Performance Improvement 1999

Publication Date

Jan 31, 1999

Foreword

Performance Improvement 1999: Evaluation Activities of the U.S. Department of Health and Human Services is the fifth annual report to Congress summarizing previous fiscal year evaluation efforts. The purpose of this report is to provide Congress with evaluative information on the Department's programs, policies, activities, and strategies. It contains brief summaries of evaluation results and provides a federal agency contact name for obtaining more detailed information. The report is useful to health and human service researchers, stakeholders and practitioners who use the information to assist their work.

In the era of results-oriented management, evaluations are playing an increasingly important role in program improvement. To this end, the Department of Health and Human Services (HHS) is committed to ensuring its evaluations yield valuable knowledge, and that knowledge is used to improve program performance. This is a consistent theme of our annual reports. Evaluations in the report can be characterized by the following improvement themes: evaluating program effectiveness, performance measurement, assessing environmental impacts on health and human services, and improving program management.

Program effectiveness provides a way to determine the impact of HHS programs on achieving intended goals and objectives. For example, a major departmental and national goal is to reduce drug abuse. Treatment programs are a key element in this effort. The Substance Abuse and Mental Health Services Administration, at the request of the Office of National Drug Control Policy, completed the Services Research Outcomes Study, the first national drug abuse treatment outcome study based on a nationally representative sample of treatment providers. The principal finding was that both drug use and criminal behavior are reduced following inpatient, outpatient and residential treatment for drug abuse, thus confirming that treatment programs work.

Performance measurement is the primary mechanism used to monitor annual progress in achieving departmental strategic and performance goals. To support performance measurement, we are investing evaluation funds to develop and improve performance measurement systems and the quality of the data that supports those systems. For example, the Office of Public Health and Science conducted a project to identify barriers to implementing performance measurement in State and local public health programs. Questions concerning the utility of measurement for decision making, uncertainty about linking performance to resource allocation, and accountability for outcomes beyond the program's span of control were among some of the barriers identified. These results are now being used by the Department, in collaboration with private foundations, to foster improvements in performance measurement of State and local health programs, particularly those supported through health and human services block grants.

Environmental assessment is the way we understand the forces of change in the health and human services environment that will influence the success of our programs and the achievement of our goals and objectives. In turn, this understanding allows us to adjust our strategies and continue to deliver effective health and human services. For example, the emergence of managed care and welfare reform may have a profound impact on a wide range of HHS programs. Therefore, we are investing in studies to understand the impact of these and other innovations on our programs. In this report, we are beginning to provide some of those results. For example, the Office of the Assistant Secretary for Planning and Evaluation assessed the impact of expanding managed care organizations and increased hospital and commercial laboratory consolidations on the viability of public health laboratories. In light of the observed impact, the study further identified ways in which these laboratories must adapt their services to changes in the health care marketplace in order to maintain their viability as part of the Nation's public health infrastructure.

Program management reflects the need of program managers to obtain information or data helpful for effectively designing and managing a program. These evaluations generally focus on developmental or operational aspects of program activities and provide understanding of services delivered and populations served. For example, the Administration for Children and Families completed an interim impact evaluation of the Parents' Fair Share demonstration project. The goal of this project was to increase employment and earnings of non-custodial fathers in order to raise support payments to children receiving welfare. The evaluation results helped program managers to learn which services could possibly increase the amount of child support collected from fathers. With these services, the number of fathers who paid child support could be increased, but with no corresponding increase in the fathers' employment duration and earnings.

Performance Improvement 1999 contains information on HHS evaluation projects completed and in progress during fiscal year (FY) 1998. The report is organized into three chapters. Chapter I presents the results of selected HHS agency evaluations that focus on measurement of program effectiveness. Chapter II highlights the results from eight FY 1998 evaluations, selected by an outside review panel as outstanding for their potential use by the larger health and human services community. Chapter III presents summaries of all FY 1998 evaluations completed and in progress by the 11 HHS agencies and the Office of the Secretary. A description of the HHS Evaluation Program, its activities, resources, planning, quality control and dissemination is provided in appendix A. The criteria used by the Evaluation Review Panel to select the reports highlighted in chapter II are in appendix B.

We hope that you will find this report useful and informative.

Donna E. Shalala	Margaret A. Hamburg, M.D.
Secretary U.S. Department of Health	Assistant Secretary for Planning and Evaluation

Acknowledgments

Performance Improvement 1999: Evaluation Activities of the U.S. Department of Health and Human Services describes the continuous efforts of the various HHS agencies to examine service and research programs for the efficiency of their operations and their effectiveness in achieving objectives. The planning, development, and coordination of those evaluations is largely the responsibility of the following HHS planning and evaluation offices:

Administration for Children and Families: Office of Planning, Research and Evaluation; Howard Rolston, Director
Administration on Aging: Office of Program Operations and Development; Edwin Walker, Director
Agency for Health Care Policy and Research: Office of the Administrator; Lisa Simpson, Deputy Administrator
Agency for Toxic Substances and Disease Registry: Office of Policy and External Affairs; Georgi A. Jones, Director
Centers for Disease Control and Prevention: Office of Program Planning and Evaluation; Kathy Cahill, Director
Food and Drug Administration: Office of Planning and Evaluation; Paul L. Coppinger, Associate Commissioner
Health Care Financing Administration: Office of Strategic Planning; Barbara S. Cooper, Director
Health Resources and Services Administration: Office of Planning, Evaluation and Legislation; Paul W. Nannis, Director
Indian Health Service: Office of Public Health; Leo Nolan, Director
National Institutes of Health: Office of Science Policy and Technology Transfer; Lana Skirboll, Associate Director
Office of the Assistant Secretary for Planning and Evaluation: Office of Program Systems; Delores Parron, Deputy Assistant Secretary for Program Systems
Office of Public Health and Science: Linda Meyers, Acting Director, Office of Disease Prevention and Health Promotion
Substance Abuse and Mental Health Services Administration: Office of Policy and Program Coordination; Mary Knipmeyer, Director

Preparation of this report and the noted appendices was coordinated by staff in the Office of the Assistant Secretary for Planning and Evaluation, under the supervision of Delores Parron, Deputy Assistant Secretary for Program Systems. Responsible staff include Mike Herrell, Paul Johnson, and Carolyn Solomon. Development and production of the report was supported, under contract, by the services of Amanda Utts and Susan Belsinger of Sanad Support Technologies, Inc.; Reid Jackson, Wayne Hall, and Carolyn Paxton of the South Carolina State University Policy Analysis Consortium; Lydia Paddock, Editorial Consultant; and David Peabody and Toni Garrison of the HHS Graphics Center. The following persons from HHS agencies contributed to writing, collecting information on evaluation activities, and reviewing the report:

Administration for Children and Families: James V. Dolson; Helen Howerton
Administration on Aging: Saadia Greenberg
Agency for Health Care Policy and Research: Wendy Perry; Harvey Schwartz
Agency for Toxic Substances and Disease Registry: Woodrow Garrett; Donna Jones
Centers for Disease Control and Prevention: Nancy Cheal; Nancy Chalmers
Food and Drug Administration: Kathleen McEvoy; Mary Gamunev
Health Care Financing Administration: William Saunders; Sydney Galloway
Health Resources and Services Administration: Anabel Crane
Indian Health Service: Frank Marion; Sarah Crazythunder; Debbie Melton
National Institutes of Health: John Uzzell; Joan Bailey
Office of Public Health and Science: Linda Bailey; Valerie Welsh
Substance Abuse and Mental Health Services Administration: Nancy Pearce; Jerri Scott-Pinckney

Evaluation Review Panel

The following individuals served on the evaluation review panel that made recommendations of the reports highlighted in chapter II of Performance Improvement 1999: Evaluation Activities of the U.S. Department of Health and Human Services.

Douglas Barnett, Ph.D.
Department of Psychology
Wayne State University
Detroit, Michigan

Heather Becker, Ph.D.
Professor, School of Nursing
University of Texas
Austin, Texas

Anna Madison, Ph.D.
University of Massachusetts at Boston
Human Services Graduate Program
Boston, MA

Tresmaine R. Grimes, Ph.D.
South Carolina State University
Orangeburg, South Carolina

Holly Korda, Ph.D., Panel Chair
Evaluation Consultant
Chevy Chase, Maryland

John Kralewski, Ph.D.
Director, Institute for Health Services Research
School of Public Health University of Minnesota
Minneapolis, Minnesota

Kenneth McLeroy, Ph.D.
Health Promotion Sciences Department
University of Oklahoma
Oklahoma City, Oklahoma

Donna Mertens, Ph.D.
Professor
Gallaudet University
Washington, D.C.

Ira Raskin, Ph.D.
Health Policy Consultant
Bethesda, Maryland

Felix A. Okojie, Ph.D.
Jackson State University
Jackson, Mississippi

Chapter I - Results in Brief of Selected Program Effectiveness Evaluations

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

TITLE: Employment Experiences of Welfare Recipients Who Find Jobs: Is Targeting Possible?

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

TITLE: Evaluation of Child Support Guidelines

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

TITLE: Evaluation of the WomanKind Program: Support Systems for Battered Women

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

TITLE: The Effect of Condition Sequencing Order on Cause-of-Death 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

TITLE: Evaluation of the Field Epidemiology Training Program (FETP)

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

TITLE: Tobacco Retailer Study: Arkansas Pilot Methods Report

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

TITLE: Report of the Prescription Drug User Fee Act (PDUFA) of 1992-Fiscal Year 1998 Report to Congress

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

TITLE: Readership Survey Analysis for the FDA Public Health Advisory: Interference between Digital TV Transmitters and Medical Telemetry Systems

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 Administration

AMBULATORY PATIENT GROUPS

TITLE: Toward a Prospective Payment System for Outpatient Services: Implementation for Outpatient Services: Implementation of APGs by State Medicaid Agencies and Private Payers

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

TITLE: Evaluation of the Demonstration to Improve Access to Care for Pregnant Substance Abusers

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

TITLE: Evaluation of Drug Use Review Demonstration Projects Final Report

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

TITLE: The Evolution of the Oregon Health Plan: First Interim Report

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

TITLE: Medicare Participating Heart Bypass Center Demonstration Extended Evaluation

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

TITLE: Evaluation of Rural Health Clinics

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

TITLE: State-Administered Programs for HIV- Related Care

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

TITLE:ACSC Experience by Usual Source of Health Care: Comparing Medicaid Beneficiaries Who Rely on CHCs with Medicaid Beneficiaries Who Rely on Other Primary Care Providers

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

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

TITLE: Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior

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

TITLE: The Implementation of Healthy Start: Lessons for the Future

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

TITLE: Evaluation of Village-Based Women's Preventive Health Services by Community Health Aides/Practitioners

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

TITLE: Evaluation of the Indian Health Service Adolescent Regional Treatment Centers

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

TITLE: Evaluation of the International Cooperative Biodiversity Groups (ICBG)

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

TITLE: Evaluation of the National Heart, Lung and Blood Institute's Short-Term Training for Minority Students Program

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

TITLE: Public Health Laboratories and Health System Change

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

TITLE: Assessment of Access to Liability Insurance for Tribes and Tribal Organizations with Self-Determination Contracts/Compacts

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

TITLE: Evaluation of the District of Columbia's Demonstration Program, "Managed Care System for Disabled and Special Needs Children"

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

TITLE: Evaluating Two Welfare-to-Work Program Approaches: Implementation, Participation Patterns, Costs and Two-Year Impacts of the Portland (Oregon) Welfare-to-Work

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

TITLE: Study of the Implementation of the OMH Bilingual/Bicultural Service Demonstration Grant Program, FY 1993-1995

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

TITLE: Retrospective Study of the Preventive Health Practices of Former Title X Clients

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

TITLE: Services Research Outcomes Study

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

TITLE: Outcome Evaluation for the Community Partnership Program

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

Chapter II - Highlights of Outstanding Evaluations Completed During Fiscal Year 1998

In this chapter, the U.S. Department of Health and Human Services (HHS) highlights evaluations of general interest to the public health, health care services, and human services community, and illustrates the diversity of HHS evaluations completed in fiscal year (FY) 1998. Included are summaries of eight evaluation projects selected by the HHS Evaluation Review Panel, a group of outside evaluation experts. The Panel reviewed 24 reports nominated by HHS agencies and selected the reports to be highlighted in this chapter on the basis of the following criteria:

Is the report important? Does it address a significant issue or problem for which evaluation would confirm or change program direction, or measure program impact? Are the findings likely to be useful and generalizable?
Is the report methodologically sound? Are its concepts, designs, data collection, and analyses conducted and reported in a competent manner?
Is the report faithful to the data? Do the conclusions and recommendations logically follow from the data and analyses, and are they relevant to the questions asked?

The eight studies are organized under three headings: program effectiveness evaluations, performance measurement, and environmental assessment. These headings represent the four most common uses of HHS evaluation resources. Program effectiveness evaluation provides a way to determine the impact of the Department's programs on achieving intended goals and objectives. Performance measurement is the primary mechanism used to monitor annual progress in achieving departmental strategic and performance goals and determine the effectiveness of program strategies or specific program activities in achieving those goals.Environmental assessment is the way we understand the forces of change in the health and human services environment that will influence the success of our programs and the achievement of our goals and objectives.

Each summary includes a brief abstract; a description of the study (including its purpose, background, methods, findings, and use of results); the names of any publications that resulted; and the name and phone number of the HHS official to contact for additional information.

A. Program Effectiveness

Working with Low-Income Cases: Lessons for the Child Support Enforcement System from Parents Fair Share

Highlights: Parents Fair Share (PFS) program model began in 1992 as a two-year pilot project by Manpower Demonstration Research Corporation (MDRC). This report represents the initial findings on program implementation and the initial impacts on several key outcomes. This interim report, which is one of several reports that will be released about the demonstration project, describes how PFS services were implemented, offers insights into challenges of the program and how they might be addressed, and provides information on the background of the parents in the PFS research sample. These early findings address the programs initial success in meeting two of the three demonstration goals: 1) increasing employment and earnings, and 2) raising the child support payments of non-custodial fathers.

Findings from the first 18 months of the project indicate that PFS did increase the number of fathers who paid child support, but with no corresponding increase in those fathers employment and earnings. Multiple factors contribute to the lack of non-custodial support to children who are poor. Non-custodial fathers who are able to pay child support will do so with some assistance and those who do not have multiple reasons for not paying support. Government-wide programs that offer a variety of support services to non-custodial fathers can impact the level of child support provided to their children. This report is based on administrative data on child support collections and earnings. The final evaluation report will include survey results from both custodial and non-custodial parents.

Purpose
The purpose of this pilot project was to implement a unique cooperative arrangement between the child support system, local community-based organizations and non-custodial fathers. It was hoped that with supportive services, such as peer group assistance, non-custodial fathers would increase their involvement with their children. It was further hoped that, with employment training and job location assistance, these fathers would find employment and increase their earnings, thereby placing themselves in the position to pay child support and to pay it in a timely fashion. The ultimate goal of this project, therefore, was to effect a system that would support more responsible non-custodial parenting.

Background
Parents Fair Share (PFS) was formed as a result of three interrelated trends and the dilemma facing courts and child support administrators. First, welfare reform efforts that gained momentum in the 1980's shifted responsibility for supporting poor children away from the public sector to the parents. Second, since the mid-1970's, continuing through the 1996 welfare law, the Federal government has required States to strengthen child support enforcement (CSE). The goal is to help low-income families stay off welfare and to recoup money spent on welfare recipients. The focus has largely been on non-custodial parents with income and assets. The research indicates, however, that a significant portion of non-custodial parents (usually fathers) of children receiving welfare have few financial resources and unstable residencies and employment.

The third trend that led to the development of PFS is the rapid decline in job opportunities for less educated men. Public policy programs have largely focused on parents receiving welfare (mostly women) and dislocated workers. Men, especially those of color, were largely overlooked in employment outreach programs and few programs were successful in increasing their employment and earnings. Thus, the growing importance of child support for poor families, low earnings and sporadic employment of men of color and the lack of alternative programs for those who are unemployed, creates a dilemma for child support administrators and the courts.

The PFS program offers a solution by offering employment referrals and job training opportunities.

To test the feasibility of the PFS approach, MDRC launched a two-year pilot phase in 1992. There were three overall goals for the pilot project: (1) to increase employment and earnings of unemployed non-custodial parents (mainly fathers) of children receiving welfare; (2) to increase child support payments; and (3) to support and improve the parenting behavior of these parents. The pilot experience was promising enough to warrant a more rigorous test of the programs effects on non-custodial parents employment rates, earnings, and child support payments, and on aspects of their parenting skills, and their childrens well-being. This is a report of the second test of the programs effectiveness, which began in 1994.

Methods
The study was based on a research design where eligible non-custodial parents were assigned, at random, to one of two groups: a program group that accessed the programs services or a control group that could not receive those services. The analysis compared the labor market, child support payment, and parenting experiences of the two groups. All differences that were measured between the two groups were attributable to the Parents Fair Share program.

Findings
During the first 18 months of this project, PFS did increase the number of fathers who paid child support. However, only three sites reported increases: Grand Rapids, Dayton and Los Angeles. These sites reported sizeable increases in the number of fathers paying child support, but not in the amount they paid. Those fathers who paid support as a result of PFS already had the means to pay something, but would have paid nothing without PFS support. The findings also suggest that one of the factors common to two of the sites that increased child support payments was the strong involvement of the Child Support Enforcement (CSE) agency.

In contrast, during the first 18 months of this project, none of the sites produced consistent and statistically significant increases in non-custodial fathers employment and earnings. In fact, during the first quarter, 50.3 percent of PFS fathers worked, compared with 51.9 percent of control group fathers. PFS produced no significant impacts on employment. Also, average earnings were no different, statistically, between the two groups. Reasons for the lack of success were not clear, although most of the sites were not able to provide a full range of employment and training services. These services were to include basic education, job search assistance, skills training, and on-the-job training. It was also found that on-the-job training was the most difficult component to develop.

The data revealed that many of the non-custodial fathers had problems that hampered their ability to obtain and keep jobs, such as a history of drug abuse, criminal backgrounds or poor education preparation.

Use of Results
This study revealed that it is possible to increase the payment of child support by non-custodial fathers through enhanced outreach and focused case review. PFS was not able to significantly impact the employment and earnings status of the fathers in the study sample. Many factors contributed to this failure, including the fact that many fathers enrolled in the program with the expectation they would obtain better jobs and thus higher pay. Their refusal to accept any job because they were holding out for the ultimate better job caused higher unemployment rates for these fathers at certain sites.

The challenges presented by this demonstration program model provide clear, substantive information for those who seek to replicate such a program. Program support can impact the level of child support to poor children by their non-custodial fathers. Non-custodial fathers who are able to pay child support will do so with some assistance. Those who do not pay have multiple reasons for not paying such support. Thus, multiple factors contribute to the lack of non-custodial support to children who are poor.

AGENCY SPONSOR: Administration for Children and Families, Office of Planning, Research, and Evaluation and Office of Child Support Enforcement

FEDERAL CONTACT: Mark Fucello

PHONE NUMBER: 202-401-4538

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

Evaluation of the WomanKind Program: Support Systems for Battered Women

Highlights
This study was conducted to document the extent to which the Minnesota-based WomanKind program influenced the quality of intervention by health care providers to victims of intimate partner violence (IPV)⁽¹⁾. The WomanKind program is based on the premise that the health care setting offers a unique opportunity to intervene and offer support, options and referrals to IPV victims. WomanKind has been successful in training health care providers in hospital and clinic settings and in establishing an ongoing supportive connection between the health care setting and community resources. The evaluation was conducted by the National Center for Injury Prevention and Control, of the Centers for Disease Control and Prevention (CDC). WomanKind volunteer advocates, hospital staff, and IPV victims were the target populations in this evaluation. It was found that the WomanKind program had a significant positive influence on the knowledge, attitudes, beliefs and behaviors of hospital staff. WomanKind training provided an understanding of the magnitude and scope of the IPV problem, increased health care providers' sensitivity, empathy, and willingness to screen patients for IPV, and prepared these providers for appropriate and timely intervention and referrals. This study provides strong evidence that specialized staff development training along with dedicated on-site client services has a positive impact on the knowledge, attitudes, beliefs and behaviors of health care providers interacting with IPV victims.

Purpose
The purpose of this study was to conduct an evaluation of the Minnesota-based WomanKind program to identify the extent to which this program influenced the quality of intervention provided by health care professionals to IPV victims. Specifically, the study assessed the program on four critical variables: (1) the extent to which health care providers reported increased capacity and motivation to screen and identify IPV victims; (2) reported confidence in their ability to assist IPV victims; (3) increased documentation in patient records of the physical and mental health consequences of violence; and (4) referrals to the on-site WomanKind program.

Background
Intimate partner violence (IPV) is a substantial public health problem for Americans that has serious consequences and costs for individuals, families, communities and society. Recent efforts have been made to increase resources to address gaps in knowledge and to improve services for victims, perpetrators and child witnesses.

In a study of emergency department visits by women, over half of all women in the study have experienced IPV at some time in their lives, while 11% of those with current husbands or boyfriends gave IPV as the reason for the visit. Non-lethal IPV results in financial losses to victims, conservatively estimated to be $150 million per year. Medical expenses accounted for at least 40% of these costs.

Preliminary research by CDC on the WomanKind program suggested that when IPV victims access the health care system, including emergency departments, they are rarely asked questions about the cause of their injuries, medical symptoms or any available support system. Findings indicated that, for the most part, IPV victims are simply treated for the medical problem and discharged. These same health care providers also became frustrated when the victim returned again and again for treatment of injuries or symptoms.

The WomanKind program began with the realization that the health care setting offers a unique opportunity for intervention with IPV victims. However, it was discovered that health care professionals may not respond appropriately to these situations for several reasons: (1) they have little or no training about IPV, (2) they are uncomfortable intervening with a victim, (3) they do not see such intervention as a part of their role or responsibility, (4) they have limited time to assess or assist the victim, and (5) they believe that their efforts ultimately will have little effect.

WomanKind is based on the premise that health care professionals intervene at a point where abuse and violence can be identified, support and education can be provided, and the victim can learn of options and community resources available. WomanKind is a hospital-based program that provides services to IPV victims in combination with education and training for health care providers. The WomanKind program consists of five full-time professional staff and a cadre of trained volunteer advocates, all of whom are available 24 hours per day, 7 days per week.

WomanKind applied the public health concept of early intervention and prevention in order to design services that would ultimately improve the health care response to IPV victims. Routine screening, identification, intervention, and appropriate referrals may result in prevention of more serious injuries, prevention of mental health/psychiatric symptoms, and prevention of abuse to children.

Methods
Three populations were under study for this evaluation: hospital staff, IPV victims (clients), and WomanKind volunteer advocates. The research team used a variety of methodologies to obtain an in-depth understanding of the WomanKind program. Although specific to each population, the research instruments were designed to measure similar information from each group. Five hospital sites were selected for the program evaluation. The WomanKind program was in place in three of the five hospitals, and the other two other hospitals were selected as comparison sites. Professional staff from three hospital departments participated: Emergency Departments (ED), Intensive Special Care Unit (ICU) and the Obstetric/Gynecology Unit (OB/GYN). Limited training by WomanKind staff was provided to interested staff at the comparison hospitals near the end of the study.

Surveys and interviews were the methods used to gather data from participants. Surveys were developed to measure knowledge, attitudes, beliefs and behaviors (KABB) of hospital staff, volunteer advocates, and IPV victims. Data were collected over a two-year period beginning January 1995 and ending March 1997. Baseline data were collected at the beginning of the study from all participating staff. Pretest and post-test surveys were administered prior to and following training conducted by WomanKind staff. Additionally, follow-up surveys were administered to all participating staff at specified intervals during the two-year assessment period.

To measure the importance of training on hospital staff knowledge, attitudes, beliefs and behaviors (KABB), a 51-item survey was administered to hospital staff. The scales that were developed measured: (1) self-efficacy for identification and interaction with IPV victims (2) self-efficacy for referral and services, (3) staff understanding of violent relationships, (4) staff role and responsibility to address IPV, (5) self-reported behaviors concerning screening and intervention, (6) staff preparation to assist IPV victims, and (7) beliefs in the importance of victim autonomy.

To assess curriculum materials used in training, all curriculum materials were reviewed, the curriculum developer and trainer were interviewed, and the training sessions were observed twice by the researchers. Training was provided consistently at the WomanKind hospitals over the two-year evaluation period. Approximately 400 hospital staff participated in 70 training sessions.

An important variable examined the perception that the health care providers held about the efficacy of the WomanKind program. The researcher conducted interviews with a sample of the participating staff at the five hospitals using open-ended questions.

A random sample of 2,531 emergency department records were reviewed to determine the extent to which hospital staff documented possible abuse in the medical record and offered victims referrals to WomanKind for services.

New WomanKind volunteer advocates received a month-long intensive training program and completed a 42-item version of the evaluation instrument.

To gather data on the clients' (IPV victims') perception of the WomanKind program's effectiveness, surveys were also administered at 3-month intervals to IPV victims who received WomanKind services over the course of the study. Participants were women who had acknowledged IPV and had been referred to the WomanKind program.

Findings
Results from the evaluation indicated that the WomanKind program had a positive effect on the knowledge, attitudes, beliefs and behaviors of both hospital staff and volunteer advocates in terms of their awareness of IPV as a problem, and in their understanding of the role of all health care providers in addressing this problem.

WomanKind training also proved effective in heightening the hospital staff's awareness of the extent to which IPV affects their patients, and the provider's vital role and responsibility in responding effectively to the needs of the IPV victim. In addition, the hospital staff reported heightened awareness in their understanding of the dynamics of IPV, their willingness and ability to identify patients who are IPV victims, and to offer referrals to the on-site WomanKind program. Hospital staff in the WomanKind hospitals reported increased knowledge and positive attitudes about the role they played in addressing IPV in contrast to staff in control hospitals, who reported little or no increase.

