Office of the Assistant Secretary for Planning and Evaluation
	Policy Information Center

In this chapter of Performance Improvement 1999, the U.S. Department of Health and Human Services (HHS) presents the "results in brief" of FY 1998 completed evaluations that specifically address the effectiveness of its programs. The evaluation may focus either on: (1) broad program strategies, which may encompass a number of authorized programs to address a particular need; (2) a single program that has it own congressional authorization and appropriation; or (3) a specific activity within a program that is essential to its overall effectiveness. These evaluations may provide important information for Congress in its decision about HHS programs.

The evaluations are organized according to the 11 HHS agencies, the Office of the Assistant Secretary for Planning and Evaluation (OASPE), and the Office of Public Health and Science (OPHS) in the Office of the Secretary. The "results in brief" presentation for each evaluation includes the program area, report title, and a summary of the purpose, principal findings, and uses of the results. More information about these FY 1998 completed evaluations can be obtained from the federal contact person listed, along with a telephone number, following the description of the evaluation. Copies of the evaluation reports can be obtained from either the federal contact person or the HHS Policy Information Center (PIC), accessible at the Internet address: http://aspe.hhs.gov/PIC/gate2pic.htm.

ADMINISTRATION FOR CHILDREN AND FAMILIES

WELFARE REFORM

ABSTRACT: ACF analyzed data from the National Longitudinal Survey of Youth (NLSY) to evaluate the effectiveness of targeting job retention services to clients who are at high risk of having negative labor market outcomes and who can benefit most from job retention services. The study concludes that programs can successfully identify high-risk cases using data on individual and job characteristics that is likely to be available and, using that data, target clients for job retention services The study also analyzes the employment patterns of welfare recipients who find jobs and the factors associated with job loss or job retention and provides rules that policy makers can use to target services to high-risk clients.

AGENCY SPONSOR: Office of Planning, Research, and Evaluation

FEDERAL CONTACT: Lawrence Wolf

PHONE NUMBER: 202-401-5984

PIC ID: 6756

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ
 

CHILD SUPPORT

ABSTRACT: From October 1994 to March 1996, ACF evaluated State child support guidelines to determine the impact of State child support guidelines on decision makers of child support payments. The purpose of the study was to determine the effectiveness of State child support guidelines in helping decision makers determine adequate and equitable child support amounts. The results are directed at whether there should be more Federal involvement in areas such as issuing national guidelines. In the cases reviewed, data show significant formal and informal deviations from the guidelines, mainly in the areas of income determinations, tax exemptions allowed, families involved, agreements between parties, health care, visitation and custody, and child care expenses. Based on the results, a panel of child support experts recommended that national guidelines are not necessary given continuing state development and experimentation with guidelines; however, states should continue to review cases every four years and the Federal government should continue to provide technical assistance in helping states perform guideline reviews.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo

PHONE NUMBER: 202-401-5364

PIC ID: 5983

PERFORMER ORGANIZATION: CSR, Incorporated, Washington D.C.
 

TITLE: Evaluation of the Child Access Demonstration Projects: Report to Congress

ABSTRACT: ACF's Office of Child Support Enforcement evaluated demonstrations to improve access of non-custodial (divorced or unwed) fathers to visit their children. Eight demonstration sites experimented with interventions to: (1) decrease the amount of time required to resolve child access disputes; (2) reduce litigation of access disputes; (3) improve compliance with court-ordered child support payments; and (4) promote adjustment of the children. An analysis of the survey results and a comparison of the demonstration sites showed that: (1) courts can effectively help parents with access problems by developing no and low cost dispute resolution interventions such as mediation; (2) mediation appears to be more effective when it is conducted near the time of the divorce or separation; (3) access interventions for parents with long-standing access problems or high levels of parental conflict appear to have less potential for resolving access disputes than interventions designed for parents with more recent and less contentious disputes; and (4) while child support and child access are definitely related, and some access interventions are associated with more favorable reports of payment, cause and effect is difficult to establish. (PIC ID: 6843)

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo

PHONE NUMBER: 202-401-5364

PIC ID: 6843

PERFORMER ORGANIZATION: American Institutes for Research, Washington D.C.
 

TITLE: Building Opportunities, Enforcing Obligations: Implementation and Interim Impacts of Parents' Fair Share

ABSTRACT: Parents= Fair Share (PFS) program model began in 1992 as a two-year pilot project to provide supportive services, such as peer group assistance, to non-custodial fathers to improve their involvement with their children. With employment training and job location assistance, it was also expected that the fathers would find employment, increase their earnings and as a result be more able to pay child support and to pay in a timely fashion. Findings from the interim impact evaluation indicate success in raising the involvement of non-custodial parents and the child support payments of the non-custodial fathers. PFS did increase the number of fathers who paid child support, however with no corresponding increase in those fathers= employment and earnings. This study shows that programs offering support services to non-custodial fathers can impact the level of child support provided to their children. The project is currently into its second phase, which will further test the program=s effectiveness.

AGENCY SPONSOR: Office of Planning, Research and Evaluation and the Office of Child Support Enforcement

FEDERAL CONTACT: Mark Fucello

PHONE NUMBER: 202-401-4583

PIC ID: 5952.1

PERFORMER ORGANIZATION: Manpower Research Demonstration Corporation, New York, NY
 

CHILD DEVELOPMENT

TITLE: National Impact Evaluation of the Comprehensive Child Development Program (CCDP)

ABSTRACT: The purpose of CCDP was to enhance child development and family economic self-sufficiency. To achieve these goals, grantees used an intensive case management model that included: (1) early intervention; (2) family involvement; (3) comprehensive social services that addressed the intellectual, social-emotional, and physical needs of infants and young children in the household; (4) services to enhance parents' ability to contribute to the overall development of their children and achieve economic and social self-sufficiency; and (5) continuous services up kindergarten or first grade level. The evaluation examined whether the model was successful in enhancing the development of participating children and the economic self-sufficiency of their parents. The results indicated that there were no observable or measurable benefits for participating children and their parents compared to children and parents in a control group that did not receive the interventions.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Michael Lopez

