State Experience and Perspectives on Reducing Out-of- Wedlock Births

Appendix:
Study State Discussion Summaries

[ Main Page of Report | Contents of Report ]

Contents

Introduction

Bonus Recipient States

Alabama

  1. Background and Introduction
  2. Discussion Topis
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PRWORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies and Community-Based Organizations
      5. Changes in the Sources of Funding
    2. Role of the Illegitimacy Bonus on Efforts to Reduce Non-marital Births

Arizona

  1. Background and Introduction
  2. Discussion Topics
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PRWORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in Sources of Funding
    2. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Massachusetts

  1. Background and Introduction
  2. General Discussion
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PWRORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in Funding Levels
    2. Role of Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Bonus Non-Recipient States

Georgia

  1. Background and Introduction
  2. Discussion Topics
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PRWORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in Sources of Funding
    2. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Maryland

  1. Background and Introduction
  2. Discussion Topics
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PRWORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in the Sources of Funding
    2. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Minnesota

  1. Background and Introduction
  2. General Discussion
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PWRORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in Funding Levels
    2. Role of Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

New York

  1. Background and Introduction
  2. Discussion Topics
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PRWORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in the Sources of Funding
    2. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Pennsylvania

  1. Background and Introduction
  2. Discussion Topics
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PRWORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in Sources of Funding
    2. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Wyoming

  1. Background and Introduction
  2. Discussion Topics
    1. General Efforts
      1. Changes in State Efforts Since the Passage of PRWORA
      2. Extent to Which Efforts Focus on Teens and/or Adults
      3. Barriers or Challenges to Program Development and Implementation
      4. Changes in Traditional Roles of State Agencies or Community-Based Organizations
      5. Changes in Sources of Funding
    2. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

References

Endnotes


Introduction

Information Collection and Contents of the Appendix

This appendix contains summaries of our discussions with representatives from TANF, health and other relevant agencies in the bonus States. During the call, Lewin staff asked call participants to describe State efforts to reduce non-marital childbearing since the passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in 1996. Participants were also asked to describe any challenges to implementation of those efforts, any changes in the roles of State agencies and community-based organizations in implementing the efforts, and any changes in the circumstances of program funding since passage of PRWORA. Finally, participants were asked about the extent to which the bonus might have influenced State efforts to reduce non-marital childbearing.

Call participants received a discussion guide prior to the call, and the headings in each summary reflect the major discussion points included in that guide. Following the initial call, we engaged in follow-up discussions with various representatives to clarify or collect additional information. In many cases, States provided written materials describing State activities. Prior to publication, we distributed the discussion summaries to respective call participants for comment.

Summaries of our discussions with bonus recipient States (Alabama, Arizona, and Massachusetts) appear first followed by summaries of our discussions with non-bonus States (Georgia, Maryland, Minnesota, New York, Pennsylvania, and Wyoming).

Program Compliance

As described more fully in the body of this report, the purpose of our discussions with officials in the nine study States was to collect general information about State efforts and experiences related to nonmarital childbearing. Our discussions were not systematic (i.e., collecting from each State structured information about a limited set of elements), nor were they intended to be. Rather, our goal was to generate rich discussions with participants that necessarily would vary by State, reflecting the range of States' approaches, experiences, and views.

This goal is important to keep in mind when reviewing the discussion summaries contained in this appendix, and in particular, when reading the discussions surrounding abstinence education activities. When asking States about their efforts related to abstinence education, we did not always specify or necessarily inquire about the funding sources associated with specific activities. For this reason, the source of funding for a particular abstinence education activity is not always clear (i.e., Section 510 of Title V, Community-Based Abstinence-Only Education planning or implementation grants, or State -only funds). The lack of specificity in this report regarding funding sources should not suggest, however, that there exists a lack of understanding or compliance within any State regarding specific program requirements. It is our assumption that each of the States is conducting all activities in accordance with all relevant federal, State, and other requirements, and nothing contained in this report should be interpreted otherwise.

Bonus Recipient States

Alabama

I. Background and Introduction

This document summarizes the major comments made by participants during a call with representatives from relevant agencies in Alabama. The call took place on November 20, 2001.

Call participants included representatives from:

II. Discussion Topics

A. General Efforts

1. Changes in State Efforts Since the Passage of PRWORA

Participants reported that during the last two and a half years the State has expanded both its abstinence education and family planning:

2. Extent to Which Efforts Focus on Teens and/or Adults

3. Barriers or Challenges to Program Development and Implementation

Participants said that Alabama has faced a number of challenges reaching the State's growing Hispanic population. For many Hispanic families, the first-generation immigrant parents are not citizens and are therefore not covered by Medicaid; as a result, linking the families to needed services is more difficult than among the Medicaid-eligible population. Language barriers within this population also inhibit service delivery.

Identifying appropriate and effective service delivery models that target adults remains a challenge. Participants said they believe that activities, policies, or programs that attempt to influence the childbearing decisions of adults are likely to be poorly received. Concern about this obstacle served as one of the motives for funding the university survey effort.

Abstinence-only education had very strong support within the State. When Alabama received its abstinence grant, the State decided to create separate funding streams for abstinence and contraception education. The abstinence education programs were developed outside the Division of Women's Health, which operates the Title X program, and grants were awarded to CBOs. This split has enabled local communities to have substantial influence over the content of local abstinence education programs.

An obstacle that they often faced was that it is challenging to get contracts through State system. Some of the contracts that are sent to the governor's office for approval get rejected or slowed down. There is no determined date for when the contracts will be approved. This presents a challenge, especially for smaller CBOs that often have other deadlines or are uncertain about when they should begin the hiring process. Contracts that have higher priorities, such as major health service contracts, are pushed through faster. Smaller contracts such as the ones that are with CBOs are less likely to be on the fast track.