Total scores on the hospital staff surveys were significantly higher for the WomanKind hospitals than for the comparison hospitals at all time intervals during the study. In addition, staff at the WomanKind hospitals scored significantly higher than staff at the comparison hospitals on four of the scales: (1) self-efficacy for referral and services, (2) self-reported behaviors, (3) staff preparation, and (4) victim autonomy.

Trained hospital staff who had previous exposure to IPV (through education or personal experience) had significantly higher mean scale scores than those without this previous experience. Specifically, six scores were statistically significant: (1) self-efficacy for identification and interaction with victims of abuse, (2) self-efficacy for referral, (3) understanding of abusive relationships, (4) responsibility to address IPV, (5) self reported behaviors, and (6) staff preparation. These findings indicate that the WomanKind training is effective in helping staff develop confidence in their ability to recognize and communicate effectively with victims of domestic abuse.

During 10 months of the evaluation, 1,719 IPV victims were identified and referred to the WomanKind program, while only 27 IPV victims were referred to trained social workers at the comparison hospitals. Chart review results indicated that emergency staff at the intervention hospitals provided appropriate documentation of IPV in patient records twice as frequently as emergency staff at the comparison hospitals.

Findings indicated that training increased the WomanKind volunteer advocates' confidence in their ability to provide advocacy and support to IPV victims. Their knowledge and competence in making appropriate community referrals for IPV victims increased. Self-reports from volunteer advocates indicated that the training helped them understand the issue of IPV and its effects on the victim and family members.

Use of Results
This study underscores the efficacy of a well-structured, comprehensive, multi-disciplinary effort in the delivery of services to IPV victims. The results of this evaluation document that specific training on the dynamics of IPV, screening, identification, and intervention provide the knowledge and skills that enable health care providers to respond more appropriately to IPV victims. It also suggests that the WomanKind program may be useful as a model prototype for both inpatient and outpatient health care settings. This study provides strong evidence that specialized staff development training along with dedicated on-site client services has a positive impact on the knowledge, attitudes, beliefs and behaviors of health care providers interacting with IPV victims

AGENCY SPONSOR: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control

FEDERAL CONTACT: Lynn Short, Ph.D.

PHONE NUMBER: 770-488-4285

PERFORMER ORGANIZATION: Macro International, Silver Spring, MD

Evaluation of Drug Use Review Demonstration Projects: Final Report

Highlights
An external evaluation was conducted on drug use review (DUR) demonstration programs within the Medicaid agencies of two States: Washington and Iowa. The States of Georgia and Maryland were included in the study for experimental and comparison purposes. Specifically, the study evaluated the efforts of Project C.A.R.E., a joint project of Washington's Department of Social and Human Services and the University of Washington's School of Pharmacy. The Washington effort was designed to test the effectiveness of payments to pharmacists for the provision of cognitive services. The Iowa Medicaid online prospective drug use review (OPDUR) demonstration project was also evaluated and tested. Both evaluation efforts were designed to improve drug prescription methods by influencing pharmacists behavior.

The findings from the evaluations of Project C.A.R.E. and the Iowa OPDUR indicate that prospective drug use review did not affect the frequency of drug problems. According to the study, expenditures on and frequencies in the use of prescription drugs and other medical services also were not measurably affected. Further, analysis of data collected from cognitive services (CS) provision also revealed no evidence of changes in the behavior of pharmacists who received OPDUR messages.

This research study found support for making no changes in DUR requirements. The analysis indicates a more effective use of Medicaid DUR funds would be to encourage more retrospective DUR, establish a way of compensating pharmacists for counseling and educating patients, and to support pharmacists by improving their capacity to prescribe.

Purpose
The purpose of this study was to test the effectiveness of the drug use review (DUR) demonstration projects in improving drug use and in reducing the negative consequences of drug misuse in the Medicaid programs of Washington and Iowa. If either of these State demonstrations proved effective, the evaluators were also expected to further study the costs of achieving these improvements compared to other policies and programs designed to improve drug use and to reduce the consequences of drug misuse.

Background
Since 1990, the Omnibus Budget Reconciliation Act has required all State Medicaid programs to implement drug use review (DUR). Also required were demonstrations of innovative models of DUR. Therefore, in 1992, the Health Care Financing Administration (HCFA) funded two experiments managed by two State Medicaid agencies: Project C.A.R.E. in the state of Washington, which tests the effects of paying pharmacists to provide cognitive services (CS); and the Iowa Medicaid OPDUR Demonstration Project, which tested online prospective drug use review (OPDUR). This is the final report of a 1993 HCFA-funded external evaluation of both demonstrations.

Methods
Two methodological tools were used for this evaluation study: The Penn State University (PSU) screener and a bibliographic database. The PSU screener is a knowledge-based research tool used for conducting epidemiologic and economic studies on potentially inappropriate drug therapy. It is capable of examining millions of drug claims records and is intended to be used with large pharmaceutical assistance and Medicaid programs. For this project, the screener was used to compute the occurrence of screen failures for a consistent set of DUR screening criteria across the two demonstration States, as well as the co-experimental and comparison States.

The DUR Outcomes Bibliographic Database was developed as a way of comprehensively and definitively linking DUR screening failures to expected clinical outcomes. The bibliographic review was then used in the selection and evaluation of candidate clinical outcomes.

To test the effects of Project C.A.R.E. on prescription drug use and costs, the evaluation team compared statistical reductions in drug cost and use of Medicaid recipients obtaining prescriptions from demonstration pharmacies against a control group of pharmacies. The same data set, comprised of geographic clusters, was used for the experimental and control groups. This involved random assignments of pharmacies. The study population was the same, with Medicaid recipients who had dual eligibility for Medicare. The sample population included 7,809 elderly subjects and 8,090 non-elderly subjects. Multiple regression models were used to test the study hypotheses.

To implement the Iowa demonstration, pharmacies had to meet a set of eligibility criteria and were recruited through newsletters, letters and articles in the Iowa Pharmacists Association Journal. All the pharmacies participating in the OPDUR demonstration were linked to an online DUR screener that reviewed all medical prescription drug claims as they were submitted electronically for payment. The pharmacies in the experimental group received feedback that identified potential prescription problems. The control group pharmacies received no messages. Although the pharmacies in both groups were told to document all cognitive services provided, they were not offered payment to do so. Iowa also adapted commercial screening software to local conditions by customizing the ProDUR systems, a commercially available online prospective DUR software. The project defined the syntax for modifications and developed software to test the syntax.

Findings
Eight years of drug claims for Medicaid programs were screened in Washington, Iowa, Georgia and Maryland. In the study of Washington's Project C.A.R.E., it was found that pharmacists and prescribers agreed on the benefits of increased communication between the two groups. Survey respondents and those who participated in focus groups supported patient counseling for healthier patients and more qualitative prescription methods. The physicians in the study believed that pharmacists could help them best by increasing narcotics monitoring and offering drug cost options. The pharmacists believed that physicians could best help them if they were allowed access to medical records or patients' diagnoses. The pharmacists also believed that they should be compensated for patient counseling.

Findings from Project C.A.R.E. demonstrate that CS payment is replicable in other States, that it is useful in providing a clear definition of what CS is, and that the provision of cognitive services to patients has no measurable impact on either drug use or cost. Project C.A.R.E. did not conduct a demonstration comparing OPDUR and cognitive services. Therefore, this study could not determine whether pharmacists had a preference for drug use review.

The Iowa study sought to determine if a system that instantly screened prescriptions for errors would improve pharmacists knowledge, increase their use of cognitive services, and improve optimal drug utilization, thereby decreasing sub-optimal drug use by Medicaid recipients. However, there was no evidence that OPDUR affected pharmacists' behavior. It was concluded from analysis of the Iowa OPDUR Demonstration and Project C.A.R.E. efforts that prospective DUR has no measurable effect on the frequency of drug problems, on how much is spent, how frequently prescriptions are used, or on clinical outcomes.

Use of Results
Since 1990, the Medicaid program has been mandated to operate prospective and retrospective drug use review programs. Now that most Medicaid patients (with the exception of the adult disabled and Medicaid/Medicare eligible elderly) will be folded into managed care operations, the question becomes whether policy makers should advocate for changes in DUR requirements based on current knowledge, fund additional research studies, or leave the system as it is.

The findings gained from this study indicate that a more effective use of Medicaid DUR funds would be to encourage more retrospective DUR, and to establish a way of compensating pharmacists for counseling and educating patients. The findings further indicate that OPDUR can continue to support pharmacists by improving their capacity to prescribe. This might be a more productive way to use public money instead of payments for generalized cognitive service provision, or standardizing and validating OPDUR screening systems.

This evaluation study also supports making no changes in the current system. There was no evidence found to support DUR policy changes that would be cost-effective for the Medicaid program or Medicaid recipients' sub-optimal drug use. There also was no evidence that OPDUR affected pharmacists' behavior. Further conclusions, from analysis of the Iowa OPDUR Demonstration and Project C.A.R.E. efforts, also indicate that prospective DUR has no measurable effect on the frequency of drug problems, how much is spent, how frequently prescriptions are used, or on clinical outcomes.

AGENCY SPONSOR: Health Care Financing Administration, Office of Strategic Planning

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

PHONE NUMBER: 410-786-6591

PERFORMER ORGANIZATION: Abt Associates, Cambridge, MA

Evaluation of the International Cooperative Biodiversity Groups

Highlights
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 their progress in achieving their goals and objectives. 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 bioactive compounds and developed systems to inventory and archive information gained on the biological diversity of their respective source countries. 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.

Purpose
The purpose of this study was to provide a comprehensive evaluation of the ICBG program to assess progress toward achieving individual program goals and objectives (drug discovery, biodiversity conservation, and sustainable economic development). The evaluation findings 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.

Background
The ecological base for sustainable human survival is contingent upon maintaining and ensuring the access of populations to resources to meet their needs, now and for future generations. There is an urgent need to protect a deteriorating global environment that provides for basic human needs while at the same time promoting economic well-being. This is especially true in both developed and developing countries where natural resources have been depleted.

Over the past two centuries technological developments have provided humans with the ability to expand the transformation of natural resources into the large scale production of goods. The world has reached a critical point in this process. In developing countries, natural resources have been severely depleted by human impacts, such as forest loss through unsustainable logging, agriculture, ranching and overgrazing. In developing countries, dwindling reserves are vulnerable because conservation awareness and legislation are often weak or non-existent.

The ICBG program was conceived as one approach to contribute toward the potential resolution of these problems. The ICBGs addressed developmental issues of importance to both the United States and the international community. Each ICBG accomplishes its work through a unique multi-national and multi-disciplinary partnership. The ICBG model provides working tools for responsible resource development and hopefully will be the catalyst for larger sustainable efforts throughout the world. The ICBG program, through each individual group, also supports research, training, technology transfer, and scientific infrastructure development.

Methods
An Evaluation Advisory Group was established for the study with membership being drawn from the scientific staff of each ICBG and each funding agency, five source countries, and outside experts. The task of this group was to develop the critical variables to be tested and to generate methods through which these variables might be assessed. After the specific variables had been identified, collection instruments were designed to collect data in four phases: (1) a pre-site visit, (2) archival data collection, (3) site visit interviews, and (4) post-site visit interviews. Because of the large amount of data to be collected, four instrument components were developed and administered over the remaining year of the current grant cycle.

After design of this methodological structure, a contract was awarded to the Center for Public Health Research and Evaluation of the Battelle Corporation for a specific approach that accomplished the following: (1) accommodated the varied and non-standard implementation of the ICBGs, (2) obtained sufficiently broad coverage of respondents, (3) minimized the burden on ICBG researchers and other respondents, and (4) incorporated cost and time efficiencies.

Contractor staff made visits to three selected sites in Chile, Peru, and Suriname. Prior to the site visits, data were collected on the organizational and programmatic (scientific) structure of the ICBG's potential site visit respondents. Additionally during this phase, Group Leaders completed a self-administered questionnaire. During Phase 2 of the data collection, two sets of instruments were used to gather data. The various activities in which the ICBGs had been engaged were collected and evaluated. A second self-administered questionnaire was again completed by the Group Leader. During the actual site visits to the three countries, interviews were conducted with program leaders and indigenous people who had been involved with the programs. The post-visit data were collected through telephone calls to the various ICBGs.

Findings
Results show that each ICBG group demonstrated significant movement toward accomplishment of the program's strategic objectives: to protect human health, advance the conservation of biologically diverse ecosystems, and promote sustainable economic development through the search for drugs to control diseases of concern to both developed and developing countries.

There were significant strides in the discovery of new drug leads. While no new drugs were discovered, substantial efforts by the ICBGs were made in the four areas. The ICBGs all accomplished the following:

Development of contractual agreements with source country organizations. It was recognized that a consensus-building process must occur before the initiation of sample collections and the establishment of the intellectual property rights. Each ICBG concluded its own set of novel agreements to govern the collaborations.
Collection and inventory of its activities. Each ICBG was able to accomplish somewhat less collecting than expected. However, 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.
Engagement of extraction activities. The ICBGs combined report producing over 6,000 extracts from samples collected and submitted these for testing in at least 60 different assays in15 different therapeutic areas.

The ICBGs facilitated sustainable economic systems by developing local capacity, scientific infrastructure, and community-based enterprises. All ICBGs carried out some level of training to increase the source country human capacity in drug discovery, and in biodiversity conservation. Two of the ICBGs have contributed toward building renovations in the source countries. Development of micro enterprise initiatives with local communities was initiated by two ICBGs.

Use of Evaluation Results
The ICBG Program was established as a unique effort to coordinate scientific, cultural, and political forces in providing new information on plant and animal species, the possibility of the development of new drugs from this diverse flora and fauna, the initiation of conservation efforts through education and understanding (including in-country legislation), and development of methods to move the collection and biodiversity conservation efforts to being self-sustaining.

This evaluation provides:

benchmarks for future biodiversity collection and conservation programs,
advances in generating and evaluating the types of data necessary for an understandingofbiodiversity-type program impact,
methods that allow for efficient and targeted collection of information for future projects,
information for future scientific capacity building of biodiversity programs in some countries,
knowledge and expertise for designing in-country agreements that are equitable to a diverse set of parties with vastly differing priorities, and
a useful model for operating new initiatives and for obtaining data that can be used to justify increased funding.

AGENCY SPONSOR:

FEDERAL CONTACT: Kirby J. Weldon

PHONE NUMBER: 301-496-2571

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

Services Research Outcomes Study (SROS)

Highlights
The Services Research Outcomes Study (SROS) was initiated at the request of the Office of National Drug Control Policy (ONDCP) in 1990 and was to be the first national drug abuse treatment outcome study based on a nationally representative sample of treatment providers. Earlier outcome studies - all showing positive outcomes from treatment - had used samples based largely on urban treatment providers. It was thought this sample bias would exaggerate positive treatment outcomes. The SROS confirmed these earlier findings of positive treatment outcomes and dispelled the notion that sample bias accounted for positive results. The SROS principal finding was as follows:

Graph: Treatment Reduces Drug Use A nationally representative survey of 1,799 persons confirms that both drug use and criminal behavior are reduced following inpatient, outpatient and residential treatment for drug abuse.

Because use of every substance decreased nationally in the five years after treatment, switching from one substance to another after treatment cannot account for the positive results.

The one exception to the overall decrease in drug use following treatment was for those who were adolescent when discharged from treatment. Following treatment, adolescents increased their use of alcohol by 13 percent and the use of crack by 202 percent, albeit from a low pre-treatment base of five percent. Specific reasons for the difficulties in treating adolescents remain unclear. Consequently, this treatment subgroup poses an ongoing challenge for addiction researchers and those who work with adolescent substance abusers.

Purpose
To conduct a drug abuse treatment outcome study using a nationally representative sample, and to update earlier findings from ten and twenty years ago.

Background
The Services Research Outcomes Study (SROS) was initiated in the National Institute on Drug Abuse at the request of the Office of National Drug Control Policy (ONDCP) in 1990 and moved to the Office of Applied Studies with the creation of SAMHSA in 1992. SROS was to be the first national drug abuse treatment outcome study based on a nationally representative sample of treatment providers. Earlier outcome studies such as DARP, TOPS, and the more recent DATOS are based on samples in which urban treatment providers predominate. It was thought that this urban sample could exaggerate positive treatment outcomes by overemphasizing the older and better-funded programs. SROS was designed to test this assumption by using a random national sample of treatment programs. SROS was also intended as an update of drug abuse treatment outcome findings to provide a periodic check on national treatment effectiveness.

Methods
These positive findings were determined through a survey of 1,799 (71.4 percent male and 28.6 percent female) persons discharged from treatment in 1989-1990. Lost through death were 277 potential respondents. Out of an eligible 2,756 respondents, 1,799 were interviewed for a survey capture rate of 65 percent, which is the expected rate for drug abuse surveys. Substance abuse records for each of the clients were provided by a nationwide sample of 99 drug treatment facilities. All 1,799 clients were fully informed of the purpose of the survey and gave their informed consent to be interviewed five years following discharge from drug abuse treatment. By weighting up to national levels, the respondents translate to 976,012 individuals discharged from treatment in 1990. SROS asked respondents to participate in a urine test of recent drug use and 76 percent agreed. The urine test results agreed with self-reported 'drug use in the last week' from 98-90 percent, depending on the drug. Urine tests agreed with self-reported alcohol use by 64 percent. The urine test is not the best measure of alcohol use, however, making it difficult to interpret these results for alcohol.

Findings
The SROS clearly demonstrates an overall national drop in the use of illicit substances five years after treatment episode. Reported use of any illicit substance dropped by 21 percent five years after treatment, which is an increase in abstinence from all illicit drugs covered by the survey.

Besides the overall increase in abstinence, each substance also showed increased abstinence, meaning that the surveyed sample was not switching from one substance to another but decreasing overall drug use. For instance, any use of alcohol decreased by 14 percent, any marijuana by 28 percent, any cocaine by 45 percent, any crack by 17 percent, and any heroin by 14 percent.

Treatment had positive outcomes for women, men, and all age groups except adolescents. Adolescents treated in 1989-90 showed a 13 percent increase in alcohol abuse and a 202 percent increase in crack use five years following treatment. Adolescent employment, however, increased dramatically. These findings describe the known tendency for adolescents to experiment unwisely, but treatment for the group must be improved to stop substance use quickly before it destroys a young life. Programs of improvement for adolescent treatment are underway at SAMHSA.

Survey results confirm those of previous studies showing that treatment for substance abuse can significantly reduce crime. Most criminal activity, including breaking and entering, drug sales, prostitution, driving under the influence and weapons use declined by between 23 and 38 percent after drug treatment. As one would expect, older age groups were more likely to reduce their post-treatment criminal activities than were younger groups.

Not only crime, but violence against oneself and other declined, specifically involvement in physical abuse and suicide attempts declined in the five years following treatment.

The positive counterpart of reductions in crime and violence was a noticeable shift toward regaining and retaining child custody after drug abuse treatment. Family stability was further enhanced by reports of more reliable housing obtained following treatment.

In locating respondents for the survey, a higher than average death rate was observed in this group, compared to the U.S. population. Due to the small number of observations, reliable estimates are not possible, but it was striking to note that white males discharged from treatment had roughly eight times as many deaths as expected (108 deaths, rather than the expected 13). White females discharged from treatment had nearly 18 times as many deaths as expected (35 deaths, rather than the expected two). Black males discharged from treatment had about five times as many deaths as expected (67 deaths, rather than the expected 13). Black females discharged from treatment had seven times as many deaths as expected (14 deaths, rather than the expected two).

Use of Results
Because SROS is based on a nationally representative sample of treatment providers, the findings describe drug abuse treatment in the U.S. as a whole This makes the study suitable to support national drug control and treatment policy. For example, knowing that treatment reduces the number of drug users nationally provides a rationale for expanding and improving treatment to reduce demand for illicit drugs and thus to shrink the illegal markets, at least in the U.S. Every drug treatment outcome study (DARP, TOPS, DATOS) has shown treatment reduces drug use, but until these findings were confirmed in a nationally representative sample, the findings were criticized as biased toward the larger urban and perhaps most effective treatment programs. SROS confirms that the consistently positive finding that drug abuse treatment reduces national drug use is not the result of sample bias. Further support for policy decision-makers will be provided by a replication of the SROS, the Alcohol and Drug Services Study (ADSS), now underway in the Office of Applied Studies, SAMHSA. The methods are those used for SROS with some additional refinements and improvements.

Just as important to policy as the overall positive results shown in SROS are the weaknesses found in the national drug treatment system. In 1989-1990, treatment was not effective for the majority of participating adolescents. While this may be understandable given the inexperience and experimentation known to characterize adolescents, treatment improvement for this group is clearly indicated. Efforts are now underway at SAMHSA to improve treatment for adolescents.

Finally, substance abuse is known as a relapsing disorder, and new studies that look at repeated treatments over time (longitudinal studies) may begin to tell us how many treatment episodes by which groups should be expected on the road to full recovery.

AGENCY SPONSOR: Substance Abuse and Mental Health Services Administration

FEDERAL CONTACT: Barbara A. Ray, Ph.D.

PHONE NUMBER: 301-443-0747

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

B. Performance Measurement

Enabling Performance Measurement Activities in the States and Communities

Highlights
This study identified existing and potential barriers to the implementation of performance measurement activities in the public health arena. To conduct the research, the project team combined a literature review with structured interviews in city, county, and regional health jurisdictions in Illinois, Oregon, and Washington. A range of perspectives and experiences were sought from private sector health providers and Federal agencies and programs, as well as from local public health agencies. The findings from the literature review were in accord with the information obtained through the structured interviews. That is, barriers do exist in implementing performance activities, and they are consistent across all health settings and public programs. As a result, this study enabled the research team to identify a set of common barriers and to offer seven recommendations to the Department of Health and Human Services (HHS) on how to overcome these barriers. Several aspects of the findings can be linked to the collaborative ongoing effort by the Robert Wood Johnson Foundation and the W.K. Kellogg Foundation's project, "Turning Point: Collaborating for a New Century in Public Health." This ongoing study is based in 14 States and 41 communities, and seeks to improve the infrastructure of health programs by developing effective performance measurement systems in States and local public health jurisdictions. The project team for this study intends to disseminate the findings from this study to the Turning Point project.

Purpose
At the heart of the controversy surrounding performance measurement, including why it works and what it takes to make it work, is a lack of understanding and fear of the process. The central aim of this study is to provide a clear understanding of performance measurement by delineating some common barriers to implementation, recommending strategies to overcome these barriers and evaluating models that can be used to implement these strategies.

Background
Over the past ten years, the HHS has committed to assisting State and local public health agencies in developing ways to improve and promote health. To assess their work, these agencies have been urged to transition from a process of counting resources used and services provided, to a method that measures and accounts for the effectiveness of these activities. Many of these agencies have done so, but in the process have met with internal and external barriers that fall into the following three categories: (1) designing an efficient performance measurement system, (2) gathering the appropriate data needed to inform such a system, and (3) reporting reliable performance measurement results. The HHS selected the Northwest Prevention Effectiveness Center and the Health Policy Analysis Program at the University of Washington's School of Public Health and Community Medicine to look for means by which the HHS could assist its components and partner agencies move toward results-oriented management. The identification of barriers and suggestions for strategies to overcome these barriers were important aspects of the study. Another important aspect was the identification of barriers that are unique to the public health field.

Methods
Two methods were used to implement this study: a review of the literature and structured interviews. The literature search included electronic database searches and searches of a broad range of published print materials from the public and private health sectors. Also included was a review of government and business literature from non-health related organizations. The literature review was followed by key informant interviews conducted with public health and academic leaders in Illinois, Oregon and Washington. These States were selected because they have developed measures and processes for assessing the performance of their public health systems. A semi-structured interview protocol was first developed and then used with the key informants to obtain specific information about barriers to implementing performance activities. Interviewees included State department directors, upper and middle-level managers, line staff and directors, and managers within associated organizations. Analysis and summary of the reviewed literature significantly contributes to the body of knowledge about performance measurement. This analysis and summary, combined with the one-on-one interviews, allowed the project team to isolate a set of 12 common barriers to performance measurement implementation and to provide the HHS with seven strategies that could be used to overcome these barriers.

Findings
The literature review consistently supported the research team's hypothesis that barriers to performance measurement and strategies to overcome them have no relation to setting. In looking at public and private programs, upper, line and lower level managers all reported some common barriers to performance measurement. Overall, the dominant barrier to performance measurement, as discovered in the literature review and from key informant interviews, was the negative perception of the process. Many could not see the value of the process and how or whether it could enhance their work. The project team viewed leadership support as critical to successful implementation of performance measurement and management systems, and found the following key techniques for communicating the value and utility of performance measurement in an organization: (1) committing adequate resources to assist staff in performance measurement activities, (2) training and involving managers as a form of encouragement, and (3) creating and using positive incentives.

Key informant interviews revealed barriers that consisted of: (1) fear that performance measurement activities would be used to judge performance, (2) fear that a program's funding would be cut, and (3) the fear of losing control over a program.

The team offered seven recommendations to facilitate performance measurement activity in State and local public health jurisdictions: (1) develop clear ideas and goals for performance measurement, (2) develop standard performance measurement terminology, (3) identify major aspects of performance measurement systems as well as a way that State and local health agencies can use them to meet their needs, (4) disseminate performance measurement tools and train others to use them, (5) develop collaboration for training and technical assistance in staff development, and (6) offer financial incentives to agencies to encourage participation in performance measurement activities.

Use of Results
Although many commonalities were identified as barriers to implementing performance measurement in the public and private health-related sectors, gaps continue to exist in the knowledge base. For example, this study was not able to note with any specificity, the particular barriers by health field. The literature provided sparse information about specific health specialities and the key informant interviews suggested the need for further analysis of barriers to performance measurement in the areas of mental health and environmental health.

The Turning Point project relates to the findings from this study in that it too suggests reshaping local and State health systems by: (1) involving key players, (2) strengthening the relationship between clinical health care and public health systems, and (3) stressing the need for more collaboration between local and State agencies in the planning and implementation of an improved public health infrastructure. At the heart of the activities should be the development of effective performance measurement systems. The findings strongly suggest that this study and the activities of the Turning Point project should be integrated.