PHONE NUMBER: 202-205-8212

PIC ID: 3868

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge MA

CENTERS FOR DISEASE CONTROL AND PREVENTION

INJURY PREVENTION

ABSTRACT: Recent efforts to address intimate partner violence have focused on developing an integrated system of health care and social service providers that offer the full complement of requisite responses-early detection, referral and treatment on a more holistic level. The purpose of this evaluation was to assess one such integrated program, WomanKind, in Minneapolis, Minnesota. Specifically, the purpose of the evaluation was to determine: (1) the extent to which the WomanKind program increased health care providers' capacity and motivation to identify cases of intimate partner violence and initiate a course of positive change through referral to WomanKind in-house services; and (2) the extent to which the WomanKind program provides assistance to the women referred. Results indicate the Woman Kind program has a positive effect on the knowledge, attitudes, beliefs, and behaviors of hospital staff, both in terms of their awareness of domestic abuse and their understanding of the role of the health care provide in addressing it. Statistics also show that WomanKind does provide more than crisis intervention services to clients. Records also show that WomanKind consistently used a range of community services as referral sources for clients, reinforcing a basic tenet of the program which is to link with the community and not to create duplicate services. Finally the study concluded the lessons learned from the WomanKind program can be extracted and adapted for other settings

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Lynn Short, Ph.D.

PHONE NUMBER: 770-488-4285

PIC ID: 6587

PERFORMER ORGANIZATION: Macro International, Inc., Silver Spring MD
 

HEALTH STATISTICS

ABSTRACT: Cause-of-death statistics from death certificates, produced by State vital registration offices and National Center for Health Statistics (NCHS), constitute perhaps the most widely used national, state, and local data for identifying the nations's health problems and our progress in dealing with them. However, a persistent concern in using mortality statistics has been the quality and completeness of the reported information on cause of death, as reported by the certifying physician. The purpose of this study was to evaluate one possible variable of quality, specifically the effect of the format of the medical certification form on death statistics. More specifically the study evaluated whether the direction of the order in which causes of death are sequenced on the death certificate form influences either the underlying cause of death selected by the physician or the number of causes of death recorded by the physician. An experimental approach was used where the standard format was reversed and physicians were asked to complete either a standard or experimental medical certification for a number of death cases. The results were that the format of the death certificate did not have a significant effect on the underlying cause of death selected. However, the results did suggest that reversing the order in which causes of death are sequenced increases the tendency to report more conditions, but the size of the effect appears small.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: James Weed, Ph.D.

PHONE NUMBER: 301-436-8951

PIC ID: 7098

PERFORMER ORGANIZATION: Research Foundation of the State University of New York at Binghamton, Binghamton, NY
 

EPIDEMIOLOGY

ABSTRACT: CDC assessed the effectiveness of the Field Epidemiology Training Program (FETP) in achieving its objective of building capacity in applied epidemiology in developing countries. Data was collected through correspondence with and site visits to four FETP countries--Mexico, the Philippines, Spain, and Thailand--and the Rockefeller Public Health Schools Without Walls (PHSWOW) program in Uganda. The evaluation found that: (1) FETP trainees are acquiring skills that enable them to assist with outbreak investigations; (2) the decentralization of the health systems has led the FETP to a more facilitative role in linking local field investigations with the knowledge and resources available nationally; (3) the efforts of FETP staff have led to reductions in morbidity and mortality in host countries; (4) the FETP supports the creation of professional linkages among epidemiologists at a national level, but opportunities for FETP graduates to interact with public health officials from other countries have been limited; and (5) FETPs need the flexibility to expand to assure their sustainability in the rapidly changing political environments that surround public health in many host countries.

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Daniel B. Fishbein, M.D.

PHONE NUMBER: 404-639-2228

PIC ID: 5923.1

PERFORMER ORGANIZATION: Battelle Corporation, Arlington VA

FOOD AND DRUG ADMINISTRATION

TOBACCO CONTROL

ABSTRACT: The U.S. Food and Drug Administration (FDA) has developed a national campaign targeted at tobacco retailers. The purpose of the campaign is to raise awareness of the new requirements that prohibit retailers from selling cigarettes and smokeless tobacco products to persons younger than age 18 and require that retailers verify, by means of photographic identification, the age of purchasers who are younger than age 27. The purpose of the evaluation was to determine if the media campaign was effective. Results of a survey of tobacco retailers suggest that the media campaign is effective in increasing the awareness of the new requirements among retailers.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Alan Heaton

PHONE NUMBER: 202-205-5394

PIC ID: 7079

PERFORMER ORGANIZATION: Market Facts, Inc., McLean VA
 

DRUG APPLICATION REVIEW

ABSTRACT: As reported in the PDUFA FY 1998 Performance Report, the Food and Drug Administration exceeded all performance goals specified under the Prescription Drug User Fee Act of 1992 (PDUFA). The Agency made its review decisions for drug and biological product submissions on time in almost every case, reviewing 100 percent of the new product applications and 99 percent of the supplements within target time reviews. By historic standards, approval rates remain high and review times and total approval times remain short. The Food and Drug Administration Modernization Act of 1997 (FDAMA) continues the progression toward quicker reviews begun under PDUFA, and extends into the investigative phase of drug development with a series of new goals that take effect in FY 99. The objective of the FDAMA goals is to speed up the entire drug development process, from research to approval, without compromising safety or sacrificing quality of the application review process.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Dennis Hill

PHONE NUMBER: 301-827-5255

PIC ID: 6079.3

PERFORMER ORGANIZATION: Office of Planning & Evaluation, Food and Drug Administration, Rockville MD
 

TITLE: Pharmaceutical Industry Cost Savings Through Use of the Scale-up and Post-Approval Change Guidance for Immediate Release Solid Oral Dosage Forms (SUPAC-IR)

ABSTRACT: The purpose of this study was to assess the impact on and cost savings to the pharmaceutical industry of the SUPAC-IR guidance. The purpose of the guidance was to implement an improved process for post-approval changes to approved drug applications involving chemistry, manufacturing and control changes. The results of the study, based on interviews with representatives of six pharmaceutical companies indicates that SUPAC-IR guidance: 1) enhances the industry's ability to plan and implement change and mange resources efficiently; 2) facilitates changes that can be implemented more confidently, quickly and efficiently; 3) generates substantial savings; and 4) enhances the application of scientific principles to improving the supplement process.

