Fast Focus

The purpose of Fast Focus is to provide brief, single-topic summaries of important IRP conferences, publications, and events to keep readers up-to-date on our latest poverty research between issues of Focus. There will be no overlap of articles in Fast Focus and Focus; the content of each will be distinct but complementary.

This is a "green" initiative; we will not be printing or mailing hard copies of Fast Focus.

Notification and an abstract of each new issue of Fast Focus will be e-mailed to "IRPFocusAlert" listserv subscribers along with a link to the full issue on IRP’s Web site.

If you would like to receive notification and an abstract of new issues of Fast Focus, send an e-mail message to join-irpfocusalert@lists.wisc.edu indicating "Subscribe" in the subject line.

Fast Focus No. 23-2016

June 2016

Deepening connections between neuroscience and public policy to understand poverty

The Institute for Research on Poverty (IRP) at the University of Wisconsin–Madison hosted a workshop in April of 2016 that brought together researchers working in the area of poverty and developmental neuroscience to discuss the current status of the research and how it can be appropriately and effectively used to inform public policy. The workshop was organized by Seth Pollak, a psychologist, director of the University of Wisconsin Child Emotion Lab, and IRP affiliate; and Barbara Wolfe, a professor of economics, population health sciences, and public affairs, and former director of IRP.

The workshop included national leaders in the neuroscience, poverty, and public policy fields, including Lawrence Berger (University of Wisconsin–Madison), Gary Evans (Cornell University), Martha Farah (University of Pennsylvania), John Gabrielli (MIT), Peter Gianaros (University of Pittsburgh), Charles Homer (US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation), Pilyoung Kim (University of Denver), Joan Luby (Washington University in St. Louis), Katherine Magnuson (University of Wisconsin–Madison), and Kimberly Noble (Columbia University). The discussion addressed several key challenges, which are summarized in this brief.

Fast Focus No. 22-2015

March 2015

Unaffordable America: Poverty, housing, and eviction

Matthew Desmond

Matthew Desmond explores the crisis faced by poor families in finding and maintaining affordable housing in this Fast Focus brief. Drawing from his own extensive ethnographic and quantitative research, Desmond outlines the trends that led to the current situation: rising housing costs, stagnant or falling incomes among the poor, and a shortfall of federal housing assistance. As a result of these trends, most poor renting families now devote over half of their income to housing costs, and eviction has become commonplace in low-income communities. Poor single mothers with young children, particularly African Americans, are at especially high risk of eviction. Desmond reviews the consequences of eviction—for parents, children, and neighborhoods—and concludes with suggested policy remedies and a call to pull housing back to the center of the poverty debate.

Fast Focus No. 21-2014

September 2014

Building human capital and economic potential
Carolyn J. Heinrich and Timothy M. Smeeding

The Institute for Research on Policy at the University of Wisconsin–Madison, in collaboration with the Center for Health and Social Policy (CHASP) at the University of Texas at Austin, launched a major research initiative on "Building Human Capital and Economic Potential" to enhance understanding of how policies and programs can build economic self-sufficiency by increasing labor market skills, employment, and earnings, particularly among low-skilled and disadvantaged populations. This Fast Focus describes the key themes and research undertakings in this initiative, the findings presented, and some of the policy ideas advances at the conference. See also two policy briefs that go into greater detail about the policy ideas: Focus on Policy Brief No. 2: "Building Economic Self-Sufficiency" and Focus on Policy Brief No. 3: "Helping the Hard-to-Employ and Their Families."

Fast Focus No. 20-2014

June 2014

Getting by: Earning, spending, saving, and borrowing among the poor
J. Michael Collins, Hallie Lienhardt, and Timothy M. Smeeding

The Institute for Research on Poverty and the Center for Financial Security at the University of Wisconsin–Madison hosted a workshop on "Financial Decision-Making, Poverty, and Inequality" on May 21 and 22, 2014. The event brought together researchers and practitioners for a focused, evidence-based conversation about how household financial management and access to financial assets, loans, and transactional accounts and products can serve to support families in their goal to be financially secure. The target group was low-income families, most of whom are unable to save for longer-term objectives. Meeting consumption needs is typically more of a goal for them than accumulating long-run savings. But each week and month, they still need to balance the books as well as make ends meet. The workshop was an opportunity to better understand how programs that might help families balance the books operate "on the ground" and how they are growing in retail financial markets. The goal was to generate insights for interventions aimed at financial access and, for some, asset building among low-income households. This issue of Fast Focus summarizes the workshop presentations and discussion; poses some provocative questions; and looks at the role of research and practice in helping low-income families stabilize their incomes, expenses, and budgets.