AGENCY SPONSOR: Office of Public Health Services, Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Linda Bailey

PHONE NUMBER: 202-205-4872

PERFORMER ORGANIZATION: University of Washington, School of Public Health and Community Medicine, Seattle, WA

C. Environmental Assessments

The Role of Home and Community-Based Services in Meeting the Health Care Needs of People with HIV/AIDS

Highlights
In the early 1980s, when AIDS first appeared, it was an unfailingly acute and fatal disease. Although the disease remains fatal, advances in AIDS-specific medical expertise and treatment have increased life expectancy for people with HIV and AIDS. As a result, AIDS treatment has shifted from an acute- to a chronic-care model. These changes have broadened the need for different types of home- and community-based services to help people with AIDS lead longer and fuller lives. Services such as assistance with daily living activities and the provision of home-delivered meals have long been an integral part of AIDS care. Because of improved health and functioning, however, people with AIDS now need help with activities such as adhering to complex treatment regimens, returning to work, and caring for families.

In identifying the challenges health care providers, planners, and policymakers face in dealing with the changing epidemic, the study noted a need for: (1) better information about service use and costs to deal with an environment increasingly dominated by cost control, (2) concrete strategies for implementing managed care for people with AIDS, and (3) a cohesive policy that addresses the health care needs of people with all types of chronic illnesses.

Purpose
The purpose of this project was to identify the policy implications for a changing AIDS population, and to set the groundwork for studying the current status and future of home- and community-based service use among people with AIDS. The project examined current service delivery environments to identify problems and assess where the gaps are or where they may be in the future.

Background
In the early days of the epidemic, the typical person with AIDS was a white man who had contracted HIV through sexual contact with another man. However, the epidemic has increasingly and disproportionately affected women and people from racial or ethnic minority groups. More and more, the mode of transmission for the disease has been injection drug use. Meanwhile, improved medical care and pharmaceutical treatment have extended the lives and improved the health of many people with AIDS, leading in1996 to the first decline in deaths since the start of the epidemic.

Changes in AIDS treatment and in the characteristics of the AIDS population have had profound and interrelated effects on the use of home- and community-based services by people with AIDS. Longer life expectancies mean that people use needed services for a longer time. Enhanced treatment has also improved health and decreased levels of functional impairment for many people, which in turn has led to a decrease in their use of such traditional home-and community-based services as home-delivered meals and personal care. At the same time, better treatment has boosted the need for other types of support, such as assistance with adhering to complex treatment plans and returning to work. Meanwhile, the increased incidence of AIDS among people with low incomes, people with substance abuse problems, and women and families has amplified the need for greater interactions between home- and community-based service providers and substance abuse treatment, mental health, family services, and public assistance systems. Medicaid, Medicare, and the Ryan White Comprehensive AIDS Resources Emergency Act have been the major public funding sources for HIV/AIDS care during the 1990s. Although 1995 Medicaid spending for AIDS care was only about two percent of total Medicaid spending, the spread of AIDS among low-income people has placed a growing burden on both the Medicaid and Ryan White programs, most recently to fund costly protease combination therapy. As the epidemic changes, these programs must also reconsider their eligibility and service coverage criteria, to reduce disincentives to work and increase flexibility in meeting chronic care needs, which typically vary in intensity and type over time.

Public programs have sought ways to increase access to home care for beneficiaries with chronic conditions that put them at risk of institutionalization. For example, Medicaid programs have used Home- and Community-Based Service waivers allowed under Section 1915© of the Social Security Act. The recent trend among Medicaid programs to rein in escalating costs by enrolling beneficiaries in managed care plans has had, to date, only a modest effect on people with AIDS. Many states exclude individuals with disabilities or chronic illnesses--like AIDS--from managed care. In addition, although Medicaid covers many of the home- and community-based services that people with AIDS need, most Medicaid managed care plans exclude these services from capitation arrangements. As a result, little is known about how best to provide the full range of AIDS-related services in a managed care environment. The spread of Medicaid managed care also raises questions about whether and how to integrate services currently provided with Ryan White funds for Medicaid beneficiaries who enter managed care.

Methods
This study involved three components, including: (1) a review of home and community-based services literature with a particular focus on financing and service delivery of care to persons with AIDS, (2) case studies of six programs that deliver home and community-based care to persons with HIV/AIDS in New York and Los Angeles, and (3) an examination of the use and cost of Medicaid home and community-based services for participants in New Jersey Medicaid and New Jersey's home and community-based Medicaid waiver program.

The project developed case studies to describe current provider approaches to delivering home- and community-based services to people with AIDS. The case studies were based on in-person discussions with staff at six large and well-established service providers in Los Angeles and New York City and were supplemented by telephone conversations with state Medicaid and Ryan White CARE Act representatives. Criteria for selection included history, size, financing, service delivery system, and primary population served, among others. In Los Angeles, the case studies examined AIDS Project LA, the second largest AIDS service organization in the US; the AIDS Health Care Foundation, which operates a Medicaid managed care system for persons with AIDS; and the Altamed Health Services Corporation- a community health center that targets the Latino community. In New York, case studies examined the Gay Men's Health Crisis, the oldest and largest AIDS service provider in New York; the Visiting Nurse Services of New York-a large, for-profit home health agency; and Village Center for Care, which provides AIDS-specific home care, day treatment, case management and in-home nursing care.

The study also included a secondary data analysis of the use and reimbursement patterns among AIDS patients in the New Jersey Medicaid Waiver program. New Jersey was selected because it closely mirrors the demographics of the nation's AIDS population, i.e. one-fourth of the population is female, two-thirds are non-white, and half are injection drug users. New Jersey also emphasizes home-based care and developed the nation's first home- and community-based service waiver for people with AIDS. In addition, the State supports the development of a longitudinal research database which links Medicaid claims with AIDS registry data. The initial sample selected for this study included 2,464 people who became Medicaid-eligible between 1989 and 1991 and were diagnosed with AIDS in 1992. Of this population, complete data were available for 1,293 persons, which formed the sub-sample population for this study. Thirty-three percent of the 1,293 participated in the waiver program known as the AIDS Community Care Alternatives Program (ACCAP), while the majority, consisting of more women, blacks, injection drug users, and people who lived close to New York City, were non-waiver participants.

Findings
The literature points to the increasing incidence of AIDS among people who must rely on multiple public programs for medical care and support services, and the growth of managed care in the public sector as serious challenges to planners who must decide how to finance and deliver health-related services for people with AIDS. Advances in AIDS treatment (i.e., combination drug therapy) that are costly and difficult to adhere to under the best living conditions compound these challenges.

The case studies spotlighted the need for providers to adapt the types of services they offer and their service delivery approaches in response to growing numbers of disadvantaged clients who are living longer, healthier lives as a result of improved AIDS treatment. Provider response to increasing numbers of multi-problem clients has included broadening the range of services they provide in-house, increasing referrals to and interactions with providers in other systems (mental health, substance abuse treatment, housing, and public assistance), reconfiguring staffing to include more trained professionals and fewer lay staff and volunteers, and developing procedures to identify clients with the most complex problems for the most intense services. While very few providers in this study had direct experience with managed care, they see it as inevitable and are concerned that many questions about managed care for persons with AIDS have not yet been answered.

An additional part of this study compared home care use and costs for participants in New Jersey's AIDS waiver program with those for Medicaid beneficiaries with AIDS who received home care under regular Medicaid between 1988 and 1996. The analysis suggested that the waiver program's approach, which focused on case management, may have reduced existing disparities in home care use between beneficiaries from different racial/ethnic and transmission groups. For example, for beneficiaries receiving regular Medicaid services, there were statistically significant differences between blacks and whites and between injection drug users and nonusers. These differences did not exist for participants in the waiver program. The findings suggest that case-managed home care may be an important tool for increasing access to care in an increasingly diverse AIDS population.

Use of Results
This study suggests that as AIDS becomes a disease of the disadvantaged, medical treatment and health-related support services begin to blend with traditional public assistance programs, such as food stamps and housing assistance. Also, as AIDS increasingly becomes a chronic, rather than an acute and fatal disease, its management has come to resemble more closely that of other serious chronic conditions. This study suggests key policy challenges (and areas for future research) including the development of cost-effective models of chronic disease management that include figuring out ways people can take responsibility for their own health (adhere to treatment regimens, maintain good self-care practices, etc.) and how to provide them with the assistance and financial support they need to take this responsibility. Substance abuse treatment, mental health services, assisted or supported living, assistance with returning to work, and help locating housing all play a bigger role in the delivery of home and community-based services for newer AIDS populations than they did in earlier days of the epidemic.

AGENCY SPONSOR: Office of the Secretary, Office of the Assistant Secretary for Planning and Evaluation

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

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

Exploratory Study of Health Care Coverage and the Employment of People with Disabilities

Highlights
This study, commissioned by the Office of Disability, Aging and Long-Term Care Policy (DALTCP) within the Office of the Assistant Secretary for Planning and Evaluation (ASPE), reviewed existing research and examined new data to gain greater understanding of the relationships between access to health care, employment, and public program participation for persons with disabilities. Major sources of data include the 1993 Survey of Income and Program Participation (SIPP), the 1994 National Health Interview Survey, and administrative data from the Social Security Administration.

The evidence accumulated in this exploratory study supports the contention that the potential lack of adequate health care coverage prevents some people with disabilities from working or working as much as they would like. Highlights of the study include the following:

Health care costs for people with disabilities are generally much higher than for those without disabilities. On average, total health expenditures for non-elderly people with disabilities are about six times greater than expenditures of their non-disabled counterparts, and out-of-pocket expenditures are three times greater. One study finds that persons with disabilities are significantly more likely to experience catastrophic out-of-pocket expenditures than persons without disabilities.
The eligibility requirements for Medicare and Medicaid create financial incentives that discourage or encourage work, depending on the current status of the individual. For people with disabilities, qualification for Medicare and Medicaid is primarily contingent on participation in the Social Security Disability Insurance (SSDI) and Supplemental Security Income Insurance (SSI) programs, which require that individuals not engage in substantial work. At the same time, these programs include work incentive programs.
Health care coverage has substantial effects on the employment or program participation of other groups--single mothers, older workers, and the elderly. A number of studies find convincing evidence of a relationship between access to health care coverage and work and program participation decisions.
The empirical analysis of SSA administrative data yields strong evidence that some SSI recipients who work substantially restrain their earnings in order to stay below the SSI 1619 (b) income threshold, an amount above which Medicaid benefits are no longer available.

Background

Evidence is clear that persons with disabilities cite the fear of loss of medical benefits and other services provided under Medicaid and Medicare, such as personal care services, employment support services, case management and long-term care services, as significant barriers to employment. Despite the need to effectively change public health care coverage to more appropriately meet the long-term care needs of persons with disabilities, there is no agreement on exactly what should be done, and little knowledge of how health and long-term care coverage work in concert with other supports.

Methods
The study reviewed the relevant literature on health care coverage, employment, and public program participation related specifically to persons with disabilities. In addition, researchers assessed the impact of increases in the earnings limit established under Section 1619 (b) of the Social Security Act on earnings among SSI recipients participating in 1619 (b). The SSI program provides income benefits to poor persons with disabilities. Participation in SSI also entitles a person with disabilities to health care benefits under Medicaid. Under 1619 (b) provisions, SSI recipients may have "chargeable income" (income after certain reductions) including earned income, and retain Medicaid coverage even though earnings are too high to qualify for SSI cash benefits.

The earnings limit (referred to as the "1619 (b) threshold") is based on average annual Medicaid expenditures for disabled people in each State, and thus varies from State to State and from year to year. Researchers examined SSA administrative data for the 4.1 percent of adult SSI recipients under age 50 who had earnings in 1990 (n=121,913). Researchers developed hypotheses based on the prediction that if some SSI recipients restrain earnings and employment to stay below the 1619 (b) limit, earnings of recipients should rise as the threshold rises. Four study groups and one control group were identified. To test prediction within and between groups, means were compared and the relationship between changes in the earnings threshold and changes in earnings for SSI recipients were examined. Multiple regression analysis was used to examine the changes in four variables--annual Social Security earnings, annual SSI payment, social security employment, and SSI participation. The first series examined data generated for 1990-1991. The series was then repeated for the 1990-1996 cohort.

Data from the 1993 Survey of Income and Program Participation (SIPP) and the 1994 National Health Interview Survey (NHIS) on employment and health care coverage were also examined to assess the relationship between employment, health insurance, and program participation for persons with disabilities.

Findings
The findings from the study indicate that some SSI recipients who are employed and have incomes close to the 1619 (b) threshold restrain their Social Security earnings in order to stay below the limit and remain eligible for medical benefits under Medicaid. It appears that recipients make marginal adjustments to their earnings as a result of threshold and unearned income changes, and not wholesale changes to their participation or employment status.

The analysis of the SIPP and NHIS survey data focus on characteristics of people with and without disabilities and characteristics of disability program participants and non-participants. The following are among the general findings from the surveys:

In general, across all categories of employment and health insurance status, persons with disabilities are older and less educated than persons without disabilities. Persons with disabilities are less likely to be high school or college graduates.
Persons with disabilities are more likely to be living in poverty and less likely to have incomes in excess of 300 percent above the poverty line.
Persons with disabilities who have health insurance are less likely to rely on private health insurance than those without disabilities; many persons with disabilities rely on Medicare and Medicaid.
Among the employed populations, people with disabilities are more likely to be self-employed than the non-disabled population, though rates of part-time employment are similar for the two groups.
Disability program participants are more likely to have severe disabilities compared to non-participants with disabilities. They are also more likely to have difficulty with activities of daily living and are more likely to have 3 or more activities of daily living (ADL) difficulties.
Program participants who are employed have a much higher rate of part-time employment than do employed non-participants.

Health care costs for people with disabilities are generally much higher than for those without disabilities. On average, total health expenditures for non-elderly people with disabilities are about six times greater than expenditures for their non-disabled counterparts, and out-of-pocket expenditures are three times greater. One study finds that persons with disabilities are significantly more likely to experience catastrophic out-of-pocket expenditures than persons without disabilities.
The eligibility requirements for Medicare and Medicaid create financial incentives that discourage or encourage work, depending on the current status of the individual. For people with disabilities, qualification for Medicare and Medicaid is primarily contingent on participation in the Social Security Disability Insurance (SSDI) and Supplemental Security Income Insurance (SSI) programs, which require that individuals not engage in substantial work, thereby creating a strong work disincentive.
Health care coverage has substantial effects on the employment or program participation of other groups--single mothers, older workers, and the elderly. A number of studies find convincing evidence of a relationship between access to health care coverage and work and program participation decisions.

Use of Results

The 1619 (b) analyses performed for this report provide some interesting insights about the dynamic use of that program and, more generally, the dynamics of employment, earnings, and program participation of disabled adult SSI recipients. A clearer picture of the use of the 1619 (b) program could be obtained by following SSI award cohorts through their entire SSI experience. Another fruitful avenue of approach would be to analyze survey data matched to Social Security administrative data to learn more about events and conditions that precipitate program participation, and persons with significant disabilities who maintain employment. Also, new studies need to collect qualitative data from people with disabilities concerning their views on barriers to employment.

AGENCY SPONSOR: Office of the Secretary, Office of the Assistant Secretary for Planning and Evaluation

FEDERAL CONTACT: Kathleen Bond

PHONE NUMBER: 202-690-6443

PERFORMER ORGANIZATION: The Lewin Group, Fairfax, VA

Intimate partner violence is often referred to as domestic violence or domestic abuse. It is violence perpetrated by a current or former spouse or other intimate partner.

Chapter III - Compendium of HHS Agency FY 1998 Evaluations Completed and in Progress

The various agencies and offices of the Department of Health and Human Services (HHS) maintain their own evaluation program--including the functions of evaluation planning and policy review, quality assurance through technical review, project coordination and management, dissemination of reports, and utilization of results. This chapter is a compendium of the evaluations completed and in progress during fiscal year (FY) 1998, organized by the following HHS components:

Administration for Children and Families (ACF)
Administration on Aging (AoA)
Agency for Health Care Policy and Research (AHCPR)
Agency for Toxic Substances and Disease Registry (ATSDR)
Centers for Disease Control and Prevention (CDC)
Food and Drug Administration (FDA)
Health Care Financing Administration (HCFA)
Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
National Institutes of Health (NIH)
Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Office of Public Health and Science (OPHS)
Substance Abuse and Mental Health Services Administration (SAMHSA)

Each HHS agency and office section begins with an overview of the relevant evaluation program, describing its philosophy, policies, and procedures. Next are descriptions of the major evaluations completed in FY 1998, grouped by major program areas. Lastly, the evaluations currently in progress are presented in chronological order of the expected date of completion.

For more information about a particular evaluation, either completed or in progress, the name and telephone number of the Federal contact person is included. Final reports for the completed evaluations listed in this chapter are located at the HHS Policy Information Center (PIC), a centralized source of information on completed and in progress HHS evaluations. The PIC maintains a projects resource data base containing information on more than 6,000 studies sponsored by HHS, as well as other Federal agencies, and private-sector entities. The PIC identification number appears after the Federal contact's phone number. Access to the PIC resource database by the public is available through the following Internet address: <http://aspe.hhs.gov/PIC/gate2pic.htm>. For additional information about using the PIC resources, please contact the Policy Information Center at (202) 690-6445.

Administration for Children and Families

Evaluation Program
The Administration for Children and Families (ACF) administers a broad range of entitlement and discretionary programs, including income maintenance (Temporary Assistance for Needy Families [TANF]); child support; children and family services (Head Start, Child Welfare, Family Preservation and Support, and youth programs); four block grants; and special programs for targeted populations, such as the developmentally disabled, immigrants, and Native Americans.

The objectives of ACF's evaluations are to furnish information on designing and operating effective programs; to test new service delivery approaches capitalizing on the success of completed demonstrations; to apply evaluation data to policy development, legislative planning, budget decisions, program management, and strategic planning and performance measures development; and to disseminate findings of completed studies and promote application of results by State and local governments.

ACF actively engages with other Federal agencies, State and local policy and program officials, national organizations, foundations, professional groups and practitioners, and consumers to stay current on emerging issues affecting its programs and to identify questions for evaluation studies. Systems changes and how they affect vulnerable populations, particularly children, are of primary concern. The movement toward devolving responsibility for health and human services to State and local organizations--in particular, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996--offer both tremendous opportunities and unprecedented challenges in redefining and implementing services for families.

Evaluation study designs are negotiated carefully with the States and other interest groups. Studies often are funded as joint ventures with Office of the Assistant Secretary for Planning and Evaluation and other Federal agencies and foundations. Such collaborations permit large-scale efforts that are better informed and more representative of varying perspectives. Proposals are reviewed by multidisciplinary experts. Work groups of various kinds are used to monitor the progress of projects and to advise on design refinements and the presentation of findings.

Fiscal Year 1998 Evaluations

Child Development

TITLE: National Impact Evaluation of the Comprehensive Child Development Program

ABSTRACT: The Comprehensive Child Development Program (CCDP) was an innovative attempt by the Administration on Children, Youth, and Families (ACYF) to ensure the delivery of early and comprehensive services with the aim of enhancing child development and helping low-income families to achieve economic self-sufficiency. Intensive case management was evaluated as a method for the effective delivery of services to low-income families resulting in positive outcomes. The charge of each local CCDP grantee was to: (1) intervene as early as possible in children's lives; (2) involve the entire family; (3) ensure the delivery of comprehensive social services to address the intellectual, social-emotional, and physical needs of infants and young children in the household; (4) ensure the delivery of services to enhance parents' ability to contribute to the overall development of their children and achieve economic and social self-sufficiency; and (5) ensure continuous services until children enter elementary school at the kindergarten or first grade level. In particular, the evaluation of the CCDP focused on: (1) the longitudinal impact of each program model on the development of the participating children and their parents; (2) the effectiveness of the programs in achieving their stated objectives; and (3) the impact of related programs to the delivery of services. Results indicate that there were no observable, measurable, positive effects resulting from the CCDP families, in comparison with control group families.

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

Child Support

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

ABSTRACT: The purpose of this pilot project was to implement a unique cooperative arrangement between the child support system, local community-based organizations and non-custodial fathers. It was hoped that with supportive services, such as peer group assistance, non-custodial fathers would increase their involvement with their children. It was further hoped that, with employment training and job location assistance, these fathers would find employment and increase their earnings, thereby placing themselves in the position to pay child support and to pay it in a timely fashion. The ultimate goal of this project, therefore, was to effect a system that would support more responsible non-custodial parenting.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Mark Fucello

PHONE NUMBER: 202-401-4538

PIC ID: 5952.1

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

TITLE: Evaluation of Child Support Guidelines (Vols 1-2)

ABSTRACT: From October 1994 to March 1996, the Administration for Children and Families (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 deviations from formal and informal 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. States should, however, 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: The 1987-88 National Survey of Children and the National Survey of Families and Households show that only one-sixth of all noncustodial (divorced or unwed) fathers visit their children at least weekly; nearly one-third to one half see their children once a year or less. This report documents the experiences of eight projects selected by the staff of the Federal Office of Child Support Enforcement to resolve child access problems. The goal of evaluation at each site was to assess the extent to which each intervention was successful in: (1) decreasing the amount of time required to resolve access disputes; (2) reducing litigation related to access disputes; (3) improving compliance with court-ordered child support payments; and (4) promoting the adjustment of children. Surveys administered to parents elicited information on the demographic characteristics of the parents, their relationship to each other, the children they had in common, existing custody situation, visitation and child support arrangements and problems with custody, visitation and child support. Based on the questionnaire findings, access problems were identified. Conclusions suggest the following: (1) courts can help parents with access problems by developing no and low cost dispute resolution interventions; (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 are difficult to establish.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo

PHONE NUMBER: 202-401-5364

PIC ID: 6843

PERFORMER ORGANIZATION: Policy Studies, Inc, Denver CO and Center for Policy Research, Denver CO

Community Services

TITLE: Micro Business and Self-Employment and Programs for the Homeless

ABSTRACT: The Demonstration Partnership Program (DPP), under Section 408 of the Human Services Reauthorization Act of 1986, authorizes a demonstration program to operate in conjunction with the Community Services Block Grant Program. This program has the unique purpose of developing and implementing new and innovative approaches in dealing with the particularly critical needs of the poor. The objectives of the program are to: (1) stimulate eligible entities (mainly Community Action Agencies) to develop new approaches to provide greater self-sufficiency for the poor; (2) test and evaluate the new approaches; (3) disseminate project results and evaluation findings so that the new approaches can be replicated; and (4) strengthen the ability of eligible entities to integrate, coordinate and redirect activities to promote maximum self-sufficiency among the poor. Under the DPP, Community action agencies were asked to develop, test and evaluate, in partnership with local organizations, new approaches to provide for greater self-sufficiency. In fiscal years 1987 through 1994, demonstration grants were made in a wide range of programs including: (1) small business ventures with technical assistance and access to a loan fund, (2) intensive case management, (3) job creation, (4) job training, and (5) early intervention programs. The client populations included such diverse groups as teenage parents, minority males, families, homeless families and individuals, public housing clients, Section 8 housing clients and food basket recipients. The purpose of this report is to capture experiences and lessons learned and to make those available to those that are interested in improving the services and opportunities available to low-income populations.

AGENCY SPONSOR: Office of Community Services

FEDERAL CONTACT: Richard Saul

PHONE NUMBER: 202-401-9341

PIC ID: 6883

PERFORMER ORGANIZATION: BHM International Silver Spring, MD

Head Start

TITLE: Head Start Program Performance Measures: Second Progress Report

ABSTRACT: Head Start has made dramatic progress toward developing an outcome-oriented accountability system, the Program Performance Measures Initiative, which can be used to determine the quality and effectiveness of Head Start. Based on the ultimate goal of Head Start--promoting the social competence of children, which is reflected in a comprehensive view of school readiness--the Performance Measures are a set of indicators that chart progress in: (1) enhancing children's healthy growth and development, (2) strengthening families as the primary nurturers of their children, (3) providing children with educational, health and nutritional services, (4) linking children and families to needed community services, and (5) ensuring well-managed programs that involve parents in decision-making. The data in this report are drawn from the Spring 1997 Family and Child Experiences Survey (FACES) field test, in which approximately 2,400 parents and children were studied in a nationally representative sample of 40 Head Start programs across the country. The survey, planned as a periodic longitudinal data collection, was an opportunity to assess the feasibility of interviewing and assessing parents and children on a large scale using selected instruments. It provided valuable information on the status of Head Start programs, children and families. Overall results from FACES indicate that: (1) Head Start classroom quality is good; (2) Head Start children are ready for school; (3) program quality is linked to child performance; and (4) Head Start families are involved, despite challenges. FACES provides information about children as they enter the program, their experiences in Head Start, and their status both at school entry and after a year of kindergarten. The full study, launched in Fall, 1997, follows 3200 children and families in 40 Head Start programs. The ongoing Performance Measures Initiative will help Head Start chart its progress in meeting GPRA goals and improving services.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Louisa Tarullo, Ed.D.

PHONE NUMBER: 202-205-8324

PIC ID: 6331.1

PERFORMER ORGANIZATION: Westat, Inc. Rockville, MD; Ellsworth Associates; Abt Associates, Cambridge MA, and The CDM Group, Bethesda, MD

Welfare Reform

TITLE: Creating New Hope: Implementation of a Program to Reduce Poverty and Reform Welfare

ABSTRACT: This report is the first in a series of reports on the New Hope Project, an assistance program in Milwaukee, Wisconsin, that enables poor people to support themselves and their families through full-time employment. The program also offers participants affordable health insurance and child care that is flexible according to individual circumstances. The benefits are phased out as individuals' earnings increase. This report was the result of a random assignment research design that recruited a diverse sample population over a 16-month period beginning in 1994. Eligibility for the New Hope program was contingent on full-time employment. Therefore, information on levels of benefit use provides preliminary information about the number of individuals in the program group who were employed. For the program group for which 12 months of post-random assignment follow-up is available, the report finds that three-quarters of New Hope participants received at least one New Hope benefit at some point during the follow-up. Of these benefits, earnings supplements were used by the majority of the program participants, followed by health insurance, community service jobs, and child care assistance. This report: (1) analyzes the issues that the New Hope staff confronted in designing and implementing program procedures and in recruiting individuals from the target neighborhoods to participate in the program; (2) presents information illustrating that they were successful in recruiting the intended mixture of working and non-working applicants, individuals receiving and not receiving public assistance, and adults with and without children; and (3) presents findings on the extent to which individuals participated in New Hope and used the program benefits. The report concludes that when data is available from planned follow-up surveys that there will be a more complete picture of the impact of the New Hope program. (Final report 192 pages.)