4. Changes in Traditional Roles of State Agencies and Community-Based Organizations

Although TANF has increased the amount of money that is available for State programs, agency roles have not changed substantially since the adoption of PRWORA, participants said. CBO grants remain centrally controlled and originate from the same agencies as under the previous welfare system, but the State is endeavoring to give the CBOs more freedom in program design and implementation. (2) Participants believe that the availability of funding under this system has helped to encourage development of local clinic services, as well as family planning and child heath services. Of the 31 pregnancy prevention grants awarded by AUPPP in fiscal year 2002, three were awarded to develop public awareness campaigns, 10 were awarded to community health departments, three funded family resource centers, eight were awarded to CBOs, three were awarded to school systems, one was awarded to a cooperative extension, and three were awarded to boys and girls clubs.

Since the passage of PRWORA indicated participants, DHR and DPH have enjoyed increased collaboration. The TANF and Public Health agencies have good working relationships. Furthermore, the State legislature does not get involved with TANF money, and the agencies have more latitude in the way that they can spend their money.

Both agencies have engaged in a joint leadership effort to win the bonus in which the Department of Public Health delivers services, and the TANF office ensures the DPH has sufficient funding.

Because DHR is more familiar with the requirements of TANF than the Department of Health, DHR has provided technical assistance to DPH in program design. Primarily, DHR provided contractual and legal assistance, since the money was funded with federal dollars and there were guidelines on how the TANF dollars could be spent.

Collaboration efforts have been successful to some degree because the departments have complementary goals and client bases. Access to family planning can have an impact on self sufficiency by preventing unintended pregnancies. To ensure access to such services, DHR staff refer TANF clients with family planning needs to DPH. DPH staff also refer family planning clients that are in need of TANF services. The State has also co-located some services, establishing outpatient clinics in the Women, Infants and Children (WIC) program offices to provide the family planning services.

One participant State d that the infusion of TANF funding helped to integrate various units of social services. Since PRWORA, DHR and DPH have had more contact with each other at the county level. DHR is more aware of the community programs offered and will generated lists of programs to which they can refer TANF clients.

5. Changes in the Sources of Funding

Approximately $8 million dollars is being spent from the TANF funds on all the programs designed to reduce the number of non-marital births in the State. The amount of TANF funding directed toward efforts to reduce non-marital childbearing has increased since the passage of PRWORA.

B. Role of the Illegitimacy Bonus on Efforts to Reduce Non-marital Births

Alabama, which has experienced declines of 2.0%, 0.3%, and 0.3% during the respective eligible periods, has received the Illegitimacy Bonus in each of the award years (i.e., 1999, 2000 and 2001).

Participants noted that prior to winning the bonus, the State did not expend much effort evaluating bonus provisions or in designing programs with an eye toward influencing outcomes relevant to the bonus. However, after winning the bonus the first time, State officials were motivated to continue to win the bonus and studied the bonus regulations to ensure the State remained eligible to compete in subsequent years. They suddenly had the resources to fund programs community programs, something they had been discussing for years prior to receiving the bonus money. One participant thought that the reason that the Alabama keeps winning the bonus is, in part, because the State has been dedicating the bonus money to expansion and improvement of existing non-marital birth programs, which are working.

The State received $65 million from winning the bonuses. Of that, approximately 50% was spent on non-marital birth programs. Eight million dollars was given to the health department and $1.2 million per year was spent on fatherhood programs. Care coordination programs are used to broaden family planning programs and combine them with a youth development program that will focus on a range of issues including encouraging teens to stay in school.

DHR is currently working on developing several new initiatives in partnership with the Governor's Office, but participants expressed concern about the fate of those programs if the economic downturn continues and the budget surplus is depleted. Participants said that some budget analysts expect that availability of State funding is going to be a problem in three years. Some of the bonus money has been set aside as a "cushion" in the event that the economy sours, which should help ensure that the programs will be able to continue.

One participant said that some agency staff are concerned about the outcome measure being employed for bonus eligibility and competition, noting that States that begin the competition with relatively low non-marital birth rates have a bigger challenge than do other States.

Another participant noted that attributing declines to the non-marital birth ratio to any particular intervention or set of interventions might be problematic, because of the difficulty isolating those interventions from other factors influencing the ratio. The University of Alabama is helping conduct an economic impact study on the State's non-marital birth programs, determine the costs and benefits of the programs and their relative success in reducing teen pregnancies and births. They hope the study will reveal that the programs produce long-term cost savings, and that they will be able to present these findings to the State legislature.

Arizona

I. Background and Introduction

This document summarizes the major comments made by participants during a call with representatives from relevant agencies in Arizona. The call took place on November 20, 2001.

Call participants included representatives from:

II. Discussion Topics

A. General Efforts

1. Changes in State Efforts Since the Passage of PRWORA

2. Extent to Which Efforts Focus on Teens and/or Adults

Participated reported that while State programs serve both teens and adults, a greater share of the State's efforts focus on teens:

3. Barriers or Challenges to Program Development and Implementation

Participants reported that substantial debate over appropriate content for proposed "abstinence-based" education programs motivated the State legislature to fund exclusively abstinence-only programs.(4)

The State's abstinence-only programs serve primarily teens, and efforts to serve adults have been contentious, said some participants, because of the concern that residents would perceive State promotion of abstinence for adults as a personal intrusion. In any case, participants said that they have had little success in identifying effective curricula to provide non-marital birth prevention services to adults.

One participant said that the family planning program faces challenges in reaching out to some of the State's hard-to-serve populations; another participant disagreed, saying that all target populations receive adequate service.

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

According to participants, since the passage of PRWORA, the relationships between and among the State and local agencies have changed little. Prior to welfare reform, State agencies provided funding and technical assistance to the CBOs, and the CBOs engaged in service delivery. These traditional roles have remained intact.

The State did not engage in much interagency collaboration regarding the design or implementation of non-marital birth prevention activities. A few State -level offices sought assistance with program development from DHS; such assistance was limited in scope, however.

