By Taylor Knopf

Between federal COVID relief funds and the $1.4 billion sign-on bonus North Carolina received for expanding Medicaid, state lawmakers were able to make significant investments in mental health services in the latest state budget.

Though state budget negotiations are done almost entirely behind the closed doors of the majority party in the General Assembly — currently the Republicans — health leaders in the House and Senate said they took care to listen to patients, families and providers while creating their mental health spending plan while also working closely with Department of Health and Human Services Secretary Kody Kinsley.

“Everybody saw that to make big changes was gonna take a lot of money,” Sen. Jim Burgin (R-Angier) said in an interview with NC Health News this week.

“And I think one of the attractions to Medicaid expansion for all of us was this once in a generation or maybe even once in a lifetime opportunity to say, ‘Mental health is a big deal,’” he said, explaining the significance of the federal sign-on bonus that came with Medicaid expansion, which lawmakers decided to use to invest in mental health services.

The result is pages of mental health policy and spending in this year’s budget document, where lawmakers committed to significant rate increases, bonuses and education for a variety of mental health workers. They set into motion big structural changes to the way behavioral health services are delivered to the most vulnerable populations across the state. And they directed hundreds of millions to support children in foster care and expand preventive mental health care and crisis care services.

‘A sense of urgency’

Burgin said he has long been committed to improving the mental health system. He demonstrated that commitment when he embarked on a listening tour with Kinsley and other legislative guests to learn about the mental health needs across the state. After more than a dozen town halls, Burgin said he saw “a different face with the same heartbreaking stories about not being able to get services. We heard that at every meeting.”

“You don’t know how bad something is until you go see it yourself,” Burgin said. “You get a sense of urgency that we have to do something.”

Rep. Donny Lambeth (R-Winston-Salem) has been dedicated to improving health care through his six terms in the state House, and he said he’s never had a better working relationship with a DHHS secretary than he does now. Lambeth described Kinsley as being an open-minded problem-solver. Burgin was also quick to praise Kinsley for the time he’s invested in helping others understand the mental health needs of the state and forming the relationships necessary to move things forward.

“We’re actually getting a lot done, but we’re having a good time doing it because we enjoy talking about it and working on it,” Burgin said. “In the next 24 months, you’re going to see some fantastic things happen in North Carolina.”

Alternatives to the emergency room 

Lambeth said that last summer he received three phone calls in one week from families with a child in a mental health crisis asking him what they should do to get help.

“Unfortunately, the only thing I could tell them is, ‘You need to go to the emergency room,’” he said. “We’ve got to get these individuals into a proper care site, not the emergency room.”

Going to the emergency room during a mental health crisis can be a traumatic experience for many, as emergency departments are not set up to treat mental health crises.

In recent years, ERs across the state have been overwhelmed by mental health patients, who often end up waiting days or weeks for an available inpatient psychiatric facility bed. Once that bed does open up, the patients are often transported under an involuntary commitment court order. They are handcuffed and driven by law enforcement officers in marked police vehicles.

Burgin said he gets similar phone calls from families with loved ones in distress. He also said the number is only increasing.

“What a shame that the entry point for mental health has become the door to the emergency room,” Burgin said. “And that’s what we’re trying to stop. There’s got to be a better entry point into mental health care.”

The expansion of Medicaid to about 600,000 low-income North Carolians who previously didn’t have health insurance is the first big step to get people into primary care offices instead of emergency rooms, Lambeth said.

“The foundation of expansion really is developing better access points, primary care —  taking care of individuals who historically have not had good access,” he said.

‘It’s primary care’

Because of a lack of psychiatrists and child psychiatrists in the state, primary care providers often find themselves out of their depth with patients who come to their offices with mental health issues. To address this, the state spending plan also includes $2 million per year in recurring dollars for the Psychiatry Access Line (NC-PAL), a partnership between DHHS and the Department of Psychiatry & Behavioral Sciences at Duke University.

“Any health care provider, usually a primary care provider or pediatrician, can pick up the phone and speak to behavioral health experts,” Kinsley said.

The budget states that required annual reports be made to state lawmakers that include the number of consultations, counties using the services and the “estimated number of avoided emergency department visits resulting from the services provided through NC-PAL.”

State lawmakers provided $5 million to advance a collaborative care model — where common mental illnesses are treated in primary care settings, rather than sending patients to another provider, often after a wait. This model of care is something DHHS has been scaling up across the state.

“Behavioral health has been thought of as a specialty-level service. It’s not. It’s primary care. Everybody needs access to it,” Kinsley said in explaining the importance of expanding this model.