Fast Focus No. 19-2014

March 2014

Less-educated workers' unstable employment: Can the safety net help?
Heather D. Hill and Marci A. Ybarra

In recent decades, workers with less than a college education have faced a "double whammy" of less-stable employment opportunities and a safety net that is increasingly contingent on employment. Beginning in the 1980s, structural changes to the economy—including declines in manufacturing and the influence of labor unions, and increases in health care costs—combined to increase the instability of employment for less-educated workers. Many workers experience unpredictable, variable, and nonstandard hours; temporary or contingent employment; and involuntary part-time positions. Policy changes during this same period—such as welfare reform and expansions of the Earned Income Tax Credit (EITC) and child care subsidies—made much of public assistance contingent on employment. To examine how the safety net responds to and prevents employment instability, and in some cases inadvertently magnifies the economic challenges of unstable work, the University of Chicago Employment Instability, Family Well-being, and Social Policy Network (EINet) hosted a policy forum on November 15, 2013, which convened researchers, policy administrators, and advocates. In this brief, EINet co-principal investigator Heather D. Hill and University of Chicago scholar Marci Ybarra summarize the discussion and key findings.

Fast Focus No. 18-2013

December 2013

New findings on New York City's conditional cash transfer program
James A. Riccio

Conditional cash transfer (CCT) programs use financial incentives that offer low-income families a way to reduce their immediate poverty while taking steps to improve their human capital. CCTs have spread across many lower- and middle-income nations with varying degrees of success. The first comprehensive CCT program in a high-income nation was a privately funded demonstration project conducted in New York City called Opportunity NYC—Family Rewards. This program was designed by the New York City Center for Economic Opportunity and nongovernmental agencies in collaboration with MDRC and offered financial rewards tied to children's education progress, family preventive health-care practices, and parents' employment. It is the subject of an ongoing long-term random assignment evaluation by researchers at MDRC. Preliminary evaluation results covering the program's early operational phase were released in 2010 and summarized by IRP. (See "Early findings from New York City's conditional cash transfer program," Fast Focus No. 5-2010, by James Riccio.) In this issue of Fast Focus, James Riccio shares new evaluation results published by MDRC in September 2013. In brief, Riccio and his team found that Family Rewards' effects through the end of the program and into the early post-program period were more modest than had been hoped for, but the range of positive effects justifies continuing to experiment with the CCT concept to try to improve it. A "next generation" version of the model is now being tested in the Bronx, NY, and Memphis, Tennessee.

Fast Focus No. 17-2013

August 2013

Reducing the effects of poverty through early childhood interventions
Katherine Magnuson

Katherine Magnuson brings together what studies suggest about how poverty and inequality in childhood—especially when experienced at a very young age—affect children and their life chances. After a review of the latest official poverty statistics and changes in inequality of family income over the last 30 years, she looks at length of time spent in poverty and how much duration varies by race and mother's education. Turning to why poverty and inequality in childhood matter, Magnuson shares her recent findings with colleagues that show clear differences by parent income in standardized test scores and less pronounced differences in problematic behavior, as reported by teachers. She also looks at emerging research in neuroscience and developmental psychology, which suggests that early childhood poverty may be especially damaging, and why, therefore, interventions that focus on young children make good sense in an era of restricted budgets. The brief concludes with an examination of what a group of studies indicates about promising programs—from the Earned Income Tax Credit to conditional cash transfers to early childhood education—to lessen poverty's effects on young children and thus boost their life chances.