AGENCY SPONSOR: Office of Planning and Evaluation, FDA

FEDERAL CONTACT: Nancy Gieser

PHONE NUMBER: 301-827-5335

PIC ID: 7059

PERFORMER ORGANIZATION: Eastern Research Group, Inc., Herndon, VA
 

MEDICAL DEVICES

ABSTRACT: The FDA Center for Devices and Radiological Health uses Safety and Public Health Advisories to transmit information pertaining to radiological health risks of medical devices to health care practitioners. An evaluation was conducted to determine the impact of these advisories on the behavior and knowledge of the recipients. Most respondents felt that the problem addressed in the advisory was clearly identified, easily understood, timely and useful, and that actions for reducing risks were clearly enumerated. Approximately 37 percent of the sample group reported that they had taken actions to eliminate or reduce the risk as a result of the advisory. The most commonly reported reason for not taking action was that the subject matter of the advisory was not applicable.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Gary Blanken

PHONE NUMBER: 301-594-1284

PIC ID: 6733.1

PERFORMER ORGANIZATION: Food and Drug Administration, Rockville MD

HEALTH CARE FINANCING AND ADMINISTRATION

AMBULATORY PATIENT GROUPS

ABSTRACT: The Balanced budget Act of 1997 mandated that Medicare begin implementing a prospective payment system for hospital outpatient services that incorporates a service classification system, such as ambulatory patient groups (APGs). Since 1990, eleven payers -five Medicaid programs and six private insurers-have designed payment systems based on APGs, and six of the eleven have implemented APG-based payment systems. The evaluator looked at the six operational APG systems to determine the effect of the systems on expenditures. The purpose of the evaluation was to determine the effect of the system on reducing outpatient costs and whether the system was easy to implement and use. Overall, the evaluator found that the six payers with APG operational experience implemented the system without major incident. They also reported success in reducing outpatient cost, where that was the immediate goal, and they believe the system encourages higher-cost facilities to reduce costs and rewards lower-cost facilities for their efficiency. Providers views were mixed. They view the system as complex. They generally cannot calculate expected payments under APGs and often let payers compute systems group-related claims rather than consolidating them prior to submission as was the intent of the system.

AGENCY SPONSOR: Center for Health Plans and Providers

FEDERAL CONTACT: Joe Cramer

PHONE NUMBER: 410-786-6676

PIC ID: 6320

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ
 

ACCESS TO CARE

ABSTRACT: This evaluation looked at the effectiveness of demonstrations in five States to improve access to prenatal care and treatment services for substance abusing women. Examined were: (1) outreach and assessment services; (2) services expansion, integration and coordination; and (3) improvement of client case management. The effects of these services on the health of drug-addicted pregnant women and birth outcomes of their infants were measured. One limitation of the study was the relatively low number of abusers enrolled in the demonstrations because pregnant substance abusers in the five demonstration sites were reluctant to be identified. Higher enrollment rates were found in those sites which implemented broad-based outreach efforts. Those sites recorded higher levels of and greater retention in substance abuse treatment. The outcome analysis showed that demonstration clients compared to other pregnant substance abusers in the site area had better results in higher birth weight infants, but the findings were inconclusive due to possible self-selection biases.

AGENCY SPONSOR: Center for Beneficiary Services

FEDERAL CONTACT: Suzanne Rotwein, Ph.D.

PHONE NUMBER: 410-786-6621

PIC ID: 6297

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Washington, DC
 

DRUG USE REVIEW

ABSTRACT: This project tested the effectiveness of prospective and retrospective drug use reviews (DURs) on pharmacist behavior and drug use and costs. Findings showed that prospective drug use reviews had no measurable effects on the frequency of drug problems or on utilization and expenditures on prescription drugs and other medical services. There were no behavioral changes in pharmacists who received online prospective drug use review messages. Instead, services most often provided by pharmacists involved counseling and educating patients rather than interactions with prescribers or other pharmacists.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Jay P. Bae, Ph.D.

PHONE NUMBER: 410-786-6591

PIC ID: 6296

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge MA
 

MEDICAID

ABSTRACT: The Oregon Health Plan (OHP) was implemented in February 1994, extending health insurance coverage (Medicaid eligibility) to uninsured State residents below poverty. The costs of expanded insurance coverage are financed through the use of a prioritized list of health care services (to determine the benefit package), increased enrollment in capitated managed care organizations (MCOs), as well as revenues generated by a cigarette tax earmarked for OHP. This interim evaluation assessed the implementation process and program impacts. Findings on the impact of OHP on providers showed that the priority list did not effect physician practice--care needed was obtained by exemptions from health plans or offering care for free; provider perception were that access and capacity had improved, especially for the expansion population; and problems occurred in the provision of after-hours care by hospital emergency medical care units. Regarding the impact on consumers, the study found that OHP positively influenced use of preventive care, but encountered problems in shifting pregnant women to managed care and the initiation of prenatal care.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Paul J. Boben, Ph.D.

PHONE NUMBER: 410-786-6629

PIC ID: 6991

PERFORMER ORGANIZATION: Health Economics Research, Inc., Waltham MA
 

MEDICARE

ABSTRACT: The purpose of the negotiated bundled payment demonstration implemented in May 1991 by HCFA was to determine the cost benefits of a negotiated package pricing arrangement for heart bypass surgery. Hospitals and physicians received a global payment (covering hospital and related physician services, including outliers and re-admissions), for each Coronary Artery Bypass Graft procedure. The negotiated rate represented a discount from what Medicare paid, on average for these procedures. Over 10,000 procedures were performed under the demonstration with an estimated savings to the Medicare program of over $50 million. Findings suggest that both Medicare and hospitals can benefit from global payment arrangements through reduced costs, better coordination of services, and improved quality of care. The bundled payment arrangement provided incentives to facilitate more cooperative relationships between physicians and hospital staff leading to quality improvement activities which, in turn, resulted in more efficient patient care delivery and lower costs while maintaining high quality of patient care. The demonstration lead to innovative physician incentive programs to improve quality and reduce costs, a nationwide proliferation of private sector bundled payment arrangements based on the demonstration, proposed legislation to establish negotiated bundled payment arrangements under the regular Medicare program, and the design of a new bundled payment demonstration for orthopedic and cardiovascular services.

