Assessing public support for social policy in times of crisis: evidence from the Child Tax Credit during the COVID-19 era in the United States

The 2021 American Rescue Plan included the temporary expansion of the Child Tax Credit (CTC)-the largest individual income tax credit program in the United States-for most families with children. In the context of the COVID-19 pandemic, how did the public perceive this social policy benefit for families, especially in relation to other traditional social programs? By focusing on the CTC, an understudied policy area, and presenting original survey data, this paper first shows that, while the majority of respondents favored the CTC, levels of support for these benefits were lower than support for other social programs. Second, the paper suggests that, compared to older people and people with disabilities, Americans view families as part of the "undeserving" population. Third, by presenting panel data, we show that there is no change in levels of CTC support even among recipients of these benefits. Overall, these findings shed light on important challenges to the development and implementation of family policy in the USA, as well as the possibility of recalibrating the US liberal welfare state.

Clinical and Sociodemographic Factors Associated with Telemedicine Engagement in an Urban Community Health Center Cohort During the COVID-19 Pandemic.

Objective: To examine chronic diseases, clinical factors, and sociodemographic characteristics associated with telemedicine utilization among a safety-net population. Materials and Methods: We conducted a retrospective cohort study of adults seeking care in an urban, multisite community health center in the Northeast United States. We included adults with ≥1 outpatient in-person visit during the pre-COVID-19 period (March 1, 2019-February 29, 2020) and ≥1 outpatient visit (in-person or telemedicine) during the COVID-19 period (March 1, 2020-February 29, 2021). Multivariable logistic regression models estimated associations between clinical and sociodemographic factors and telemedicine use, classified as "any" (≥1 visit) and "high" (≥3 visits). Results: Among 5,793 patients who met inclusion criteria, 4,687 (80.9%) had any (≥1) telemedicine visit and 1,053 (18.2%) had high (≥3) telemedicine visits during the COVID-19 period. Older age and Medicare coverage were associated with having any telemedicine use. Older and White patients were more likely to have high telemedicine use. Uninsured patients were less likely to have high telemedicine use. Patients with increased health care utilization in the pre-COVID-19 period and those with hypertension, diabetes, substance use disorders, and depression were more likely to have high telemedicine engagement. Discussion: Chronic conditions, older patients, and White patients compared with Latinx patients, were associated with high telemedicine engagement after adjusting for prior health care utilization. Conclusion: Equity-focused approaches to telemedicine clinical strategies are needed for safety-net populations. Community health centers can adopt disease-specific telemedicine strategies with high patient engagement.

Changes in Acute ED Visits by Race/Ethnicity During the Early COVID-19 Pandemic.

Emergency department (ED) visits for conditions unrelated to the Coronavirus Disease 2019 (COVID-19) pandemic decreased during the early pandemic, raising concerns about critically ill patients forgoing care and increasing their risk of adverse outcomes. It is unclear if Hispanic and Black adults, who have a high prevalence of chronic conditions, sought medical assistance for acute emergencies during this time. This study used 2018-2020 ED visit data from the largest safety net hospital in Los Angeles County to estimate ED visit differences for cardiac emergencies, diabetic complications, and strokes, during the first societal lockdown among Black and Hispanic patients using time series analyses. Emergency department visits were lower than the expected levels during the first societal lockdown. However, after the lockdown ended, Black patients experienced a rebound in ED visits while visits for Hispanics remained depressed. Future research could identify barriers Hispanics experienced that contributed to prolonged ED avoidance.

Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The COVID-19 pandemic prompted rapid federal, state, and local government policymaking to buffer families from the health and economic harms of the pandemic. However, there has been little attention to families' perceptions of whether the pandemic safety net policy response was adequate, and what is needed to alleviate lasting effects on family well-being. This study examines the experiences and challenges of families with low incomes caring for young children during the pandemic. METHODS: Semi-structured qualitative interviews conducted from August 2020 to January 2021 with 34 parents of young children in California were analyzed using thematic analysis. RESULTS: We identified three key themes related to parents' experiences during the pandemic: (1) positive experiences with government support programs, (2) challenging experiences with government support programs, and (3) distress resulting from insufficient support for childcare disruptions. Participants reported that program expansions helped alleviate food insecurity, and those attending community colleges reported accessing a range of supports through supportive counselors. However, many reported gaps in support for childcare and distance learning, pre-existing housing instability, and parenting stressors. With insufficient supports, additional childcare and education workloads resulted in stress and exhaustion, guilt about competing demands, and stagnation of longer-term goals for economic and educational advancement. CONCLUSIONS: Families of young children, already facing housing and economic insecurity prior to the pandemic, experienced parental burnout. To support family well-being, participants endorsed policies to remove housing barriers, and expand childcare options to mitigate job loss and competing demands on parents. Policy responses that either alleviate stressors or bolster supports have the potential to prevent distress catalyzed by future disasters or the more common destabilizing experiences of economic insecurity.