Fast Focus No. 16-2013

March 2013

Local food prices: Effects on child eating patterns, food insecurity, and overweight
Taryn W. Morrissey, Alison Jacknowitz, and Katie Vinopal

Both obesity and food insecurity are important public health problems facing young children in the United States. A lack of affordable, nutritious foods is one of the neighborhood factors presumed to underlie both overweight and under-nutrition among children. Despite the importance of adequate nutrition during early childhood, to date, little research has examined how food prices relate to weight and food insecurity outcomes during early childhood. This study fills these gaps in the literature by estimating how local food prices influence the weight outcomes, food insecurity, and food consumption of children from infancy to 5 years of age. The study found that higher-priced fruits and vegetables are associated with higher standardized measures of children's BMI; higher-priced soft drinks are associated with a lower likelihood of being overweight; and surprisingly, higher fast food prices are associated with a greater likelihood of being overweight; food prices are largely unassociated with children's food consumption.

Fast Focus No. 15-2012

December 2012

The Affordable Care Act: What does it do for low-income families?
Linda J. Blumberg

In October 2012, Linda J. Blumberg, an economist and senior fellow at the Health Policy Center of the Urban Institute, presented a seminar at IRP on "Implementation of the Affordable Care Act: Early Experiences in Ten States." Her talk drew a large crowd of faculty and students from across campus over a range of disciplines, and sparked considerable discussion. This brief extends Blumberg's talk to include a look at the pre-reform health care system as well as examination of the ways in which low-income families stand to benefit from the Affordable Care Act (ACA) reforms.

Fast Focus No. 14-2012

May 2012

A consumer's guide to interpreting various U.S. poverty measures
David S. Johnson and Timothy M. Smeeding

Each year, the U.S. Census Bureau releases a number of public reports on the level of poverty in the previous year and trends in the level and composition of the poor from year to year. To make their annual assessment, Bureau analysts use the official poverty measure that was created around the time when President Lyndon Johnson launched the War on Poverty in 1964. The measure was devised to define and quantify poverty in America and thereby provide a yardstick for progress, or regress, and in that sense has served the nation well. However, since the measure's inception, criticisms of it have abounded, as have suggestions for alternative approaches. While continuing to use the official measure, the Census Bureau also has pursued ancillary measures, most recently the Supplemental Poverty Measure, whose first results were released in November 2011. In addition, the Census Bureau and many state and local entities have devised their own, place-specific measures, in an attempt to better understand the level and trend of poverty in their region and to gauge the effectiveness of antipoverty efforts. This issue of Fast Focus seeks to make sense of these various measures at the federal, state, and local levels.

Fast Focus No. 13-2012

January 2012

Boosting the employment and productivity of American workers
Harry J. Holzer

This issue of Fast Focus introduces an award-winning proposal by Harry J. Holzer that takes on the challenge of connecting less-educated and less-skilled unemployed Americans to education and training programs, and ultimately to employers that need more-specialized workers. He shows that there are good-paying jobs that do not require a four-year college degree, but not enough skilled workers to fill them. His plan is to create more effective education and training systems to improve workers' success and connect employers to the skilled workforce they need in the global labor market. This would be done through competitive grants from the federal government to states that expand proven training programs for the disadvantaged and, more generally, encourage education and workforce institutions to align themselves more closely with growing sectors that provide good-paying jobs. Evidence suggests that such grants could generate benefits that far outweigh their costs, including lower unemployment rates and higher earnings among the disadvantaged. Holzer presented his proposal at a forum hosted by the Hamilton Project at the Brookings Institution on November 30, 2011, on training programs geared toward the needs of today's workforce. Holzer received the Hamilton Project's 2011 Policy Innovation Prize for the best proposal to create jobs and enhance productivity. The broader proposal appears in Raising Job Quality and Skills for American Workers: Creating More-Effective Education and Workforce Development Systems in the States, The Hamilton Project, Brookings Institution, Washington, DC.

Fast Focus No. 12-2011

October 2011

American poverty and inequality: Key trends and future research directions
Timothy Smeeding, Maria Cancian, John Karl Scholz, Barbara Wolfe, Robert Haveman, Jennifer Noyes, Katherine Magnuson, Carolyn Heinrich, Thomas Kaplan, Lawrence M. Berger, Marcia Carlson, J. Michael Collins, Julia Isaacs, Daniel R. Meyer, and James Walker