The budget allocates $80 million over two years for new mobile crisis teams and for crisis and respite facilities. These are alternatives to the emergency room for people who are experiencing mental health distress. The mobile crisis units consist of specialized teams of behavioral health providers that can meet someone where they are located. Respite facilities give people who are having emotional issues the opportunity to spend time in a therapeutic environment, receiving support from behavioral health workers or peer support specialists, people with lived experience of mental illness, all outside of a hospital setting.

Kinsley said he was happy to see $20 million over two years to fund a non-law enforcement pilot program for transporting patients for voluntary and involuntary psychiatric admissions. Putting distressed mental health patients in handcuffs in the back of a police vehicle is “not trauma-informed. That is not appropriate,” Kinsley said.

This spending plan offers “more access points. There’s more prevention. There’s better crisis services and more trauma-informed services if we need to go down that path,” Kinsley said.

Workforce investments

The budget includes hundreds of millions in ongoing funding, which will increase reimbursement rates for several health care positions, including skilled nursing facility workers ($71 million in state dollars), personal care service providers ($50 million in state dollars), direct care workers for people on a state- and federally funded Medicaid program that serves people with intellectual and developmental disabilities ($55 million in state dollars).

Rates for mental health providers have not increased since 2012, and Lambeth and Burgin said they consistently hear about this issue. For years, health leaders have called for rate increases to attract and retain workers for these types of positions.

The budget includes, for example, increasing the hourly rate for direct care providers for people with disabilities who receive enhanced community services. Additionally, the budget provides $10 million in ongoing annual funding for 350 more people to receive services through the program, which makes it possible for people with disabilities to live in the community instead of a facility.

Due to the job’s time commitment and low wages, it’s become increasingly difficult for people with disabilities to keep their direct support providers who help them with simple everyday tasks — from bathing and dressing to going to appointments. Meanwhile, workforce shortages have also led to unstaffed inpatient psychiatric beds at the state’s psychiatric hospitals, thus reducing the overall number of beds available, even as people in need sit and wait in emergency departments for psychiatric beds.

“We can’t do this if we don’t have people to take care of the folks, and we’ve got hundreds of beds empty across the state because we don’t have workers,” Burgin said.

Kinsley said he applauded state lawmakers for committing continuing money to sustain these rates, instead of allocating one-time funding.

“It really unlocks a lot of potential,” he said.

The budget also includes one-time funding of $40 million over two years for sign-on and retention bonuses for employees of state mental health facilities. The spending plan includes $18 million over two years to “establish a workforce training center that would provide no-cost training to public sector behavioral health providers, and to administer grants to community colleges to enhance behavioral health workforce training programs.”

There is also a $2 million grant in the budget to pilot a “mental health in the workplace” program. Truusight Health Solutions will enter into a two-year public-private partnership in Cabarrus and Stanly counties aimed at helping employees access behavioral health services and supporting employers who are navigating the state’s complex behavioral health system.

Improving access in rural communities 

Rural communities have long lacked medical care, particularly mental health care.

“We’re desperately short of people that are highly-trained, especially psychiatrists and family practice doctors. So we put dollars aside to pay them up to $100,000 to work in tier-one or tier-two counties,” Burgin said.

The state budget includes large expansions to the N.C. Loan Repayment program — to the tune of $50 million over two years. The North Carolina Area Health Education Center programs will develop and implement plans to recruit and enroll participants, and the state’s Office of Rural Health will track related data. The loan repayment programs are specifically aimed at recruiting and retaining primary care and behavioral health providers to rural or underserved areas of the states.

And with the expansion of Medicaid, more patients with health insurance will be able to walk through the doors. Having insured patients will help financially sustain these rural health practices.

The state spending plan also includes $20 million for grants over two years to rural health care providers for start-up equipment for telehealth, which will improve access for patients with transportation or other barriers to in-person medical care.

Mental health services for children, foster care system

North Carolina’s foster care system has been struggling for years with high-profile failures that include children living in emergency rooms and sleeping on the floors of social services offices. The state health department has also had to take over some failing county operations.

“[The foster care system] is a high priority to us,” Burgin said. “We think that has got to be completely renovated, rejuvenated and reconstituted into a well-run statewide plan, where we can keep up with these kids.”

He said his goal is “limiting the number of times that they have to change places where they lay their little heads.”

The state budget includes the creation of a statewide specialty Medicaid plan for kids in foster care and their families that aims to streamline their physical and mental health care. The groups responsible for providing this care have pushed back on the statewide plan for a couple years, but state lawmakers and Kinsley have said the groups have not made enough progress toward improvement.

The state budget directs DHHS to issue requests for proposals from agencies who wish to hold the contract for the statewide foster care plan, with the new services set to begin by December 2024.