AGENCY SPONSOR: Office of Clinical Standards and Quality

FEDERAL CONTACT: Armen H. Thoumaian, Ph.D.

PHONE NUMBER: 410-786-6672

PIC ID: 5958.5

PERFORMER ORGANIZATION: Health Economics Research, Inc., Waltham MA
 

TITLE: Evaluation and Technical Assistance of the Medicare Alzheimer's Disease Demonstration

ABSTRACT: The purpose of the Medicare Alzheimer's Disease Demonstration was to determine the effectiveness, cost, and impact on health status and functioning of providing comprehensive in-home and community-based services to beneficiaries who have dementia. Two models of care were studied under this project. Both models included case management and a wide range of services, such as homemaker/personal care services, adult day care, companion services, caregiver education, and family counseling. The two models varied by the intensity of the case management provided to beneficiaries and their caregivers and the amount of demonstration service costs that could be paid for by Medicare. The demonstration achieved a number of its goals, but showed mixed results in its usefulness to informal support systems. Access to community care increased by more than a factor of two and the level of unmet task assistance in caring for the person with dementia was reduced by half among those in the treatment group. These supports generally did not replace the amount of informal care, instead they allowed this time to be redirected to specific tasks. These instrumental program achievements did not lead to significant reductions in caregiver burden or depression, nursing home placement rates, or overall Medicare expenditures.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Dennis M. Nugent

PHONE NUMBER: 410-786-6663

PIC ID: 6305

PERFORMER ORGANIZATION: University of California, San Francisco, Institute for Health and Aging, San Francisco CA
 

RURAL HEALTH

ABSTRACT: The Rural Health Clinic Services Act of 1977 authorized a new type of provider, Rural Health Clinic(RHC), for certification and licensure. The legislation provides for cost-based reimbursement for the clinics for Medicare and Medicaid. There has been rapid growth in the numbers of these clinics (3,067 RHCs listed nationwide in 1996, compared to 1,157 certified clinics in 1993. This evaluation was undertaken to assess this rapid growth. Since RHCs receive enhanced payment from Medicare and Medicaid, the concern involved whether these increased costs are justified by improvements in access to rural populations. The evaluation found that (from the sample of clinics surveyed) access to health care is increased to an extent to justify increased costs. Disadvantages to the program are primarily that the gains in access are in more heavily populated rural areas and that competition for Medicaid patients exists in medically underserved areas. An assessment of the impact of managed care on RHCs indicated that these clinics will have to adjust to increasingly competitive delivery systems in rural areas.

AGENCY SPONSOR: Center for Health Plans and Providers

FEDERAL CONTACT: Siddhartha Mazumdar

PHONE NUMBER: 410-786-6673

PIC ID: 6299

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro NJ
 

RYAN WHITE CARE ACT

ABSTRACT: The study analyzed state-administered government programs to cover and finance the health care needed by people infected with HIV, particularly under Title II of the Ryan White Care Act. The study documented a number of successful innovations developed by individual states. The study also presents assessments that administrators of AIDS service organizations have about how well each of these state-administered public programs addresses the health care needs of people with HIV in their state. Findings are presented for each of the programs. Conclusions for Title II were that generous eligibility criteria and coverage of a broad array of health services has strengthened the safety net for financing the care needed by people with HIV before they become eligible for Medicaid or Medicare. However, if federal funding for Title II is not sufficiently increased to keep up with the increasing number of people expected to receive benefits, or if future Medicaid reform allows states to establish more restrictive Medicaideligibility, Title II may not be able to provide services for all eligible people.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Michael Kendix

PHONE NUMBER: 410-786-6631

PIC ID: 6993

PERFORMER ORGANIZATION: South Carolina Department of Health Administration and Health Policy, Charleston, SC

HEALTH RESOURCES AND SERVICES ADMINISTRATION

COMMUNITY HEALTH CENTERS

ABSTRACT: The purpose of this study was to explore the extent to which Medicaid beneficiaries who rely on Community Health Centers (CHCs) as their main source of primary care are likely to experience hospitalization for ambulatory care sensitive conditions (ACSCs), as compared with beneficiaries who rely on other providers. The study found that Medicaid CHC users experienced ACSC hospitalization rates 22 percent lower than those of the comparison group. Medicaid CHC users were 16 percent more likely to have outpatient visits for ACSCs and had lower emergency room use. Finally, outpatient visits were found to be reasonably good markers and performance measures for identifying populations potentially at risk for ACSCs. HRSA is using the study results as a source for a performance measure concerning hospitalization rates for ACSCs. The results have also served as the basis for a current study focused on episodes of care. (See PIC ID 7127)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 6001

PERFORMER ORGANIZATION: MDS Associates, Inc., Wheaton, MD
 

TITLE: Evaluation of the Impact of the Medicaid Waivers on Consumers and Services of Federally Qualified Health Centers

ABSTRACT: This study assessed the early impacts of Medicaid managed care waivers on federally qualified health centers (FQHCs) as Medicaid providers, and on their consumers. FQHCs have often been a primary provider of services to Medicaid recipients in their community and have derived between 30 to 40 percent of their revenues from Medicaid. Therefore, the shift of States to managed care systems for Medicaid beneficiaries can have a significant impact on FQHCs. Results were: 1) the experience of FQHCs showed great variation in the amount of change in their Medicaid population, varying from a decrease of 22.7 percent to an increase of 58 percent; 2) managed care placed a new and increased emphasis on the importance of primary care and primary care providers; 3) access to care for FQHC patients, especially adults, improved in many cases; 4) demands on FQHCs by Medicaid enrollees strained the capacity of some FQHCs resulting in fewer services available to uninsured patients while expanding capacity in other centers increased access to services; 5) the financial impact is complex and the result of a variety of interacting factors; 6) FQHCs experience a number of administrative and management challenges, such as increasing paperwork demands and complex billing procedures; and 7) consumer were generally satisfied with FQHC services despite changes resulting from the implementation of managed care. Study results are being used as source for identifying factors that will affect health centers in future waiver programs, and to improve HRSA program policy and technical assistance.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 5738