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Richard Jakopic

PHONE NUMBER: 202-205-5930

PIC ID: 5982

PERFORMER ORGANIZATION: The New Hope Project, Inc., Milwaukee, WI

TITLE: Employment Experiences of Welfare Recipients Who Find Jobs: Is Targeting Possible?

ABSTRACT: This project presents the motivation for and results from an analysis of the employment experiences of welfare recipients who find jobs using data from the 1979 to 1994 National Longitudinal Survey of Youth (NLSY). The analysis sample included single mothers with children who, at some point during the panel period, started a job either while receiving Aid to Families with Dependent Children (AFDC) or within three months after ending AFDC. The analysis describes five aspects of welfare recipients who find jobs: (1) characteristics and how they compare with those of other similar groups of individuals; (2) the duration of employment, and the duration of nonemployment for those who exit welfare; (3) overall experiences during the two and five year periods after the start of first employment; and (4) the extent to which wages and earnings grow over the five-year period following initial employment.

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

Evaluations in Progress

Child Care

TITLE: Role of Child Care in Low-Income Families' Labor Market Participation

ABSTRACT: This project will develop optional research designs to identify and address child care services needed by parents to succeed at work, keeping in mind the role quality child care plays in children's lives. The major work in this contract will consist of a series of stand-alone working papers that critically evaluate relevant research related to child care and labor force attachment, and that develop a rationale for the factors included in the research designs. The project will prepare three working papers that will evaluate bearing on critical aspects of child care for low income parents including affordability, quality and flexibility. These papers will provide the rationale for the development of rigorous research designs to test the effects on families and children and the costs of promising components and programs. Each research design will contain: (1) a complete description and rationale; (2) design methodology; (3) the number of sites and their characteristics; (4) criteria for site selection; (5) methods for identifying the client population or subpopulation; (6) sample size requirements; (7) strategies for sampling and case assignment; and (8) proposed intervention, projected schedule and plan for implementation. Additionally, the pros and cons of each design will be presented.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Richard Jakopic

PHONE NUMBER: 202-205-5930

PIC ID: 6846

PERFORMER ORGANIZATION: Urban Institute/Mathematica Policy Research Washington, D.C.

PROJECTED DATE OF COMPLETION: 12/18/98

Child Development

TITLE: Prenatal and Early Childhood Nurse Home Visitation Program -- Replication/Dissemination

ABSTRACT: The Administration for Children and Families (ACF) and the Department of Justice (DOJ), Office of Juvenile Justice and Delinquency Prevention are supporting this initiative. The project allows for data collection and evaluation of an initiative to replicate and disseminate the nurse home visiting model. The model has been tested through randomized trials and found to be effective in improving outcomes for mothers and their children on a number of important outcome measures, including: (1) educational attainment, (2) employment, (3) welfare dependency, (4) parenting attitudes, and (5) subsequent pregnancies. The DOJ funded a grant to support technical assistance and training to replicate the model in selected sites. This project supports the evaluation component of the initiative to test the effectiveness of the replication process within normal operating environments. The initiative will answer questions pertaining to: (1) whether programs are implemented with fidelity to the original program model; (2) whether the program is reaching the target population of at-risk, low-income pregnant women; (3) the aspects of the model that are most difficult to implement and maintain; (4) the factors explaining site variation in program fidelity; and (5) the outcomes for pregnant women and families enrolled in each site.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Nancye Campbell

PHONE NUMBER: 202-401-5760

PIC ID: 6757

PERFORMER ORGANIZATION: University of Colorado Health Sciences Center, Denver CO 80262

PROJECTED DATE OF COMPLETION: 2/29/00

Child Support

TITLE: Study of the Impact of the Child Support Enforcement (CSE) Program on Avoiding Costs to Public Programs

ABSTRACT: The purpose of this study is to develop a conceptual framework for determining cost avoidance that would be appropriate for use in the Federal and State budgetary and appropriation processes. This study will also assess the current technology in terms of the development and potential application of a cost-avoidance methodology for the Child Support Enforcement program. This study will result in contractor recommendations as to how to prioritize the various components of cost avoidance, i.e., which mechanical and behavioral aspects of cost avoidance should be addressed first, and the sequence of steps to take to quantifying the costs avoided for each area. The contract objectives are: (1) review the literature on cost avoidance and prepare an annotated bibliography; (2) identify academics, research firms and States conducting child support cost avoidance related research; (3) assess microsimulation models; (4) assess the capacity of State administrative databases to measure cost avoidance; and (5) identify the most promising cost avoidance model or models for further testing and refinement.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: Tom Killmurray

PHONE NUMBER: 202-401-4677

PIC ID: 6842

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 3/17/99

TITLE: Multisite Evaluation of OCSE Responsible Fatherhood Programs and MIS Development

ABSTRACT: This contract will provide technical assistance to assist States with appropriate MIS and data collection in order to facilitate an evaluation and the other contract will evaluate the projects. The projects are eight separate State demonstration projects which attempt to facilitate increased payment of child support through assistance to low or no income fathers who owe child support. Services involve the following: (1) child support services, (2) training, (3) related social services, (4) case management, (5) fatherhood motivation, and (6) access and visitation assistance.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: David Arnaudo

PHONE NUMBER: 202-401-5364

PIC ID: 7055

PERFORMER ORGANIZATION: Policy Studies, Inc, Denver CO and Center for Policy Research, Denver CO

PROJECTED DATE OF COMPLETION: 9/20/00

TITLE: Partner and Father Involvement in the Lives of Low-Income First Time Mothers and Their Children

ABSTRACT: This project will investigate the role that fathers and partners play in improving the material, emotional, and developmental well-being of low-income women and children. It consists of a set of secondary analyses using data from three longitudinal experiments of a program of prenatal and infancy home visitation serving first time mothers from various ethnic and racial groups.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Mark Fucello

PHONE NUMBER: 202-401-4538

PIC ID: 6799

PERFORMER ORGANIZATION: Children's Hospital Denver CO

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: Partners for Fragile Families

ABSTRACT: The Partners for Fragile Families Project strives to assist low-income unemployed, and underemployed, mainly minority fathers to work with the mothers of their children to become "team" parents and share the legal, financial and emotional responsibilities of parenthood. To achieve these goals, the grantee will develop, test and implement Fatherhood Development Workshops, grassroots organizations working with low income fathers, develop and implement a Peer Learning College for child support enforcement professionals. These efforts serve to encourage, support, and assist child support agencies that have recognized the barriers these fathers face to becoming responsible fathers. The Ford Foundation is also providing funding for this project.

AGENCY SPONSOR: Office of Child Support Enforcement

FEDERAL CONTACT: Susan A. Notar

PHONE NUMBER: 202-401-4606

PIC ID: 6844

PERFORMER ORGANIZATION: National Center for Strategic Nonprofit Planning and Community Leadership, Washington, DC

PROJECTED DATE OF COMPLETION: 9/30/00

Community Services

TITLE: Factors Related to Gang Membership Resistance

ABSTRACT: This project will investigate and gather data on gangs from two contrasting Los Angeles communities. One area will have street gang activity higher than the city's typical Hispanic and African-American activity level, and the other will have activity below this level. The project is designed to increase understanding of how youth in urban areas with high levels of street gang activity avoid gang involvement. Phase I involves site selection; Phase II includes instrumentation and data identification; Phase III includes data collection and analysis, and Phase IV deals with steps toward validation and report writing. The project anticipates creating a replicable interview protocol, data tapes for other researchers, and a final report on the results (including implications for prevention programming); and plans for extended validation and replications. Principal data sources will be youth interviews, observations by adult residents and practitioners, and agency data. The project will attempt to narrow the gap in knowledge regarding how some youth avoid gang activity through the use of the following comparisons: (1) gang versus nongang members from similar settings; (2) within an area of high gang activity, a community with heavy gang activity, and one with lower gang activity; and (3) individuals and community variables and characteristics in the two contrasting sites. See also PIC ID 5042.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Terry Lewis

PHONE NUMBER: 202-205-8102

PIC ID: 5042.1

PERFORMER ORGANIZATION: University of Southern California, University Park, Los Angeles CA

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Job Opportunities for Low -Income Individuals (JOLI) Program

ABSTRACT: This project will provide training and technical assistance and evaluation assistance to grantees funded under the Job Opportunities for Low-Income Individuals Program (JOLI). The services provided will assist the grantees in the development of their project designs and in the finalization of their evaluation plans. These plans will provide the Office of Community Services (OCS) with useful insights into both project outcomes and processes. In addition, the services provided will assist OCS to effectively evaluate the impact of the demonstration and to disseminate the project results to the Congress and other interested parties.

AGENCY SPONSOR: Office of Community Services

FEDERAL CONTACT: Nolan Lewis

PHONE NUMBER: 202-401-5282

PIC ID: 6430

PERFORMER ORGANIZATION: Trans-Management Systems Corporation Washington D.C.

PROJECTED DATE OF COMPLETION: 9/29/02

Family Services

TITLE: Evaluating Quality of Out-of-Home Care in Kinship Foster Care

ABSTRACT: The Research Triangle Institute, with the American Bar Association's Center on Children and the Law and the Child Welfare League of America, will conduct a study to identify criteria for assessing the quality of out-of-home care provided to children in kinship care foster homes. In addition to identifying indicators of quality in the home and family, the investigator will also examine the quality of kinship foster family care in its larger ecological context. This project will develop a set of instruments to measure the following: quality of care in the kinship family home; contextual factors impacting on kinship family functioning; indicators of child functioning in the home. Instructions for using the instruments in home studies and for case monitoring will be written, and specific recommendations for further research will be provided. These instruments will be useful in agency licensing, training, and monitoring activities. In addition, they will provide a foundation for future research on instrument development, quality of kinship foster family care, and evaluation of child and case outcomes. The study will consist of three phases: (1) item identification and instrument development; (2) assessment of validity and reliability in five sites from two states, including African-American, white, and Hispanic respondents; and (3) creation of a set of recommended instruments for preliminary use in the field. The project will seek to identify, operationalize, and validate core items that signify quality of care across variations in site, culture, and age groups, as well as items that are sensitive to differences in situation, child characteristics, and culture.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Cecelia Sudia

PHONE NUMBER: 202-205-8764

PIC ID: 6852

PERFORMER ORGANIZATION: University of Illinois, Champaign, IL

PROJECTED DATE OF COMPLETION: 10/1/98

TITLE: Family Preservation and Family Support Services (FP/FS) Implementation Study

ABSTRACT: The 1993 Family Preservation and Support Legislation expands both the array of services provided and the types of families served. This study examines the FP/FS implementation across States and communities, and among different stakeholders over time. It examines the process in all 50 states providing an in-depth look in ten States and 20 communities. Study findings will help to identify areas where further policy guidance is needed to assist States in implementation.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Helen Howerton

PHONE NUMBER: 202-205-3604

PIC ID: 5975

PERFORMER ORGANIZATION: James Bell Associates, Inc., Arlington, VA

PROJECTED DATE OF COMPLETION: 6/20/99

TITLE: National Evaluation of Family Support Programs

ABSTRACT: In September 1994, the Administration on Children, Youth, and Families (ACYF) awarded a contract to conduct a national evaluation of Family Support Programs. The evaluation stems from legislation that provides funding to States for family support and preservation efforts. It represents an innovative attempt to combine knowledge derived from prior and ongoing research with new research studies designed to enhance our understanding about the effects of different programmatic approaches to family support. The study has three parts: (1) a comprehensive review of what is currently known about family support programs and their effects, (2) a phase that focuses on planning and implementing a series of research studies designed to fill the gaps in understanding programs and their effects, and (3) a synthesis of the two earlier parts. The evaluation is a five-year effort. The program and research reviews conducted in the first year will guide the formulation of a research strategy for the remaining years of the project. Up to ten new evaluation studies will be designed to fill gaps in the current knowledge base. These evaluations will be implemented in the second, third and fourth years of the study. The work of the final year will combine the information gained in the preceding years into an integrated and comprehensive report.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Mary Bruce-Webb, Ph.D.

PHONE NUMBER: 202-205-8628

PIC ID: 5848

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Evaluation of the Impact of Homelessness on ACYF Programs

ABSTRACT: This study: (1) assessed the impact of homelessness on programs run by the Administration for Children, Youth, and Families (ACYF); and (2) identified creative and successful service models that address the problem. The two-year evaluation was intended to determine the service demands placed upon ACYF programs serving homeless families, children, and youth. The evaluation involved: (1) conducting site visits; (2) collecting information from service providers for the homeless, administrators, and representatives of local service delivery networks in 40 communities; (3) examining programs supported by ACYF; (4) reviewing non-ACYF sponsored programs; and (5) conducting a small-scale longitudinal study of homeless people and the impact of services upon them. Five local programs will serve as case studies. The results of the review focus on key strategies for increasing the effectiveness of ACYF programs and on measures that could help reduce risk of homelessness.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Helen Raikes, Ph.D.

PHONE NUMBER: 202-205-2247

PIC ID: 4396

PERFORMER ORGANIZATION: Price Waterhouse Washington D.C.

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Evaluation of Transitional Living Program for Homeless Youth

ABSTRACT: This evaluation of the Transitional Living Program (TLP) for Homeless Youth will determine: (1) the number and characteristics of homeless youth served; (2) the type of activities carried out; (3) the program's effectiveness in alleviating the immediate problems of homeless youth; (4) project effectiveness in preparing homeless youth for self-sufficiency and in helping them decide upon future education, employment, and independent living; and (6) the ability of such projects to strengthen family relationships and encourage the resolution of intra-familial problems through counseling and the development of self-sufficient skills. Data were collected in a three part structured interview: a pre-program baseline, an interview at program exit, and an interview six months after program completion. Data will also be collected on comparison youth at corresponding points in time. Overall, 600 TLP participants and an equal number of comparison youth have been sampled over a two-year period.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Henry Doan, Ph.D.

PHONE NUMBER: 202-260-2667

PIC ID: 4397

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

PROJECTED DATE OF COMPLETION: 9/30/99

Foster Care

TITLE: Home Visiting Services Demonstration

ABSTRACT: The demonstrations will test whether adding weekly home visitor services will result in helping first-time teen mothers better support themselves and their children while promoting positive parenting and reductions in repeat childbearing. The home visitors are paraprofessionals. The demonstration sites are Chicago, Illinois; Dayton, Ohio; and Portland, Oregon.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

PHONE NUMBER: 202-401-5070

PIC ID: 5980

PERFORMER ORGANIZATION: University of Pennsylvania, Graduate School of Education, Philadelphia, PA

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Project REFRESH: Research and Evaluation of Foster Children's Reception into Environmentally Supportive Homes

ABSTRACT: Little is known about everyday occurrences in foster family homes. Assessment tools and evaluation protocols are needed to examine factors affecting quality and satisfaction with care in kinship/non-kinship placements. Project REFRESH, a three-year study, identifies factors affecting quality of care and children's integration into kinship/non-kinship foster settings. Objectives are to: (1) evaluate quality of care, (2) evaluate participants' satisfaction with care, (3) assess perceived quality and quantity of caregiver training, (4) test an integration model, (5) develop an assessment tool and evaluation protocol, and (6) disseminate project results. This case study design assesses children's integration processes and juxtaposes integration and quality, and satisfaction with care, in kinship/non-kinship settings. Variables examined during family interviews are: (1) status, (2) time, (3) space, (4) resources and (5) language. Members and associated caseworkers of 60 kinship/non-kinship families serve as data sources in family interaction assessment. A subsample of 10 families/caseworkers will participate in a qualitative component. Data collection methods include (1) interviews, (2) questionnaires, (3) observations, (4) children's drawings, (5) rating scales and (6) videotaped family interaction sessions. Based on the findings, an assessment tool and evaluation protocol will be developed and tested to aid in placement decisions. An immediate benefit is a richer understanding of kinship and non-kinship foster placements. The ultimate benefit is the creation of frameworks within which to assess the quality of services to foster children.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Cecelia Sudia

PHONE NUMBER: 202-205-8764

PIC ID: 6851

PERFORMER ORGANIZATION: University of Oregon, Family Studies Center, Corvallis, OR

PROJECTED DATE OF COMPLETION: 6/30/99

TITLE: National Study of Outcomes for Children Placed in Foster Care with Relatives

ABSTRACT: This study examines: (1) the outcomes for children and families in the various configurations of relative foster care compared to the configurations of non-relative foster care, and (2) the associated costs of relative foster care compared to the costs of non-relative foster care. An initial survey was conducted in nine selected States to determine the specificity of the information available at the State and local levels pertaining to children currently placed in relative foster care, their birth families, the relatives responsible for their care, and the information pertaining to children formerly in relative foster care. The specific information obtained in this survey was used in the design of a national study to examine children placed in relative foster care compared to those placed in non-relative foster care.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Henry Doan, Ph.D.

PHONE NUMBER: 202-260-2667

PIC ID: 5846

PERFORMER ORGANIZATION: TransAmerica Systems, Inc. Washington D.C.

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: How Decisions to Change the Case Plan Goal Are Initiated

ABSTRACT: The Jane Addams College of Social Work, in collaboration with the National Resource Center for Permanency Planning at the Hunter College School of Social Work of the City University of New York, the Illinois Department of Children and Family Services, and the New York City Child Welfare Administration proposes a three year study of children entering State custody as infants in Chicago and New York City. The purpose of the study is to identify the factors which facilitate or delay changes in the case plan goal. Data will be collected through in-depth interviews with caseworkers responsible for selected cases. Approximately 600 cases will be selected for interviews to be conducted around the child's anniversary date of entering State custody. Half of the children in each cohort will be living with relatives and others will be living in non-related family foster care at the time of the first case selection. Caseworkers will complete brief follow-up questionnaires at 6 months and 12 months following the initial interviews to determine if the case plan goal changed, who initiated the change, and what factors facilitate or delay the change. In this way, barriers and facilitating conditions which occur in a child's second, third and fourth year in care will be identified. Key informants will be interviewed in the final year of the project to develop an understanding of systems factors which appear to facilitate or hinder changing the case plan goal. Key informants and the questions they are asked will be determined through analysis of data collected at the case level. Products of this study will include three major reports and policy and practice recommendations for facilitating permanence for children entering State custody as infants.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Cecelia Sudia

PHONE NUMBER: 202-205-8764

PIC ID: 6848

PERFORMER ORGANIZATION: Jane Addams College of Social Work, Univ. of Illinois at Chicago, Chicago, IL

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Factors Related to the Quality of Family Foster Care

ABSTRACT: The purpose of this study is to determine the quality of the foster care experience and the factors that influence it, based on data collected from a sample of 500 families whose children spent time in foster care in Wayne County, Michigan, during 1993. The study examines the relationship between the agency and services characteristics (e.g., private versus public agency, caseload size, staff turnover, continuity of case services, provision of family preservation services, and use of kinship care) and quality foster care. The five components of the quality of foster care experiences are: (1) the health and well-being of the child while in care; (2) maltreatment in care; (3) family continuity; (4) types and numbers of placements; and (5) duration of care and recidivism. Examining the experiences of families whose child(ren) entered care in 1993 will allow analysis of the entire stay in foster care for the majority of foster children, and analysis of a four year span of experiences for those children who remain in care through the end of the study or return to care during that time frame. Analysis of these data will proceed in three stages: (1) determination of the quality of the foster care experience for the children in the sample; (2) multivariate analysis of the factors leading to different levels of quality; and (3) development of alternative models of foster care which maximize the quality of foster care experiences for different types of families. Characteristics of the family, characteristics of the child, and reasons for the child coming into care will be included in the model. This research aims to discover which factors are most significant in affecting the foster care experience for which types of children and families. This study will produce a handbook that can be used for informing agency policy, improving agency practice and training agency staff.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Geneva Wave-Rice

PHONE NUMBER: 202-205-8654

PIC ID: 6849

PERFORMER ORGANIZATION: Ryan, Patricia, Eastern Michigan University, Ypsilanti, MI

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Assessing the Quality of Foster Family Care: An Initiative for the Integration of Research and Practice

ABSTRACT: The underlying mission of this project is to promote quality in the caretaking environments of foster children. The overall goal of the research is to fill the gap in the literature on foster family care by examining the individual characteristics of foster parents across domains, as well as the environmental characteristics of the home. The research design will include a comparison of relative and non-relative foster homes, and a comparison of African-American and Caucasian foster homes. The participants in this study will be drawn from the pool of foster parents and children in Prince George's and Montgomery Counties, MD, which border three quadrants of Washington, D.C. Both counties are socioeconomically and ethnically diverse, and have had an increase in their high-risk populations due to migratory patterns from the District and foreign countries. It is anticipated that 120 families will be recruited from each county for a total of 240 families. Project results will be presented at national and local conferences, submitted to professional journals, and disseminated to policy and program development entities. A major objective of the proposed project is to produce an instrument that can be utilized by social service staff to assess the quality of foster home placements.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Geneva Wave-Rice

PHONE NUMBER: 202-205-8654

PIC ID: 6850

PERFORMER ORGANIZATION: University of Maryland, Institute for Child Study, College Park, MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Prevention of Foster Care Placement of Children at Risk for Domestic Violence

ABSTRACT: The Family Advocate Project (FAP) will build on the existing programs operated by the Family Intervention Center of the Children's Hospital of Pittsburgh, which provides medical and psycho-social evaluations to battered women and their children. The study will examine 150 mothers assigned to either a study or a control group. The mothers in the study group will receive intensive services in the areas of counseling, housing assistance, legal assistance and health care. Upon entry into the study, the mothers will undergo an extensive evaluation that will focus on control, maternal support, depression symptoms and attitudes toward discipline. The study will look at ways to alleviate the emotional trauma of battered women, and will explore whether the provision of support services to increase self-esteem and coping skills can prevent out-of-home placement or reduce the length of time children spend in foster care. FAP also will develop a replicable foster care prevention model. Finally, FAP is following both the experimental and control groups for a specified time after services are delivered.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Cecelia Sudia

PHONE NUMBER: 202-205-8764

PIC ID: 4378

PERFORMER ORGANIZATION: Children's Hospital Pittsburgh, PA

PROJECTED DATE OF COMPLETION: 10/1/99

TITLE: National Longitudinal Study of Children and Families in the Child Welfare System

ABSTRACT: The purpose of this study is to describe the outcomes experienced by children and families who come to the attention of the child welfare system, and to gain an understanding of the factors, including system-level and service factors, as well as child and family characteristics, that contribute to those outcomes. The study will select a nationally representative sample of 6,000 children upon entry into the child welfare system. Information on this sample will be collected at baseline and at three annual follow-up interviews from the children and their caregivers, caseworkers, and other agency personnel and service providers. Public use data sets will be prepared following each wave of data collection.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Mary Bruce-Webb, Ph.D.

PHONE NUMBER: 202-205-8628

PIC ID: 6748

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/03

Head Start

TITLE: Evaluation of Head Start Family Child Care Homes

ABSTRACT: This evaluation will assess the effectiveness of the Head Start Family Child Care Homes (HSFCCH) demonstration projects, funded by the Agency for Children, Youth, and Families (ACYF) during Fiscal Year 1992. It will determine the quality of Head Start services provided in FCC homes, and whether these services meet quality standards, including Head Start Program Performance Standards. It will also compare services delivered in FCC homes to those delivered in Head Start centers. Eighteen program grants were awarded for a three year project period. Head Start grantees participating in the demonstration have at least forty children in the year prior to kindergarten entrance enrolled in the HSFCC program, and a comparable number of children enrolled in the center-based program. Children are randomly assigned to the experimental and control groups. Data will be collected on the cognitive, socio-emotional and physical development of the two cohorts of children participating in the study. A series of interviews will be conducted with parents, family child care providers, grantee staff and administrators. Systematic observation of program service delivery is also employed to assess effectiveness.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Louisa Tarullo, Ed.D.

PHONE NUMBER: 202-205-8324

PIC ID: 4975

PERFORMER ORGANIZATION: RMC Research Corporation, Portsmouth, NH

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: Evaluation of the Head Start/Public School Early Childhood Transition Demonstration

ABSTRACT: This evaluation of the Head Start/Public School Early Childhood Demonstration projects will assess the effectiveness of providing comprehensive, continuous and coordinated services to Head Start families and children from the time of Head Start enrollment through the third grade. Working in concert with local evaluators, the contractor will develop a set of common data collection instruments to be used across all sites. The project will provide data regarding the effectiveness of the Transition Project models in maintaining the gains that children and families achieve while in Head Start. The evaluation and the demonstrations were mandated by the Head Start reauthorization legislation. Other studies completed during the ten years prior to 1992, notably the Head Start Transition Study and Developmental Continuity, did not provide information on the experiences or services extended to children after leaving Head Start. Additionally, these studies collected only limited data on families, the institutions and the community. This study is intended to supplement these other studies.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Mary Bruce-Webb, Ph.D.

PHONE NUMBER: 202-205-8628

PIC ID: 4393

PERFORMER ORGANIZATION: University of Alabama Birmingham, AL

PROJECTED DATE OF COMPLETION: 6/20/99

TITLE: Descriptive Study of Families Served by Head Start

ABSTRACT: This three-year descriptive study will provide information on a nationally representative sample of families served by Head Start in forty programs across the country. Through a survey and more intensive case study methods, the study will chart families' demographics, strengths, needs, expectations and experiences within Head Start programs, as well as programmatic efforts to join in partnership with families. (See PIC ID 6331.1)

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Louisa Tarullo, Ed.D.

