial contributions to the consortium would eventually result in benefits for its researchers.
  
• Joint Economic Development Entity
  We found four different types of collaborative economic development agency models aimed at increasing the local economic impact of academic research. All are aimed at encouraging and supporting the transfer of technology to local industry and start-ups, but each does so a little differently. The biggest hurdle for this model is sustainability - a previous, state-funded, southeast Wisconsin economic development effort, TechStar, proved unsustainable.

In addition to considering the creation of a new full-fledged collaborative infrastructure based on one of the three models above, the region's research institutions could consider collaborating on more targeted strategies to ensure that their research positively impacts the local economy:

1. Expand the UWM-MCW First Look Forum to other research institutions—Offer more researchers the opportunity to participate in these events designed to connect academic researchers to investors and industry.
2. Jointly offer start-up support or an entrepreneur-in-residence program—Collaborate to ensure local researchers have the opportunity to be educated about commercializing technology through company formation, mentored through the technology development and venture formation process, and connected with outside resources that can provide services, advice, funding, and management expertise.
3. Jointly raise funds for pre-seed grants—Expand the UWM Catalyst Grant program to other research institutions by working together to raise additional funds from foundations and industry.
4. Utilize a joint tech transfer advisory committee—Maximize local resources by forming a joint advisory committee of investors and industry leaders to advise on patenting decisions, particularly those arising from research projects conducted collaboratively by two or more CTSI institutions.
5. Create a local industry database—Provide researchers at all local institutions with data about industry needs and interests, as well as contacts, by jointly creating and managing a local industry database.
6. Host clinician informant panels—Increase awareness among researchers who are not also clinicians by jointly hosting opportunities for discussion of clinical problems in need of solutions.

It is clear that the region’s academic research institutions have yet to capture the full economic development potential of their research. By collaborating more closely to identify local discoveries that fill gaps in the global market, and by working together to help create or grow local players in that market, academic leaders could take better advantage of their rapidly emerging research prowess.

Let's not focus on the achievement gap

A thought-provoking essay in the current issue of National Affairs by the prolific and sardonic Rick Hess of the American Enterprise Institute calls for a retreat from education reform's long-held focus on closing the achievement gap. Hess feels the federal No Child Left Behind Act has, ironically, become "education policy that has shortchanged many children." His thesis is that by focusing on improving achievement scores of the lowest performing subgroups of students, opportunities for reform that would also benefit the other students have been passed up. The result is that many parents, educators, principals, and elected officials see school reform as inapplicable to the average- or highly-performing students who make up the majority of children in most classrooms across the country.

Which begs the question--if most children in the country are, in fact, being served pretty well by their public schools (and there can be strong arguments made that children who are white, or female, or upper class, or suburban are served well enough by public schools), then why should the adults who care for and educate them want to reform their schools? Should education reform affect change throughout the system or should it focus more narrowly on those students poorly served by public schooling?

Hess puts himself firmly in the camp of reformers desiring wide-scale change in the nation's public education system. But there are certainly other schools of thought. Until recently, Wisconsin's school reform history exemplified reform targeting the lowest-performing students in the lowest-performing schools by providing options mostly for low-income, urban students. When Governor Walker came into office and expressed a need to reform labor relations laws applicable to all school districts in the state, as opposed to urban districts only, and to support an expansion of the private school choice program beyond Milwaukee, he ushered in a new era of systemic reform.

A new debate is now waging in our state. Do we need to rethink how we're delivering education services to all students, or should we remain focused on the students falling furthest behind? Hess argues that even the best schools are producing graduates suited only to thrive in a 19th century, or perhaps 20th century, world. For him, the need for systemic reform arises from the 21st century reforms the world is experiencing in nearly all other aspects, from technology to the economy to governance. He concludes, "[D]eciding that school is the place where we teach poor children to read and do math — and that everyone else will be left alone to figure out the rest — seems an impoverished and ultimately self-defeating agenda for education reform in the 21st century."


There are still a significant number of education policy thinkers and reformers who are not ready to conclude the entire system needs an overhaul, however. Just this week, the MacArthur Foundation awarded one of its "genius grants" to an economist whose work focuses on the achievement gap, for example.