This issue of Fast Focus summarizes the research agenda of the Institute for Research on Poverty (IRP) at the University of Wisconsin–Madison under a new, five-year national Poverty Research Center grant from the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services. The award is one of three made in ASPE's reconfigured poverty center program that is designed to combat poverty and inequality in the 21st century (Stanford University and the University of California, Davis host the other two new centers). In receiving the award, IRP will continue the work it has pursued since 1966, when it was established as the nation's original, university-based center for research into the nature, causes, and cures of poverty and inequality in the United States. Central to the mission of the poverty research center program is capacity-building—supporting faculty research and faculty training; mentoring students; and enhancing awareness of issues related to poverty and inequality through dissemination of research findings to a range of audiences. The new program features formalized cross-poverty-center networks and a centralized advisory committee that oversees all three centers in collaboration with ASPE analysts. In this brief, IRP researchers assess poverty and inequality in the United States. They examine key trends over the decades since the War on Poverty was launched in the 1960s, review past research, and look ahead to how poverty may continue to change and require new approaches to mitigate its effects on individuals and families. They evaluate the policies and programs devised to improve opportunities for the disadvantaged and to help them on the path to self-sufficiency. Finally, they look ahead to project what researchers, policymakers, and practitioners will need to know to improve the life chances of all Americans and what research evidence is needed to inform and improve antipoverty efforts.

Fast Focus No. 11-2011

September 2011

Stepparents and half-siblings: Family complexity from a child's perspective
Maria Cancian, Daniel R. Meyer, and Steven T. Cook

In this issue of Fast Focus, Maria Cancian, Daniel R. Meyer, and Steven T. Cook summarize findings published in the journal Demography, which document the incidence and evolution of family complexity from the perspective of children. Following a cohort of firstborn children whose mothers were not married at the time of their birth, the authors consider family structure changes over the first 10 years of the child's life–considering both full and half-siblings who are coresidential or who live in another household. They find that 60 percent of firstborn children of unmarried mothers have at least one half-sibling by age 10. Complex family structures are more likely for children of parents who are younger or who have low earnings and for those in larger urban areas. Children who have half-siblings on their mother's side are also more likely to have half-siblings on their father's side, and vice versa, contributing to very complex family structures–and potential child support arrangements–for some children.

Fast Focus No. 10-2011

June 2011

Jobs, skills, and policy for lower-wage workers
Robert H. Haveman, Carolyn J. Heinrich, and Timothy M. Smeeding

This issue of Fast Focus is based on the presentations made by a group of economists, sociologists, and public policy and education experts at a national working conference hosted by IRP in March 2011, with financial support from the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. The “Employment Prospects for Lower-Wage Workers: Easing the Implications of a Slow Recovery” conference, which was organized by Robert Haveman, Carolyn Heinrich, and Timothy Smeeding, featured presentations by leading researchers on the sources of U.S. labor market polarization and its impacts  on workers with varying types and levels of skills. Issues of technological change, job-outsourcing, the decline of trade unions, and the effect of minimum wages were assessed. Conference participants explored the consequences of these developments on a variety of economic and social phenomena, including the growth of wage and income inequality, the demand for public transfers, and the health and well-being of displaced workers and their families. To view the conference PowerPoint presentations, visit IRP’s Web site at www.irp.wisc.edu and search for “employment conference.”

Fast Focus No. 9-2011

March 2011

Unmarried parents in college: Pathways to success
Sara Goldrick-Rab and Kia Sorensen

This issue of Fast Focus is based on an article published by Sara Goldrick-Rab and Kia Sorensen in the fall 2010 issue of The Future of Children (Vol. 20, No. 2; used here with permission), which focuses on “fragile families,” defined as families in which the parents were unmarried when the child was born. The authors examine unmarried parents in college at a time when postsecondary education and training have become increasingly important to workers’ success in the U.S. labor market and therefore to families’ economic security. Noting that access to higher education has dramatically expanded in the past several decades, Goldrick-Rab and Sorensen focus on how unmarried parents fare once they enter college. They argue that, contrary to the expectation that college access consistently promotes family stability and economic security, deficiencies in current policy lead to adverse consequences for some families headed by unmarried parents. And although rates of college attendance have substantially increased among unmarried parents, their college completion rates are low. The authors examine their barriers to success, and the effects of their studies on family life, describing empirically tested supports that have helped more unmarried parenting students attain a degree and thus find better employment at higher wages.