PHONE NUMBER: 202-205-8324

PIC ID: 6331

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 7/18/99

TITLE: Evaluation of the Head Start Family Service Center Demonstrations

ABSTRACT: This project conducted an evaluation of the 41 Family Service Center Demonstrations through a consortium of local evaluators. The contractor provided coordination, technical assistance and analysis on common data elements across sites to yield a coordinated and integrated summary of process and impact evaluations. The consortium approach ensured a consistent and technically sound method of evaluating these demonstrations of how Head Start can collaborate with community programs to meet the needs of Head Start families dealing with problems such as illiteracy, substance abuse and unemployment. The contractor also reviewed local evaluation reports to identify lessons to be learned.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Henry Doan, Ph.D.

PHONE NUMBER: 202-260-2667

PIC ID: 4394

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Study of the Characteristics of Families Served by Head Start Migrant Programs

ABSTRACT: This study will document and describe the implementation of 26 Head Start Migrant programs. It will provide a profile of Head Start migrant families in the main migratory streams, and generate information on unique issues related to serving migrant families through Head Start programs. It will also document the availability and coordination of services for Head Start families during their migration. Finally, it will provide a national estimate of the number of eligible migrant children versus the number of those children being served by the Migrant Head Start programs. Findings from the study will be used to inform future policy decisions on Head Start migrant programs, as well as the new Early Head Start program for infants and toddlers. Data sources for this study have included Head Start grantee directors, staff and parents, children's health records, State and local agencies and associations providing services to migrant Head Start families, current grantee applications, and On-Site Program Review Instrument reports maintained by the Migrant Programs Branch. A final data source will be one or more of the 3 databases containing information and statistics on the migrant population.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Michael Lopez

PHONE NUMBER: 202-205-8212

PIC ID: 4974

PERFORMER ORGANIZATION: Aquirre International San Mateo, CA

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Descriptive Study of Head Start Bilingual/Multicultural Program Services

ABSTRACT: Head Start currently serves a diverse range of bilingual and multicultural children and families, and has developed innovative strategies to serve the unique needs of these populations. As the number of bilingual and multicultural children and families increases, several issues must be addressed. First, the number, geographic distribution, and sociodemographic characteristics of the Head Start eligible population for different cultural and linguistic groups must be assessed regionally and nationally. The number and nature of bilingual and multicultural children actually served by the Head Start program must also be determined as well as the range of bilingual and multicultural services provided nationally. Finally, there is need for an in-depth assessment of the service models, staff training approaches, community partnerships, and administrative plans and processes of a sample of 30 Head Start programs that have developed innovative methods for addressing diverse cultural and linguistic needs.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Henry Doan, Ph.D.

PHONE NUMBER: 202-260-2667

PIC ID: 5845

PERFORMER ORGANIZATION: STRA, Inc. Washington D.C.

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Early Head Start Research and Evaluation National Study

ABSTRACT: The Early Head Start National Study will evaluate the effectiveness of the Early Head Start (EHS) program in fifteen diverse communities: Brattleboro, Vermont; Pittsburgh, Pennsylvania; New York, New York; Washington, D.C.; Sumter, South Carolina; Russellville, Arkansas; Marshalltown, Iowa; Kansas City, Kansas; Kansas City, Missouri; Denver, Colorado; Logan, Utah; Jackson, Michigan; Auburn, Washington; Grandview, Washington; and Venice, California. The study will examine child, family, staff and community outcomes in a sample of 3,400 children and their families, who will be randomly selected into program and comparison groups when the mothers are pregnant or children are under 12 months of age. Assessments of children, families and child care environments will be made when children are 14, 24, and 36 months of age. Service use interviews will be conducted every six months, and programs will be visited each year. The study will produce the following reports: (1) Descriptive Study of EHS Programs; (2) Study of Program Variations; (3) Pathways to Early Head Start Quality; (4) Interim Study of Outcomes; (5) Longitudinal Study of EHS Outcomes; and (6) Selected Policy Papers.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Louisa Tarullo, Ed.D.

PHONE NUMBER: 202-205-8324

PIC ID: 3570

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

PROJECTED DATE OF COMPLETION: 9/30/00

Welfare Reform

TITLE: Management-Focused Welfare Reform Evaluation Data Access and Policy Manual Development
ABSTRACT: The purpose of this contract is to develop and pilot test (a) a software package that organizes public assistance evaluation data into readily accessible formats that can be continually accessed and used for timely and responsive decision-making; (b) a policy analysis manual that assists users in understanding how to read and apply continually accessed outcome or impact data to program or policy decisions; and © technical documentation for systems personnel and regular users. Tools that provide administrators access to evaluation data in "real time" rather than when analysis is complete could mean that more policy decisions will be made based on systematically gathered information than would otherwise be the case.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Mark Fucello

PHONE NUMBER: 202-401-4538

PIC ID: 6836

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

PROJECTED DATE OF COMPLETION: 10/30/98

TITLE: Examination of State Diversion Programs

ABSTRACT: This project will collect information from all States regarding the policies and practices the constitute diversion programs and/or activities designed to divert Temporary Assistance for Needy Families (TANF) applications. More detailed case studies will be conducted in five to seven States in order to document actual implementation and operation of the diversion policies and activities. A major focus of the study will be an examination of linkages between Medicaid enrollment and diversion programs/activities. The study will also attempt to examine whether and how local communities and institutions, particularly traditional safety net providers, might be affected by diversion programs and/or activities. The project will address the following issues: (1) how state diversion programs or activities are being conceived, structured, and implemented; (2) the effects of these programs/activities on participants, particularly with respect to Medicaid enrollment; (3) how local community institutions are affected, particularly by Medicaid enrollment rates; and (4) whether strategies for monitoring changes in Medicaid enrollment rates can be developed based on existing data.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Nancye Campbell

PHONE NUMBER: 202-401-5760

PIC ID: 6759

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 11/30/98

TITLE: Welfare Policy Typology Project

ABSTRACT: With the enactment of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), there are few, if any, strict Federal requirements for welfare programs, and States are not required to submit descriptions of their policies in any detail. This project will lay the groundwork for a database that would contain key information about State welfare policies (including Temporary Assistance for Needy Families), State-funded maintenance-of-effort programs, and Federally funded child care assistance programs.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe

PHONE NUMBER: 202-401-4537

PIC ID: 6837

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Neighbors, Services Providers, and Welfare Reform in Los Angeles County

ABSTRACT: This project will examine neighborhood variation in the availability of public and private social services throughout Los Angeles County. It will investigate how agencies are adapting to the current and anticipated changes in demand for their services as a result of welfare reform.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

PHONE NUMBER: 202-401-5070

PIC ID: 6763

PERFORMER ORGANIZATION: Rand Corporation Santa Monica, CA

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Post-Employment Services Demonstration

ABSTRACT: Policymakers and program operators recognize that job loss among newly employed welfare recipients is a major barrier to increasing the rate at which recipients obtain employment and leave welfare. Numerous studies have shown that employment is one of the primary avenues by which single parents can become self-sufficient and end a period of welfare dependency. However, employment has been found to be an uncertain path out of dependency, because a high proportion of Aid to Families with Dependent Children (AFDC) recipients who become employed lose their jobs and return to public assistance, often within a few months. The Administration for Children and Families (ACF) is sponsoring a four-site demonstration and evaluation to address this important aspect of a comprehensive welfare-to-work strategy. The demonstration is being operated in the following locations: Riverside, California; Chicago, Illinois; Portland, Oregon; and San Antonio, Texas. The Illinois Department of Public Aid is the lead State for the demonstration. Under the demonstration, each site is providing job retention and re-employment services to recently employed Job Opportunities and Basic Skills Training (JOBS) program participants.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf

PHONE NUMBER: 202-401-5984

PIC ID: 5974

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

PROJECTED DATE OF COMPLETION: 4/20/99

TITLE: Wisconsin Pay for Performance/Self-Sufficiency First Evaluation

ABSTRACT: Under the self-sufficiency first portion of this Aid to Families with Dependent Children (AFDC) demonstration, applicants for AFDC who were not exempt from Job Opportunities and Basic Skills (JOBS) had to complete 60 hours of JOBS activities prior to approval. Under the Pay for Performance portion of the demonstration, recipients were required to participate in up to 40 hours of JOBS activities per week, and for each hour the recipient did not participate, the AFDC grant and food stamp allotment was reduced by the Federal minimum wage.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach

PHONE NUMBER: 415-437-7671

PIC ID: 6838

PERFORMER ORGANIZATION: State of Wisconsin, Dept. of Workforce Development, Madison, WI

PROJECTED DATE OF COMPLETION: 5/30/99

TITLE: Florida Family Transition Program (FTP) Evaluation Project

ABSTRACT: This project continues an evaluation of a welfare reform waiver demonstration in Escambia County, Florida, that includes a 24-month time limit on cash assistance (with some exceptions), increased earned income disregards and asset limits, increased eligibility for two-parent families, and school attendance requirements for teenagers. The evaluation will produce process, impact, and cost-benefit studies using a random-assignment experimental design, and will examine the effects of FTP on individuals' participation in program activities, welfare use, and self-sufficiency.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe

PHONE NUMBER: 202-401-4537

PIC ID: 6820

PERFORMER ORGANIZATION: Florida Department of Children and Families, Tallahassee, FL

PROJECTED DATE OF COMPLETION: 4/30/00

TITLE: Welfare Reform Studies and Analyses (Rural TANF)

ABSTRACT: The purpose of this research project is to conduct an in-depth process evaluation of family response to the implementation of welfare reform in three remote rural counties of northeastern Washington State: Stevens, Ferry and Pend Oreille. The study will specifically look at family strategies to attain economic self-sufficiency, support for families from social networks, and assistance provided by community agencies, including transportation and child care. The major research questions are: (1) How do families formulate and act upon strategies to attain economic self-sufficiency in an environment of scarcity? (2) What is the relationship of a family's social network to their effectiveness in formulating strategies and successfully carrying out a plan to implement those strategies? (3) How do the actions of community agencies and organizations carrying out the tasks of welfare reform respond to family strategies? A variety of instruments, including structured interviews with families and agencies, and instruments to measure social supports and difficult life circumstances, will be used to measure the TANF implementation process effects on client behaviors and circumstances.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Jamie Kendall

PHONE NUMBER: 202-401-5600

PIC ID: 6834

PERFORMER ORGANIZATION: Eastern Washington University, Cheney, WA

PROJECTED DATE OF COMPLETION: 4/30/00

TITLE: Family Investment Program (FIP)

ABSTRACT: This study continues the evaluation of a welfare reform demonstration combining program changes designed to ease a family's transition from welfare to work with strict requirements that recipients participate, the Family Investment Agreement (FIA), under Iowa's employment program. The FIA details the steps a family will take to become self-sufficient and establishes a time frame for doing so. See also PIC ID 6762.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

PHONE NUMBER: 202-401-5070

PIC ID: 6761

PERFORMER ORGANIZATION: State of Iowa, Department of Human Services, Des Moines, IA

PROJECTED DATE OF COMPLETION: 6/30/00

TITLE: Youth Employment and Training Initiative (YETI)

ABSTRACT: The State will complete an evaluation of its Youth Employment and Training Initiative (YETI), which operated as a welfare reform demonstration from November 1993 until July 1997, when TANF was implemented in the State. YETI focused on inner-city youth in welfare families and provided counseling and classes designed to (1) help participants to stay in high-school and graduate, (2) increase life skills and self-esteem and reduce the incidence of pregnancies and substance abuse, (3) increase job-readiness and vocational skills, and (4) facilitate the transition from school to work. The overall objective of the project is to reduce the likelihood of welfare dependency among inner-city youth.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: John Maniha

PHONE NUMBER: 202-401-5372

PIC ID: 6821

PERFORMER ORGANIZATION: Illinois Department of Human Services Springfield, IL

PROJECTED DATE OF COMPLETION: 7/1/00

TITLE: Evaluation of Community-based Job Retention Programs

ABSTRACT: This project includes two phases. In Phase I, the project will provide a detailed implementation analysis and short-term outcome findings for participants receiving various mixes of job retention and post-employment services. The services will be provided to about 700 employed TANF recipients through five community-based neighborhood service organizations in Pittsburgh that received funding through The Pittsburgh Foundation (referred to as the GAPS program). A common set of services will be provided, but within the context of different existing service delivery systems among the community-based organizations (CBOs). Phase II, in project years 2 and 3, will include State-funded job retention programs in addition to the GAPS projects. The project will address such issues as: (1) the post-employment services that are most instrumental in helping newly employed TANF recipients maintain employment; (2) the organizational features important to successful delivery of job retention services; and (3) the appropriate duration of services.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Nancye Campbell

PHONE NUMBER: 202-401-5760

PIC ID: 6760

PERFORMER ORGANIZATION: Pittsburgh Foundation, Pittsburgh PA

PROJECTED DATE OF COMPLETION: 9/29/00

TITLE: State Welfare Reform Evaluation Track 2

ABSTRACT: This project, which complements a separately funded evaluation being completed on Iowa's Family Investment Program (FIP), consists of two studies: (1) a study of repeat limited benefit plan (LBP) assignments; and (2) a study of post-employment services. The study of repeat LBP assignments will describe the experiences and outcomes of welfare cases that have been assigned to the LBP more than once. The study of post-employment services will describe and compare standard and enhanced post-employment services and assess their contribution to a client's progress toward self-sufficiency. See also PIC ID 6761.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

PHONE NUMBER: 202-401-5070

PIC ID: 6762

PERFORMER ORGANIZATION: State of Iowa, Department of Human Services, Des Moines, IA

PROJECTED DATE OF COMPLETION: 9/29/00

TITLE: Maryland Family Investment Program Evaluation

ABSTRACT: This is a Statewide process study to examine and document front-line assessment and allocation practices under TANF in Maryland's 24 local jurisdictions. The objective of this analysis is to help clarify the relationship between agency factors and county-level characteristics by describing county-level variation in front-line procedures.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Mark Fucello

PHONE NUMBER: 202-401-4538

PIC ID: 6823

PERFORMER ORGANIZATION: University of Maryland, School of Social Work and Community Planning, Baltimore, MD

PROJECTED DATE OF COMPLETION: 9/29/00

TITLE: Evaluation of the North Carolina Work First Program

ABSTRACT: This project will evaluate North Carolina's Work First program which requires TANF families to work towards self-sufficiency. Through Work First, parents can receive short-term training and families can receive child care and other services.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

PHONE NUMBER: 202-401-5070

PIC ID: 6829

PERFORMER ORGANIZATION: North Carolina DHHS, Raleigh, NC

PROJECTED DATE OF COMPLETION: 9/29/00

TITLE: Evaluation of Los Angeles Jobs-First GAIN

ABSTRACT: Using experimental methodology, this project will consist of an implementation/process study, impact study and a cost-benefit study. It will evaluate the results of changing Los Angeles GAIN, a human resource focused welfare-to-work program, into Los Angeles Jobs-First GAIN, a labor force attachment strategy. The change involved: (1) strengthening the job club and having case managers make immediate job activity referrals universally; (2) locating job developers in GAIN offices; (3) using goals and performance-based contracts to reinforce the Work First message within GAIN; (4) change program guidelines and staff training to communicate importance of finding employment; and (5) informing enrollees of the financial advantage of even minimum wage jobs.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf

PHONE NUMBER: 202-401-5984

PIC ID: 6840

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

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: Front-Line Management and Practice Study

ABSTRACT: This is a study of Temporary Assistance to Needy Families (TANF) implementation at the local level, and is embedded in the larger SUNY-Albany State Capacity study, which is a 20 State implementation analysis. The principal objective of the Front-Line Management and Practice Study is to evaluate whether front-line workers are implementing the welfare goals and policies established by the States. Locally-based researchers will conduct in-depth observations in three local offices from each of four States. Sites have not yet been chosen, but no two offices will be selected from one county/city. A criterion for site selection dictates that the State give primary emphasis to work and job preparation, thus enabling the researchers to make comparisons among management practices that aim to affect the same sort of policy outcomes. Some sites will be chosen because they use traditional rule-based management and others because they rely on performance-based management.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Mark Fucello

PHONE NUMBER: 202-401-4538

PIC ID: 6841

PERFORMER ORGANIZATION: State University of New York at Albany, Albany, NY

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: Minnesota Family Investment Program (MFIP)

ABSTRACT: Using experimental methodology, this project will evaluate Minnesota's Family Investment Program (MFIP) with the following provisions:(1) increasing disregards below a specified income threshold; (2) requiring long-term recipients to participate in intensive employment/training services, including case management; and (3) consolidating benefits and simplifying rules for TANF, GA and Food Stamps.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf

PHONE NUMBER: 202-401-5984

PIC ID: 6824

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

PROJECTED DATE OF COMPLETION: 12/31/00

TITLE: New Hampshire Employment and Training Program Process and Outcome Study

ABSTRACT: This Process and Outcome Study goes hand-in-hand with the New Hampshire Impact Study. By using surveys of recipients, staff and employers, this process study will determine how Temporary Assistance for Needy Families (TANF) was planned, designed and implemented. There will also be several special studies concerning diversion from welfare, sanctions, child care and transitional case management.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach

PHONE NUMBER: 415-437-7671

PIC ID: 6827

PERFORMER ORGANIZATION: New Hampshire DHHS Concord, NH

PROJECTED DATE OF COMPLETION: 9/29/01

TITLE: Training, Education, Employment, and Management (TEEM) Project

ABSTRACT: This project will produce a process evaluation of the TEEM project. The TEEM project consolidates TANF and LIHEAP into a single cash assistance program. TEEM includes the following major provisions: (1) a social contract, (2) increased work incentives, (3) sanctions, (4) raised asset limits, and (5) incentives for family stability and marriage.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

PHONE NUMBER: 202-401-5070

PIC ID: 6830

PERFORMER ORGANIZATION: North Dakota DHHS, Bismarck ND

PROJECTED DATE OF COMPLETION: 9/29/01

TITLE: Child Impact Studies

ABSTRACT: This project augments the existing welfare reform demonstration evaluations in five States (Connecticut, Florida, Indiana, Iowa and Minnesota) to assess the effects of different welfare reform approaches on child well-being outcomes, including school achievement, behavioral problems, and health status. The effect of intervening mechanisms, such as the quality and regularity of the home environment, child care arrangements, and parental employment and income, will also be examined.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Alan Yaffe

PHONE NUMBER: 202-401-4537

PIC ID: 6847

PERFORMER ORGANIZATION: Multi-Professional Services Contracts. Washington, DC

PROJECTED DATE OF COMPLETION: 9/29/01

TITLE: California Welfare Reform Impact Evaluation

ABSTRACT: This demonstration will attempt to estimate the impact of California's Temporary Assistance for Needy Families (TANF) program. Generally, impacts will be assessed by comparing outcomes in the post-TANF period with the pre-TANF period. The impact of various county programs may also be examined by comparing outcomes among the counties. In developing models to estimate impacts, California will use a 10 percent Statewide sample of welfare recipients. These samples date back to 1987, providing a rich database to use to test the models. The sample data consist of Department of Social Services information on Aid to Families with Dependent Children (AFDC), Supplemental Security Income (SSI), Medi-Cal and foster care. These data have been supplemented by data on unemployment and disability insurance, and Department of Health Services data on births. The major research questions concern the impact of State's TANF program on self-sufficiency, family composition, and child well-being. To the extent possible, the impacts of TANF on different subgroups will be considered. Subgroups will include racial and ethnic subgroups, as well as urban and rural subdivisions. Attempts will also be made to determine the impacts of differing implementation of TANF among the counties.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach

PHONE NUMBER: 415-437-7671

PIC ID: 5548

PERFORMER ORGANIZATION: California Department of Social Services, Sacramento, CA

PROJECTED DATE OF COMPLETION: 3/31/02

TITLE: Achieving Change for Texans

ABSTRACT: This project continues an evaluation of the State of Texas' original welfare reform demonstration. The demonstration consists of four major components: (1) a number of policies implemented Statewide addressing such recipient responsibilities as immunization for children, school attendance and adherence to a personal responsibility agreement; (2) a number of policies implemented in counties operating JOBS, the primary feature of which is differential benefit time limits based on consideration of work experience and the need for education; (3) a number of policy options implemented in four counties, providing for individual development accounts and fill-the-gap budgeting; and (4) a one-county pilot offering a check for $1,000 in lieu of regular Temporary Assistance for Needy Families (TANF), with no re-application for benefits for one year.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: John Maniha

PHONE NUMBER: 202-401-5372

PIC ID: 6765

PERFORMER ORGANIZATION: State of Texas, Department of Human Services, Austin, TX

PROJECTED DATE OF COMPLETION: 3/31/02

TITLE: Evaluation of Arizona Employing and Moving People Off Welfare and Encouraging Responsibility Program (EMPOWER)

ABSTRACT: Under this Aid to Families with Dependent Children (AFDC) and Temporary Assistance for Needy Families (TANF) demonstration, recipient families are encouraged to become self-sufficient by: (1) time-limiting cash assistance for adult recipients, (2) imposing a family cap, (3) extending transitional Medicaid and child care to 24 months, (4) eliminating the 100 hour rule for two parent families, (5) requiring unwed minor parents to live with a responsible adult, and (6) requiring 13 to 16 year old parents to participate in Job Opportunities and Basic Skills (JOBS).

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach

PHONE NUMBER: 415-437-7671

PIC ID: 6818

PERFORMER ORGANIZATION: Arizona State Department of Economic Security Phoenix, AZ

PROJECTED DATE OF COMPLETION: 4/30/02

TITLE: State Welfare Reform Evaluation Project (Jobs First)

ABSTRACT: Using experimental methodology, this project will continue an originally planned evaluation of the Jobs First demonstration, later incorporated into the State's TANF plan. The evaluation includes: (1) a short (21 month) eligibility time limit for non-exempt recipients; (2) 24 months of transitional Medicaid; (3) liberalized disregards; (4) "Family Cap", limited eligibility for children born while the family receives assistance; (5) strong job search emphasis, with employability assessment only if a search fails to yield a job; and (6) progressive sanctions for non-compliance.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf

PHONE NUMBER: 202-401-5984

PIC ID: 6819

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

PROJECTED DATE OF COMPLETION: 4/30/02

TITLE: Indiana Welfare Reform Evaluation Project

ABSTRACT: This project continues the evaluation of implementation and impacts of the "Indiana Manpower Placement and Comprehensive Training Program" (IMPACT) welfare reform waiver demonstration, now operating under Temporary Assistance for Needy Families (TANF).

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Richard Jakopic

PHONE NUMBER: 202-205-5930

PIC ID: 6869

PERFORMER ORGANIZATION: Indiana Family and Social Services Administration Indianapolis, IN

PROJECTED DATE OF COMPLETION: 4/30/02

TITLE: Welfare Restructuring Project (WRP)

ABSTRACT: This project continues the evaluation of a welfare reform demonstration project. One of the key features is a time limit that requires some adult recipients to participate in community work experience after fifteen months (for two-parent families) or thirty months (for single-parent families) of receiving cash assistance.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

PHONE NUMBER: 202-401-5070

PIC ID: 6764

PERFORMER ORGANIZATION: State of Vermont, Department of Social Welfare, Waterbury, VT

PROJECTED DATE OF COMPLETION: 5/31/02

TITLE: Minnesota WorkFIRST Program (Track 2)

ABSTRACT: Using a quasi-experimental, pre-test/post-test comparison group design consisting of both an impact and process study, this study will compare the WorkFirst and MFIP-S programs. WorkFirst uses a rapid labor force attachment strategy versus MFIP-S, which represents a progressive labor force attachment model.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Lawrence Wolf

PHONE NUMBER: 202-401-5984

PIC ID: 6825

PERFORMER ORGANIZATION: Minnesota Department of Human Services, Health Care Admin. St. Paul, MN

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Evaluation of the Employment First Program

ABSTRACT: This process evaluation will primarily focus on implementation and operation of the Nebraska Employment First Program and will conclude a special study to assess successful case management. In addition, a separate impact evaluation will be carried out comparing an intensive up-front job search strategy with the "traditional" up-front assessment approach.

AGENCY SPONSOR: Administration on Children, Youth and Families

FEDERAL CONTACT: Michael Dubinsky

PHONE NUMBER: 202-401-3442

PIC ID: 6826

PERFORMER ORGANIZATION: Nebraska State Department of Health and Human Services Lincoln, NE

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Impact Study of the New Hampshire Employment Program

ABSTRACT: This demonstration is designed to determine the impact of New Hampshire's entire Temporary Assistance for Needy Families (TANF) program. It will attempt to determine the effects of TANF on caseload and on employment and earnings, as well as the effects on areas such as foster care placements, child abuse and neglect, homelessness and child support collections.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Leonard Sternbach

PHONE NUMBER: 415-437-7671

PIC ID: 6828

PERFORMER ORGANIZATION: New Hampshire DHHS Concord, NH

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Virginia Independence Program

ABSTRACT: This project evaluates the State's TANF implementation, which continues policies begun under its welfare reform demonstration, Virginia Independence Program (VIP). Among the policies to be studied under the state's VIP are: (1) diversionary assistance, (2) a family cap, (3) time-limited assistance, (4) person responsibility agreements, (5) expanded earned income disregards, (6) school attendance requirements, (7) paternity establishment rules, (8) requiring minor parents to live in adult settings, (9) child immunization requirements, and (10) incentives promoting individual savings accounts and Medicaid and child care benefits.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: John Maniha

PHONE NUMBER: 202-401-5372

PIC ID: 6831

PERFORMER ORGANIZATION: Virginia Commonwealth University, Dept of Health Administration Richmond, VA

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Assessing Effective Welfare-to-Work Strategies for Domestic Violence Victims and Survivors in the Options/Opciones Project

ABSTRACT: This research project will study the effective strategies in addressing the needs of abused women as they try to enter the labor market. This project will document the needs of battered girls and women on welfare, and will identify successful strategies employed to eliminate violence and exit welfare.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Mary Ann MacKenzie

PHONE NUMBER: 202-401-5272

PIC ID: 6833

PERFORMER ORGANIZATION: Taylor Institute Chicago, IL

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: National Study of Child Care for Low Income Families

ABSTRACT: This project will study the low income child care market in 25 communities in 16 States with a sub-study to examine the family child care market in 5 neighborhoods drawn from these communities. The information provided from the study will help inform the issues surrounding subsidized child care and its implementation by the States, with particular attention to the provisions in the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) over time, as well as how significant shifts in welfare policy and programs affect the child care market for welfare recipients and the working poor at the community level.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Richard Jakopic

PHONE NUMBER: 202-205-5930

PIC ID: 6845

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Ohio Works First Evaluation

ABSTRACT: This demonstration will evaluate the Ohio Works First provisions and Temporary Assistance for Needy Families (TANF) policies which include: (1)completion of a self-sufficiency contract, (2) more generous income disregards, (3) a 36-out-of-any-60 month time limit, and (4) whole family sanctions. In Ohio, local jurisdictions have great flexibility in running their TANF programs, and this evaluation will attempt to determine the differential effects of the various local programs.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Nancye Campbell

PHONE NUMBER: 202-401-5760

PIC ID: 6758

PERFORMER ORGANIZATION: State of Ohio, Department of Human Services, Columbus, OH

PROJECTED DATE OF COMPLETION: 9/30/02

TITLE: Welfare-to-Work: Monitoring the Impact of Welfare Reform on American Indian Families with Children

ABSTRACT: The overall purpose of this project is to monitor and document the implementation, and assess the impact of, welfare reform on American Indian families and reservations in Arizona caused by the evolving State and tribal responses to Temporary Assistance to Needy Families (TANF). Extensive demographic, contextual, socioeconomic and case-level data are to be compiled from a variety of sources, and analyzed in order to document the baseline conditions and changing patterns, and to identify short-term outcomes. The researchers will: (1) use existing national data (e.g., Census, CPS, and SIPP) on American Indians to provide a context for the study of Arizona, (2) collect quarterly case- or household-level data on the welfare recipients on Indian reservations in Arizona to examine their characteristics and monitor changes in their situations under TANF, and (3) track and document TANF implementation by tribal entities using content analysis of relevant documents, in-depth telephone interviews and site visits. The evaluation of the long-term impact of the reform program is to be undertaken during the last four years of the project.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Hossein Faris, Ph.D.