State lawmakers also instructed DHHS to form a work group of child welfare experts and agencies to identify innovative Medicaid service options to address gaps in the care of children receiving foster care services.

Additionally, the state spending plan instructs DHHS to develop a proposal for federal approval to provide more Medicaid-paid mental health services to adults with serious mental illness and to children with serious emotional issues. The goal of this waiver would be to provide more community-based services for these populations while reducing psychiatric hospitalizations and emergency room visits.

The budget provides $80 million over two years “to support families and other caregivers of children with high behavioral health or other special needs by expanding intensive supports in the community and increasing structured options for meeting the needs of these children” and “to strengthen specialized treatment options for children with complex behavioral health or other special needs.”

Diversion and treatment

The budget provides $99 million over two years for community-based, pre-arrest diversion programs and programs to help people reentering the community after incarceration. The money will fund local partnerships between law enforcement, counties and behavioral health providers, as well as community-based and detention center-based restoration programs for those with mental illness and substance use disorders.

Scattered across the budget are several provisions aimed at services for those with substance use disorders, using money from the nationwide opioid settlement funds coming into the state.

The General Assembly is given a small portion of those settlement dollars to distribute, while the majority flows directly to the counties to spend in their communities according to set guidelines. Many of those dollars are flowing to smaller organizations in lawmakers’ home districts, some which have thin track records.

The legislature also set aside nearly $11 million to make grants available on a competitive basis to each campus of the University of North Carolina system for opioid abatement research and development projects.

Meanwhile, at a time when people are dying at record numbers from drug overdoses, state lawmakers eliminated annual funding of $100,000 to the North Carolina Harm Reduction Coalition which was used to purchase overdose reversal medications.

One substance use allocation that pulls from funds outside of the opioid settlement funding is $2.3 million to DHHS for administration, about half of which to be used to create nine new positions to help administer substance use grants.

The post State officials tout ‘once in a lifetime’ investment in North Carolina’s mental health services appeared first on North Carolina Health News.

With House Republicans delaying progress on 2024 budget negotiations under an October 1, 2023 deadline, the effects of a government shutdown if an agreement is not reached could be a swift and brutal blow to rural America, according to Secretary of Agriculture Tom Vilsack.

“The extreme Republicans pushing this… represent a small minority that don’t seem to care if the government shuts down,” said Secretary of Agriculture Tom Vilsack in a Daily Yonder interview. “Farmers, ranchers, and producers all across rural America are going to feel this.”

There are 12 appropriations bills that dictate spending for federal agencies that require annual approval from Congress. Negotiations over how much the government should spend is always a lengthy process, but this year especially so, as House Republicans quarrel over how much money should be allocated to agencies like the Department of Agriculture, Interior, Justice, and more.

According to Vilsack frustration toward the group of Republicans stalling progress on this year’s budget is acute. And the drawn-out negotiations could mean spending will grind to a halt come this Sunday, October 1.

Government support payments and loan applications for farmers would be put on pause, according to Vilsack. Benefits from the Women, Infants, and Children (WIC) program could end as early as next week, and benefits from the Supplemental Nutrition Assistance Program (SNAP) would dry out at the end of October.

According to 2018 data from the Food Research and Action Center, rural Americans rely the most on SNAP benefits. Food banks would be the only other option for those who rely on these benefits, a support system not always accessible to the country’s most rural communities.

The five-year Farm Bill is set to expire on October 1. Congress is likely to extend the lifespan of the bill until the end of 2023, but Vilsack warned that progress would be slow if policymakers are also contending with a government shutdown.

“It slows [the Farm Bill] down because people aren’t there to work on it,” Vilsack said. “We’ll be focused on getting the government back open, and maintaining funding for the offices that service farmers and ranchers.” Commodity prices could skyrocket with a delayed Farm Bill, affecting food prices for consumers across the country. These are just some of the concerns at the top of policymakers’ minds as negotiations on the 2024 budget continue to stall.

Thousands of federal employees could be furloughed come Monday without pay, national forests and parks would be closed, and new homebuyers would be unable to access loans. Many publicly funded assistance programs that require annual budget approval would halt payments if their money ran out during the shutdown as well.

“It’s so unfortunate that a small handful of Republican extremists want this when no one else does,” Vilsack said.

The post USDA’s Vilsack Warns of Rural Fallout with Government Shutdown Likely appeared first on The Daily Yonder.

Cochran County, which borders New Mexico, joins a small group of other rural Texas counties that have passed these ordinances. Abortion-rights supporters say the new policies are not legal.