5. Changes in Sources of Funding

Participants said the passage of PRWORA provided additional funds for abstinence-only education through both the block grant and through Title V Section 510. In FY 2001, $2 million in TANF block grant funds were budgeted for abstinence-only education programs. However, the State's recent economic downturn, which has led to a shrinking State budget, has led to shifts in the sources, and possibly, amounts of funding. In FY 2002, $2 million in funds from the State tobacco settlement replaced TANF block grant funding, and participants expressed concern that this funding level might be reduced in the future. Whether, and to what extent, TANF funds will be available to support the program in 2003 is uncertain.

Arizona is one of the few States that does not contribute State funding toward family planning programs. The Governor vetoed a bill that would have directed State funds to family planning initiatives, citing revenue shortfalls.

Through a Medicaid waiver, Arizona provides family planning services for two years after pregnancy occurs to families eligible for Medicaid under the Sixth Omnibus Budget Reconciliation Act of 1986 (SOBRA). Currently, the Arizona Public Health Association is working to increase access to family planning to individuals who have not yet experienced a pregnancy.

B. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Arizona, which experienced a 1.4% decline in its illegitimacy ratio during the eligible period, was one of five States receiving the Illegitimacy Bonus in 2000.

Participants said that State agencies did not focus on winning the bonus, nor did they implement or modify policies with an eye toward competing for the bonus money. Participants from DHS said they had been surprised when Arizona received the bonus, and only after receiving the bonus did the some State officials examine the bonus's eligibility provisions.

Upon bonus receipt, several State agencies lobbied the legislature to spend the funds on increasing nonmarital birth prevention activities, but the Governor, who has line item veto authroity, chose to assign the money to a "rainy day" fund within DES instead. One participant noted that substantial support exists within several agencies to expand the nonmarital birth prevention activities, but funding is lacking. Some funds were assigned to increase support for abstinence-only education, which one participant noted serves teens almost exclusively. No additional funds to serve adults have been assigned from the bonus funds.

Massachusetts

I. Background and Introduction

This document summarizes the major comments made by participants during calls with representatives from relevant agencies in Massachusetts. The calls took place November 26, 2001 and January 18, 2002.

Call participants included representatives from:

II. General Discussion

A. General Efforts

1. Changes in State Efforts Since the Passage of PWRORA

In 1995, Massachusetts created the Transitional Aid to Families with Dependent Children (TAFDC) program, the main cash assistance program operating under TANF. It is administered through the Department of Transitional Assistance. The TAFDC program is a component of the Massachusetts' welfare reform effort (i.e., Legislative Act Chapter 5) that began in 1995, one year prior to the passage of PRWORA.

According to participants, numerous State agencies have assisted in the development, funding, and implementation of programs and policies within the Commonwealth of Massachusetts designed to influence childbearing behavior. The Department of Public Health (DPH) works with the Department of Transitional Assistance (DTA) and the State Medicaid agency in administering the State's pregnancy prevention programs and pregnancy prevention program components. The primary purpose of the State's pregnancy prevention and other efforts differ in an important way from the parallel purpose within PRWORA. While PRWORA focuses on reducing nonmarital childbearing, Massachusetts focuses on reducing the incidence of unintended childbearing. In doing so, the State hopes to improve the health and well-being of children and families by ensuring that every child born is a wanted child.

Since the passage of PRWORA, the State has expanded existing efforts to reduce unintended pregnancies and childbearing, as well as implementing a number of new efforts. We summarize below major efforts identified by participants.

Existing and/or expanded efforts include:

New efforts include:

2. Extent to Which Efforts Focus on Teens and/or Adults

Participants noted that the majority of the State's efforts focus on the teen population, in part because the very large majority (91%) of births to teen mothers are nonmarital. However, the State's family planning programs mainly serve adults, who comprise 70% of all users of State family planning services. In addition, Title X providers engage in outreach and education efforts at State and community colleges within the Commonwealth.

3. Barriers or Challenges to Program Development and Implementation

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

Participants reported that collaboration regarding both policy and implementation between DPH and DTA has increased since the passage of welfare reform.

5. Changes in Funding Levels

The availability of TANF funds, participants said, increased the funding levels of several programs, including child care, child welfare, and prevention programs such as healthy choices, healthy families, and the outreach program.

B. Role of Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Massachusetts's two-year average nonmarital birth ratio declined from 26.1% (1994-1995) to 25.7% (1996-1997), a decline of approximately 1.5%. Massachusetts received the bonus in 1999.

Participants agreed that shortly after the passage of PRWORA, the potential for receiving bonus money inspired efforts to identify strategies for winning the bonus. An inter-agency task force on welfare reform held several meetings in which options for reducing nonmarital childbearing, and their possible impact on the State's bonus eligibility, were discussed. Although decisions regarding changes to the State's pregnancy prevention policies were not motivated entirely by the potential availability of the bonus, it did provide framework for discussions.

Among its policy recommendations, the Governor's Commission on Responsible Fatherhood and Family Support advocated that "public and private agencies and communities that are already involved in pregnancy prevention step up their efforts and coordinate their resources to win [the illegitimacy] bonus award." The Commission also recommended "that the Commonwealth consider an incentive structure to reward State and local agencies that successfully integrate pregnancy prevention into their strategies."

Participants said that while the State initially considered plans for tracking progress toward the bonus, over time interest in explicit pursuit of the bonus declined. According to the agency representatives we interviewed, bonus competition is no longer mentioned in discussions regarding State pregnancy prevention programs.

Participants said that staff in a number of agencies expressed early concerns about the outcome measure employed in the calculation to determine bonus eligibility (i.e., the percent decline in the nonmarital birth ratio). Because of the State's relatively low incidence of nonmarital births, participants said that many agency staff expected that the State could not expect to experience large percentage declines in the nonmarital birth ratio, making bonus eligibility very difficult.