PHONE NUMBER: 202-205-4922

PIC ID: 6832

PERFORMER ORGANIZATION: Washington University, School of Social Work, St. Louis MO

PROJECTED DATE OF COMPLETION: 9/30/02

TITLE: Jobs-Plus: Community Revitalization Initiative for Public Housing Families

ABSTRACT: This is a seven and one-half year demonstration program aimed at dramatically increasing employment, earnings and job retention among the working-age residents of family housing developments, a large percentage of whom are on public welfare or at risk of dependency. The program supports the planning, development, implementation and evaluation of locally-based approaches to providing saturation-level employment opportunities, including a combination of training and supportive services, financial and other incentives (occasioned by the welfare reform and new public housing policies), and vigorous efforts to rebuild and strengthen the community in support of work. The bottom line question for the Jobs-Plus Demonstration is: Does the program achieve its primary goal of dramatically increasing employment and earnings among public housing residents? And, does a large increase in employment and earnings lead to a better quality of life for residents? Questions concerning the sites' implementation strategies and experiences are also important and will be a major focus of the research. The evaluation design developed for the demonstration combines experimental and quasi-experimental methods in an unusually rigorous approach for studying the effectiveness of a place-based comprehensive social intervention. (It uses randomly-selected sets of treatment and comparison sites.) The study will use administrative records data as well as survey data covering a wide variety of outcomes. It will examine whether the program's impacts vary across sites and whether certain program strategies are likely to yield better results. The evaluation will include comprehensive cost and benefit-cost analyses.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Hossein Faris, Ph.D.

PHONE NUMBER: 202-205-4922

PIC ID: 6835

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

PROJECTED DATE OF COMPLETION: 12/31/03

TITLE: Capitalizing the Bridge from Welfare to Independence (CBWWI)

ABSTRACT: This project is designed to expand the employment and training services provided by Goodwill Industries by constructing new centers in four counties in southwest Florida and six parishes in southeast Louisiana. Once constructed, the centers are expected to be self-supporting (i.e., no need for continuing public support) by utilizing the business activity and payroll generated by the donated goods business.

AGENCY SPONSOR: Office of Planning, Research and Evaluation

FEDERAL CONTACT: Girley Wright

HONE NUMBER: 202-401-5070

PIC ID: 6755

PERFORMER ORGANIZATION: Goodwill Industries of Manasota, Inc., Sarasota, FL and Goodwill Industries of Acadiana, Inc., Scott, LA

PROJECTED DATE OF COMPLETION: 6/30/07

Administration on Aging

Evaluation Program
The Administration on Aging (AoA) is the Federal focal point and advocate agency for older persons and their concerns. The AoA administers key Federal programs mandated under various titles of the Older Americans Act. These programs help vulnerable older persons remain in their own homes by providing supportive services. Other programs offer opportunities for older Americans to enhance their health and to be active contributors to their families, communities, and the Nation through employment and volunteer programs. The AoA works closely with its nationwide network of regional offices and State and Area Agencies on Aging to plan, coordinate, and develop community-level systems of services that meet the unique needs of individual older persons and their caregivers. The AoA collaborates with Federal agencies, national organizations, and representatives of business to ensure that, whenever possible, their programs and resources are targeted to the elderly and coordinated with those of the network on aging. As the responsibilities of this nationwide network of State and Area Agencies on Aging continue to grow, it is essential that they have the necessary information to meet these responsibilities.

The overall evaluation priorities of the AoA are to support studies that provide information on the following: (1) the success of existing program implementation in meeting the goals of the Older Americans Act; (2) the design and operation of effective programs; and (3) issues relevant to policy development, legislative planning, and program management.

Fiscal Year 1998 Evaluations in Progress

Support Services to Elderly Persons

TITLE: Evaluation of the Supportive Services and Senior Centers Provided under the Older Americans Act (Title III-B): Design Phase

ABSTRACT: During fiscal year 1997, the AoA initiated a study to plan an evaluation of the Supportive Services and Senior Centers provisions of the Older Americans Act (Title III-B). Through this project, the AoA is identifying the conceptual and methodological issues in the evaluation and will develop an approach to this evaluation. The evaluation is expected to develop outcome measures with broad applicability which can be used repeatedly over time.

AGENCY SPONSOR: Administration on Aging

FEDERAL CONTACT: Edwin L. Walker

PHONE NUMBER: 202-619-0011

PIC ID: 6855

PERFORMER ORGANIZATION: Westat, Inc. Rockville MD

PROJECTED DATE OF COMPLETION: 10/1/98

Agency for Health Care Policy and Research

Evaluation Program
The Evaluation Program within the Agency for Health Care Policy and Research (AHCPR) provides information on the Agency's effectiveness in meeting its long-term goals and priorities, the efficiency of the Agency's program performance through internal evaluations, and critical Agency and departmental concerns via "fast-track" or quick-turnaround assessments.

Evaluation components are built into virtually all major AHCPR programmatic activities and a wide variety of "freestanding" projects are undertaken as needs are identified. Among the evaluation mechanisms used by the Agency are targeted evaluation studies undertaken through contracts or grants; efforts to obtain feedback from "customers" on the usefulness of AHCPR research efforts, including such mechanisms as focus groups and surveys; and feedback from AHCPR's User Liaison program (which provides information and technical assistance to State policymakers, health departments, and officials). Information gathered from AHCPR's evaluation-related activities will be used in the annual performance plans developed in response to the Government Performance and Results Act starting in FY 1999.

All "freestanding" evaluation activities undergo two levels of review. First, brief evaluation proposals are developed by staff and undergo review by affected senior managers. Those proposals approved by senior managers are submitted for review by the administrator. The administrator evaluates proposals for policy relevance, priority, cost effectiveness, and timeliness. Those that receive the administrator's approval are then methodologically developed and centrally reviewed for technical merit, including technical feasibility, costs, and relation to ongoing evaluation activities.

Fiscal Year 1998 Evaluations

Performance Measurement

TITLE: Inventory of DHHS Performance Measures-Phase II-Data Collection/Testing and Analysis

ABSTRACT: As part of an effort to prepare an inventory of health care performance measures, the final report of Phase II (of three) in the department recommends that: (1) data collection forms and instructions used during Phase II be reviewed with the objective of eliminating or simplifying data elements and response categories; (2) agency staff charged with completing forms or using software packages to enter their performance measures receive additional training; (3) more time be allocated for data collection, since the individuals who should be completing the entries tend to be those staff members most busy within their agencies; and (4) the appropriate representative in each participating agency recruit those who will be asked to complete the forms and ask them to attend a training session. See also PIC ID 6691 and 6691.2 (Final report 19 pages plus appendices.)

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Marge Keyes

PHONE NUMBER: 301-594-1349

PIC ID: 6691.1

PERFORMER ORGANIZATION: Center for Health Policy Studies Columbia, MD

Evaluations in Progress

Evidence-Based Medicine

TITLE: Development and Implementation of Evidence-Based Practice Center (EPC) Program Evaluation

ABSTRACT: The Agency for Health Care Policy and Research (AHCPR) supports 12 Evidence-based Practice Centers (EPCs) to undertake scientific analyses and evidence syntheses on high-priority topics. The science syntheses-evidence reports and technology assessments produced by the EPCs provide the scientific foundation for public and private organizations to use in developing and implementing their own practice guidelines, performance measures and other tools to improve the quality of health care and make decisions related to the effectiveness or appropriateness of specific health care technologies. This project will implement an evaluation of the EPC program that assesses the impact of the evidence reports and technology assessments produced by the EPCs.

AGENCY SPONSOR: Center for Practice and Technology Assessment

FEDERAL CONTACT: Margaret Coopey

PHONE NUMBER: 301-594-4022

PIC ID: 7037

PERFORMER ORGANIZATION: Medstat Group Washington, DC

PROJECTED DATE OF COMPLETION: 2/28/00

Health Services Research

TITLE: Health Services Research Education: Assessing Customer Satisfaction and Program Needs

ABSTRACT: In addition to individual fellowship, dissertation, and institutional innovation incentive awards, the AHCPR currently supports 25 diverse health services research programs which train over 150 pre-doctoral and post-doctoral students annually. This effort will include a customer satisfaction survey/evaluation of scholars whose training was supported by AHCPR institutional training program grants, and key informant feedback on the satisfaction of training program directors with the NRSA training program. In addition, the project will include a qualitative needs assessment relying on input from training program directors and other experts in health services research education.

AGENCY SPONSOR: Office of Research Review, Education and Policy

FEDERAL CONTACT: Debbie Rothstein

PHONE NUMBER: 301-594-2918

PIC ID: 7011

PERFORMER ORGANIZATION: Battelle Columbus Laboratories Columbus, OH

PROJECTED DATE OF COMPLETION: 6/20/99

Informatics

TITLE: Health Care Informatics Standards of Selected Federal Agencies: A Revised and Updated Report and Conference

ABSTRACT: This project builds on prior work conducted in support of the Department of Health and Human Services (HHS) Data Council's Committee on Health Data Standards and the Information Infrastructure Task Force's Health Information Working Group to collect and summarize information on Federal agency health informatics standards activities of Federal agencies. This follow-up project will update previously collected data, expand data collection efforts to those not previously surveyed, and synthesize information for presentation to the Department through a one day conference.

AGENCY SPONSOR: Center for Organization and Delivery Studies

FEDERAL CONTACT: Stanley Edinger, Ph.D.

PHONE NUMBER: 301-594-1598

PIC ID: 6387

PERFORMER ORGANIZATION: Washington Consulting Group Bethesda, MD

PROJECTED DATE OF COMPLETION: 3/31/99

Performance Measurement

TITLE: CONQUEST Evaluation

ABSTRACT: The Computerized Needs Oriented Quality Measurement Evaluation System (CONQUEST) is a quality improvement software tool that provides information on 1,200 clinical performance measures, both process and outcomes, on more than 50 conditions. This project will: (1) design an evaluation for CONQUEST 2.0; (2) design an evaluation for a future procurement that builds upon CONQUEST 2.0 which will become a part of the RFP for that future product; and (3) implement an evaluation of CONQUEST 2.0. In addition, information will be gathered on recommendations for improvement in the tool to better meet the needs of its users.

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Marge Keyes

PHONE NUMBER: 301-594-1349

PIC ID: 7010

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle, NC

PROJECTED DATE OF COMPLETION: 1/31/00

Crosscutting

TITLE: Evaluation of Improvements to Grant Application Receipt and Review (Large and Small Grants)

ABSTRACT: The purpose of this project is to determine whether changes made to the grant application submission and peer review processes have resulted in improved efficiency and effectiveness from the perspectives of applicants, reviewers and agency staff.

AGENCY SPONSOR: Office of Management

FEDERAL CONTACT: Joan Hurley

PHONE NUMBER: 301-594-1449

PIC ID: 6696

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 3/21/99

TITLE: Inventory of DHHS Performance Measures -- Phase III -- Data Collection, Analysis, and Reporting

ABSTRACT: The purpose of this project is to complete work on an inventory of Department of Health and Human Services (DHHS) clinical, population, and systems performance measures for consumers, purchasers, regulators, providers, and public health officials in managed care. This includes gatekeeper arrangements and traditional non-managed care fee-for-service environments that will assist the DHHS Managed Care Forum and the Secretary's Initiative on Quality of Care. See also PIC ID 6691 and 6691.1.

AGENCY SPONSOR: Center for Quality Measurement and Improvement

FEDERAL CONTACT: Marge Keyes

PHONE NUMBER: 301-594-1349

PIC ID: 6691.2

PERFORMER ORGANIZATION: Center for Health Policy Studies Columbia, MD

PROJECTED DATE OF COMPLETION: 5/28/99

Agency for Toxic Substances and Disease Registry

Evaluation Program
The Agency for Toxic Substances and Disease Registry (ATSDR) was created as a Federal agency by the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA), more commonly known as Superfund legislation. ATSDR was created to implement the health-related sections of CERCLA and other laws that protect the public from hazardous waste and environmental spills of hazardous substances. The ATSDR evaluation program is coordinated with the agencywide strategic planning process to implement requirements of the Government Performance and Results Act (GPRA). ATSDR's strategic goals and its annual performance plan are the result of an interactive process that reflects a long-term commitment by Agency staff to develop stronger relationships among external clients and stakeholders, to assess products and services using relevant data, and to improve our processes and systems for more efficient accomplishment of ATSDR's mission.

There are four strategic questions important to the Agency. How should ATSDR evaluate the public health needs of its stakeholders and involve those stakeholders in the Agency's program planning, implementation, and evaluation? How should ATSDR's roles in assessment, science, health promotion, and service be implemented to meet the needs of its stakeholders and to achieve its mission? How does ATSDR ensure that it has the authorities and resources necessary to address the public health needs of its stakeholders? And finally, how should ATSDR evaluate the public health impact of its products and services?

Fiscal Year 1998 Evaluations

Emergency Events Surveillance

TITLE: Hazardous Substances Emergency Events Surveillance (HSEES)-1997 Annual Report

ABSTRACT: Since 1990, the Agency for Toxic Substances and Disease Registry (ATSDR) has maintained an active, State-based Hazardous Substances Emergency Events Surveillance (HSEES) system to describe the public health consequences associated with the release of hazardous substances. This report summarizes the characteristics of events reported to the surveillance system by 13 State health departments during 1997. Data on acute hazardous substances emergency events were collected, includinggeneral information on the event, substance(s) released, victims, injuries, and evacuations. Several data sources were used to obtain the maximum amount of information about each event. These sources included, but were not limited to, records or oral reports of State environmental protection agencies, police and fire departments and hospitals. The data obtained were computerized using an ATSDR-provided data entry system and were sent to the ATSDR on a quarterly basis. The 13 participating States reported a total of 5,531 events for 1997; approximately 80 percent of the events occurred at fixed facilities, and 20 percent were transportation related. In 96 percent of the events, only a single substance was released. The most commonly reported categories of substances were volatile organic compounds, acids, ammonia, pesticides, other inorganic substances, mixtures involving more than one category, and the category designated "other," which included substances that could not be placed in one of the other 10 categories. During this reporting period, 372 events (approximately seven percent of all events) resulted in a total of 1,896 victims. The most frequently reported injuries sustained by victims were respiratory irritation, headache, eye irritation, and nausea or vomiting. A total of 28 persons died as a result of all events, and 514 events required evacuations. These findings have been relatively consistent with previous years since the HEES was started.

AGENCY SPONSOR: Office of Policy and External Affairs

FEDERAL CONTACT: Donna Jones

PHONE NUMBER: 404-639-5001

PIC ID: 6854.1

PERFORMER ORGANIZATION: Agency for Toxic Substances and Disease Registry, Atlanta, GA

Evaluations in Progress

Emergency Events Surveillance

TITLE: Hazardous Substances Emergency Events Surveillance (HSEES)

ABSTRACT: This report, generated annually, discusses the evaluations conducted for the ATSDR's Hazardous Substances Emergency Events Surveillance (HSEES) program, and is based on the ability to measure the sensitivity and reliability of the system. Sensitivity is measured by the ability of the system to receive notification of events involving hazardous substances meeting the HSEES case definition, evaluated by comparison to other national data collection systems (i.e., DOT, EPA). Reliability is measured by the ability of the system to receive uniformly recorded data from the 13 State health department partners. To address the reliability of HSEES, each quarter the ATSDR mails a report describing a case study involving the release or threatened release of a hazardous substance or substances to participating State health departments. State health department partners review the case study and complete a hard copy data collection form which is returned to the ATSDR. The ATSDR then compares the responses on these forms to each other and to the ATSDR's preferred responses.

AGENCY SPONSOR: Division of Health Studies

FEDERAL CONTACT: Wendy E. Kaye, Ph..D.

PHONE NUMBER: 404-639-6203

PIC ID: 6854

PERFORMER ORGANIZATION: Agency for Toxic Substances and Disease Registry Atlanta, GA

PROJECTED DATE OF COMPLETION: 12/31/98

Centers for Disease Control and Prevention

Evaluation Program
The Centers for Disease Control and Prevention (CDC) conducts evaluation studies designed to provide information essential for CDC's 11 strategies to achieve its mission:

Conduct public health research, including epidemiology, laboratory, behavior, and social sciences.
Develop and implement ongoing evaluation of scientific research.
Assure that scientific information is communicated effectively to the general public.
Develop and implement public health information systems for monitoring and promoting the health of the Nation.
Deploy multidisciplinary teams to detect and investigate health threats.
Develop and implement a system for establishing CDC scientific and programmatic priorities.
Routinely evaluate the effectiveness and cost of CDC programs.
Demonstrate the value of investment in health prevention.
Collaborate with diverse partners.
Design, implement, and evaluate prevention programs based on community needs.
Prepare the public health leaders (present and future) through training in management and public health science.

Fiscal Year 1998 Evaluations

Chronic Disease

TITLE: Development of an Evaluation Strategy for State-Based Diabetes Control Cooperative Agreement Programs

ABSTRACT: Diabetes and diabetes-related complications are a major cause of morbidity and premature mortality in the United States. Since 1977, Diabetes Control Programs (DCPs) have been supported by the Centers for Disease Control and Prevention (CDC), on the premise that the health consequences of diabetes can be substantially reduced by effective widespread clinical and health applications of preventive programs. This project develops a comprehensive evaluation strategy that provides the Division of Diabetes Translation the capacity to assess uniformly the progress that State-based DCPs are making in reducing the burden of diabetes in an evolving health system. This project: (1) identifies priority program performance standards; (2) delineates priority evaluation questions, health program outcomes, measurement methods, data sources, analyses and reporting strategies; (3) establishes process and outcome evaluation plans to assess components of State-based diabetes control programs; and (4) proposes strategies for implementing and managing proposed evaluation plans. The report concludes that: (1) DCPs should be encouraged to grow in ways that are appropriate to individual States; and (2) the multiplicity of program approaches does not hinder program evaluation and planning as long as certain base criteria are met. Recommendations for the program include: (1) provide technically and culturally competent health education; (2) provide access to and use of basic preventive services; (3) assist patients in compliance with diabetes control measures, including early detection and follow-up, to prevent or delay onset of symptoms; and (4) provide access to and use of cost-effective clinical services for complications and follow-up to prevent delay, or to delay progress from mild to severe symptoms. (Final report 121 pages plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Bud Bowen

PHONE NUMBER: 770-488-5011

PIC ID: 6584

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

TITLE: Evaluation of Dental Treatment and Health Status Differences Attributable to Water Fluoridation

ABSTRACT: For over 50 years, public health officials have known that water containing fluoride at a level of 0.7-1.2 mg/L reduces the occurrence of dental caries. However, as the use of other fluoridated products has increased, the observed differences in caries prevalence between children residing in fluoridated (F) and nonfluoridated (NF) communities have declined. Given the decline in caries prevalence, several review groups have noted the need for current data on the effectiveness of water fluoridation. This report assesses whether dental treatment experiences of children and adult members of a group-model HMO differ among those who consume fluoridated water and those who do not. The research setting for this project was Kaiser Permanente, Northwest Division, and the study period was 1990-1995. The two principle data sources for the project were the Membership Information Process System and the TEAM dental treatment database. Fluoridation status was determined through a random sample of subscribers. Outcomes of interest included: (1) dental care utilization, (2) mean number of filled surfaces, (3) dental care costs, (4) supplemental fluoride dispensings, and (5) endentulism rates. Descriptive statistics and regression analysis were used to compare results in the fluoridated and non-fluroridated samples. The report finds that, despite the sociodemographic characteristics of this insured population, community water fluoridation appeared to reduce total costs and total restorative costs. (Final report 41 pages plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Dolores Malvitz, Dr.PH.

PHONE NUMBER: 404-639-8376

PIC ID: 6334

PERFORMER ORGANIZATION: The HMO Group New Brunswick, NJ

Environmental Health

TITLE: Evaluability Assessment of CDC-funded Traumatic Brain Injury and Spinal Cord Injury Programs

ABSTRACT: In 1988, the Centers for Disease Control and Prevention (CDC) created the Disabilities Prevention Program (DPP) to reduce the incidence and severity of primary and secondary disabilities in the United States and to promote the independence and productivity of persons with disabilities. This report was commissioned to assess the feasibility of conducting an evaluation of the traumatic brain injury and spinal cord injury (TBI/SCI) programs funded through the DPP, the National Center for Environmental Health (NCEH), and the CDC. Interviews were conducted with Federal and State staff with a background or interest in DPP, external stakeholders, and program staff in eight States. Interview data were used to prepare a logic model of State-level TBI/SCI programs, along with a set of measurable program components that match the activities and the objectives set forth in the logic model. The report finds that: (1) there is a consensus among all stakeholders as to the TBI/SCI capacity building programs' intended goals and on indicators that can be used to measure attainment; and (2) identifying the logic model and framework of measurable components for these programs offers many benefits. In order to strengthen CDC-State partnerships, the report recommends: (1) an appropriate balance in the partnership that allows States to be flexible but also provides parameters to ensure consistency; (2) the provision of regular, consistent feedback on State plans, activities, quarterly reports and surveillance data; (3) grounding program design and decisions on valid data, whenever possible (in the absence of data, programs should proceed with a phased approach involving both the CDC and the States in the evolutionary learning process); and (4) the expansion of partnerships at the federal, State, and community levels. (Final report 33 pages plus appendices.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Doug Browne

PHONE NUMBER: 404-488-7098

PIC ID: 6338

PERFORMER ORGANIZATION: Toal, Susan 917 Barton Woods, Atlanta, GA

TITLE: Evaluation of Training for Staff of Childhood Lead Poisoning Prevention (CLPP) Programs, in Light of CDC Revised Policy and Program Priorities

ABSTRACT: Since 1989, Congress has authorized the Centers for Disease Control and Prevention (CDC) to fund State and local health departments to increase childhood blood lead level screening, to improve the follow-up of children with elevated blood lead levels (EBLLs), and to provide protection information. Since 1990, many at-risk children who formerly used health department preventive services have now begun receiving their care from private providers and surveys of national BLLs show significant decreases in the number of children with elevated BLLs. The Childhood Lead Poisoning Prevention program priorities were revised according to these changes. This report evaluates the learning objectives of two workshops provided by the National Lead Training and Resource Center (NLTRC), which provides training for CLPP program staff and program managers. "Fundamentals of Childhood Lead Poisoning Prevention"--a 3.5 day training session targeting frontline staff providing direct service--and "Essentials of Program Management for Lead Poisoning Prevention Programs"--a 2.5 day training session targeting generic management issues. The report finds that: (1) the NLTRC and the CDC need to devise a way to systematically review the content of the courses, patterns in the responses of the participants, and trends within grantee programs to determine areas in which updating is necessary; (2) the NLTRC and the CDC should develop an advisory board with representatives from CLPPs and the CDC to decide on course content and training methods for both courses; (3) the NLTRC should combine the best aspects of both of these courses and match the professional training team with the lead content experts; (4) the registration form should be revised to reflect in more detail the level, work setting, and job setting of the participant; and (5) program participants need to be tracked to see if the course is reaching the appropriate target audience. (Executive summary and final report bound separately.)

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Nancy Tips

PHONE NUMBER: 770-488-7277

PIC ID: 6702

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

Epidemiology

TITLE: Evaluation of the Field Epidemiology Training Program (FETP)

ABSTRACT: This report assesses the effectiveness of the Field Epidemiology Training Program (FETP) in achieving the Centers for Disease Control and Prevention's (CDC's) objective of building capacity in applied epidemiology in developing countries. Data were 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 report finds 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 in order to assure their sustainability in the rapidly changing political environments that surround public health issues in many host countries. In addition to general recommendations, the report identifies three clear roles for the CDC, which include: (1) providing prestige and political clout to their in-country counterparts who will support the program at a national level; (2) providing specialized technical assistance; and (3) supporting the development of an international network of epidemiologists. (Final report 134 pages plus appendices.)