“Demand went up, prices went up and supply went down, and access to some of the COVID resources that food banks had disappeared,” he says. “So it’s like everything hit them simultaneously.” If House Republicans decide to shut down the government this week, the state’s already stressed food pantries will likely face a surge in […]

The post Government Shutdown Would Strain Overburdened Rural Food Shelves appeared first on Barn Raiser.

Farmworkers often struggle to access healthcare. While working, they live in remote areas, sometimes with no personal vehicle. In Colorado, nothing in the law enshrined farmworkers’ rights to quality healthcare.

Until 2021.

That year, Colorado Gov. Jared Polis signed the Agricultural Workers’ Rights bill into law in June. This law guarantees farmworkers have the right to contact “essential service providers” — health professionals, attorneys, consuls, and clergy members — during their breaks.

However, an industry group is challenging the law. The Colorado Livestock Association filed a lawsuit in June that focuses on the section of the law requiring employers to not impede farmworkers’ reasonable access to service providers during their off time. The group wants it ruled unconstitutional.

In the lawsuit, the Colorado Livestock Association requested the court declare the provision allowing key service providers access to its property violates employers’ rights to exclude people from their property.

“The State of Colorado has not paid just compensation for this (violation) nor initiated eminent domain proceedings to do so,” the organization said in court documents. This is the second time an organization tied to the state’s agricultural industry has challenged the law.

The Colorado Livestock Association did not immediately return a request for comment.

In response, a farmworker – identified as Jane Doe in court documents – and Colorado Legal Services, a nonprofit providing legal advice to low-income people in the state, filed a motion to intervene as defendants on Sept. 13.

Colorado Legal Services is receiving support and advice from a newly formed entity known as FarmSTAND, a nonprofit organization comprised of a national network of attorneys to represent communities affected by industrial agriculture. Towards Justice and Farmworker Justice are also involved in the lawsuit.

According to the organization’s press release, FarmSTAND seeks to concentrate resources — bringing lawyers and their expertise together — on certain cases that can set precedents, working in partnership with a broad base of local and national organizations.

“We try to support partners who are doing great work in this space to try to reform industrial animal agriculture and transform the food system,” said Kelsey Eberly, the FarmSTAND attorney counseling on the case.

A community with specific characteristics

An estimated 2.4 million people work on farms and ranches nationwide, according to the U.S. Department of Agriculture’s census of agriculture. This population, mostly Latino, is roughly equal to the population of Chicago. About half are undocumented.

In Colorado alone, the agricultural industry employed 19,339 workers, experiencing a 5.7% growth in direct crop production jobs in 2022, according to the Colorado Department of Labor and Employment. The farmworker community in Colorado constitutes 4.1% of the rural workforce.

Eberly emphasized the unique challenges faced by farmworkers.

“These workers are some of the most isolated and vulnerable,” she said.

Their remote residences and long and demanding work hours create significant barriers when seeking access to essential services, such as health professionals, that many other workers often take for granted.

Eberly also highlighted the importance of the existing law for farmworkers’ rights in Colorado for seasonal laborers who arrive to work on farms during the summer months and often find themselves entirely reliant on their employers for various aspects of their livelihood.

“They live at the place where they work, and they don’t have transportation necessarily, so the only way for them to get any help is for people to come to them,” she said. “That’s why this law is so important.”

Access to assistance becomes especially critical when workers have health issues, particularly given the challenges posed by the effects of climate change.

According to the National Institutes of Health, farmworkers are 35 times more likely to die from heat exposure than workers in other sectors. One of the reasons is that this demographic group has a higher incidence of diabetes, hypertension, and chronic kidney disease.

There is little legislation to protect agricultural workers in the U.S.

“This Colorado Law was so groundbreaking, and why it’s so important to protect it,” Eberly said, “so that it can be used as a model for other states.”

The post A new network of attorneys seeks to defend abuses of industrial agriculture. First up, Colorado. appeared first on Investigate Midwest.

Reading Time: 6 minutes

Story highlights

• Black infants in Wisconsin are three times more likely to die than white infants. The state has one of the highest mortality rates for Black infants in the country.
• Stress felt from poverty, lack of health care and racism can impede a baby’s growth during a pregnancy, research suggests. Addressing such societal factors may improve pregnancy outcomes.
• Boosting access to information during a pregnancy and support from doulas could also help.

This story is part of our series Unhealthy Wisconsin, which examines areas where Wisconsin falls short in well-being.

When her daughter was born weighing just 1 ½ pounds, Dr. Jasmine Zapata experienced firsthand the danger she now spends her professional life battling: Wisconsin’s stubbornly high rate of preterm birth and mortality, especially among Black babies.

Zapata works at the University of Wisconsin School of Medicine and Public Health as a pediatrician and public health researcher. For the last two years, she also has served as the state epidemiologist for maternal and child health and chronic diseases at the Wisconsin Department of Health Services (DHS).