Finally, a number of participants said that some agency staff anticipated that changes in behaviors important for reducing the rate of nonmarital childbearing (e.g., getting married), would be very difficult to influence through public policy.

Participants said that the State legislature was pleased with winning the bonus, and that bonus money was added to the general fund and was not dedicated to nonmarital programs.

In Massachusetts, the legislature funds TANF programs prior to receiving federal grant money; federal block grant funds are allocated to the general fund to offset amounts already contributed by the State on the block grant's behalf. As a result, State agencies must persuade the legislature to provide up-front funding. While the legislature has reduced funding in other programs, one participant suggested that bonus receipt might have influenced the legislature to not reduce pregnancy prevention program benefits earlier.

A number of participants expressed frustration that the bonus money was not dedicated by the legislature to pregnancy prevention programs. This decision discouraged agencies from continued bonus pursuit, they said.

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Bonus Non- Recipient States

Georgia

I. Background and Introduction

This document summarizes the major comments made by participants during a call with representatives from relevant agencies in Georgia. The initial and subsequent calls took place between October 2001 and January 2002.

Call participants included representatives from:

II. Discussion Topics

A. General Efforts

1. Changes in State Efforts Since the Passage of PRWORA

At least one participant said that a relatively high rate of turnover in the Commissioner's office within DFCS has delayed State progress in fashioning and expanding efforts to reduce the incidence of out-of-wedlock births. Since the passage of PRWORA, existing programs have received funding boosts and have been able to expand service delivery to a larger percentage of the target populations, in part by expanding statewide pilot programs targeting teens. However, most of the resources went to expanding existing programs, rather then creating new ones.

Participants identified existing programs that have increased coverage or service delivery since welfare reform:

The Adolescent Health and Youth Development initiative, which is a collaboration among the divisions of Public Health, Family and Children Services, and other State, county and community agencies, with the goal of reducing the birth rate to young women age 15-19 by 5% per year between 1999 and 2002. The initiative has three broad objectives:

The Adolescent Health and Youth Development initiative includes four components:

A new program implemented since welfare reform is Second Chance Homes, which provides alternative living arrangements for minor parents and their children. The program is available to TANF recipients and provides 24-hour supervision and a structured environment with the goal of reducing repeat pregnancies. As of July 2002, six Second Chance Homes operate within the State.

2. Extent to Which Efforts Focus on Teens and/or Adults

Participants noted that the majority of Georgia's programs focus on the teenage population primarily for three reasons:

Efforts to serve the adult population center on influencing behavior of the welfare population through the State's family cap. (8) The TANF caseworker explains the family cap provision to each client, and each client is given a referral to a family planning clinic. TANF funding is used to provide family planning services to referred clients.

3. Barriers or Challenges to Program Development and Implementation

Participants noted the following challenges in developing programs designed to address nonmarital childbearing among adults:

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

Participants said that the level of collaboration across agencies in the State has increased since the passage of PRWORA.

5. Changes in Sources of Funding

Participants noted that prior to the implementation of welfare reform, most pregnancy prevention efforts in the State were funded through Title X. Since the passage of PRWORA, however, TANF dollars now account for substantial portions of most of the budgets of pregnancy prevention programs and components. For example, TANF funds are the only source of funding for the Second Chance Homes program, and TANF funds constitute substantial portions of the budgets of the Adolescent Health and Youth Development program, and the Early Intervention Services program. TANF funds contribute modestly to the State's family planning programs budget. In 1998, the State began using its Indigent Care Trust Fund (Medicaid funds used to compensate hospitals that disproportionately provide indigent care and to support expanding primary care programs) to help establish family planning clinics in non-traditional locations.

In short, the influx of TANF dollars coincided with a period when Georgia had the highest teen pregnancy rate in the nation. This circumstance helped produce community consensus around the goal of lowering the rate, and spurred program creation and expansion.

Participants expressed concerns about future levels of funding. Any increase in TANF rolls would likely leave less money available for ancillary programs, such as pregnancy prevention. The State cut spending on nonmarital birth programs by 2.5% for the current year, and officials project a 5% cut next year due to reduced State revenues from the economic slowdown. G-CAPP expressed concern that private funding might decline, as well, due to the recession.

B. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Participants agreed that in the first year of potential eligibility, the State engaged in efforts to monitor performance to determine whether Georgia could compete successfully for the bonus. However, agencies have generally concluded that they cannot develop interventions capable of successfully serving all women at risk for a nonmarital birth, which would be required in order to have a large impact on the bonus's outcome measure (i.e., the proportion of births that are nonmarital). As a result, while excitement about the bonus was high initially, it soon became less of a rallying point for program development.

Reasons for the decline in interest, according to participants, included:

One participant noted that occasionally DFCS staff are asked about the bonus by State legislators, but there is no general or sustained interest in it.

Maryland

I. Background and Introduction

This document summarizes the major comments made by participants during a call with representatives from relevant agencies in Maryland. Initial and follow-up calls took place between November 19, 2001 and January 31, 2002.

Call participants included representatives from:

II. Discussion Topics

A. General Efforts

1. Changes in State Efforts Since the Passage of PRWORA

According to participants, when PRWORA was passed, the Secretary of the Department of Human Resources (DHR) approached the Governor to discuss developing a statewide plan for reducing nonmarital births. As a first step in developing a coordinated State policy, the Governor convened a group of more than 80 participants from all State agencies presumed to have a role in implementing the coordinated policy. By including all potential stakeholders from the start, the effort secured the buy-in of implementing agencies, and reduced duplication of effort among agencies, which helped ensure efficient use of TANF and other funds. The group identified the landscape of potential issues, obstacles, and challenges revolving around nonmarital birth policy, and established a long-term strategy for policy development and execution.

In addition to endorsing continued support for existing programs, the group recommended the State develop and implement two additional programs: Healthy Families, a home-visitation pilot program serving men and women at risk for nonmarital childbearing; and Best Friends, a youth development program serving girls and young women enrolled in school between the fourth grade and high school senior level.