In places like Milwaukee, where most students are poor, most are minority, and overall achievement scores are low, the debate over targeted versus systemic reform may be beside the point. But as more and more suburban school districts experience growth in their low-income, minority, and/or immigrant student populations, and see test scores drop, the debate is very relevant.

Networked schools outperform independent schools in world's largest school choice market

Milwaukee's private school voucher program, now in its twelfth year, is dwarfed by the 30-year-old voucher program in Chile, where almost half of all students attend private voucher schools. The Chilean program is therefore of significant interest to school reformers and researchers looking to make voucher and charter schools a success in the US.

The most recent research, published by the Cato Institute, finds that when the Chilean public school test scores are compared with those of independent private schools and with those of private schools that are part of multi-school networks or franchises, the students in the franchised private schools perform best. (The independent, mom-and-pop private schools do about the same as the public schools.) In addition, the Chilean research indicates the more schools there are in the franchised networks, the better they outperform the others.

The researchers note that in Chile, "The private voucher school sector is essentially a cottage industry. More than 70 percent of private voucher schools are independent schools that do not belong to a franchise." The franchised schools are either owned by for-profit school management companies; affiliated with non-profit, secular organizations; or part of the Catholic or Protestant school systems.

Do these findings reflect what we know about Milwaukee's program? Its hard to say, since only one year of comparative data on student performance in voucher schools is available and it does not differentiate between the various types of private schools. However, those data do indicate considerable variability in performance across Milwaukee's voucher schools--some are producing high scoring students and some are no better than the worst public schools. It would be nice to know if all the high performing private schools had something in common besides the fact they participate in the voucher program.

We do know that Milwaukee is in two major ways very dissimilar to Chile, where most private voucher schools are of the independent, mom-and-pop variety. Here, most voucher schools would be considered franchises under Chilean standards, as they are affiliated with a religious organization such as the Catholic Archdiocese or a Lutheran Synod. In addition, for-profit school management networks do not have a significant presence in Milwaukee, although that sector appears likely to grow, particularly in the charter school market.

What might explain the Chilean experience? The researchers posit that the franchised schools may benefit from economies of scale in purchasing, fundraising, and administrative expenses, allowing their leadership to spend less time worrying about budgets and more time focused on instruction. In addition, they suggest that larger networks are better able to spread the costs of implementing new curricula or other reforms. However, the researchers caution there may be another explanation; perhaps the larger franchises are simply better at recruiting good schools to join their networks.

As for-profit school management companies look to expand into the Milwaukee education market, these findings and possibilities are worth bearing in mind. However, at least one education policy wonk cautions not to read too much into any research on the Chilean program, since their system arose not from "a richly democratic public debate, but emerged instead from the policies imposed by the military dictatorship that ... controlled the country ... under the rule of strongman Augusto Pinochet."

UPDATE: School Choice Wisconsin reported on private school networks in December 2010, noting that despite the lack of national charter school networks in the city, the school choice program had resulted in growing local networks.

The Heisenberg Uncertainty Principle applied to schools

Werner Heisenberg's Uncertainty Principle states that one cannot simultaneously measure the location of a particle while also measuring the momentum of that particle. When you apply this principle to schools, it's a little disheartening--if we attempt to measure where we are now, we are no longer certain how fast we're improving. If the environment in which the measurement is taking place is also moving (think of the vast legal and budgetary changes at the state level), the uncertainty is all but overwhelming.

Thus, this year's analysis of public school data in southeast Wisconsin heeds Heisenberg and emphasizes the use of the 2010-11 data as a baseline. Knowing that all Wisconsin school districts will be in a state of flux over the next few years due to changes in contractual bargaining legislation, the state budget, a slow economic recovery, a new standardized testing system, and new standards for curriculum, in the future we hope to measure their improvements over time as these various "new normals" kick in. For now, we emphasize where they've been and where they are currently.

By analyzing trends in performance indicators such as WKCE reading and math scores, ACT scores, and graduation rates – and breaking down the numbers by minority group and gender – this year’s report provides a basic understanding of the strengths, weaknesses, and challenges of individual districts. Comparing these data with those from future years will provide insight into the impacts of the historic changes recently adopted at the state level.

This year's major findings include:
• The region trails the rest of the state in several grade levels and subjects when it comes to proficiency on state standardized tests. In addition, the data show a progressively wider disparity between the region and the state in all subjects at the higher grades, raising a red flag in the context of current efforts to drive educational reform toward college and career readiness.