Why Social Justice is the Most Effective Means of Disaster Impact Mitigation: Lessons from the Pandemic

The COVID-19 pandemic has shown that the impact of a systemic crisis depends very much on the prevailing level of inequality in the society concerned. This paper shows how the affordability of food was reduced dramatically for millions of people due to income loss in the wake of the pandemic, and the consequences this had. An analysis of the political economy of crisis then illustrates how economic inequality acts as a massive amplifier of disaster impacts on disadvantaged individuals and populations. Environmental degradation, across a broad spectrum from climate change to biodiversity loss, acts similarly as an impact amplifier in this and most other crises. Economically disadvantaged people are more immediately exposed to the impact of ecological degradation or may be forced to disregard the need for nature protection, which means the two factors are also mutually reinforcing. Inequality literally kills people, the more so in this century of worsening multidimensional crises. The paper argues that inequality on this scale is not just immoral but undermines human security, even for relatively privileged population groups, as well as threatening the stability of international relations. Addressing inequality, and especially inequitable policies in the food producing rural sector which acted as a major safety net for the poor during lockdowns, is thus the best pathway to mitigate future crises and their impact on food security.

Government Responses to COVID-19 and Their Implications on Food Security in Indonesia

COVID-19 has triggered unprecedented movement restrictions measure and disrupted to the lives, economic and social, around the world. Indonesia continues to be severely affected by COVID-19. Pandemic inevitably threatens food security particularly for poor and most vulnerable groups. The poor and most vulnerable groups including lower income workers and informal sectors have less protection than formal sectors. In addition, increasing of unemployment has lowered the purchasing power and may threaten to access to food. To anticipate and mitigate the emerging global food crises predicted by the Food and Agricultural Organization (FAO) of the United Nations as result of COVID-19. There are two keys priority policy taken by government, (1) social safety nets program to reduce the economic burden of the low income society during the pandemic and (2) food estate program to strengthening government food reserves at local level with mega food estate project outside Java started in October 2020. These two programs are not without controversies and critics. This chapter examines COVID-19 and its implications on food security in Indonesia. We examine government response and challenges in strengthening food security in times of COVID-19 and its implications on the achievements of the UN Sustainable Development Goals (SDGs) 1 and 2 zero poverty and hunger in Indonesia. This study uses literature review and published public materials to collect and analyze the data. We conclude that targeted social safety protection remains a critical policy in times of pandemic. In the implementation, it needs to be improved particularly on data of beneficiaries through one data policy to address food insecurity toward poor and vulnerable groups. Investing in a sustainable future forms a pillar of the COVID-19 response. Priority to strengthen resilience of the local food system and facilitate food production at local level with ensuring smallholders have financial support and minimizing the impact to the environment is critical rather than mega project with causing more land tenure conflicts and environmental degradation. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer 2022.

Shift in Prehospital Mode of Transportation for Trauma Patients During the COVID-19 Pandemic.

INTRODUCTION: Since the start of the COVID-19 pandemic, we experienced alterations to modes of transportation among trauma patients suffering penetrating injuries. Historically, a small percentage of our penetrating trauma patients use private means of prehospital transportation. Our hypothesis was that the use of private transportation among trauma patients increased during the COVID-19 pandemic and was associated with better outcomes. METHODS: We retrospectively reviewed all adult trauma patients (January 1, 2017 to March 19, 2021), using the date of the shelter-in-place ordinance (March 19, 2020) to separate trauma patients into prepandemic and pandemic patient groups. Patient demographics, mechanism of injury, mode of prehospital transportation, and variables such as initial Injury Severity Score, Intensive Care Unit (ICU) admission, ICU length of stay, mechanical ventilator days, and mortality were recorded. RESULTS: We identified 11,919 adult trauma patients, 9017 (75.7%) in the prepandemic group and 2902 (24.3%) in the pandemic group. The number of patients using private prehospital transportation also increased (from 2.4% to 6.7%, P < 0.001). Between the prepandemic and pandemic private transportation cohorts, there were reductions in mean Injury Severity Score (from 8.1 ± 10.4 to 5.3 ± 6.6: P = 0.02), ICU admission rates (from 15% to 2.4%: P < 0.001), and hospital length of stay (from 4.0 ± 5.3 to 2.3 ± 1.9: P = 0.02). However, there was no difference in mortality (4.1% and 2.0%, P = 0.221). CONCLUSIONS: We found that there was a significant shift in prehospital transportation among trauma patients toward private transportation after the shelter-in-place order. However, this did not coincide with a change in mortality despite a downward trend. This phenomenon could help direct future policy and protocols in trauma systems when battling major public health emergencies.