Other initiatives identified by participants include:

The State continues to support the following programs, identified by participants, which have been in existence since prior to passage of PRWORA:

2. Extent to Which Efforts Focus on Teens and/or Adults

In reviewing existing policies and programs, noted participants, the coordinating group determined that the State already offered many programs serving teens designed to prevent pregnancy. However, the group found that the State offered relatively few programs to serve either pre-teens or individuals over the age of 21. For example, the State's community-based programs target teens who are pregnant and in high school, but relatively few such programs targeted adults age twenty and older. For this reason, the group decided to focus available TANF funding on programs serving these two populations.

3. Barriers or Challenges to Program Development and Implementation

A number of Maryland's initiatives are based on nationally-recognized models, and participants noted that complying with the requirements to receive certification by the sponsoring organizations has been a challenge. The requirements range from meeting eligibility issues to generating proper documentation from caseworkers and community-based organizations (CBOs).

Participants cited as a challenge to State agencies the need to train CBOs to submit grant proposals for State funding of programs.

Developing consensus within local communities about the appropriate mix of services has been difficult. In order to help inform the discussion, the State is funding research and formal impact evaluations of several programs with the goal of identifying and promoting those efforts that are most effective in reducing the incidence of teen and nonmarital pregnancies.

Some participants said that delivering abstinence education to Hispanic communities has posed a challenge, and one participant said that the State has not made a concerted effort to overcome this barrier. Another disagreed, noting that a Maryland family planning brochure, "The Choice Is Yours," which includes abstinence as a family planning method, is distributed through the community in both English and Spanish versions. Maryland Law requires that this brochure be printed by DHMH and distributed by the Clerks of the Courts along with marriage licenses. For many years, this brochure was also distributed annually to recipients of AFDC in an effort to meet the requirement to provide family planning information.

Participants also identified rising costs of service delivery as an ongoing challenge. Nursing costs, for example, have increased substantially over the past few years as have costs to provide methods of contraception such as DepoProvera, Norplant, and the contraceptive patch, but agency budgets have not increased proportionately. Declining teen pregnancy rates also threaten funding, as the perceived need for pregnancy prevention programs declines. One participant said even though the rates seem to be declining, the need for services among underserved and uninsured populations remains high.

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

Participants reported that collaboration among State agencies and CBOs, and between State agencies, has increased since the passage of PRWORA for a number reasons:

5. Changes in the Sources of Funding

Before the establishment of the TANF block grant, Maryland had little funding to develop these types of community-based, collaborative programs. TANF provides flexibility to fund such efforts, and is more involved in community services and although funding levels have stayed relatively constant since implementation, program funding has been extended for longer periods than was typical prior to the passage of PRWORA.

B. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Participants said that while development of a plan to pursue the illegitimacy bonus was initially a primary purpose of a gathering convened by the Governor, interest in bonus pursuit dissipated relatively soon. Discussants concluded that while State programs might have an impact on the non-marital birth ratios of the teen or welfare populations, such programs did not have sufficient range or size to have a substantial impact on the State's overall non-marital birth ratio. Discussants were also skeptical about the reliability of the State's data on abortion, and in being able to demonstrate that abortion rates did not increase in the State. Maryland does not require providers to report abortions, and anecdotal evidence indicates that large numbers of women cross jurisdictions to receive abortions. (10) As a result, members re-framed their efforts and focused primarily on developing policies that would improve the health and welfare of State residents.

Another participant noted that the Governor had assigned a high priority to efforts within the State designed to reduce nonmarital births prior to passage of PRWORA because he believed it was an appropriate policy to pursue. According to this participant, the potential availability of the bonus had no impact on policy design or implementation.

One participant believed that were Maryland to win the bonus, DHR would likely not direct the funds to DHMH programs, but would instead use the funds to support its core temporary assistance and work preparation programs. This belief, held by some portion of DHMH officials, further decreased the importance of the bonus within DHMH. Another participant, however, concluded that were Maryland to win the bonus, DHR would use the funds to expand coverage of the statutory rape and the teen pregnancy prevention programs.

Minnesota

I. Background and Introduction

This document summarizes the major comments made by participants during a call with representatives from relevant agencies in Minnesota. The call took place on November 26, 2001.

Call participants included representatives from:

II. General Discussion

A. General Efforts

1. Changes in State Efforts Since the Passage of PWRORA

Participants noted that both the passage of PRWORA, which created the TANF block grant, as well as declining State welfare rolls, have enabled the State to enhance its efforts to reduce unintended or out-of-wedlock pregnancies. While the State funds activities serving both teens and adults, programs for teens predominate.

The 2000 and 2001 Legislature authorized the transfer of TANF funds from the Department of Human Services to the Department of Health. In addition to the $7 million in TANF funds appropriated in FY 2000, an additional $9 million was appropriated in FY 2001 to supplement a variety of existing State -funded programs directed at improving the health and well being of Minnesota children, youth and families.

A primary focus of the 2002 appropriations is on the third federal purpose: the prevention and reduction in the incidence of out-of-wedlock pregnancies.

Programs identified by participants as receiving TANF Funding include:

Related programs identified by participants as not receiving any TANF funds include:

2. Extent to Which Efforts Focus on Teens and/or Adults

Participants noted that while the State engages in efforts to reduce non-marital childbearing among both adults and teens, State efforts using TANF funds emphasize activities targeting unwed teens.

3. Barriers or Challenges to Program Development and Implementation

Barriers and challenges to program development and implementation cited by participants included:

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

Participants noted that since the passage of PRWORA, State agencies have engaged in increased coordination and collaboration. This has been a critical element to the success of the Family Home Visiting program.

Minnesota has traditionally looked to the community to help plan and provide services, and have worked with a number of Community-Based Organizations (CBOs) that have been strong and active partners in teen pregnancy prevention efforts.