PERFORMER ORGANIZATION: The Lewin Group, Fairfax VA
 

TITLE: Medicaid Managed Care and FQHCs: Experiences of Plans, Networks and Individual Health Centers

ABSTRACT: This study looked at the impact on and responses to Medicaid managed care among federally qualified health centers (FQHCs) in eight U.S. markets. The study found that: 1) nearly all of the centers in the study experienced a decline in users, revenues and/or net income under managed care since 1993 with more centers experiencing losses during 1996 than in the earlier time periods; 2) most centers reported having experienced an increase in the volume and proportion of uninsured users; 3) many centers (but less than half) have improved their facilities and operations (e.g., adding services, expanding hours), but several have had to make cuts in hours and services. In addition, FQHCs have responded to managed care by choosing to participate in FQHC plans and networks, strengthened their ties with local hospital systems, and expanded their involvement in Medicare and managed care contracts.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 6353

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Washington, DC
 

TITLE: The Performance of C/MHCs Under Managed Care: Case Studies of Seven C/MHCs and Their Lessons Learned

ABSTRACT: This study examined how Community and Migrant Health Centers (C/MHCs) have performed as managed care providers, how participation in managed care has affected C/MHC operations, and how C/MHCs could be assisted in improving their performance in a managed care environment. Based on data provided by managed care organizations (MCOs) for each C/MHC and the regional network of providers, average C/MHC costs were consistently lower for referrals and pharmacy services, and C/MHCs experienced lower or comparable total hospital and non-maternity admissions. Centers reported higher maternity admissions and maternity days. MCO staff emphasized the Centers' strategic importance in the network because of geographic location, reputation in the community, experience with Medicaid beneficiaries, and focus on primary care and prevention. Weaknesses cited for some centers included physician turnover, insufficient extended hours, and inadequate 24-hour coverage. Findings are used in discussions with managed care associations and networks concerning C/MHC experiences, and to inform program policy and technical assistance.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Julia Tillman

PHONE NUMBER: 301-594-4062

PIC ID: 6354

PERFORMER ORGANIZATION: The Lewin Group, Fairfax VA
 

COMMUNITY HEALTH WORKERS

ABSTRACT: In recent years, HRSA's primary health care programs have increased their use of community health workers (CHWs) to augment and complement the care patients receive from medical and social service staff members. This study examined the impact of CHWs on access to and use of health services and on patient knowledge and behavior. The study found that CHWs were effective in helping clients find needed services and in providing services that were previously unavailable or limited; CHWs assisted patients with the proper use of services, such as immunizations and breast cancer screening; and CHWs provided education programs to increase patient knowledge about a variety of topics such as hygiene, substance abuse, nutrition, and domestic violence. CHWs were actively involved in case finding and case management in most programs. In some locations, CHWs provided services (e.g., adult day care) that had been unavailable in the community.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Remy Aronoff

PHONE NUMBER: 301-594-4461

PIC ID: 6355

PERFORMER ORGANIZATION: The George Washington University, Washington, DC
 

MATERNAL AND CHILD HEALTH

ABSTRACT: The Healthy Start program was begun in 1991 to demonstrate innovative ways to reduce infant mortality in areas with some of the highest rates in the country. The National Evaluation of the program includes a cross-site process component and an outcome study of the original 15 demonstration sites. This report, the final product of the process component, features an analysis of the factors that facilitated or impeded implementation in 14 of the 15 original projects. (A separate report will be issued on the Northern Plains project). The study found that, with substantial federal funding, local communities can develop and implement innovative approaches to reducing infant mortality. Program components include community involvement, outreach and case management, enhanced clinical services, non-traditional support services, and community-wide public information campaigns. Ability to mange effectively-that is, to develop and execute sound administrative procedures, recruit and retain a strong staff (especially senior staff), and monitor contractors-was found to be a critical factor in successful implementation.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 5610.1

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Washington, DC

INDIAN HEALTH SERVICE

PREVENTIVE HEALTH SERVICES

ABSTRACT: The National Cancer Institute, and the Centers for Disease Control supported two pilot projects to train and support community health aide/practitioner (CHA/Ps) in providing prevention screening for cervical and breast cancer, STDs, and tobacco reduction to inhabitants of remote Alaskan villages. The screening services were provided in southwest rural Alaska, an area about the size of the state of South Dakota located about 400 miles from Anchorage composed of 50 remote Eskimo and Indian villages with a total population of over 20,000. The purpose of the evaluation was to determine whether the pilot projects succeeded in increasing the health screening levels and access to care of Native women. The evaluation found that training and support of CHA/Ps resulted in an increased screening and identification of health conditions. As a result of the findings, the Yukon Kuskokwim Health Corporation, the largest health corporation in rural Alaska, will expand village-based preventive health services through training more health aides/practitioners in the region with additional community health education.

AGENCY SPONSOR: Office of Public Health, Staff Office of Planning , Evaluation, and Research

FEDERAL CONTACT: Leo J. Nolan

PHONE NUMBER: 301-443-4245

PIC ID: 6406

PERFORMER ORGANIZATION: Alaska Native Health Services, Anchorage AK
 

SUBSTANCE ABUSE TREATMENT

ABSTRACT: The Indian Health Service evaluated nine Regional Treatment Centers (RTCs) that provide alcoholism and substance abuse rehabilitation treatment to American Indian/Alaska Native youth. This retrospective study involved site visits to the RTCs, staff interviews, client chart reviews, and collection of client follow-up data. The RTC clients, treatment processes, outcomes were compared with similar treatment centers in urban and suburban areas. The treatment outcome findings showed that 52 percent of the IHS-RTC clients completed treatment compared to 60 percent in the comparison sites. The post-discharge sobriety follow-up findings on the IHS-RTC clients indicated that less than 25 percent had relapsed to alcohol and drug use levels prior to treatment. The analysis identified the important client characteristics and treatment components associated with successful completion of treatment and post-discharge sobriety. The conclusions of the evaluation were that: (1) RTCs are only one important component of care for adolescents with alcohol and other substance abuse problems and a continuum of care needs to be fostered that includes improved screening and case finding for children by health care providers and post-discharge client care; (2) greater resources and management practices are needed to improve RTC effectiveness and efficiency; and (3) the more effective RTCs utilize client satisfaction, post-discharge, and peer-evaluation data to conduct self-evaluation.

