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Local health departments (LHDs) are under increasing pressure to improve performance with limited resources. While research has found that financial resources may be associated with better health outcomes, there are some LHDs that maintain exceptional performance, even with limited budgets. Our interest was identifying LHDs that positively deviate in MCH outcomes compared with their peers while taking into account local context including geography and finances. We found that our method for identifying positive deviants was effective, and that LHD expenditures may not be linked to MCH outcomes. The next step in our work is to conduct in-depth analysis with positive deviants to understand the practices they use to achieve exceptional health outcomes. Section 317 of the Public Health Services Act is a federal program that provides funds for the purchase of vaccines. These annual Congressional allocations fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act requires first dollar coverage of immunizations and other preventive care, allowing a reduction in federal funding for vaccine purchase and a reallocation of funds to other uses such as infrastructure development. In fiscal year 2013, Section 317 rules redefined the population eligible for immunization with Section 317 purchased vaccines. In Tennessee, the response was a policy change that redefined the population who would receive immunizations at health departments.

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The demographics of the traditional American family are changing. More couples are electing to become domestic partners and remain unmarried; domestic partners include same-sex as well as opposite-sex relationships. Understanding the environment within which employers offer domestic partner benefits (DPBs) is essential. DPBs are an issue of marital status as benefits proposed to married employees differ slightly from those offered, if at all, to domestic partners. Our purpose is not only to provide a broad landscape of the barriers surrounding the offering of DPBs from a human resource perspective, but also some of the advantages of doing so.

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