• Measures of college preparation show mostly good news. For the third straight year, the most recent data show the average ACT score in the region held steady at 22.8 (even as the number of students tested rose by 6.3%), while the statewide average score dropped slightly. The region’s percentage of students passing Advanced Placement exams (13.6%) also is well above that of the rest of the state (10.7%). The region’s high school completion rate of 86.1% is below that of the state (89.9%), but increased more over the previous year than the statewide rate.

• Individual districts in southeast Wisconsin continue to compare favorably with state averages for attendance, truancy, and dropout rates, with 41 of the 50 districts achieving an attendance rate of 95% or better, and 36 posting truancy rates below 3% and high school dropout rates at 1% or lower. The region’s three largest districts – MPS, Kenosha and Racine Unified – lag well behind the rest of the region in all three indicators, however.

• Southeast Wisconsin school districts continue to rely more on property taxes and federal aid than those in the rest of the state. Meanwhile, regional spending allocations among categories such as instruction and administration mirror the rest of the state, but the region’s per-pupil spending of $12,422 exceeds the statewide average by nearly $1,000. Overall, per-pupil spending in the region rose slightly compared to the 2009-10 academic year.

• Enrollment in the region’s public schools tilted slightly upward for the first time in more than five years, which is primarily attributable to growth in 10 moderately-sized districts of between 2% and 7%. Amid this relatively steady overall enrollment, minority enrollment is accelerating. Minority enrollment in the region exceeded 40% in 2010-11 and grew 1.3%, whereas the last several years saw growth levels of below 1%.

In total, the data from 2010-11 continue to show a region whose largest and poorest school districts continue to struggle, and one in which the racial achievement gap remains large and static. While there is plenty of uncertainty about the direction and speed in which the schools will change over the next several years, it is certain that staying put is not an option for many districts.

The full report, as well as a poster-sized summary detailing data from individual districts, can be found here.

Underwriters of this year's edition include: Alverno College, Multiple Listing Service, Northwestern Mutual Foundation, Southeastern Wisconsin Schools Alliance, Stifel Nicolaus, and Waukesha County Technical College.

People Speak poll: High rates of satisfaction with municipal services

The latest edition of the People Speak poll, released today, finds that residents of southeast Wisconsin are mostly satisfied with the services they receieve from their city, town, or village government. The poll, conducted in late June and early July, surveys 391 adult residents of Milwaukee, Ozaukee, Washington, and Waukesha Counties.

The majority of survey respondents also report feeling their municipal government is a good value. The overall perception of local government's value is mostly unchanged from 2001, the last time we polled on this issue.

Other highlights:

• High rates of satisfaction with municipal service quality (89% are satisfied), types of municipal services (85%), and access to municipal services (87%). Lower rates of satisfaction with the cost of municipal services (67%).


• When asked to name the most important municipal service, 34% of respondents named a public safety service such as police or fire. About half (51%) of these respondents feel public safety services are best provided by individual municipalities, 17% feel they are best provided collaboratively by two or more municipalities, and 23% feel they are best provided by county government.


• The sharing of municipal services across municipal boundaries is seen by a majority respondents as a likely way to cut costs. The percent of respondents saying service sharing is likely to save taxpayers money varies by the type of service.


• When asked whether they would support state policy to require or provide incentives for greater collaboration or consolidation among municipalities or school districts, a majority of respondents indicate they would oppose such legislation. Fifty-four percent would oppose state fiscal incentives to encourage municipal service sharing and 55% would oppose requiring consolidation of small school districts.

The People Speak is conducted by the Forum in partnership with the Center for Urban Initiatives and Research at UWM and The Business Journal Serving Greater Milwaukee. The latest poll was funded by UWM.

For complete poll results, see the People Speak website.

A misplaced trust in leadership

There is a common presumption that when it comes to improving public school performance, constructive changes, whether originating at the top or the bottom, cannot take hold unless they are championed by the superintendent. The superintendent of the Atlanta Public School District is often cited as an example of the type of leadership that brings about dramatic improvement. Dr. Beverly Hall had one of the longest tenures of any large urban district superintendent, having led APS over 12 years. She won many national awards and accolades over those years and the Atlanta schools were on a steep trajectory of improvement.