AGENCY SPONSOR: Office of Public Health, Staff Office of Planning, Evaluation, and Research

FEDERAL CONTACT: Leo J. Nolan

PHONE NUMBER: 301-443-4245

PIC ID: 6744

PERFORMER ORGANIZATION: Indian Health Service, Alcohol and Substance Abuse Program Branch, Albuquerque, NM

NATIONAL INSTITUTES OF HEALTH

RESEARCH PROGRAM SUPPORT

ABSTRACT: The International Cooperative Biodiversity Groups (ICBG) are the first large scale, multi-country attempt to combine natural products drug discovery with measures to promote conservation of diverse biological species around the world. This study evaluated the ICBGs to determine progress in achieving goals of stimulating new drug discovery while promoting biodiversity conservation and sustainable economic development. The findings from this study are to be used to assist ICBG sponsors in managing the program and to provide useful ideas on innovations and lessons learned from the individual programs. The results indicate that each ICBG group made real accomplishments toward finding new drug lead compounds, advancing conservation techniques, and promoting sustainable economic development through their multi-disciplinary research and capacity-building activities. All ICBGs discovered novel bio-active compounds and developed systems to inventory and archive information gained on the biological diversity of their respective source countries. Over 3,000 species had been collected during the first four years. The ICBGs also developed new approaches to sample collection and testing and improving methods. The ICBGs produced over 6,000 extracts from samples collected and submitted these for testing in at least 60 different assays in15 different therapeutic areas. Also significant was that all ICBGs provided training in biodiversity conservation, drug discovery and drug development in their source country. The results from this evaluation study will provide a useful model and significantly contribute to scientific capacity building in future biodiversity programs in other countries.

AGENCY SPONSOR: Fogerty International Center

FEDERAL CONTACT: Kirby J. Weldon

PHONE NUMBER: 301-496-2571

PIC ID: 6641

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA
 

TITLE: Evaluation of the NHLBI Programs of Excellence in Molecular Biology: Summary Report and Final Report

ABSTRACT: The National Heart, Lung, and Blood Institute, the second largest research institute at NIH, developed and implemented an initiative (Programs of Excellence in Molecular Biology--POEMB) to stimulate the use of molecular biology approaches in areas where these new techniques have been underutilized; and by providing opportunities for investigators who have the potential for establishing or redirecting research. The purpose of this evaluation was to measure the extent to which the initiative realized its objectives and its appropriateness as a model for promoting the application of new research techniques and methodologies to existing areas of research. In summary, the program resulted in an increase in individuals pursuing and applying the techniques of molecular biology and related fields of study which should result in greater application of these techniques in the future.

AGENCY SPONSOR: National Heart, Lung, and Blood Institute

FEDERAL CONTACT: Carl A. Roth, Ph.D.

PHONE NUMBER: 301-496-3620

PIC ID: 5584

PERFORMER ORGANIZATION: Battelle Human Affairs Research Centers, Seattle WA
 

RESEARCH TRAINING

ABSTRACT: In order to increase the number of under-represented minority individuals pursuing advanced degrees in the biomedical and behavioral sciences, the NHLBI established the Short-Term Training for Minority Students Program (STMSP). The program: (1) provides minority undergraduate and graduate students and students in health professional schools exposure to opportunities inherent in research careers in areas relevant to cardiovascular, pulmonary, and hematologic health and diseases, transfusion medicine, and sleep disorders; (2) attracts highly qualified minority students into biomedical and behavioral research careers in the areas of heart, lung and blood health, transfusion medicine, and sleep disorders; and (3) bolsters the already short supply of qualified minority investigators. The evaluation found that STMSPs are successful in their efforts to: attract highly qualified minority individuals; expose trainees to a broad range of quality research experiences; satisfy trainees with their level of mentor involvement; positively affect trainee education and career decisions.

AGENCY SPONSOR: National Heart, Lung, and Blood Institute

FEDERAL CONTACT: Barbara F. James

PHONE NUMBER: 301-402-3421

PIC ID: 6118.1

PERFORMER ORGANIZATION: KRA Corporation, Silver Spring MD

OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION

PUBLIC HEALTH

ABSTRACT: All fifty States and the District of Columbia operate their own Public Health Laboratories (PHLs). Changes in the private health care delivery system, especially the growth of managed care organizations (MCOs), hospital consolidations, and large commercial laboratories are causing public health professionals to examine the viability of publicly funded laboratories in this new environment. The study found that: (1) PHLs experienced a reduction in testing volume to MCOs; (2) MCOs showed a lack of awareness of and responsiveness to disease reporting; (3) PHLs face competition from large commercial labs. The report concludes that PHLs, as part of the broader public health infrastructure, must change with the health care marketplace, such as focusing mainly on lab services not commercially viable within the private sector and ones critical to identifying emerging diseases. PHLS should play a role in quality assurance and consistency of laboratory testing. In the future, PHLs must develop policies to address the growth of managed care and changes in the health care delivery system. The study recommends increased federal guidance in: (1) assessing the regionalization of laboratory services; (2) supporting information infrastructure development; and (3) facilitating communication between private and public sectors.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Cheryl Austein-Casnoff