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

Health Statistics

TITLE: Race Reporting on Birth Records by Multiracial Women: An Evaluation of Question Format Alternatives

ABSTRACT: This report examines the implications of changing the format of the race item on the birth record filled out for every birth in the United States at the location of birth. Procedures for filling out birth certificates vary from State to State and, in some States, from hospital to hospital. To provide uniform information to the vital registration system, the Federal government, in cooperation with the States, developed the U.S. Standard Certificate of Live Birth, which records relevant information about the race and origin of the parents, but not the baby. This study: (1) evaluates how women of multiracial and Hispanic backgrounds interpret the race question on the birth certificate; (2) evaluates experimental race questions such as the use of a multiracial cue and the use of a "mark all that apply" format; and (3) provides information about the response processes that women use when answering questions about race. Nine States and the District of Columbia recruited 763 women to participate in this study. The study tests the effects of different questions on race both in a mail and a follow-up telephone survey. The mother's self-reported race is compared with what she reported on the actual birth record. Further, for those residents with two children, the study compared consistency of race reporting between the last two birth records. The report concludes that: (1) the percentage of women reporting more than one race increases when the race questions include a multiracial cue or "mark all that apply" format; (2) women who report more than one race are more likely to enter two specific races rather than a term such as "multiracial"; (3) among the mothers whose parents belonged to two or more racial groups, self-reports of race on the last two birth records were inconsistent 25 percent of the time and; (4) self-reports of race were different 40 percent of the time between the birth record and the standard version of the mail survey.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Susan Schechter-Ryan

PHONE NUMBER: 301-436-7111

PIC ID: 5918

PERFORMER ORGANIZATION: Westat, Inc. Rockville, MD

TITLE: The Effect of Condition Sequencing Order on Cause-of-Death Statistics

ABSTRACT: This study evaluated whether the direction of the order in which causes of death are sequenced on the death certificate influences either selected underlying cause of death or the number of causes recorded. Physicians read one of four case vignettes and completed either the standard or an experimental medical certification section. On the standard format, certifiers were to enter temporally-backward sequences of conditions. On the experimental format, certifiers were to enter temporally-forward sequences. For each response, underlying cause was selected according to the rules of the International Classification of Diseases and the number of entered causes was counted. The results were that the certificate format did not influence significantly the distribution of selected underlying causes of death. Significantly more causes were recorded, on average, on the experimental certificates than on the standard certificates, but the difference in number was small. The data do not indicate that reversing the sequencing order would elicit better cause of death information for purposes of tabulating underlying cause of death, but suggest that reversing the sequencing order has the potential to elicit more information for multiple cause of death analyses. This final study evaluated the effect of the medical certification format on the quality of death statistics.

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 Binghamton, NY

Immunization

TITLE: Immunization Related KAPs of Primary Care Provider

ABSTRACT: The main objective of this study was to obtain information that can be used to assess changes in primary care providers' levels of knowledge about immunization programs and the extent to which these physicians' attitudes and practices have been affected by the programs and policies of the NIP, CDC, and other U.S. Public Health Services programs. Two independent national surveys of primary health care providers in the U.S. were conducted. Data collected in these surveys were then used to investigate the association between medical specialty, license type and perceived level of immunization coverage and physicians' practice characteristics, attitudes, opinions, and adopted practices. Major study findings are organized according to these categories. See also PIC ID 5930. (Final report 39 pages plus appendices.)

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Jorge Rosenthal, Ph.D.

PHONE NUMBER: 404-639-8218

PIC ID: 5930.1

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

Infectious Disease

TITLE: Disease and Injury Prevention and Health Promotion in Elder Care: Needs and Opportunities as Perceived by Elder Care Providers, the Elderly, and their Families

ABSTRACT: As the American population ages, the health and safety of the aging population presents new concerns for the elderly and their families. This study identifies interests of the elderly, their families, and elder care providers in selected areas of health and safety to inform the development of a handbook delineating the Centers for Disease Control and Prevention (CDC) policies and recommendations in disease prevention and health promotion in elder care settings. Focus groups provided the data for this report, which examines: (1) topics of interest in preventing disease and injury and promoting healthy behaviors; (2) the role of public health agencies in encouraging health and safety through consultation, inspection, regulation, and similar mechanisms; (3) opportunities to educate the elderly, their families and elder care providers in disease prevention and health promotion; and (4) opportunities for direct delivery of prevention and public health services through elder care settings, especially for the elderly in medically underserved areas. The report concludes that: (1) the handbook should have common sections on basic health and safety information and other sections specific to the needs of the elderly and their care givers; (2) the format of the report should include large print, easy access to information, and clear graphics; (3) while care givers would appreciate classes and seminars, this format has no appeal for the elderly themselves; and (4) a lack of public awareness about public health agencies limits their potential usefulness as a source of information. (Final report variously paginated.)

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Cyndy Hale

PHONE NUMBER: 404-639-6477

PIC ID: 6708

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

Injury/Violence Prevention

TITLE: Assessment of Violence Technical Assessment to Health Departments

ABSTRACT: The National Center for Injury Prevention and Control (NCIPC) at the Centers for Disease Control and Prevention (CDC) provides technical assistance to all State and local health departments interested in developing and evaluating violence prevention programs. This report assesses the needs of the 50 State health departments for violence prevention technical assistance compared with the ad hoc services provided by the NCIPC. The contractor developed and sent a questionnaire to the State and Territorial Injury Prevention Directors Association (STIPDA) representative in each of the 50 State health departments. The representative was asked to complete the questionnaire or deliver it to the person most appropriate for the task. A 100 percent response rate was achieved. The report finds that: (1) 64 percent of State health departments lack formal centralized management or coordination of violence prevention within a single unit or person; (2) the types of violence prevention efforts vary considerably in the types and the number of activities undertaken; (3) State departments clearly identify a few top priority needs for technical assistance; and (4) 70 percent of State health departments report having received technical assistance in violence prevention from the CDC within the past five years. Although State health departments are diverse in their approaches to violence prevention programs, they identified a set of top priority needs for technical assistance, and articulated a set of coherent suggestions for future technical assistance. The study suggests that the CDC can be productive in advancing violence prevention among the State health departments by providing focused efforts in technical assistance. (Final report 48 pages plus appendices.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Lloyd Potter, Ph.D.

PHONE NUMBER: 770-488-1557

PIC ID: 5929

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Evaluation of the WomanKind Program: Support Systems for Battered Women

ABSTRACT: The purpose of this study was to conduct an evaluation of the Minnesota-based WomanKind program to identify the extent to which this program influenced the quality of intervention provided by health care professionals to IPV victims. Specifically, the study assessed the program on four critical variables: (1) the extent to which health care providers reported increased capacity and motivation to screen and identify IPV victims; (2) reported confidence in their ability to assist IPV victims; (3) increased documentation in patient records of the physical. (Executive summary, final report, and appendices are independently bound.)

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. Atlanta, GA

Laboratory Services

TITLE: Survey of Assisted Reproductive Technique Embryo Laboratory Procedures and Practices

ABSTRACT: The Centers for Disease Control and Prevention (CDC) has the responsibility to develop a model certification program for assisted reproductive technology (ART) embryo laboratories in the United States. The model program will be implemented, on a voluntary basis, by the States or through laboratory accreditation by independent certifying groups approved by the States.

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Steven Steindel, Ph.D.

PHONE NUMBER: 770-488-4144

PIC ID: 6716

PERFORMER ORGANIZATION: Analytical Sciences, Inc. Durham, NC

Minority Health

TITLE: Development of a Public Health Surveillance Plan to Evaluate CDC Activities in the Atlanta Empowerment Zone

ABSTRACT: In 1994, Atlanta was one of six U.S. cities awarded funding under the Administration's Empowerment Zone initiative to revitalize inner-city and rural communities. The Centers for Disease Control and Prevention (CDC) began work with partner agencies in the Atlanta area in support of public health initiatives in the Atlanta Empowerment Zone (AEZ). The CDC's Epidemiology Program Office (EPO) contracted with the Research Triangle Institute to provide support services for the development of evaluations for CDC efforts in the AEZ. This report focuses on two CDC initiatives in the AEZ: (1) the development of the data aggregation system for decision support; and (2) the development of a partnership to start a community-based initiative to prevent and manage childhood asthma. Under contract with CDC's Public Health Practice Program Office (PHPPO), the contractor developed a prototype computer-based system that aggregates, analyzes, and displays data at the level of the AEZ, neighborhood, or other small geographic unit. AN assessment of current community health surveillance and subsequent surveillance system modification is critical in monitoring project activity implementation, measuring the impact on health and the quality of life, and developing a body of knowledge that can be applied to other communities. The study concludes that: (1) to maintain and use the prototype aggregation system requires addressing many data issues and investing substantial resources, capability and commitment; and (2) the development of the asthma partnership initiative demonstrates the need to recognize that a large number of partners involves tradeoffs, such as a long development period and the need for substantial coordination. (Final report variously paginated.)

AGENCY SPONSOR: Office of Program Planning and Evaluation

FEDERAL CONTACT: Scott F. Wetterhall, M.D.

PHONE NUMBER: 404-639-7080

PIC ID: 5925

PERFORMER ORGANIZATION: Research Triangle Institute Research Park, NC and MEDSTAT Group Washington, D.C.

Occupational Safety

TITLE: Effective Health and Safety Promotion: Evaluation of NIOSH Small Business Interventions

ABSTRACT: Successful National Institute of Occupational Safety and Health (NIOSH) small business interventions entail the adoption of the controls and changes in work practices suggested by NIOSH research. This report analyzes a number of self-described successful interventions and elicits specific lines of action that appear to be associated with successes, in order to provide theoretical hypotheses and practical guidance to inform the practices of NIOSH technical staff. Four NIOSH initiatives were identified for case study: (1) asphalt paving, (2) furniture stripping, (3) radiator repair, and (4) brake repair. Targeted interviews were conducted between June and December 1997, with a range of informants including manufacturing partners, industry trade associations, trade and other relevant publications, and other State and/or government partners. The report concludes that, across the four case studies, the following patterns emerge and seem to be related to successful behavioral change and/or adoption of control technology: (1) involving relevant trade associations and critical industry partners as early as possible, (2) including steps that specify intended promotion/education channels in the earliest stages of NIOSH activities, (3) involving communications specialists in NIOSH initiatives whenever and as early as possible, (4) supporting the dissemination phase of a project, and (5) recognizing when an industry is not ready for an intervention, or when the NIOSH proposal does not accord with industry needs. (Executive summary 10 pages; final report 26 pages bound separately.)

AGENCY SPONSOR: National Institute of Occupational Safety and Health

FEDERAL CONTACT: Theodore Schoenborn

PHONE NUMBER: 513-841-4321

PIC ID: 6336

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

Prevention Services

TITLE: Evaluation of Tuberculosis Outreach Worker Activities

ABSTRACT: In 1987, the Advisory Committee for the Elimination of Tuberculosis (TB) urged the Nation to establish the goal of TB elimination by the year 2010. Recommended strategies for the control of TB included increasing funding for outreach workers (ORWs) and for outreach activities. This project sought to answer three evaluation questions: (1) What activities do outreach workers perform? (2) In carrying out these activities, how do TB outreach workers interact with other health care personnel and patients? (3) What factors influence the effectiveness of TB outreach worker activities? The report finds that: (1) On the whole, ORWs spent significantly more time providing direct and support outreach services in the field than in clinical settings. (2) ORWs who participated in the study were familiar with the cultures and spoke the languages of the populations to which they provided services. (3) The ways in which the ORWs interacted with one another and the nature of their relationships reflected the social organizations and interpersonal dynamics of the different study locations and specific health care settings. (4) The ORWs often treated patients and their relatives with consideration and even personal concern. In addition, ORWs, their supervisors and patients indicated the kinds of knowledge and skills, and the attitudes and attributes that they thought TB ORWs should possess in order to be effective. The report recommends these characteristics, as well as increased and improved ORW training in patient interaction, interviewing techniques, and report writing. These characteristics can serve to inform TB control programs that are seeking to recruit appropriate individuals for ORW positions. (Final report 57 pages plus appendices.)

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Zachary Taylor, M.D.

PHONE NUMBER: 404-639-6201

PIC ID: 5502

PERFORMER ORGANIZATION: Casals and Associates Arlington, VA

TITLE: Project to Assess the Feasibility and Need for Support of Cervical Cancer Screening in Public STD Control Clinics

ABSTRACT: This report presents the results of the first phase of a three-phase project sponsored by the Centers for Disease Control and Prevention (CDC) to assess the feasibility and need for support of cervical cancer screening in publicly-funded sexually transmitted disease (STD) control clinics. Site visits were conducted of nine STD clinics to explore the availability, adequacy, and usefulness of data elements in addressing the research questions. The report finds that: (1) the number of patients seen in each clinic ranged from about 70 per month to 1,929; (2) women make up between 30 and 50 percent of STD clinic clientele, and approximately 40 to 90 percent of those were first time patients; (3) no reliable information could be gathered on where and when women seen in STD clinics received Pap testing; (4) there is wide variability in the collection and management of information among the STD clinic sites; (5) staffing patterns in the STD clinics correspond to particular functions (intake, education and counseling, examination and tracking, follow up and referral); and (6) there is agreement among the literature and the people interviewed that patient education is important in a cervical cancer screening program . The report concludes that it is feasible to carry out cervical cancer screening in public STD clinics, but the information systems necessary to demonstrate the need for this activity are lacking. The report recommends the implementation of a demonstration project, so that further information can be developed concerning the use of STD clinics for reaching women who may not be receiving Pap testing, an important public health measure for the prevention of cervical cancer. (Final report 102 pages; Site reports 119 pages.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Margaret Brome

PHONE NUMBER: 770-488-4976

PIC ID: 6705

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

Evaluations in Progress

Chronic Disease

TITLE: Evaluation of Public Health Care Providers Training, Screening and Referral Practices for Pregnancy-Related Violence

ABSTRACT: This project will conduct national population-based surveys of administrators and clinical providers in family planning programs funded by Titles X and XX, maternal and child health programs funded by Title V, and the federally-funded Primary and Migrant Health Centers. The information obtained from these surveys will be used to develop recommendations for the development of future clinical guidelines.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Alison Spitz

PHONE NUMBER: 770-488-5260

PIC ID: 6712

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 6/15/99

TITLE: Evaluation for CDC's NPCR

ABSTRACT: Congress established the National Program of Cancer Registries (NPCR) in 1992 by enacting the Cancer Registries Amendment Act. The purpose of this project is to assess, develop and implement a comprehensive evaluation strategy which will provide the Cancer Surveillance Branch (CSB) with the capacity to assess NPCR's progress toward program objectives during its second five-year funding period.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Leah Simpson

PHONE NUMBER: 770-488-4158

PIC ID: 7050

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 7/30/99

TITLE: Strategic Plan for the National Diabetes Control Program

ABSTRACT: In light of major changes in funding and further developments of core capacity and infrastructure of State diabetes control programs, there is a need to step back and form a collective vision of the National Diabetes Control Program. This vision will form the basis for the FY 1999-2000 National Diabetes Control Program announcement for cooperative agreement renewals.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Dara Murphy

PHONE NUMBER: 770-488-5046

PIC ID: 7051

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 8/27/99

TITLE: Coordinated Evaluation of Tobacco Control Efforts

ABSTRACT: An increased level of scrutiny by the Department of Health and Human Services (HHS) has been directed at evaluating the overall impact and the relative cost-effectiveness of tobacco control programs. This project will focus on activities related to implementing a comprehensive and coordinated evaluation of Statewide tobacco control efforts.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Don Sharp

PHONE NUMBER: 770-488-5703

PIC ID: 6714

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 9/30/99

Crosscutting

TITLE: Urban Health Systems Sentinel Network

ABSTRACT: This project will coordinate a review of the Centers for Disease Control and Prevention's (CDC) analysis of the impact of restructuring on essential public health services in Los Angeles County. It will collect case study data in up to six urban public health systems impacting the capacity to deliver essential public health services. It will also describe a set of predictive relationships applicable to other State and local health departments.

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Pomeroy Sinnock, Ph.D.

PHONE NUMBER: 770-488-2469

PIC ID: 6276

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 4/2/99

TITLE: OPPE Strategic Planning Pilot

ABSTRACT: The purpose of this project is threefold: (1) to conduct strategic planning within the Office of Program Planning and Evaluation (OPPE) to assess and focus the office's major activities to ensure that they will meet the evolving needs of the agency; (2) to develop and pilot a strategic planning framework within OPPE to assure consistent and linked planning, performance management and evaluation efforts; and (3) conduct an organizational assessment that will enhance the strategic planning framework by identifying roles, responsibilities, key business practices, and information needs and internal capacity requirements to implement strategic planning. Strategic planning capacity requirements may include identifying skills, management support, and systems and processes to support an integrated planning and evaluation system. The OPPE is responsible for leading and coordinating a diverse range of support activities for the Office of the Director, as well as coordinating and integrating legislative activities, special initiatives, committees, and reporting across CIOs, Operating Divisions within the Department of Health and Human Services, and Congress. OPPE activities range from a mixture of standard business practices to addressing unique, time dependent, political issues, or special assignments. With the passage of GPRA, integrating planning and evaluation processes agencywide has taken on greater importance for OPPE as it relates to external stakeholders, Congress, the Department of Health and Human Services and other operating divisions.

AGENCY SPONSOR: Office of Program Planning and Evaluation

FEDERAL CONTACT: Connie Carmack

PHONE NUMBER: 404-639-7073

PIC ID: 7049

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 5/15/99

TITLE: Evaluation of C. Everett Koop Community Health Information Center (CHIC)

ABSTRACT: The purpose of this evaluation is to evaluate the effectiveness of the C. Everett Koop Community Health Center (CHIC) to serve as a national physician-based model.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Christine Fralish

PHONE NUMBER: 770-488-5050

PIC ID: 6709

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 5/30/99

TITLE: Community Indicators -- Literature Search

ABSTRACT: This request for services is to assist in a search for literature and other information that identifies cultural and social-structural characteristics of communities that are associated with HIV/AIDS risk behavior and prevention efforts. Materials and information found in the search will be used to support community-level research on HIV/AIDS prevention.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Esther Sumartojo

PHONE NUMBER: 404-639-8300

PIC ID: 6701

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 10/1/99

Environmental Health

TITLE: Water Fluoridation

ABSTRACT: The purpose of this task is to evaluate the needs of State water fluoridation programs in order to improve the quality of water fluoridation nationally. The task will assess the surveillance and monitoring of water fluoridation systems, the engineering and administrative aspects of the same, and the fluoridation training needs of States.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Kit Shaddix

PHONE NUMBER: 770-488-6074

PIC ID: 7052

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: Evaluation of CDC Guidelines on Screening Lead Poisoning

ABSTRACT: This project is in response to the CDC's goal of eliminating childhood lead poisoning in the U.S. by the year 2010. The project will evaluate the process followed by two State health departments as they develop Statewide screening plans. The evaluation will culminate in two case studies to be used by other State health departments as they complete their screening policies.

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Nancy Tips

PHONE NUMBER: 770-488-7277

PIC ID: 7045

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 7/1/99

TITLE: Folic Acid and the Prevention of Spina Bifida

ABSTRACT: This project proposes to evaluate the effectiveness of a free folic acid supplement distribution program in a family planning setting using blood folate determinates in conjunction with questionnaires of knowledge and supplement use behaviors.

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: Margaret Watkins

PHONE NUMBER: 770-488-7187

PIC ID: 7042

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 7/31/99

TITLE: Evaluation of the ZAP Asthma Program

ABSTRACT: The purpose of this project is to conduct a process evaluation of the following two components of the ZAP Asthma Project: (1) the project's health education component, health communication component and the project's use of community health workers; and (2) the process of public/private/community collaboration, community engagement and empowerment, and systems improvement and capacity building at the community level.

AGENCY SPONSOR: National Center for Environmental Health

FEDERAL CONTACT: James Rifenburg

PHONE NUMBER: 770-488-7322

PIC ID: 7048

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 9/1/99

Epidemiology

TITLE: Evaluation of Data Use of National Electronic Telecommunications System for Surveillance (NETSS) and Public Health Laboratory Information System (PHLIS)

ABSTRACT: This project will determine how surveillance data transmitted through the National Electronic Telecommunications System for Surveillance (NETSS) and the Public Health Laboratory System (PHLIS) are used at the local, State and Federal levels.

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Roy Baron, M.D., M.P.H.

PHONE NUMBER: 404-639-2697

PIC ID: 6332

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 6/30/99

TITLE: Evaluation of the Public Health Prevention Service

ABSTRACT: In 1997 the Epidemiology Program Office established the Public Health Prevention Service (PHPS), a new three-year training program, designed to improve the Nation's public health practice by preparing entry-level public health professionals to conduct prevention programs. This evaluation project will establish the foundation for a monitoring and evaluation system designed to provide feedback to the PHPS program for continuous improvement.

AGENCY SPONSOR: Epidemiology Program Office

FEDERAL CONTACT: Dennis Jarvis

PHONE NUMBER: 404-639-4087

PIC ID: 7038

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 7/23/99

Health Statistics

TITLE: Evaluation of the NHIS--Surv. Sentinel Health Indicators

ABSTRACT: This project proposes to evaluate the potential of the National Health Interview Survey (NHIS) for the surveillance of sentinel health indicators in the U.S.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Ann M. Hardy, M.D.

PHONE NUMBER: 301-436-7085

PIC ID: 7040

PERFORMER ORGANIZATION: TRW Government Information Services Fairfax, VA

PROJECTED DATE OF COMPLETION: 12/1/98

TITLE: Evaluation of the U.S. Standard Certificates

ABSTRACT: The overall objective of this project is to evaluate the birth, death and fetal death information currently obtained from State vital registration programs to determine if relevant and high quality data are being collected for State and national decision making. The assessment will also consider what changes should be made to the standard certificates to improve their use and utility.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Julia Kowaleski

PHONE NUMBER: 301-436-8815

PIC ID: 6699

PERFORMER ORGANIZATION: Laurel Consulting Group Laurel, MD

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: Evaluation of BRFSS as Source for Selected Risks

ABSTRACT: The Centers for Disease Control and Prevention (CDC) spends millions of dollars each year to conduct population-based surveys on health. This project will examine 1994 and 1995 Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS) data on the same health risk factors to determine if it is statistically appropriate to pool BRFSS data from the 51 separate State surveys.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Carol Stanwyk, Ph.D.

PHONE NUMBER: 770-488-5300

PIC ID: 7039

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: Evaluation of Medicaid Reporting Using SLAITS

ABSTRACT: The State and Local Area Integrated Telephone Survey (SLAITS) is a newly developed survey mechanism which utilizes the sampling frame and screening procedures of the ongoing National Immunization Survey (NIS). The object of this project is to evaluate SLAITS as a modality for monitoring State performance in implementing the State Children's Health Insurance Program during a period of rapid State restructuring of health and welfare institutions.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Marcie Cynamon

PHONE NUMBER: 301-436-7085

PIC ID: 7046

PERFORMER ORGANIZATION: Robert Wood Johnson Foundation Princeton, NJ

PROJECTED DATE OF COMPLETION: 9/30/00

HIV/STD Prevention

TITLE: Program Evaluation Technical Assistance Needs for HIV Prevention

ABSTRACT: The purpose of this study is to provide the Centers for Disease Control and Prevention (CDC) with the information needed to develop an effective program evaluation technical assistance (TA) system for HIV prevention. This evaluation will be based on both qualitative and quantitative research approaches and will target health departments, community planning groups, community-based organizations providing HIV prevention services and the CDC staff.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Tracey Barrington

PHONE NUMBER: 404-639-0953

PIC ID: 6715

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: HIV Prevention Indicators

ABSTRACT: The Centers for Disease Control and Prevention (CDC) is collaborating with State and local health departments and others to develop, field test and implement a set of standard indicators for assessing trends in the levels of HIV infection and risk factors for HIV transmission in State or local health jurisdictions. The purpose of this project is to review published literature and other available information sources regarding a set of proposed indicators.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Deborah Rugg, Ph.D.

PHONE NUMBER: 404-639-0952

PIC ID: 6707

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 10/30/98

TITLE: PCP Guidelines in Underserved Communities

ABSTRACT: Little is known about the factors associated with failure to initiate and continue PCP prophylaxis, although there is some evidence that HIV-infected women and persons in underserved communities may be less likely to receive prophylaxis. The focus of this study is to identify risk factors for failure to initiate and/or comply with PCP prophylaxis, using a multi-center strategy.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Vance Dietz, M.D.

PHONE NUMBER: 770-488-7771

PIC ID: 6704

PERFORMER ORGANIZATION: University of Puerto Rico Medical Services San Juan, Puerto Rico

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Management and Operational Indicators of HIV Community Planning

ABSTRACT: HIV prevention community planning, implemented in January 1994, represented a major policy change in Centers for Disease Control and Prevention (CDC) requirements of health departments seeking financial assistance from CDC for HIV prevention. Prior to the change, the majority of federal funds available to the sixty-five health department recipients of CDC HIV prevention funding were intended for HIV counseling and testing services. Now, via the HIV prevention community planning process, recipients set their own priorities, which they document in a Comprehensive HIV Prevention Plan. The system to be pilot tested is based on a set of management and operational indicators developed over the past year.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Robert D. Moran

PHONE NUMBER: 770-639-0952

PIC ID: 5518

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 1/15/99

TITLE: Evaluation of the HIV TA Network

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Tracey Barrington

PHONE NUMBER: 404-639-0953

PIC ID: 6706

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: Survey of Syphilis and HIV Treatment, Reporting

ABSTRACT: The purpose of this project is to conduct a survey of a sample of physicians' diagnosis, treatment, reporting and partner management practices for syphilis and HIV infection. The study will determine when, under what conditions, for which diseases, how and for which patients, practitioners notify and/or treat the sexual partners of patients who are diagnosed with syphilis and HIV infection.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Janet St. Lawrence, Ph.D.

PHONE NUMBER: 404-639-8376

PIC ID: 7054

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 5/30/99

TITLE: STD Partner Notification Protocol

ABSTRACT: The purpose of this project is to develop a research plan and protocol for a systematic evaluation of notification to sexual partners of individuals who are diagnosed with sexually transmitted diseases (syphilis, N. gonorrhea, Chlamydia trachomatis, and human immunodeficiency virus infection).

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Janet St. Lawrence, Ph.D.