Now, the Atlanta Journal-Constitution reports that trajectory was launched not by the vision of a strong leader, but was systematically manufactured by a superintendent who tolerated, and possibly encouraged, outright cheating by school staff on state standardized tests. The evidence, gathered by a governor's task force, is overwhelming, alarming, and shocking. The task force report names 178 educators, including 38 principals, as participants in cheating. More than 80 educators confessed to actions such as erasing students' wrong answers and changing them to correct answers. Cheating was confirmed in 44 of the 56 schools examined.

The consequences are yet unknown—Will Dr. Hall have to pay back performance bonuses earned by improved test scores? Will colleges stand behind acceptance decisions for which good test scores were a factor? Will the federal government hold the district accountable under the No Child Left Behind Act? Will criminal charges be brought? One clear result: Students who never learned their real scores lost opportunities to improve their weaknesses and build on their strengths.

Like the recently-exposed problems with the New York state exams, this cheating scandal raises questions about the wisdom of building education reforms around standardized tests. Some will use these developments as a reason to oppose merit pay for teachers, strengthening No Child Left Behind, or requiring private schools accepting voucher students to participate in the tests. Others will argue that a few bad actors cannot be allowed to spoil the best, albeit imperfect, method of monitoring school performance.

These opposing views each have a foothold in Wisconsin, which is currently in the process of developing a new standardized testing scheme. The public debate over the ways in which the new test is to be used for policymaking and accountability purposes is sure to be long and hard. But this debate gives rise to an opportunity to make Badgerland lemonade from other states’ lemons. Wisconsin could anticipate the potential for organized cheating on standardized tests and explicitly spell out the ways in which the Department of Public Instruction will monitor test security and integrity, and the penalties for cheating. For example, DPI might rule that any school turning in score sheets with wrong-to-right answer erasures numbering more than three standard deviations above the norm (statistically unlikely to have happened coincidentally) would trigger an automatic investigation.

Currently, according to DPI's policy and procedure manual, penalties for school staff found to be complicit in cheating are not regulated by the state; it is left to a district to administer any penalties according to local policy. The New York Times reports that in Atlanta, the school board was loath to criticize Dr. Hall, whom the directors felt had done much to improve the perception of their schools and city. Perhaps the lesson of Atlanta is that districts cannot be allowed to self-police as long as their test results are used to determine more than just student performance.

Anchor institutions may be called on to do more

A New York Times article yesterday noted that financially-challenged municipalities across the country are calling on land-holding non-profit/tax-exempt organizations to make larger contributions in lieu of property taxes. These organizations, usually college campuses or hospital facilities, might represent a significant portion of a municipality’s property tax base. These “eds and meds” thus represent a potential drag on city government finances by requiring considerable city services but paying no property taxes.

Viewing education and medical campuses as drains on the tax base is hard to resist during tough budget times, and Milwaukee itself budgeted an 8.4% increase in payments in lieu of taxes for 2011. Yet some are able to see these organizations as assets in economic development. From that lens, the eds and meds are “anchor institutions” serving as resources for local economic development. These institutions are neighborhood anchors due both to their size and resources. They are often among a city’s largest employers, but unlike a private business, they are unlikely to relocate.

It is obvious how these institutions can assist in economic development: by employing significant numbers of resident workers, investing in neighborhood infrastructure, and purchasing goods and services from local vendors. What is less obvious is why they may wish to do so. Lacking a mission to serve local residents, why should an institution implement preferences for local employees, goods, or services?

A report from Chapin Hall at the University of Chicago analyzes the costs versus the benefits of local investments by anchor institutions and concludes that, while it will differ by institution, in general the benefits to the institution will outweigh the costs. For example, investing in streetscaping and lighting beyond the campus may bring about a measurable decrease in crime or vandalism on campus. But more often, these benefits can be somewhat intangible, arising from the goodwill, trust, and knowledge gained by partnering with local government and/or community organizations.

Many of the anchor institutions in Milwaukee practice local investing. Marquette University, for example, has helped lead the redevelopment of the neighborhoods on the city’s near West Side. UWM and Aurora Health Care have “walk to work” programs that provide faculty and staff with home-buying assistance when purchasing homes in the neighborhood.