PHONE NUMBER: 202-690-6102

PIC ID: 6458

PERFORMER ORGANIZATION: The Lewin Group, Fairfax VA
 

TITLE: Evaluation of the Minority Male Consortium for Violence Prevention

ABSTRACT: This project evaluated the Office of Minority Health (OMH) Minority Male Consortium for Family and Community Violence Prevention Programs. Nineteen historically black colleges and universities (HBCUs) participated in the program. Features of violence prevention program models at 13 historically black colleges and universities/family life centers' (HBCUs/FLCs) were synthesized to determine approaches that could prevent or minimize violence in communities committed on or by minority males. The finding of the synthesis was that HBCUs reported major gains in participants' knowledge, attitudes and behavior, such as school bonding, self-esteem, academic performance, alcohol and other drugs, and cultural awareness and pride. The conclusion of the evaluation, however, stated that violence prevention programs suffer from an inability to produce valid performance data demonstrating that prevention investments pay off in the long run. Two recommendations are: (1) that without completely centralizing the design process, that the federal government and the Consortium should move towards a consensus-seeking information model in which individual schools are no longer free to pursue independent designs; and (2) that constraints should be introduced on which program models are implemented by which schools.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Margaret Price

PHONE NUMBER: 202-260-0382

PIC ID: 5789.2

PERFORMER ORGANIZATION: Macro International, Inc., Calverton MD
 

HEALTH CARE FINANCING

ABSTRACT: The grant of immunity from tort claims provided under the Federal Tort Claims Act (FTCA) for tribes and tribal organizations operating programs under the Indian Self-Determination and Education Assistance Act should have resulted in tribes and tribal organizations paying less for private liability insurance and increased access to insurance coverage. The primary purposes of the study were to examine: 1) whether the intended outcomes of the FTCA have been realized; 2) continuing barriers to the appropriate pricing of private liability insurance; and 3) recommend strategies that will assist tribes, tribal organizations, and other contractors and self-governance compactors to continue to reduce the need for private liability insurance, as well as its cost. The study found the some tribes and tribal organizations have been able to reduce their private liability insurance premiums substantially and, in some cases, completely drop certain types of coverage (e.g., medical malpractice) because of the FTCA. However, the study also found that some tribes and tribal organizations may not have fully realized the benefits of the FTCA, because of uncertainty, confusion, and lack of understanding among tribes, brokers, and insurance companies as to what activities are covered by the FTCA, when private sector coverage is unnecessary or duplicative, or how an FTCA claim proceeds through the system. The study recommends a number of ways to correct the problem of understanding that include: creation of a clearinghouse where tribes could share experiences; technical assistance and informational outreach by the Federal government; and, a more consistent approach to interpretation and application of policies and procedures within and across Federal agencies.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Tom Hertz

PHONE NUMBER: 202-690-7779

PIC ID: 6345

PERFORMER ORGANIZATION: Center for Health Policy Research, Washington, DC
 

DISABILITY

ABSTRACT: This project evaluates the District of Columbia's managed care demonstration program for disabled and special needs children. Specifically the evaluation looked at the organizational, provider and child and family-level outcomes of the demonstration. Initial finding are that primary care physicians in the network are more satisfied, in general, than physician specialists and that demonstration enrollment appears to be very successful at 71% of located children and little disenrollment due to dis-satisfaction. The study characterized significant start-up problems faced by the demonstration, including severe cost problems in DC Medicaid program, the lack of close working relationships between the principal DC agencies involved, and the changes in DC home rule and overall changes in the Medicaid program.

AGENCY SPONSOR: Office of Disability, Aging, and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7015

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge MA and Urban Institute, Washington D.C.
 

HUMAN SERVICES

ABSTRACT: This report presents findings from the Portland, Oregon, welfare-to-work program run between 1993 and 1996. Through the program, Portland, provided employment and support services to a broad cross-section of the AFDC caseload, who were, in turn, required to participate in program activities, or face reductions in their welfare grants. Although designed and implemented prior to the 1996 welfare reform law, the program's goals were very similar: to foster the self-sufficiency of adult recipients through increased employment and decreased welfare receipt. This report describes the implementation, participation patterns, and cost of the Portland program, and examines the effects of the program on employment, earnings, and welfare receipt during the two years following people's enrollment in the program. A control group methodology was used. The report finds that over the two-year period: (1) employment levels increased 11 percent and earnings increased by $1,800 per sample member, a 35 percent increase over the control group's earnings; (2) the proportion of people with full-time jobs increased by 13 percent, and the number with employer-provided health benefits increased by 10 percent; (3) welfare expenditures were reduced by 17 percent; (4) the impact of the program was consistent for recipients with few barriers to employment and those typically considered hard-to-place; and (5) though program group members' average combined income from earnings, AFDC, and Food Stamps was not substantially higher than that of control group members, more positive results at the end of the program period suggest that the control group may be better off in the future.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576.3

PERFORMER ORGANIZATION: Manpower Demonstration Research Corporation, New York, NY
 

TITLE: Implementing Welfare Reform Requirements for Teenage Parents: Lessons from Experience in Four States

ABSTRACT: Federal welfare policy requires minor custodial parents receiving cash assistance to attend school and to live with their parents or in an adult-supervised setting. These requirements were established as part of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). This study summarizes the results from the operational experiences in four states (Arizona, California, Massachusetts, and Virginia) that implemented waivers requiring school attendance and certain living arrangements under the AFDC program (prior to PRWORA). The study found that: (1) identifying teenage parents, particularly those who do not head their own cash assistance cases, can be a major challenge; (2) persistent staff training to correct errors, the use of alternative information sources to identify teenage parents, and establishing positive incentives for identifying and referring all teenage parents can help to address these challenges; (3) requiring all children in families receiving cash assistance to attend school as a condition of assistance eliminates the need to identify teenage parents in order to enforce a school attendance requirement; (4) a range of education options, including GED programs, should be available; (5) programs must determine the focus and scope of case management in light of goals and costs; (6) monitoring school attendance increases welfare agency workload, sometimes substantially and can complicate the relationship between welfare agencies and schools; (7) a very restrictive living arrangement requirement may create implementation difficulties; and (8) funding group homes may enable states to have fewer exceptions to the requirement; but, despite their advantage for teen parents, many may not choose to reside in them.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-690-5883

PIC ID: 6228

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ
 

TITLE: Moving Into Adulthood: Were the Impacts of Mandatory Programs for Welfare- Dependent Teenage Parents Sustained After the Programs Ended?