5. Changes in Funding Levels

Funding levels for these initiatives have generally increased since the passage of TANF, but lack of availability of funds remains a substantial problem in the State, said participants.

B. Role of Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

The participants said that the potential availability of the bonus had not influenced policy design or implementation decisions.

Because bonus receipt is conditional, participants said the State made program decisions based upon estimates of non-bonus revenue only.

Participants noted that while Minnesota has a high nonmarital birth rate among minorities, the State's overall rate is very low. Officials believed further reductions in the rate, given the relatively low starting point, would be difficult.

Several participants said they would like to see the bonus discontinued; they would rather receive funds on a formula basis. They said that designing programs to affect the nonmarital birth ratio could be particularly difficult (depending on the State ). For example, States with large or particularly diverse populations are likely to pose greater challenges to efforts intended to influence childbearing behavior than would be posed by States with smaller or more homogenous populations.

New York

I. Background and Introduction

This document summarizes the major comments made by participants during a call with representatives from relevant agencies in New York. The initial call took place on January 11, 2002 with representatives from relevant agencies in New York. Subsequent follow-up calls occurred between the initial call date and mid-February.

Call participants included representatives from:

II. Discussion Topics

A. General Efforts

1. Changes in State Efforts Since the Passage of PRWORA

Since the passage of PRWORA, New York has intensified its efforts to reduce nonmarital childbearing through the creation of a number of new initiatives, and through increased funding and intensity in existing programs, reported participants:

2. Extent to Which Efforts Focus on Teens and/or Adults

While the State administers programs that serve both adults and teens, the State's primary focus is on service delivery to the teen population. State efforts to serve adults include family planning, child support enforcement, and the paternity acknowledgment program. In addition:

3. Barriers or Challenges to Program Development and Implementation

Barriers and challenges to program development and implementation cited by participants included:

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

5. Changes in the Sources of Funding

B. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

Participants said that soon after the passage of PRWORA discussions among State agencies regarding the illegitimacy bonus concluded that bonus pursuit would probably yield little benefit for the following reasons:

Participants believed that the outcome of interest for bonus receipt (i.e., change in the ratio of nonmarital births to all births in the State ) put New York at a substantial disadvantage to smaller States, which participants believed would be more likely to influence the behavior of their relatively small populations.

The value of the bonus ($25 million maximum) was relatively small compared to the State's annual TANF expenditures ($2 billion in 2000).

The State's interest in reducing long-term dependency on welfare had motivated the State to focus its efforts on teen pregnancy and childbearing rather than nonmarital childbearing among adults. Even if the State were to have a substantial impact on the State's teen birth rate, participants said State officials had concluded that the impact on the State's overall nonmarital birth ratio would likely be small.

State law prohibits the State from recording the marital status of the mother on birth certificates, and the State relies primarily on paternity acknowledgment records to categorize births as marital or nonmarital. One participant reported concerns about whether and to what extent this issue would have an impact on observed changes in New York nonmarital birth ratio.

Pennsylvania

I. Background and Introduction

This document summarizes the major comments made by participants during a number of calls with representatives from relevant agencies in Pennsylvania. The calls took place between November 28, 2001 and January 8, 2002.

Call participants included representatives from:

II. Discussion Topics

A. General Efforts

1. Changes in State Efforts Since the Passage of PRWORA

Pennsylvania does not have any specific nonmarital birth programs, said participants; however, participants noted the State administers a number of programs that target both school age and adult males and school-age and adult females that likely affect the State's nonmarital birth ratio.

2. Extent to Which Efforts Focus on Teens and/or Adults

Participants noted that Pennsylvania's programs focus on both populations, with efforts serving adults delivered mainly through components of employment preparation programs. Some teen programs, such as the abstinence education program, are intended to reach the entire teen population.

The State has identified minority teens as a special needs population because of their disproportionately high birth rates. While the State's 1999 teen birth rate (36 births per 1,000 females age 15 - 19), is well below the 1999 national average (50 births per 1,000 females age 15 - 19), the birthrates of black and Hispanic teens exceed the national average (i.e., 103 for African American teens and 83 for Hispanic teens). The State is currently developing and refining culturally-appropriate initiatives, delivered in both English and Spanish, that target these populations. For example, the State has developed a Hispanic abstinence curriculum targets the State's resident Latino population. The State is currently developing outreach efforts for the large migrant population that requires services on a seasonal basis.

3. Barriers or Challenges to Program Development and Implementation

As noted above, there are ideological tensions underlying the selection of approach(es) to achieve a shared goal of reducing nonmarital births. In addressing the tension concerning the implementation of family planning and education in schools, said participants, the Departments of Public Welfare and the Department of Health have:

Service integration has also posed challenges for many agencies, said participants. For example:

One participant said that lack of funding is the biggest barrier the State faces in implementing new programs to provide health care services to all members of targeted populations.

One participant reported that some residents are reluctant to seek out services because of the stigma of accepting government support. Residents in the State's rural areas disproportionately hold this perception. About 31% of the State is rural, (19) and some portion of each of the State's 66 counties (except Philadelphia County) is designated rural, making it expensive to target and serve effectively the entire rural population.

One participant said that providing services to State residents with disabilities is a particular challenge because of the population's relatively large size and broad diversity of underlying impairments. This diversity requires that the State develop unique outreach and service programs for each type of impairment (e.g., providing materials in Braille to individuals with hearing impairments while providing cognitively-appropriate materials for people with mental retardation). Doing so would require access to funding and knowledge of program models that the State currently does not possess.

A number of participants said that developing a consensus regarding content and means of service delivery of abstinence education programs continues to challenge the State. The Department of Health has received funding requests for 800 abstinence education programs across the State, each proposing unique content. While most communities are supportive of abstinence education, many are reluctant to implement programs without learning more about program effectiveness. The Department of Health has substantially increased its efforts in providing technical assistance to such communities as they identify, select, and implement local abstinence education programs.