Exploring HPV vaccination policy and payer strategies for opportunities to improve uptake in safety-net settings.

Introduction: We explored priorities and perspectives on health policy and payer strategies for improving HPV vaccination rates in safety-net settings in the United States. Methods: We conducted qualitative interviews with policy and payer representatives in the greater Los Angeles region and state of New Jersey between December 2020 and January 2022. Practice Change Model domains guided data collection, thematic analysis, and interpretation. Results: Five themes emerged from interviews with 11 policy and 8 payer participants, including: (1) payer representatives not prioritizing HPV vaccination specifically in incentive-driven clinic metrics; (2) policy representatives noting region-specific HPV vaccine policy options; (3) inconsistent motivation across policy/payer groups to improve HPV vaccination; (4) targeting of HPV vaccination in quality improvement initiatives suggested across policy/payer groups; and (5) COVID-19 pandemic viewed as both barrier and opportunity for HPV vaccination improvement across policy/payer groups. Discussion: Our findings indicate opportunities for incorporating policy and payer perspectives into HPV vaccine improvement processes. We identified a need to translate effective policy and payer strategies, such as pay-for-performance programs, to improve HPV vaccination within safety-net settings. COVID-19 vaccination strategies and community efforts create potential policy windows for expanding HPV vaccine awareness and access.

No Calm Before the Storm: Low-Income Latina Immigrant and Citizen Mothers Before and After COVID-19

Government pandemic provisions occurred alongside a safety net that excludes or dissuades Latina mothers from participation. These families are also disproportionately exposed to punitive immigration policies and rhetoric that may shape their views on such provisions and, in turn, influence their post-pandemic well-being. To understand these complexities, we draw on interviews before and after COVID-19 with thirty-eight Latina immigrant and citizen mothers, most of whom are undocumented (N = 29). We find that pre-pandemic distrust of public institutions and the safety net was common, increased after COVID-19, and negatively affected undocumented respondents' post-pandemic circumstances relative to that of citizen mothers. Findings suggest that safety net expansion on its own will not offset pandemic effects for these families without addressing exclusion from public benefits and alienation from and distrust of government.

COVID-19 Mortality by Demographics in a Brooklyn Hospital

Previous publications have shown worse COVID-19 outcomes in African American and LatinX patients. We are sharing the experience of a 750-bed tertiary safety net hospital in Brooklyn, NY. Copyright © Wolters Kluwer Health, Inc. All rights reserved.

Suffering, the Safety Net, and Disparities During COVID-19

The economic and public health crisis caused by COVID-19 was devastating and disproportionately hurt Blacks and Hispanics and some other groups. Unemployment rates and other measures of material hardship were higher and increased more during the crisis among Blacks and Hispanics than among non-Hispanic Whites. Congress authorized a historic policy response, incorporating both targeted and universal supports, and expanding both the level and duration of benefits. This response yielded the remarkable result of an estimated decline in the Supplemental Poverty Measure between 2019 and 2020. We study administrative data to investigate the impact of the Supplemental Nutrition Assistance Program (SNAP) during the crisis. We find that participation in SNAP increased more in counties that experienced a larger employment shock. By contrast, the increase in total SNAP benefits was inversely related to the employment shock. The SNAP benefit increases were less generous to Black and Hispanic SNAP participants than to White.

Use of Interactive Texting Is Associated With Higher Odds of Continued WIC Participation During the COVID-19 Pandemic.