Never the less, while it is likely that these investments have improved property values in the neighborhood, when a local government is faced with an unsustainable structural deficit, the tax-exempt property owned by an anchor institution may feel more like an anchor around the neck.

Are Milwaukee County's child care providers ready for YoungStar?

New results from a statewide survey of 1,425 child care providers show that Milwaukee County providers compare favorably to providers across the state with respect to several measures that will be rewarded under the state's new YoungStar child care rating system.

The survey, conducted by the Forum in partnership with the Wisconsin Early Childhood Association, was designed to provide a picture of the status of the early childhood workforce in the state. Provider characteristics such as educational attainment, experience, professional credentials, and salary were measured. Providers were also given a chance to express their opinions about the new rating system.

Key findings include:

• The 223 respondents from Milwaukee County demonstrate higher educational attainment and earned professional credentials than their colleagues statewide, factors that can earn a provider a higher rating under YoungStar.


• Providers in Milwaukee County appear to enjoy greater access to professional development than providers elsewhere in the state, via higher rates of membership in professional associations and use of scholarship and stipend programs.


• Providers in Milwaukee County have higher median wages than the state as a whole and have higher child care subsidy usage rates. Not surprisingly, Milwaukee County providers also charge higher fees.


• Child care centers in Milwaukee County are more likely to be accredited. Accreditation can mean a center automatically receives the highest rating under YoungStar.


• Milwaukee County providers are more likely to see YoungStar as an opportunity to improve the quality of their early childhood programming than providers statewide.

For the full report, visit the Forum's website.

People Speak Poll: Budget Debate Trumps Jobs

The latest People Speak Poll, conducted by the Public Policy Forum and the Center for Urban Initiatives and Research at UWM in partnership with The Business Journal Serving Greater Milwaukee, finds that the state budget ranks as the most important issue in the minds of southeast Wisconsin residents. The poll of 400 residents of Milwaukee, Waukesha, Ozaukee, and Washington Counties was conducted in late February and early March, at the peak of the debate over the budget repair bill. Four previous polls over the past two years had found jobs were the issue of most concern.

Analysis and full results of the latest poll, along with those of previous polls, are available at http://www.peoplespeakpoll.org/.

Other findings:

• The region's citizens are less optimistic about the nation's economic future and Milwaukee's eocnomic future than they were in September 2009.


• No major change in opinion has occurred since September 2009 with regard to state government--40% of residents feel the state is on the right track.


• Crime in the City of Milwaukee is not perceived by most to have declined over the past year, despite the actual drop in crime.


• Half of respondents consider the north side of Milwaukee to be an unsafe place to be in the middle of the afternoon.


• One in five respondents feel unsafe in the middle of the afternoon at Mayfair and Grand Avenue Malls.

Measuring up education

A common complaint about education reform is the slow pace with which it takes place. I've often heard the analogy, "Improving a school system is like turning a battleship." In contrast, political changes can occur quite rapidily, as this state has witnessed over the past several months. And while the Forum's mission is to conduct timely and topical research, sometimes the policy world moves faster than we had anticipated. Such is the case with the report we release today.

The report, entitled "Measuring Up Education: Community-Driven Accountability in Milwaukee," was commissioned last summer by the Greater Milwaukee Foundation (GMF) in a quest to find community consensus on a dozen or so simple metrics that could be used to measure progress in the Milwaukee Public Schools.

Since that time, the voters have elected a new governor, and the state legislature has enacted new laws dramatically changing the landscape for local governments and school districts. These changes affirm the need for consensus when it comes to holding the district accountable, yet they also make consensus more difficult to achieve. And, in this case, they perhaps make consensus on turning the ship around less of a priority than simply keeping it upright.

Nonetheless, we believe the report contains important information for those seeking a simple framework through which to view the district's momentum. We suggest several metrics that could find consensus in Milwaukee based on experiences in other urban districts, the priorities Milwaukee education reformers have voiced, and the district's internal and external goals (as reflected in the MPS strategic plan and state and federal regulations).

In the end, while reasonable people will disagree about the specific strategies needed to improve the quality of teaching and learning at MPS, it would be constructive for community leaders at least to agree on how we will measure whether those strategies are succeeding, and how to ensure accountability if they are not.