Her second child, born prematurely at just 25 weeks of gestation, faced several life-threatening illnesses in the neonatal intensive care unit. As Zapata knows better than most, complications caused by prematurity are the leading cause of Black infant mortality in Wisconsin.

“She was almost a statistic,” Zapata said. “I was a statistic with my birth outcome … the one about college-educated Black women having higher rates of preterm birth compared to white women who don’t finish college.”

Her daughter is now 13 years old and “thriving,” but the experience still fuels her passion for combating inequities in maternal and child health.

Wisconsin has one of the highest mortality rates for Black infants in the United States. The two main causes of death within the first year of life for Black infants are low birthweight and sudden unexpected infant death, according to a 2023 DHS report.

The report calls for more parental education around safe sleeping habits (babies alone on a surface on their backs, free from soft objects and loose bedding), prioritizing breastfeeding when possible and better access to prenatal and postpartum care.

Research, including at the University of Wisconsin, has highlighted societal factors — including stress caused by poverty and racism — as major causes of negative outcomes for Black babies.  Wisconsin is home to outsized Black-white disparities across society, including in education, wealth, health, housing and the justice system.

Mortality rate remains high

In 1990, Black infants in Wisconsin were 2.7 times more likely to die within a year of birth than white infants in the first year of life, according to DHS. Three decades later, Black infants in the state are three times more likely to die than white infants.

“This isn’t new news,” said Theresa Duello, a reproductive cell and molecular biologist who researches misconceptions of race, a social construct, in genetic studies.

The overall rate at which infants die during the first year of life in Wisconsin in 1990 was 8.4 deaths per 1,000 live births. By 2021, that number dropped to 5.3 deaths per 1,000 live births, similar to the national rate.

Negative birthing outcomes for Black infants have not improved as quickly as those for white babies.

Among white infants, the rate dropped from 7.2 to 4.4 deaths per 1,000 births between 1990 and the 2019-2021 period — a 39% decrease. Among Black infants, the rate dropped from 19.7 to 13.2 deaths per 1,000 live births over the same period, a 33% drop and still triple the rate for white infants.

“I think we should reexamine how we take responsibility for this,” Duello said.

Preterm birth is top cause of infant deaths

Preterm birth, those occurring before 37 weeks of pregnancy, is the leading cause of newborn mortality.

Wisconsin’s rate of neonatal deaths due to preterm birth was 21% above the national average in 2018. That year, 15.6% of Black births were premature, compared to 9% of white births.

Low birth weight — infants less than 5 pounds, 8 ounces — and prematurity are both associated with infant mortality, Duello noted.

Low birth weight is often associated with intrauterine growth retardation (IUGR), when the fetus is smaller than expected for the number of weeks of pregnancy. Researchers hypothesize that an increase in the hormone cortisol during pregnancy may harm blood flow to the placenta, compromising access to nutrients and impairing fetal growth.

When low birth weight babies are born in consecutive generations, some may incorrectly assume the issue is genetic, Duello said. But if pregnant women in the same family face great stress over the generations, such as poverty, lack of health care and racism, they will more likely have high cortisol levels — and likely deliver a small baby. Addressing such stressors could improve pregnancy outcomes, research shows.

Stress blamed for racial disparities

Mothers of color disproportionately live in areas with fewer resources and thus may face greater stresses that increase the odds of negative birth outcomes, DHS says in a 2018 report.

“The Black-white difference in infant death is considered an inequity because its causes are systemic, avoidable and unfair,” the report says.

While poverty affects stress levels, a California-based study suggests racism can play an even bigger role in infant mortality disparities than wealth. In California, the wealthiest Black parents lost more babies on average — 437 per 100,000 births — than the poorest white parents: 350 per 100,000 births.

“We know what to do. We lack sufficient intent,” Duello said. “And that doesn’t mean there aren’t good people working really hard.”

Infant mortality in Wisconsin’s state budget

The federal American Rescue Plan Act (ARPA) and the Title V Maternal and Child Block Grant program provide key resources for reducing maternal and infant mortality rates in Wisconsin, according to DHS.

Thirty community organizations — eight of which are based in Milwaukee County — have received grants to reduce infant and maternal mortality rates in Wisconsin.

But ARPA funds are not permanent.

In his 2023-2025 budget, Wisconsin Gov. Tony Evers proposed $5.7 million over two years in grants for community organizations working to lower maternal and infant mortality. The funding would have also supported fetal and infant mortality review teams and grief and bereavement efforts.

Evers’ proposal would have helped community-based grants stretch beyond the time frame of ARPA and built on the work started with the ARPA-funded community grants, according to Elizabeth Goodsitt, a DHS spokesperson.