BACKGROUND: In Los Angeles County (LAC), California, the demand for Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services increased during the COVID-19 pandemic, concurrent with the shift to fully remote WIC service delivery in March 2020. Technologies for facilitating remote services were critical for accommodating increases in participation during the COVID-19 pandemic. OBJECTIVE: The objective of this study was to quantify patterns of remote-service utilization and to determine whether use of remote services (phone, interactive texting, e-mail, online education, video appointments) was associated with higher rates of recertification among WIC participants early in the COVID-19 pandemic. DESIGN: Cross-sectional survey with administrative data for follow-up PARTICIPANTS AND SETTING: This study used data from the 2020 LAC WIC Survey and WIC administrative data to evaluate remote service utilization across LAC WIC agencies (unweighted n = 3,510; weighted n = 3,540). MAIN OUTCOME MEASURES: Recertification on WIC, determined by the issuance of a food package in the first 2 months after the end-date of the prior certification period. STATISTICAL ANALYSIS: Survey data were merged to WIC administrative data to determine whether participants completed a recertification; the association of utilization of each remote service with the odds of recertification among WIC-participating children 0 to 3 years of age was assessed with multivariable logistic regression. RESULTS: Most survey respondents reported using phone appointments (95.5%), interactive texting (77.3%), e-mail (60.1%), and online education (71.2%) to access WIC services during 2020, and over 82% of children successfully recertified. Interactive texting utilization was associated with 27% higher recertification odds (95% confidence interval, 1%-59%); associations between all other remote services and odds of recertification were not statistically significant. CONCLUSIONS: These results suggest that WIC investment in interactive texting technological infrastructure, and appropriate staff training, can help local WIC agencies successfully reach and provide high-quality services to WIC participants.

Social Service Providers' Perceptions of Older Adults' Food Access During COVID-19.

The COVID-19 pandemic exacerbated risk factors for food insecurity among older adults, while also altering how government agencies and social service organizations could serve this population given their disproportionate vulnerability to the virus. The current study sought to understand social service providers' perspectives about how low-income community-dwelling older adults' access to food and related resources changed during the COVID pandemic. Data were collected via in-depth interviews with 22 social service providers from Oregon-based public and private social service agencies. Responses indicated that changes to older adults' food access during the pandemic stemmed from increases in public benefit amounts and social distancing guidelines. Participants indicated that temporary increases in SNAP allotments supported older adults' food security. Additionally, social distancing guidelines disrupted usual ways of procuring food, such as going to grocery stores, obtaining food with the assistance of family or neighbors, receiving deliveries from social programs, and visiting congregate meal sites. Food assistance programs changed their operations to reduce in-person interaction and increase the use of technology. When investigating older adults' food access, future research should consider adults' experiences of and barriers to SNAP receipt, social support from social networks and safety net programs, and technology access and knowledge.

Social service providers offer a unique perspective on older adults' food access.Interviews with providers documented older adult food access during COVID.Expanded federal assistance and social distancing shaped seniors' food access.Food access may vary by program eligibility, social support, and technology access.

At the intersection of trust and mistrust: A qualitative analysis of motivators and barriers to research participation at a safety-net hospital.

INTRODUCTION: The underrepresentation of Black, Indigenous, and People of Color (BIPOC) individuals in healthcare research limits generalizability and contributes to healthcare inequities. Existing barriers and attitudes toward research participation must be addressed to increase the representation of safety net and other underserved populations. METHODS: We conducted semi-structured qualitative interviews with patients at an urban safety net hospital, focusing on facilitators, barriers, motivators, and preferences for research participation. We conducted direct content analysis guided by an implementation framework and used rapid analysis methods to generate final themes. RESULTS: We completed 38 interviews and identified six major themes related to preferences for engagement in research participation: (1) wide variation in research recruitment preferences; (2) logistical complexity negatively impacts willingness to participate; (3) risk contributes to hesitation toward research participation; (4) personal/community benefit, interest in study topic, and compensation serve as motivators for research participation; (5) continued participation despite reported shortcomings of informed consent process; and (6) mistrust could be overcome by relationship or credibility of information sources. CONCLUSION: Despite barriers to participation in research studies among safety-net populations, there are also facilitators that can be implemented to increase knowledge and comprehension, ease of participation, and willingness to join research studies. Study teams should vary recruitment and participation methods to ensure equal access to research opportunities. PATIENT/PUBLIC CONTRIBUTION: Our analysis methods and study progress were presented to individuals within the Boston Medical Center healthcare system. Through this process community engagement specialists, clinical experts, research directors, and others with significant experience working with safety-net populations supported data interpretation and provided recommendations for action following the dissemination of data.

HPV vaccine recommendations by age: A survey of providers in federally qualified health centers.