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

Pennsylvania has a bifurcated approach in funding community-based organizations (CBOs), said one participant. One policy approach is to identify local programs that work well and fund them. A second approach is to convince communities to adopt existing and proven programs that have been developed at the State level. A number of participants believe that this second policy produces better outcomes, and results in increased client access to programs. However, the first approach enables State agencies to support smaller, more individualized programs that are in better touch with the needs of specific communities. The pursuit of both approaches is not new under TANF, but has been expanded through access to increased funding .

Participants also note that the level of collaboration between the Departments of Public Welfare and Health has increased since the passage of PRWORA because of the substantial increase in TANF funds that flow from DPW to DPH.

The roles of Department of Public Welfare (DPW) staff have changed substantially since AFDC, when caseworkers primarily determined eligibility. Under TANF, the caseworkers not only determine eligibility, but they now engage in numerous work support activities, such as emphasizing work requirements to clients, linking clients to needed services, and taking more active roles in removing obstacles to work. Some local offices provide information to clients about pregnancy prevention as a part of "life skills" training, but such efforts vary considerably in content and degree of effort across localities. To support changes in DPW staff roles, State agencies have increased collaboration.

For example, the Departments of Labor, Health and Education actively engage each other much more frequently than before, especially regarding information sharing and identifying service delivery options. The Governor has established a policy office in every department to help coordinate activities and programs among departments. Office staff are able to serve as knowledgeable liaisons between staff, and they help ensure that activities and efforts remain consistent with over-arching policy intent.

5. Changes in Sources of Funding

Under TANF, the level of funding available for nonmarital birth prevention activities has increased relative to funding available under the previous welfare program. Participants said that in addition to the increase in funding available through TANF, other sources have also contributed to the increase in funding, including funding from the Department of Health, The Department of Education, and the federal-State Vocation Rehabilitation program.

B. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

The participants said that the availability of the bonus had not affected program design or implementation choices.

While the State was aware of the availability of the bonus, the State decided to focus its early efforts under welfare reform on providing short-term assistance and moving families from welfare to work, as stipulated by the first two purposes of the TANF block grant program identified within PRWORA. (20)

Pennsylvania's Act 35, the State's welfare-to-work law passed in 1996, emphasizes work preparation consistent with these goals. More recently, the State has expanded its efforts to reduce nonmarital births and promote two-parent families, consistent with the third and fourth purposes of TANF.

Several participants said they think the bonus eligibility criteria were problematic because they required the State to compete against all other States, some of which might begin with comparative advantages. This made the bonus a "moving target," as other States implemented additional programs. Participants suggested that having States compete only against their own historic rates, and not against the performance of other States, would have been more appropriate.

Wyoming

I. Background and Introduction

This document summarizes the major comments made by participants during a call with representatives from relevant agencies in Wyoming. The call took place on November 19, 2001.

Call participants included representatives from:

II. Discussion Topics

A. General Efforts

1. Changes in State Efforts Since the Passage of PRWORA

Following the passage of PRWORA, State agencies used the existing Unintended Pregnancy Prevention Task Force as a mechanism for increasing relevant prevention efforts, said participants. Following deliberation, said the participants, the task force, which included representatives from both State agencies and community-based organizations (CBOs), determined that the State would engage in the following new efforts: (21)

The task force also recommended the continuation of the State's home visiting program:

The Best Beginnings for Wyoming Babies effort, a component of the Home Visiting program, provides perinatal carethat extends over the first two years of a child's life, with the goal of protecting or improving both maternal and infant health.

2. Extent to Which Efforts Focus on Teens and/or Adults

Wyoming's efforts to decrease unintended pregnancy include programs focused both on adults and teens, reported participants:

3. Barriers or Challenges to Program Development and Implementation

One participant noted that a key challenge in designing and implementing programs was keeping a diverse group of interested people focused on the common goal--reducing the nonmarital birth rate.

For example, family planning advocates and social conservatives have different agendas, which can distract from focusing on outcomes. In order to keep both groups focused on the goal of reducing births, DFS recognized the task force facilitator would need to be skilled and unbiased. The selected task force chair is an executive director from a CBO with a public health background. This has worked well, because the chair is not perceived as politically biased.

Participants also said that a critical factor in building consensus was preventing highly polarized positions from dominating the agenda, which has encouraged willingness among participants to put aside ideological differences to reach the common goal.

A participant noted that Wyoming has one of the highest low-birth-weight rates in the country, partially attributable to unintended pregnancy. While health care staff wants to deliver this message, they point out that this message is very difficult to deliver because many adults believe the State should not interfere in their personal lives.

Another participant said that identifying effective yet acceptable program models has been a challenge, in part because providing sexual education in schools can be problematic in a conservative State.

One participant cited inadequate funding as a challenge, noting that the State legislature funded other TANF programs more generously than nonmarital birth projects. Participants are interested in securing more community-based financial support, in order to decrease reliance on TANF funds. The State currently operates one program solely with community money, but typically it is difficult to achieve funding levels high enough to significantly reduce reliance on TANF funding. Although the State launched eight projects that were to be transitioned from TANF money to community funding, only Gillette, Wyoming has been able to continue their unintended pregnancy program without the assistance of federal money.

Through the Unintended Pregnancy Prevention Task Force, the State provided grants to support local pregnancy prevention efforts. However, participants said the efforts weren't particularly effective because of lack of interest and participation at the local level.

Finally, lack of across-agency communication among staff in separate agencies providing services to common clients has hampered local efforts. The statewide meetings were well-received by agency staff because it enabled them to meet and interact with staff that normally would have little contact with each other. Staff are interested in continuing to participate in these large meetings, which they believe contributes to better State -level planning, and increased quality in service delivery.