ABSTRACT: Teenage parents have a high probability of engaging in behaviors and lifestyles that place them and their children at risk of poor health and long-term dependency on welfare. Therefore, from 1987 through 1991, HHS and the states of New Jersey and Illinois operated a demonstration to test innovative approaches for this population. The programs provided intensive case management support, allowances for child care costs and transportation, and other training-related expenses, as well as a variety of workshops designed to develop the teenagers' life skills, motivations, and ability to pursue continued education, training, or employment. Failure to participate could result, after prescribed warnings, in a sanction until the teenage parent complied with the program. The early findings show that States can operate large-scale, mandatory work-oriented programs for teenage parents and that demonstrations were able to increase school attendance, job training and employment but not influence changes in marriage, living arrangements, fertility, or child support. Regarding longer-term self-sufficiency, the evaluation found that: (1) the cycle of poverty was not broken for most young mothers; (2) program early impacts faded once the demonstrations ended and participants returned to AFDC and JOBS programs; (3) early impacts eroded once time sanctions and support services ended; (4) only 20 percent of mothers received child support payments after 6-7 years of being enrolled in the programs. The demonstrations had no clearly measurable effect on the child's development, parenting skills, and use of child care.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Reuben Snipper

PHONE NUMBER: 202-690-5880

PIC ID: 2771.9

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc., Plainsboro, NJ

OFFICE OF PUBLIC HEALTH AND SCIENCE

MINORITY HEALTH

ABSTRACT: This evaluation was a two-stage review of the effectiveness and efficacy of the OMH's bilingual/bicultural service demonstration grant program, a community-focused grants program aimed at increasing access to services for limited English-proficiency (LEP) populations. The evaluation examined FY 1993 and 1994 one-year project grants and three-year grants made in FY 1995. Projects were diverse and representative of racial/ethnic and language groups. Forty-three languages were spoken by the recipients of services provided under these grants. Eight evaluation questions were addressed including: Did the program build capacity? Did it increase health professionals' skills to address cultural and linguistic barriers? Did the program increase knowledge of health care systems and access to care for LEP minorities? The study found that these community projects achieved notable impacts. For example, capacity building was shown in that more than one-half of the projects were continued beyond OMH funding. Organizational policies such as required staff training and integration of cultural competency were adopted in many cases and many projects demonstrated success in moving LEP individuals into health care through provision of enabling services such as interpreter and case management services. More than 5,000 health providers participated in training which documented changes in attitudes and knowledge about specific cultural circumstances (e.g., refugee experiences). Increased awareness of prevention and knowledge of the health care system were identified as one of the strongest impact areas. Barriers to project implementation and successful strategies to address these problems were presented.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Joan Jacobs

PHONE NUMBER: 301-443-9923

PIC ID: 6247

PERFORMER ORGANIZATION: Development Services Group, Inc., Bethesda, MD
 

PREVENTIVE HEALTH CARE

ABSTRACT: This purpose of this study was to evaluate the impact Title X health education and counseling on the preventive health care practices of former Title X clients who no longer receive their care in Title X-funded clinics. Strategies that promote or hinder retention of health care messages were also identified. These clients received services until 1995 and the Title X clinic was their primary point of access to organized health care. Specifically, the study examined whether former clients of Title X clinics currently seek periodic health care screenings or practice health prevention and if those practices were influenced by the education they received when they used Title X clinic services. In general, the women who participated in the study had high praise for the Title X personnel, the providers, the clinics and the services. Many of the educational messages were retained, and some participants continued to rely on the clinic for advice and education rather than their private physicians. Many said the quality and amount of information received was superior to that of other providers. Although the education influenced some women to change or institute health measures, such as regular Pap smears, this was not universal. Other factors influencing preventive health care practices were money, insurance companies, TV, reading, the experience of friends, family and religious beliefs, personal medical history and current medical symptoms. Belief in personal risk had a strong effect on preventive health practice.

AGENCY SPONSOR: Office of Public Health and Science, Region VIII

FEDERAL CONTACT: John McCarthy

PHONE NUMBER: 303-844-6163

PIC ID: 6685

PERFORMER ORGANIZATION: University of Colorado Health Sciences Center, Denver, CO

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

SUBSTANCE ABUSE TREATMENT

ABSTRACT: Federally supported drug abuse treatment services are offered in hospital inpatient, residential, outpatient methadone, and outpatient nonmethadone settings. This evaluation is the first broad nationally representative study of substance abuse treatment outcomes and is representative of the almost a million individual discharges from treatment in 1990. Major findings include the following: (1) the overall drop in the use of any illicit drug use following treatment was 21 percent; a 14 percent decline in alcohol use; 28 percent in marijuana use; 45 percent in cocaine use; 17 percent in crack use; and a 14 percent drop in heroin use; (2) the decrease in post-treatment substance abuse was larger among females than males; (3) adolescents were the exception, showing a 13 percent increase in alcohol abuse and a 202 percent increase in crack use following treatment; and (4) those remaining in treatment the longest were more likely to reduce or eliminate abuse of substances following treatment. The study confirms that both drug use and criminal behavior are reduced following drug abuse treatment.

AGENCY SPONSOR: Office of Applied Studies, Office of the Administrator

FEDERAL CONTACT: Barbara Ray, Ph.D.

PHONE NUMBER: 301-443-0747

PIC ID: 7036

PERFORMER ORGANIZATION: National Opinion Research Center (NORC), Chicago IL
 

SUBSTANCE ABUSE PREVENTION

ABSTRACT: Between 1990 and 1996, SAMHSA funded a Community Partnership Program to provide community based substance abuse prevention and health promotion activities. This large-scale evaluation sought to determine the effectiveness of this program by studying outcome in 48 communities-24 partnerships and 24 demographically matched comparison communities without partnerships. The study found that: 1) prevalence rates for the use of illegal drugs and alcohol were lower in partnership communities than in the comparison group; and 2) partnerships helped to promote change in the overall community environment, not just prevention . The study also identified characteristics of effective community partnerships.

FEDERAL CONTACT: Shakeh Kaftarian

PHONE NUMBER: 301-443-9136

PIC ID: 4997

PERFORMER ORGANIZATION: Cosmos Corporation, Bethesda MD