But the Wisconsin Legislature’s Republican-controlled Joint Committee on Finance removed the provisions along with hundreds of others before Evers ultimately signed the budget in July. The final budget allocated $222,700 per year for “reducing fetal and infant mortality and morbidity” — the same level DHS has received for more than a decade.

Doulas seen as a solution for improving pregnancy outcomes

A 2014 study found better birth outcomes for Black and white mothers who participated in Healthy Start, a community-based federal program involving home visits, health information and access to medical and community services.

Another approach is the use of doulas: support people during pregnancy, labor and birth. Hanan Jabril, a community doula and sexual and reproductive health and rights educator in Madison, said a doula’s role is to support and empower the patient to facilitate a safe pregnancy and birth.

“We don’t speak on behalf of the patient, but we can help facilitate conversations between the patient and the provider,” Jabril said.

One goal is to reduce “obstetric violence,” which refers to harm inflicted during or in relation to pregnancy, labor and the postpartum period, sometimes by providers who hold implicit biases against people of color.

One example Jabril observed: a patient who was denied pain medication in the hours after a cesarean section after a provider suspected “drug-seeking behavior” — contrary to what some of the patient’s nurses thought. Although the patient advocated for herself, the experience showed the potential harm of implicit bias and the need for doulas, Jabril said.

The presence of doulas can improve birth outcomes. Doulas have been shown to decrease cesarean sections — surgical procedures with higher risks than nonsurgical births — by anywhere from 28% to 56%, according to DONA International, the largest doula-certifying organization.

People partnered with doulas often forgo epidurals or other pain medication, and they are four times less likely to deliver a baby with a low weight, according to a 2013 study.

The price of doulas ranges widely depending on the type — for instance their availability before or after a birth. Although most insurance companies do not cover a doula’s full cost, Jabril considers them “always worth it.”

Patients in need of financial help have options. The city of Milwaukee, for instance, since 2019 has matched residents with free doulas through its Birth Outcomes Made Better program.

Some doulas-in-training or volunteer doulas are willing to work for free. Jabril provides free services.

Wisconsin DHS recently disbursed almost $1 million to four community organizations that train doulas or provide doula services. Two of those organizations — both based in Milwaukee — received more than $700,000 for doula workforce development. They include the WeRISE Community Doula Program, which provides free services.

Zapata admits her work to improve birth outcomes often is “daunting” and “discouraging,” but it’s also important.

“And it’s important for us to remember that behind all of the statistics and numbers these are real lives and real families that are forever impacted,” she said.

The nonprofit Wisconsin Watch (www.WisconsinWatch.org)  collaborates with WPR, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication. All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

Wisconsin’s Black infants have some of the country’s highest mortality rates. These solutions could help. is a post from Wisconsin Watch, a non-profit investigative news site covering Wisconsin since 2009. Please consider making a contribution to support our journalism.

Six months ago, Anthony “AJ” McKenzie, a 30-year-old cool vegetable crop and livestock farmer in North Carolina, stopped farming on his 40 acres. Last year, a drought killed at least 85% of his crop, which caused him to lose income. Usually, he’d grow his cabbage and turnip, mustard, and collard greens twice in the fall […]

The post How Black Farmers Are Navigating Climate Change With Limited Federal Support appeared first on Capital B.

When people ask how Cathy Darling Allen is doing, she no longer responds with the socially-appropriate “fine” people expect to hear, because she’s not fine.

For more than two years, Allen, who runs the elections office in northern California’s Shasta County, has spent much of her time fending off accusations that her office falsifies election results.

“I’ve actually heard people say, ‘Well, you’re cheating to get where you want so that your people will win,’” Allen said in a Daily Yonder interview. “Oh, Lord, if I only had the time for that.”

In January 2023, the Shasta County board of supervisors decided in a 3-2 vote to cancel their electronic voting system contract after mounting pressure from election deniers. The county is the center of a small metropolitan area and has a mix of rural and urban communities. It comes in at more than 112,000 registered voters and now plans to use a hand-count system.

The decision adds to the growing number of counties – rural, suburban, and urban – where election deniers have successfully urged local governments to recount election results or throw out electronic voting machines altogether.

While the movement has targeted communities of every size, civics experts say rural communities have the most to lose from the pressures of the election denial movement.

“We’re at this period that I think should be being celebrated as a sort of high point of participation in American democracy,” said Justin Grimmer, a political science professor at Stanford University who studies election denialism, in a Daily Yonder interview. But the election denial movement threatens this progress, he said.