4. Changes in Traditional Roles of State Agencies or Community-Based Organizations

CBOs are playing a larger role in service delivery since the passage of welfare reform, reported participants. Because much of Wyoming's population is thinly distributed in the State's large rural areas, CBOs have typically played a role in service delivery, providing services in areas State agencies do not easily reach. Since the passage of PRWORA, CBOs have, in many cases, taken on additional service provision. DFS believes CBO service delivery is advantageous for two reasons:

Some of the disadvantages to partnerships with CBOs include:

5. Changes in Sources of Funding

Welfare reform has not resulted in a significant change in the level of TANF funding for projects related to preventing nonmarital births, said participants.

B. Role of the Illegitimacy Bonus on Efforts to Reduce Nonmarital Births

One participant said the availability of the bonus had had no effect on State decisions regarding design or implementation of nonmarital births programs. Rather than reviewing existing programs to determine probable impact on populations specified by the bonus criteria, the State has pursued programs consistent with its own priorities regarding non-marital childbearing and unintended pregnancy.

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References

References Child Trends (2001). Facts at a Glance. Washington, DC: Child Trends.

Division of Family and Children Services (2001). Georgia's Temporary Assistance for Needy Families State Plan (Atlanta, GA: Department of Human Resources). December.

Garfinkel, Irwin; Sara McLanahan; Daniel Meyer; and Judith Seltzer (1998). Fathers Under Fire: The Revolution in Child Support Enforcement (Working Paper #98-28). Princeton, NJ: Center for Research on Child Wellbeing.

Maternal and Child Health Needs Assessment: Issue Paper (undated). Document provided by the Department of Family Services (Cheyenne, WY)

Purpose of the Abstinence Education Project (undated). One-page summary provided by the Department of Family Services (Cheyenne, WY).

Task Force on Out of Wedlock Pregnancies and Poverty (2001). Renewing Parterships in the 21st Century: Final Report to Governor George F. Pataki from the Task Force on Out of Wedlock Pregnancies and Poverty. Albany, NY: Task Force on Out of Wedlock Pregnancies and Poverty (2001).

Unintended Pregnancy Prevention Task Force (2001). Abstinence-Only Education Resources Available (News Release) (Laramie, WY).

Unintended Pregnancy Prevention Task Force (undated), Intendedness Matters. Document provided by the Department of Family Services (Cheyenne, WY).

Division of Family and Local Health (2000). Maternal and Child Health Services Title V Block Grant Program New York State 2001 Needs Assessment and Application and 1999 Annual Report. Department of Health: Albany, New York. July 19.

Endnotes

1.  The home visitation programs are based on models designed by David Olds.

2.  The Aid to Families with Dependent Children (AFDC) program, which was replaced with the TANF program in 1996.

3.  The home visitation program is based on models developed by David Olds.

4.  One official conveyed that communities, residents, agency staff, and elected officials engaged in lengthy debates regarding program design, which hinged on how "abstinence-based " and "abstinence-only " programs were defined. For example, some argued that abstinence-based education should teach abstinence as well as proper and effective use of birth control, while abstinence-only education should teach abstinence as well as the risks associated with birth control use. Others disagreed, offering alternative definitions. The State did not develop a consensus.

5.  Approximately 90% of all births to Massachusetts teens are nonmarital (Child Trends, 2001).

6.  The Teen Living program and similar programs in other States are identified in PRWORA as "Second Chance Homes."

7.  Sexually Transmitted Diseases/Acquired Immunodeficiency Syndrome.

8.  Under Georgia's family cap, the amount of a family's cash assistance grant does not increase for the addition to the family of a child conceived while the parent was receiving TANF. This provision applies only to families receiving cash assistance for ten or more months, and the provision does not apply to a child born as a result of a verifiable rape or incest (Division of Family Services, 2001).

9.  Special Projects of Regional and National Significance

10.  Maryland borders both the District of Columbia and the Commonwealth of Virginia.

11.  This program is modeled after the California ENABL program.

12.  The primary Title X grantee is Planned Parenthood of Minnesota/South Dakota.

13.  This outcome should not be interpreted as a measure of program impact because the program has not been formally evaluated.

14.  Participants noted that the State's efforts to increase child support enforcement have a basis in research finding that increased child support enforcement efforts are associated with declines in nonmarital childbearing. (See Garfinkel et al., 1998 for a brief review of the literature.)

15.  This program was recognized with an award from the John F. Kennedy School of Government at Harvard University.

16.  According to one New York official, the Governor spent more time raising awareness and promoting the State's child support enforcement policies than he spent on any other welfare-related issue.

17.  Information on the source(s) of funding for the State's abstinence education and media campaigns was not available.

18.  While the participants interviewed noted various challenges to program implementation, this does not imply that the State or any of its agencies failed to meet applicable program requirements.

19.  Based on data from the 1990 Census.

20.  The four purposes of the TANF block grant, as identified within PRWORA are: (1) to "provide assistance to needy families so that children may be cared for in their own homes or in the homes of relatives;" (2) to "end the dependence of needy parents on government benefits by promoting job preparation, work, and marriage;" (3) to "prevent and reduce the incidence of out-of-wedlock pregnancies and establish annual numerical goals for preventing and reducing the incidence of these pregnancies;" and (4) to "encourage the formation and maintenance of two-parent families."

21.  Task Force membership includes representatives from the Department of Health, the Department of Education, the Department of Family Services, the Wyoming Health Council, the Wyoming Community Coalition for Health Education, the State Legislature, the Life Choice Pregnancy Center, the Wyoming Parent Teacher Association, the Casper Caring Center, and the Wyoming Public Health Association. The task force meets quarterly.

22.  This program is modeled after the "Sex Can Wait" program developed in Michigan.

23.  The initiatives were sponsored for a year, and during that time the teen birth rate declined 25%. However, participants believe the initiatives were too limited to be the key cause of the decline.

24.  This program is based on the model developed by David Olds.

25.  The Department of Health previously enjoyed a collaborative relationship with DFS, which continues.


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