Fast Focus No. 8-2010

December 2010

Fighting child poverty in the United States and United Kingdom: An update
Timothy M. Smeeding and Jane Waldfogel

Last year Timothy Smeeding and Jane Waldfogel published an article in the Journal of Policy Analysis and Management that showed how child poverty trends in the United States and United Kingdom had diverged over the past decade, during which the United Kingdom pursued an ambitious war on child poverty. Now there are new data for the two countries, which reveal that the differences are even starker than before. This Fast Focus brief is designed to update their findings in the context of the ongoing recession as well as the change in government in the United Kingdom and subsequent ongoing changes in public policy toward poor children. Ten years into the U.K. initiative to halve child poverty in 10 years, if poverty is measured in absolute terms as we do in the U.S., they have more than achieved their interim goal, because of both fiscal effort and persistence, as Jane Waldfogel documents in her book Britain’s War on Poverty (published by Russell Sage Foundation in 2010). The authors assert that a more concerted national effort will be needed if the United States is to achieve anything like the successes of the United Kingdom in reducing its high child poverty rates.

Fast Focus No. 7-2010

December 2010*

*This brief is a revision of Fast Focus No. 7-2010, which was originally issued in October 2010. The first version of the brief contained only two of the provisions of the ARRA (i.e., increased SNAP benefits and expanded tax credits), while this final version presents results for a simulation using four provisions: SNAP benefits, refundable tax credits (EITC and Child Tax Credit), Making Work Pay Credit, and Economic Recovery Payment.

The effects of the 2009 ARRA on poverty in Wisconsin
Timothy M. Smeeding, Julia B. Isaacs, Joanna Y. Marks, and Katherine Thornton

The American Recovery and Reinvestment Act (ARRA) of 2009 contained temporary policy changes to offset or lessen the negative effects of the economic recession. These policies included provisions increasing refundable tax credits for families and larger nutrition assistance benefits for those enrolled in the program. In this brief, the authors analyze the effect of the tax and nutrition assistance portions of the ARRA on poverty in Wisconsin, using a broader, more complete measure of poverty developed at IRP. Under the Wisconsin Poverty Measure, we can observe how the existence of refundable tax credits and non-cash benefits (particularly nutrition assistance) serves to reduce poverty, even before the enactment of the ARRA. This brief demonstrates that the 2009 expansions of the safety net under the ARRA helped mitigate poverty even more than the existing tax credit and nutritional assistance programs extant in 2008. The effect was greatest on families with children, in accordance with the design of the policy changes.

Fast Focus No. 6-2010

August 2010

Promising antipoverty strategies for families
Maria Cancian, Daniel R. Meyer, and Deborah Reed

American families are becoming increasingly diverse, dynamic, and dependent on labor market earnings to avoid poverty and economic distress. Children are less likely to live in families with both parents and more likely to rely on their mother’s earnings to avoid poverty. The recession has highlighted the urgent need for antipoverty programs supporting families, but the authors emphasize that the needs the programs address are longstanding, not only cyclical, and therefore require a sustained response. In this brief, the authors review changes in family structure, the relationship between family structure and employment, and early evidence on differential impacts of the recession on families, and they explore the implications of these changes for policy. They argue that supporting resident parents’ efforts to balance work and family responsibilities and supporting and enforcing nonresident parents’ contributions to their children will help reduce poverty and economic difficulties.

Fast Focus No. 5-2010

May 2010

Early findings from New York City's conditional cash transfer program
James A. Riccio

In 2007, New York City’s Center for Economic Opportunity launched Opportunity NYC: Family Rewards, an experimental, privately funded, conditional cash transfer (CCT) program to help families break the cycle of poverty. CCT programs offer cash assistance to reduce immediate hardship, but condition these transfers on families’ efforts to build up their “human capital,” often by developing the education and skills that may reduce their poverty over the longer term. Family Rewards is the first comprehensive CCT program in a developed country.

Aimed at low-income families in six of New York City’s highest-poverty communities, Family Rewards ties cash rewards to prespecified activities and outcomes in children’s education, families’ preventive health care, and parents’ employment. The three-year program is being operated by Seedco—a private, nonprofit intermediary organization—in partnership with six community-based organizations. It is being evaluated by MDRC through a randomized control trial involving approximately 4,800 families and 11,000 children, half of whom can receive the cash incentives if they meet the required conditions, and half who have been assigned to a control group that cannot receive the incentives. This brief summarizes an MDRC report on initial findings during the program’s early operating period.