Voter turnout in the last three federal elections broke records. The 2020 presidential election saw the highest turnout in the 21st century with 66.8% of citizens age 18 or older casting a vote, according to the U.S. Census Bureau. A series of reforms have also been passed to make election infrastructure – how votes are cast, counted, and reported – safer and more efficient.

Former President Donald Trump’s unfounded attacks on the U.S. election system and the resulting election-denial movement put these gains in jeopardy. Rural areas could be among the first to suffer from the attacks.

Rural America already has lower voter turnout rates, which some researchers argue is due to inadequate election infrastructure. One 2022 study found that voting-by-mail restrictions hurt rural voters the most because there are fewer rural polling locations than urban ones, increasing the distance a person must travel to cast a vote. Along with skepticism about electronic voting machines, election deniers have also questioned the use of mail-in ballots, even though voting by mail has been used in some form in the United States since the 1860s.

Reversing the progress that has been made to improve election infrastructure – the use of equipment that more accurately counts votes and ensuring better access to voting through absentee and mail-in ballots, for example – could set back civic participation, Grimmer said.

“If localities start acting in a reactionary way because of these election integrity groups and they decide that they’re gonna peel back some of these reforms…you could actually end up eliminating some of the transparency that has been implemented,” Grimmer said. “It may be harder to track your ballot, which could ironically make people more skeptical about the election than they were before.”

The current election denial movement began in the months leading up to the 2020 presidential election. Trump said in a speech to supporters in August of that year that “the only way we’re going to lose this election is if the election is rigged.” He voiced similar comments on Twitter.

In the weeks following the election, organized efforts began in several states to overturn the election results, claiming the elections were stolen. (In mid-August 2023, Trump was indicted in Georgia on charges that he and others illegally tried to overturn the election in the state.)

Then came January 6, 2021, when more than 2,000 people broke into the Capitol in an effort to block certification of the Electoral College results. (In early August 2023, Trump was indicted on federal charges related to those events.)

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After Trump left office, the election denial movement shifted to a core group of “influencers,” including MyPillow CEO Mike Lindell, former business-law professor David Clements, former math and science teacher Douglas Frank, and former U.S. Army Captain Seth Keshel. Over the past two-and-a-half years, these influencers have made it a full-time job traveling the country to spread the election denial movement’s primary message: elections are being stolen, and it’s the government’s fault.

In some places, this messaging has worked. According to data compiled by the Daily Yonder as of August 24, 2023, seven U.S. counties have successfully held a hand-count or plan to in future elections.

Along with Shasta County, California; Spalding County, Georgia, and Cleburne County, Arkansas, recently approved hand-counts for future elections. Nye and Esmeralda counties, Nevada, both held hand-counts for their 2022 elections, as did Tripp County, South Dakota. Lycoming County, Pennsylvania, recounted by hand the results of the 2020 presidential election in January of 2023.

Four out of the seven counties that held a hand-count or completely eliminated their electronic voting systems are nonmetropolitan, or rural.

Some voting districts within counties in Maine, Massachusetts, New Hampshire, Vermont, and Wisconsin plan to hand-count ballots in 2024, according to the nonpartisan organization Verified Voting.

But many pushes to pass hand-count policies have failed. In June of 2023, Governor Katie Hobbs of Arizona – the only state to try mandating hand-counts statewide – vetoed a bill that would have allowed any county in the state to hand-count ballots. Similar efforts at county and municipal levels have also failed.

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Although the movement’s success may be waning at the moment, some civics experts warn that election denial “is down…not out.”

Election deniers are now putting energy into grassroots organizing, a quieter version of the loud-and-proud campaigning led by Trump that occurred in the movement’s nascent days.

“They’re kind of spreading the [erroneous] word about how voting machines particularly are stealing elections, and they’re encouraging people to put in Freedom of Information Act-types of requests and at the extreme, encouraging let’s just say impolite behavior toward election officials,” said Charles H. Stewart, a professor of political science at the Massachusetts Institute of Technology, in a Daily Yonder interview. Stewart published research in early 2023 exploring the characteristics that lead people to the election denial movement.

“The thing that we’re seeing in 2020 that we didn’t see in 2016, or in 2012 or other times when these sorts of [election integrity] questions arose, is that we now have about a half-dozen of these traveling road shows,” Stewart said. Few of these “road shows” are held in major cities, according to Stewart.

An NPR analysis of grassroots election denial events between January 6, 2021, and June 30, 2022, showed that the gatherings occurred in nearly every state. The events hit major cities like Minneapolis, St. Louis, and Washington, D.C. But they tended to steer toward the suburbs, smaller metropolitan areas, and in some cases, rural counties.