Clinician recommendation remains a critical factor in improving HPV vaccine uptake. Clinicians practicing in federally qualified health centers were surveyed between October 2021 and July 2022. Clinicians were asked how they recommended HPV vaccination for patients aged 9-10, 11-12, 13-18, 19-26, and 27-45 y (strongly recommend, offer but do not recommend strongly, discuss only if the patient initiates the conversation, or recommend against). Descriptive statistics were assessed, and exact binomial logistic regression analyses were utilized to examine factors associated with HPV vaccination recommendation in 9-10-y-old patients. Respondents (n = 148) were primarily female (85%), between the ages of 30-39 (38%), white, non-Hispanic (62%), advanced practice providers (55%), family medicine specialty (70%), and practicing in the Northeast (63%). Strong recommendations for HPV vaccination varied by age: 65% strongly recommended for ages 9-10, 94% for ages 11-12, 96% for ages 13-18, 82% for age 19-26, and 26% for ages 27-45 y. Compared to Women's Health/OBGYN specialty, family medicine clinicians were less likely to recommend HPV vaccination at ages 9-10 (p = .03). Approximately two-thirds of clinicians practicing in federally qualified health centers or safety net settings strongly recommend HPV vaccine series initiation at ages 9-10. Additional research is needed to improve recommendations in younger age groups.

Addressing the unmet social needs of gynecologic oncology patients as identified by a universal screening tool in a safety net hospital

Objectives: To identify the unmet, actionable social needs of gynecologic oncology patients using a self-administered social needs assessment tool and quantify the interventions subsequently provided to our patients. Method(s): This is a study of data collected in an ongoing performance improvement initiative in a gynecologic oncology clinic at a safety net hospital and was determined to be exempt from review by the institutional IRB. Eligible patients completed the social needs screening tool from October 2021 to March 2022. The following social needs domains were assessed: food insecurity, utility insecurity, housing insecurity, transportation insecurity, need for childcare, exposure to violence, lack of companionship, difficulty reading, or difficulty accessing medical care due to fear of losing job. Patients were asked if they desired to speak with a social worker and if any needs were urgent. Data from the screening tool was collected and supplemented by data from the EMR. Univariate descriptive statistics were used to report the patient demographic information, prevalence of social needs, and referral rates for social needs identified. Result(s): There were 475 patients seen in the gynecologic oncology clinic since October 2021. 286 (60%) patients completed the screening tool. 139 (49%) screened positive for at least 1 social need;of those 98 (70%) were Hispanic with a median age of 56 years. 27 (6%) patients were receiving treatment for a gynecologic malignancy, of whom 19 (70%) had at least 1 social need. 25 (92%) patients were insured through Medi-Cal. 12 (44%) patients were being treated for endometrial cancer, followed by ovarian (7, 26%) and cervical (4, 15%). The social needs identified in all patients and in patients actively receiving cancer treatment are summarized in Fig. 1. Patients reporting lack of companionship were referred to mental health or cancer support groups through the American Cancer Society or the Los Angeles County Department of Public Health. Those needing transportation or utility services were linked with services available through their insurance or LA County, ride share vouchers, low-income energy assistance programs, COVID rent/mortgage relief programs. Patients with food and housing insecurity were assisted in applying for public housing or food stamps;local food banks were provided. Patients were assisted with applying for disability insurance as needed. To date, all actively treated patients reporting lack of companionship, need for transportation, avoiding medical care for fear of losing their job, and utility insecurity were provided resources;80% received resources for food insecurity. Conclusion(s): Universal screening for social needs in gynecologic cancer patients identifies a high rate of unmet needs within a safety net hospital. Cancer care navigators can successfully provide these patients community-based resources tailored to their individual social needs. Our next steps will be to determine if and how these resources impact our patients' experiences and treatment outcomes.[Formula presented]Copyright © 2022 Elsevier Inc.

Gender, Social Protection, and Crises of Social Reproduction: Contextualizing NREGA

The COVID-19 pandemic has underscored the importance of social protection programs such as India's Mahatma Gandhi National Rural Employment Guarantee Act (NREGA). And yet, acute crises such as pandemics are layered upon existing inequalities of gender and caste in India. We show that a distinctive feature of twenty-first-century Indian capitalism is a restructuring of the caste-gender division of labor in rural India, such that women's unpaid labor of social reproduction has increased, particularly for women from marginalized castes. Thus, patterns of participation in NREGA cannot be understood without understanding the specifics of the underlying crisis of social reproduction for labor. Social protection programs that do not consider the labor of social reproduction and are unaccompanied by broader socialization of such labor then likely fall short of mitigating deep-rooted inequalities. JEL Classification : B54, J21, J88 [ABSTRACT FROM AUTHOR] Copyright of Review of Radical Political Economics is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Racial framing of pandemic outcomes has conditional indirect effects on support for COVID-19 mitigation policies: Examining moral and threat-based mediating mechanisms