Fast Focus No. 4-2009

December 2009

The "Great Recession" and redistribution: Federal antipoverty policies
Gary Burtless

Brookings economist and IRP affiliate Gary Burtless presented a lecture at IRP on November 19, 2009, on "Recession and Redistribution: The Economy, Public Policy, and the Poor." His talk, summarized in this issue of Fast Focus, represents one presentation in IRP's continuing series on the "Reorganization of Social Policy in a Recession," an interdisciplinary seminar series that brings distinguished researchers from other institutions to the UW–Madison campus to present their work on designing and evaluating public policies that support people in the current recession and on the net effects of those policies on vulnerable (especially poor) children and families. Support for the series is provided by the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services.

Fast Focus No. 3–2009

June 2009

Measuring the "faith factor" in social service program outcomes
Jennifer L. Noyes

The Institute for Research on Poverty's working conference on "Measuring the Role of Faith in Program Outcomes" was convened to begin to address gaps in knowledge about whether and why the faith factor might improve social service program outcomes. Support for the conference was provided by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and the Lynde and Harry Bradley Foundation. Faith-based providers, current evaluators of faith-based services, and other experienced evaluators in attendance all left with a better shared understanding and an articulation of the elements of FBO service delivery that require evaluation. In this brief summary of conference outcomes, Jennifer Noyes summarizes the key evaluation challenges identified: What are faith-based services? How does context influence the role of faith? How does faith intersect with service delivery? And how does the interaction of faith and service provision affect desired outcomes? Noyes concludes by noting the opportunities and directions for additional research in this arena that may be fruitful for learning the contribution of the faith factor in social service program delivery.

Fast Focus No. 2–2009

March 2009

President Obama and antipoverty policy: What does the stimulus bill do to fight poverty, educate citizens, and improve public health?
Timothy Smeeding

IRP Director Timothy Smeeding moderated a panel discussion about the economic stimulus bill on which this issue of Fast Focus is based. Daniel R. Meyer, Professor of Social Work and IRP Affiliate, commented on the bill's cash and noncash transfer programs, indicating that the stimulus bill represents both a continuation of thirty-year trends in policies affecting low-income families (such as providing work supports over aid to nonworkers) and some nontrivial increases in existing benefit-program outlays. Sara Goldrick-Rab, Assistant Professor of Education Policy Studies and Sociology, Scholar at the Wisconsin Center for Advancement of Postsecondary Education, and IRP Affiliate, spoke about aid to education in the bill, lauding the administration's new emphasis on higher education as essential to escaping poverty, but also noting that more than half of the $100 billion earmarked for new education funding will go to keeping schools open. Pamela Herd, Assistant Professor of Public Affairs and Sociology and IRP Affiliate, talked about health and health care support, noting that about one-fifth of the stimulus is for broadly construed health and health care, about half of which is to keep the public health insurance system going, mainly through increased Medicaid funding. Herd noted that the broader context of President Obama's health care plan is two-fold: expand coverage and control costs. Andrew Reschovsky, Professor of Public Affairs and Applied Economics, IRP Affiliate, and Affiliate of the Wisconsin Center for Advancement of Postsecondary Education, presented a synopsis of how the federal stimulus bill influenced the State of Wisconsin's education budget, noting that federal stimulus funds will support poverty-related programs and special education, and that this budget has no increase in equalization aid, unlike in past years.

Fast Focus No. 1–2008

December 2008

A state of agents? Third-party governance and implications for human services and their delivery
Carolyn Heinrich

This brief concerns the increasing use of “agents of the state” (nongovernmental for-profit or nonprofit organizations) to provide and administer social service programs formerly handled by government, and it explores the implications of this practice, especially for vulnerable citizens. Third-party governance was the focus of an IRP conference held in summer 2008, and in this overview, conference organizer Carolyn Heinrich summarizes the proceedings and presents key insights from three of the conference papers that focus on social service delivery (affordable housing, foster care and family services, and mental health). The research efforts reveal that government exercises very limited oversight of agents of the state, yet the organizational structures and incentives that government establishes to promote service quality, efficiency, and effectiveness appear to weigh heavily on service outcomes. Government plays a far more vital and active role than just funding the services, even if it is not engaging directly in service provision. That role is essential for ensuring equity in access to services and improving service outcomes.