In Pennsylvania, for example, the NPR database shows there were no events in the city of Pittsburgh, but four counties within the Pittsburgh metropolitan area did have events. Philadelphia had one event, and there were two in the city’s surrounding counties. Only one Pennsylvania event on the NPR list was in a nonmetropolitan, or rural, county.

These in-person events distinguish the election denial movement from other far-right conspiracies that have existed primarily online.

“The election integrity movement is distinct from something like QAnon, which was by and large an online phenomenon,” said Stanford University’s Grimmer. “Here, I think it’s reversed.”

While people are getting some of their information about election denialism online, Grimmer said, the real force of the movement comes from the in-person meetings. “Individuals are coming together, discussing the things that they think are surprising or suspicious in their local elections and then actually going out in their community and doing something,” Grimmer said.

This played out in Lycoming County, Pennsylvania, a small metropolitan area with about 114,000 residents. In January 2023 a local election denial group successfully petitioned for a recount of the 2020 presidential election. Most of the group’s organizing has been conducted in-person at various community centers around Williamsport, Pennsylvania (population 28,000), the Lycoming County seat.

Poll workers recounted nearly 60,000 ballots by hand; the difference between the electronic and manually-counted ballots came in at just a handful of votes. Election officials attributed the difference to poorly-circled ovals on the ballot that the machine could not detect.

Lycoming County’s elections director says the election denial group represents a loud minority in the community. “I think it’s easy to walk up to somebody and get them to sign almost anything,” said elections director Forrest Lehman. “In doing this hand-count, probably 4,900 out of those 5,000 people [who signed the petition] are gonna say, OK, well fine. I guess the results were correct.”

But it’s the other 100 people who are driving the movement in rural areas like Lycoming County, Lehman told the Daily Yonder.

Even after the hand-count results showed no proof of fraud in the electronically-counted ballots, the local election denial group has doubled down on their accusations, inviting election denier Sam Faddis, a retired CIA officer, to speak at their meetings. Like the election deniers touring nationally (such as Mike Lindell and Seth Keshel), Faddis has toured Pennsylvania to speak with other election denial groups.

“They allege that our vote totals were off by thousands based on these questionable statistical analyses that are being peddled not only in this state, but in a lot of places by a couple big names that keep coming up,” Lehman said.

Nearly 2,000 miles to the west of Lycoming County, a county clerk is experiencing similar accusations fueled by the election denial movement’s main talking points.

In La Plata County, Colorado, an influx of open records requests have poured in since 2020 challenging the election tools the county uses, which include Dominion Voting Systems – an electronic voting hardware and software company – and mail-in ballots. The county has relied on mail-in ballots since 1992.

“What’s happened to us is people from the outside and different organizations that don’t have anything to do with our local communities are attacking us because ‘Oh my gosh, you have Dominion or you use mail ballots and we don’t trust you,’ ” said La Plata County Clerk Tiffany Lee in a Daily Yonder interview. “That’s been really hard on us.”

Most of the open records requests use the same language provided by state and national election denial groups, Lee said.

Lee has not experienced the violent threats other election officials have received (a Maricopa County, Arizona election official received death threats through voicemail in 2021, for example), but her office is on high alert, especially as they move into the 2024 presidential election year.

And they have good reason to be.

In 2021, the U.S. Department of Justice established the Election Threats Task Force to investigate threats to election workers, which they identified as on the rise post-2020.

In the task force’s first year, more than 1,000 threats were reported, and approximately 11% of them met the requirements for federal criminal investigation, according to a press release. Of the potentially criminal threats, 58% of them were in states with post-election lawsuits, audits, and recounts.

In May 2023, the Department of Homeland Security released a national terrorism advisory bulletin that warns of a heightened domestic violence threat moving into the 2024 election year. The causes for this violence include individuals’ “perceptions of the 2024 general election cycle and legislative or judicial decisions pertaining to sociopolitical issues.” The advisory expires November 23, 2023.

The psychological toll these threats take on election workers is severe: In Colorado, 23 of the state’s 64 county clerks were new to the office last year, according to Lee. This high turnover poses another risk to the elections process.

“If we chase off election workers with this insanity, we’re going to make elections run more poorly,” said Grimmer from Stanford University. “We’ll be hemorrhaging so much experience and expertise for no reason other than the sort of falsehoods that are in people’s brains.”

As election officials gear up for local and state elections this November and a presidential election next year, county clerks are preparing to head off even more fraud accusations.

Rural county clerks hope their communities will trust them through the process.

“We’re just here to do our jobs,” Lee said. “Just like your county treasurer, your county assessor, your coroner, your surveyor; your county clerks are the same. We’re just administrators of the law.

“And I hope that rural communities across the United States understand that, that we’re just human beings doing good work for the people’s voices to be heard.”

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