Two studies explored the intersection between the COVID-19 pandemic and the continuing fight for racial justice. The pandemic has exacerbated existing racial inequalities in the United States in terms of public health and economic outcomes, and it is well-established that individuals higher in racial bias are less likely to support social safety net programs such as those meant to improve public health and reduce poverty. This is particularly true among individuals who perceive racial minorities as overbenefitting from safety net programs. Accordingly, the primary focus of the current studies was to examine whether framing the pandemic in terms of its disproportionate impact on minorities would reduce support for pandemic mitigation policies. In addition, we examine whether such effects were mediated through psychological mechanisms of moral outrage and perceptions of realistic and symbolic threat, and moderated by participants' racial bias. Participants' belief in a just world was included as a covariate given its established role in predicting many related social outcomes. Results suggested that racial framing interacts with participants' racial bias to affect policy support indirectly through multiple mechanisms. Broad implications regarding the relationship between racial bias and public support for a strong social safety net are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

COVID-19-Related Emergency Department Visits Among Undocumented Patients in Los Angeles County

Undocumented immigrants may be vulnerable to poor COVID-19 outcomes, but also may be less likely to seek medical care. To our knowledge, there have not been any investigations of potential COVID-19 disparities by immigration status. We analyzed emergency department (ED) visit data from March 20, 2020 to September 30, 2020 among patients in a safety-net hospital in Los Angeles County (n=30,023). We compared the probability of COVID-19-related ED visits between undocumented immigrants and Medi-Cal patients. We also examined differences in these comparisons over time. Undocumented patients had higher odds of COVID-19-related ED visits than Medi-Cal patients (OR: 1.41, 95% CI: 1.24–1.60) for all months in the study period except September. Even in the earliest days of the pandemic, undocumented patients were more likely than Medi-Cal patients to have a COVID-19-related ED visit. Additional analyses suggest this was likely because of higher COVID-19 exposure rather than differences in ED utilization.

Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement.

Colorectal cancer (CRC) screening reduces morbidity and mortality, but screening rates in the USA remain suboptimal. The Colorectal Cancer Control Program (CRCCP) was established in 2009 to increase screening among groups disproportionately affected. The CRCCP utilizes implementation science to support health system change as a strategy to reduce disparities in CRC screening by directing resources to primary care clinics to implement evidence-based interventions (EBIs) proven to increase CRC screening. As COVID-19 continues to impede in-person healthcare visits and compel the unpredictable redirection of clinic priorities, understanding clinics' adoption and implementation of EBIs into routine care is crucial. Mailed fecal testing is an evidence-based screening approach that offers an alternative to in-person screening tests and represents a promising approach to reduce CRC screening disparities. However, little is known about how mailed fecal testing is implemented in real-world settings. In this retrospective, cross-sectional analysis, we assessed practices around mailed fecal testing implementation in 185 clinics across 62 US health systems. We sought to (1) determine whether clinics that do and do not implement mailed fecal testing differ with respect to characteristics (e.g., type, location, and proportion of uninsured patients) and (2) identify implementation practices among clinics that offer mailed fecal testing. Our findings revealed that over half (58%) of clinics implemented mailed fecal testing. These clinics were more likely to have a CRC screening policy than clinics that did not implement mailed fecal testing (p = 0.007) and to serve a larger patient population (p = 0.004), but less likely to have a large proportion of uninsured patients (p = 0.01). Clinics that implemented mailed fecal testing offered it in combination with EBIs, including patient reminders (92%), provider reminders (94%), and other activities to reduce structural barriers (95%). However, fewer clinics reported having the leadership support (58%) or funding stability (29%) to sustain mailed fecal testing. Mailed fecal testing was widely implemented alongside other EBIs in primary care clinics participating in the CRCCP, but multiple opportunities for enhancing its implementation exist. These include increasing the proportion of community health centers/federally qualified health centers offering mailed screening; increasing the proportion that provide pre-paid return mail supplies with the screening kit; increasing the proportion of clinics monitoring both screening kit distribution and return; ensuring patients with abnormal tests can obtain colonoscopy; and increasing sustainability planning and support.