PHONE NUMBER: 404-639-8376

PIC ID: 6711

PERFORMER ORGANIZATION: Battelle Seattle, WA

PROJECTED DATE OF COMPLETION: 7/15/99

TITLE: Evaluation of CDC's STD Treatment Guidelines

ABSTRACT: The objective of this project is to evaluate the impact of STD treatment guidelines in public and private settings, to identify factors associated with compliance with guidelines, and assess the relationship between adherence to guidelines and associated health outcomes.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Ruth Irwin, M.D.

PHONE NUMBER: 404-639-8956

PIC ID: 7047

PERFORMER ORGANIZATION: The HMO Group New Brunswick, NJ

PROJECTED DATE OF COMPLETION: 9/1/99

TITLE: Evaluating Guidelines for Preventing Perinatal HIV

ABSTRACT: This project will develop, pilot and conduct a survey, and produce technical reports of survey data on health care providers' knowledge, attitudes and practices regarding HIV counseling and testing. These data will augment ongoing research efforts to reduce barriers to implementation of the U.S. Public Health Service (PHS) guidelines for the prevention of perinatal HIV transmission.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Janet Saul

PHONE NUMBER: 404-639-6143

PIC ID: 6279

PERFORMER ORGANIZATION: Analytical Sciences, Inc. Durham, NC

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Community Indicators for Assessing HIV Prevention

ABSTRACT: Several research projects have been funded and conducted through the Centers for Disease Control and Prevention (CDC) in order to establish the efficacy of community-level interventions for HIV prevention. By taking the lead on this endeavor, the CDC will be able to provide constituents with the technical assistance needed to work effectively in this evolving priority area.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Esther Sumartojo

PHONE NUMBER: 404-639-8300

PIC ID: 6278

PERFORMER ORGANIZATION: Macro International, Inc. Atlanta, GA

PROJECTED DATE OF COMPLETION: 7/1/00

Immunization

TITLE: Evaluation of the Use of Data from Immunization Information Systems

ABSTRACT: Currently, at least 22 States have immunization information systems (IIS) functioning either State-wide or in some counties or local communities. At this point in the development cycle, it is important to evaluate how the data in the IIS are used. If it is understood how these data are used and structural and functional barriers to data use can be identified, recommendations can be made to promote the full use of these data resources.

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: John Stevenson

PHONE NUMBER: 404-639-8730

PIC ID: 6713

PERFORMER ORGANIZATION: Advanced Technology Systems Johnson City, TN

PROJECTED DATE OF COMPLETION: 5/30/99

Infectious Disease

TITLE: Evaluation of Group B Strep Guidelines

ABSTRACT: Group B Streptococcus (GBS) is the leading cause of bacterial infection in newborns in the United States. This project will assess a number of issues that affect successful management of GBS disease in the United States.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Anne Schuchat, M.D.

PHONE NUMBER: 404-639-2215

PIC ID: 6333

PERFORMER ORGANIZATION: American Association of Health Plans Washington, D.C.

PROJECTED DATE OF COMPLETION: 1/29/99

TITLE: Evaluation of Implementation/Impact of VRE Guidelines

ABSTRACT: In response to the recent emergence of vancomycin resistance among enterococci (VRE), the Centers for Disease Control and Prevention (CDC) published "Recommendations for Preventing the Spread of Vancomycin Resistance." The purposes of this study are to determine the efficacy of different types of VRE control measures and their costs, and to develop a community-wide facility approach to VRE control.

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Jerome Tokars, M.D., MPH

PHONE NUMBER: 404-639-6418

PIC ID: 6703

PERFORMER ORGANIZATION: Health Care Financing Administration Baltimore, MD

PROJECTED DATE OF COMPLETION: 8/7/99

Injury/Violence Prevention

TITLE: Evaluation of MMWR Recommendations/Bike Helmets

ABSTRACT: The National Center for Injury Prevention and Control (NCIPC) published recommendations on the use of bicycle helmets in preventing head injuries in the Morbidity and Mortality Weekly Report (MMWR) of February 17, 1995. The evaluation of the bicycle helmet guidelines offers a timely opportunity to explore "lessons learned" before NCIPC develops and disseminates future guidelines.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Jeffrey Sacks, M.D.

PHONE NUMBER: 770-488-4652

PIC ID: 6700

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 6/15/99

Prevention Services

TITLE: Evaluation of Teen Pregnancy Interventions

ABSTRACT: The purpose of this project is to address the assessment and testing of interventions and the evaluation of adolescent pregnancy prevention initiatives in 13 cities in the United States. The objectives of the study are to assist the 13 cooperative agreement cities in field testing components of their teen pregnancy prevention intervention programs.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Michael Dalmat

PHONE NUMBER: 404-488-5136

PIC ID: 6274

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 10/1/98

TITLE: PMI Case Study Demonstration Projects

ABSTRACT: Case studies are a key component of a program assessment of the Prevention Marketing Initiative (PMI) Local Demonstration Sites Project. The purpose of the current case study is to describe program participant experiences during the last two years of the project, covering three major project phases.

AGENCY SPONSOR: National Center for HIV, STD, and TB Prevention

FEDERAL CONTACT: Kim Boyd

PHONE NUMBER: 404-842-6592

PIC ID: 7053

PERFORMER ORGANIZATION: Battelle Corporation Arlington, VA

PROJECTED DATE OF COMPLETION: 12/15/98

TITLE: Evaluating the Responsiveness of Guide to Community Services

ABSTRACT: In 1996, a Task Force of non-Federal public health experts were appointed to develop a Guide to Community Preventive Services. An evaluation of the Guide is proposed to field test and evaluate six Guide modules addressing three study areas.

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Pomeroy Sinnock, Ph.D.

PHONE NUMBER: 770-488-2469

PIC ID: 7043

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

PROJECTED DATE OF COMPLETION: 8/30/99

Food and Drug Administration

Evaluation Program
The Food and Drug Administration's FY 1998 Evaluation Program ultimately reflects the four broad goals established and promulgated by the Department of Health and Human Services (HHS) for which FDA has responsibility. HHS's goals are products of its strategic performance planning process, and FDA uses its own strategic framework to accomplish these goals. This process also satisfies the implementation requirements of the Government Performance and Results Act (GPRA) and the Food and Drug Administration Modernization Act of 1997 (FDAMA). The strategic and performance process is an evolving set of program directions for FDA as changes occur in FDA's dynamic environment. FDA's challenges, now and in the future, will rest on its ability to leverage that environment, which will grow increasingly complex and become more institutionally networked. The Agency will strive to develop and maintain the scientific integrity necessary to achieve greater effectiveness in assuring the quality and availability of the products it regulates.

One goal area within FDA's strategic framework is Pre-Market Review, where the objective is to make timely and cost-effective pre-market review decisions, while assuring product safety and efficacy. The results achieved and reported in the Prescription Drug User Fee Act (PDUFA) FY 1998 Performance Report, are one indication of how well FDA is meeting its goal of making timely pre-market review decisions. FDA exceeded all of the performance goals specified under the Prescription Drug User Fee Act. FDAMA continues the progression toward quicker review times initiated under the Prescription Drug User Fee Act of 1992, extending into the investigative phase of drug development with a series of new goals that will take effect in FY 1999. The objective of the FDAMA goals is to expedite the entire drug development and review process, from research to approval, without compromising the safety or the quality expected from the Agency's application review process.

Another goal area within FDA's strategic framework is Internal Capacity, which focuses onFDA's ability to make effective pre- and post-market regulatory decisions. One strategy for accomplishing this goal is through the implementation of decision-supportive information systems where reporting burdens are being reduced for the regulated industry. FDAMA is affording FDA greater flexibility in the scope and amount of data collected and reported on medical devices than was possible under the previous mandate. It has removed the mandatory requirements for post-market surveillance and tracking, thereby enabling the Agency to redirect resources to more significant health concerns. The Agency has reevaluated those requirements already in place, while removing those that no longer made sense from a public health perspective. As a result, hundreds of device tracking and post-market surveillance orders were rescinded for more than a dozen product types. FDAMA has also enabled FDA to modify its user-facility reporting program for medical devices from a mandated universe of facilities to a representative sample of facilities.

External Leverage, another element of FDA's strategic framework, reflects the ability of external stakeholders to manage FDA-regulated risk. This goal represents a significant shift in FDA's direction for the twenty-first century, as the Agency will attempt to leverage a more technologically complex environment. One strategy used to accomplish this goal is fostering industry quality assurance programs, thereby capitalizing on the quality and safety control capabilities already resident in the regulated industry. HACCP (Hazard Analysis Critical Control Point) programs and the implementation of the Mammography Quality Standards Act (MQSA) are two examples of this approach that are underway.

The fourth and final goal area within FDA's strategic framework is Post-Market Assurance, a goal that strives to strengthen the assurance that products on the market, or about to enter the market, are safe. One strategy of accomplishing this goal is by targeting high-risk products. The Tobacco Program illustrates one of the initiatives in this area. FDA plans to reduce access to tobacco products by youths under 18 through new FDA requirements for retailers.

Fiscal Year 1998 Evaluations

Food Safety and Nutrition

TITLE: Assessment of Nutrient Requirements for Infant Formulas

ABSTRACT: This report on infant formulas was prepared by the American Society of Nutrition Sciences under contract with the Food and Drug Administration (FDA). It contains the results of a literature review to identify information pertaining to the questions raised by the FDA regarding nutrient specifications for infant formulas. It also contains specific recommendations by an expert panel of scientists with expertise in infant nutrition. The FDA needs this information in order to assure the safety and nutritional quality of infant formulas as mandated by the Infant Formula Act of 1980 (IFA). Regulations for infant formulas include specifications for minimum levels of 29 nutrients and maximum levels of nine nutrients. These nutrient specifications were last revised in 1985. Because additional research has provided information on the nutritional needs of infants not available at that time, the FDA needed to review nutrient requirements of infants as a prerequisite to consideration of revision of nutrient specifications for infant formulas.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: James Tanner

PHONE NUMBER: 202-205-4525

PIC ID: 7078

PERFORMER ORGANIZATION: American Society of Nutrition Sciences, Bethesda, MD

TITLE: Consumer Responses to Warning Labels on Menus

ABSTRACT: The U.S. Food and Drug Administration conducted two series of focus groups exploring the proposed use of consumer advisories in restaurants to alert consumers to the potential risks of foodborne illnesses. The first series of focus groups was conducted in 1996 and the second in 1998. The focus groups concentrated on persons with compromised immune systems, parents of young children, people over age 60, and the general population. The research indicates that the biggest defect in the consumer advisory statement is that it allows multiple interpretations that may lead to inconsistent behavioral responses. Consumers recognized that risk information can have multiple purposes that are not equally appropriate in a restaurant context. Depending on the purpose, consumers may question both the utility and the appropriateness of the information. Respondents reported getting most of their information about food safety from television, which was their preferred method of receiving food safety information.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Alan Heaton

PHONE NUMBER: 202-205-5394

PIC ID: 7080

PERFORMER ORGANIZATION: Macro International, Inc. Calverton, MD

Drug Application Review

TITLE: FY 1998 PDUFA Performance Report

ABSTRACT: In FY 1998, 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 review times. 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: Hill, Dennis

PHONE NUMBER: 301-827-5255

PIC ID: 6079.3

PERFORMER ORGANIZATION: Office of Planning and Evaluation, FDA Rockville MD 20857

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 determine the impact on, and cost savings to, industry resulting from the Immediate Release Solid Oral Dosage Forms (SUPAC-IR) guidance. Representatives of six pharmaceutical firms were interviewed to ascertain their experiences with the SUPAC-IR program. The survey showed that positive results were achieved because the Food and Drug Administration (FDA) had established a uniform policy for post-approval chemistry and manufacturing and control changes that brought clarity to the regulatory requirements. All of those interviewed thought that the greatest impact of the SUPAC-IR program was the enhancement of industry's ability to plan, implement change, and manage its resources efficiently.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Nancy Gieser

PHONE NUMBER: 301-827-5335

PIC ID: 7059

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

Medical Devices

TITLE: Readership Survey Analysis for the FDA Public Health Advisory: Interference Between Digital TV Transmitters and Medical Telemetry Systems

ABSTRACT: The Food and Drug Administration (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. A randomly selected sample of 308 recipients of the Public Health Advisory entitled, "Interference Between TV Transmissions and Medical Telemetry Systems" were surveyed. The purpose of the survey was to help the Center evaluate the format and content of the advisory, as well as its effectiveness as a means of communication. Most respondents felt that the problem addressed in the advisory was clearly identified, easily understood, timely, 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 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. An annual survey will continue to be conducted in order to determine the impact of safety alerts and public health advisories on the behavior and knowledge of the recipients. The collection and reporting of these data are important steps in determining how well the Food and Drug Administration (FDA) is communicating risk.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Gary Blanken

PHONE NUMBER: 301-594-1284

PIC ID: 6733

PERFORMER ORGANIZATION: Center for Devices and Radiological Health, FDA Rockville MD

Tobacco Control

TITLE: Tobacco Retailer Study

ABSTRACT: The Food and Drug Administration (FDA) conducted an advertising campaign aimed at raising tobacco retailers' awareness of the new FDA tobacco regulations and motivating retailers to comply. The campaign ran in ten states to study levels of awareness of, and reported compliance with, both the regulations before and after the advertising campaign.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Sharon Natanblut

PHONE NUMBER: 301-827-3442

PIC ID: 7079.1

PERFORMER ORGANIZATION: Market Facts, Inc., McLean VA

TITLE: Tobacco Retailer Study: Arkansas Pilot Methods Report

ABSTRACT: The Tobacco Program is part of the Food and Drug Administration (FDA) Post-Market Assurance strategic goal. This goal assures that products on the market, or about to enter the market, are safe. With an estimated 420,000 annual deaths from tobacco use, the FDA plans to reduce access to tobacco products by youth under age 18 through new FDA requirements for retailers. The FDA is developing a national campaign targeting these retailers with the goal of increasing awareness of the new requirements and encouraging compliance. A pilot media campaign was launched during 1998 in two Arkansas markets and a questionnaire was used to assess the campaign's effectiveness. While the Tobacco Retailer Study Arkansas Pilot Methods Report did not attempt to analyze the study findings, the pilot test indicated that the questionnaire was acceptable, and that the media campaign would have the intended impact.

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

Small Business Support

TITLE: FDA Activities in Support of Small Business

ABSTRACT: Under the Small Business Regulatory Enforcement Fairness Act, the Food and Drug Administration (FDA) must establish a program to respond to inquiries and to assist and advise small businesses and other small entities to apply FDA rules. Currently, FDA provides assistance and advice to small businesses in a number of ways. This project assessed the level of success achieved in coordinating multiple sources of advice and the usefulness and appropriateness of the assistance. Elements evaluated included the frequency, subjects, sources, and recipients of inquiries and the type and timeliness of the response. Summaries of activities conducted by FDA offices in support of small business during the last five quarters were completed. FDA's Small Business Guide as well as a comprehensive list of agency guidance, rules, and regulations are available on the FDA's homepage on the Internet at www.fda.gov.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: John Friel

PHONE NUMBER: 301-827-3373

PIC ID: 6462

PERFORMER ORGANIZATION: Office of Planning and Evaluation, FDA, Rockville, MD

Evaluations in Progress

Food Safety and Nutrition

TITLE: Economic Cost Benefit Studies: Analysis of Changing Food Labels to Include Information on Trans Fatty Acids

ABSTRACT: On February 14, 1994, the U.S. Food and Drug Administration (FDA) received a citizen petition from the Center for Science in the Public Interest (CSPI), requesting that the FDA amend the definition of saturated fatty acids to include trans fatty acids. The CSPI also requested that certain fat and cholesterol claims be based on the combined level of saturated and trans-fatty acids. The FDA is currently preparing to respond to this petition through rulemaking. When considering rulemaking, the FDA is required to assess all costs and benefits of available regulatory alternatives and, when regulation is necessary, to select the regulatory approach that maximizes net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity.) A rule is classified as significant if it meets any one of a number of specified conditions, including having an annual effect on the economy of at least $100 million, or adversely affecting in a material way a sector of the economy, competition or jobs, or if it raises novel legal or policy issues. In addition, the FDA is required by the Regulatory Flexibility Act to determine the impact of its rules on small entities. To fulfill its requirements, the FDA needs certain information. This study will analyze the impact of changing food labels in order to provide information on trans-fatty acids. (See also 6865, 6865.1)

AGENCY SPONSOR: Office of Management

FEDERAL CONTACT: Ed Arnold

PHONE NUMBER: 301-827-7161

PIC ID: 6865.2

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 11/2/98

TITLE: Harmonizing Nutritional Goals and Food Processing

ABSTRACT: This study will generate information that can be used to assess the costs and benefits of regulatory alternatives with respect to providing information on trans-fatty acids in food. The following will be available as a result of this initiative: (1) identification of products containing trans-fatty acids; (2) characterization of the firms that produce these products; (3) estimation of the industry response to the proposed regulatory changes; and (4) estimation of the consumer response to improved access to information on trans-fatty acids in food. A consumer study will also be conducted as part of this effort, to determine whether consumers would prefer particular elements of the standards to be retained, modified, or eliminated.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Clark Nardinelli

PHONE NUMBER: 202-205-8702

PIC ID: 6864

PERFORMER ORGANIZATION: Center for Food Safety and Applied Nutrition, FDA Washington, D.C.

PROJECTED DATE OF COMPLETION: 1/31/99

TITLE: Survey of Current Hazard Assessment Quality Control Points (HACCP) Practices of the Food Industry

ABSTRACT: This project consists of a two-part survey that will: (1) yield information for the purposes of estimating the HACCP-related practices of the food industry (except seafood, meat and poultry), and (2) estimate the marginal costs to firms for compliance with HACCP.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Clark Nardinelli

PHONE NUMBER: 202-205-8702

PIC ID: 6866

PERFORMER ORGANIZATION: Center for Food Safety and Applied Nutrition, FDA Washington, D.C.

PROJECTED DATE OF COMPLETION: 1/31/99

TITLE: Economic Cost Benefit Studies: Economic Characterization of the Dietary Supplement Industry

ABSTRACT: This study will provide information on the nature, size and scope of the dietary supplement industry, thereby enabling the Food and Drug Administration (FDA) to determine the effects of regulations issued under the authority established by the Dietary Supplement Health and Education Act of 1994 (DSHEA).

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Clark Nardinelli

PHONE NUMBER: 202-205-8702

PIC ID: 6865.1

PERFORMER ORGANIZATION: Center for Food Safety and Applied Nutrition, FDA, Washington, D.C.

PROJECTED DATE OF COMPLETION: 2/20/99

TITLE: Economic Cost Benefit Studies: Consumer Attitudes Toward Potential Changes in Food Standards of Identity

ABSTRACT: On December 29, 1995, the FDA announced its intention to review its regulations pertaining to identity, quality and fill of container for standardized foods, and its common or usual name regulations for non-standardized foods. The agency solicited comments from interested parties on whether these regulations should be retained, revised, or revoked. The FDA solicited comments on the benefits or lack of benefits of such regulations in facilitating domestic and international commerce. The FDA also asked for comments on the value of these regulations to consumers, and on alternative means of accomplishing the statutory objective of food standards. This was done in an effort to promote honesty and fairness in the interest of consumers. The FSIS published a similar announcement regarding its intent to consider whether to modify or eliminate specific Standards on Identity for meat and poultry products, or to modify its overall regulatory approach to standardized meat and poultry products. The FDA and the FSIS need information on how consumers would be affected by changes in Federal Standards of Identity for foods. Most importantly, the two agencies need information on whether consumers would prefer particular elements of Standards to be retained, modified, or eliminated for various types of food. The agencies are obtaining information on the consumer preferences. (See PIC ID 6865.1, 6865.2)

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Ed Puro

PHONE NUMBER: 202-205-4279

PIC ID: 6865

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 6/30/99

TITLE: Dietary Supplement Sales Information

ABSTRACT: The objective of this task order is to collect information on dietary supplement products sold in the United States. The type of information being collected includes: (1) product name, (2) manufacturer or distributor and address, (3) ingredients, and (4) claims currently being made (i.e., health or nutrient content claims and nutritional support statements). This information will provide the agency with the information necessary to perform its regulatory mission.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Laina Bush

PHONE NUMBER: 202-205-5271

PIC ID: 7082

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Fortification of Enriched Cereal-Grain Products in the U.S. with Folic Acid

ABSTRACT: This project will assess the level of folic acid in enriched cereal grain products. The Food and Drug Administration (FDA) regulations mandate the fortification with folic acid of a wide range of enriched cereal grain products. During FY 1998, the FDA developed a methodology for measuring folic acid in cereal grain products and conducted a study of more than 100 enriched cereal grain products from the marketplace. The results of the study will be published in FY 1999.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Gerad McCowin

PHONE NUMBER:

PIC ID: 7095

PERFORMER ORGANIZATION: Center for Food Safety and Applied Nutrition, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Food Labeling and Package Survey (FLAPS)

ABSTRACT: This survey was implemented by the Food and Drug Administration (FDA) in 1977 with the purpose of producing a database containing label and package information obtained from a sample of processed food products. Food Labeling and Packaging (FLAPS) data enable FDA personnel to keep abreast of market responses to food labeling rules via changes in package labels.

AGENCY SPONSOR: Center for Food Safety and Applied Nutrition

FEDERAL CONTACT: Beth Benedict

PHONE NUMBER: 410-786-7724

PIC ID: 5711

PERFORMER ORGANIZATION: Center for Food Safety and Applied Nutrition, FDA Washington, D.C. and A.C. Nielson Company Chicago IL

PROJECTED DATE OF COMPLETION: 12/31/99

Drug Application Review

TITLE: Develop and Validate Toxicology Predictive Modeling Systems

ABSTRACT: The reproductive toxicity predictive module is expected to assist review divisions in evaluating the potential reproductive risks to female subjects in association with early clinical trials of drugs that have not yet been tested for reproductive toxicity. Commercial distribution of the modules is expected to generate resources that can be used to support the maintenance, improvement and development of toxicology prediction software.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Ed Matthews

PHONE NUMBER: 301-827-5188

PIC ID: 7105

PERFORMER ORGANIZATION: Center for Drug Evaluation and Research, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 6/20/99

TITLE: Methods Validation

ABSTRACT: This project seeks to verify the suitability of NDA and ANDA analytical methods for drugs, antibiotics and hormones for quality control and regulatory purposes.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Joe Hanig

PHONE NUMBER: 301-594-5026

PIC ID: 7106

PERFORMER ORGANIZATION: Center for Drug Evaluation and Research, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: Review of Therapeutic Agents as an Antimicrobial Adjunct in Treatment of Sepsis

ABSTRACT: Sepsis affects half a million people annually. Even though a large number of trials have been conducted, no therapeutic agent demonstrating clinical benefit or superiority to standard care has been identified. Designing clinical trials that have any probability of demonstrating efficacy is challenging, due to the heterogeneity of patient populations, poor understanding of the pathophysiology of acute sepsis, and lack of uniformly accepted standards of care in international trials. Intensive efforts have been undertaken by the Food and Drug Administration (FDA) to propose the optimal trial design and prospective analysis plans. Currently, an analysis of the failed sepsis trials is being initiated by the FDA in the hopes of better clinical trials for the evaluation of the adjunctive therapy of sepsis in the future.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Rosemary Roberts, Ph.D.

PHONE NUMBER: 301-827-2183

PIC ID: 6736

PERFORMER ORGANIZATION: Center for Drug Evaluation and Research, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 10/1/00

TITLE: Drug Metabolism: Drug-Drug Interactions

ABSTRACT: Recent examples of studies that have provided information to specific review decisions include: (1) interactions and metabolism studies of anti-cancer drugs such as paclitaxel, (2) anti-abuse drugs such as LAAM, (3) anti-HIV drugs such as the protease inhibitors, (4) anti-epileptic drugs, (5) cardiovascular drugs, and (6) anti-malarial drugs. In addition to the general technical expertise brought to bear on these problems, results from the program have been incorporated into final product labeling for some drugs, including paclitaxel and saquinavir. Labeling changes for other drugs are under discussion. Also, cutting-edge issues regarding cases of intermediate potency for cytochrome P450 pathways are under investigation.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Jerry Collins

PHONE NUMBER: 301-427-1065

PIC ID: 7103

PERFORMER ORGANIZATION: Center for Drug Evaluation and Research, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 10/1/00

Medical Devices

TITLE: FDAMA Mandated User Facility Reporting Program

ABSTRACT: FDAMA mandated that CDRH change its current user facility reporting from a universal program to a sample of user facilities constituting a representative profile of facilities. On September 30, 1998, CDRH completed a year of data collection study designed to identify barriers to user reporting and to see whether or not the quality of the data would improve once the barriers were removed.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Susan Gardner

PHONE NUMBER: 301-594-2812

PIC ID: 7108

PERFORMER ORGANIZATION: Center for Devices and Radiological Health, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 1/31/99

TITLE: Continuation of the Mammography Quality Standards Act of 1992

ABSTRACT: During FY 1998, the Food and Drug Administration (FDA) initiated new work requirements to accommodate additional regulations under FDA's GPRA-style program, the Mammography Quality Standards Act of 1992 (MQSA). These additional requirements consist of developing standards to authorize states as certifying bodies, thereby ensuring that mammography facilities comply with the final quality standards as implemented by the FDA. Analyses of the impacts of the enabling regulations will assist the agency in ensuring that proposed rules will minimize the impact on state regulatory bodies, while maintaining acceptable levels of facility quality. This work will include a methodology for estimating costs of regulations associated with authorizing states as certifying bodies. The following costs will be estimated: (1) inspecting facilities in certifying areas, (2) applying to become a certifying state, (3) the impact on national inspection fees after states acquire certification authority, and (4) rescinding authorization.

AGENCY SPONSOR: Office of Planning and Evaluation

FEDERAL CONTACT: Steve Tucker

PHONE NUMBER: 301-827-5339

PIC ID: 6080.2

PERFORMER ORGANIZATION: Office of Planning and Evaluation, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Nationwide Evaluation of X-Ray Trends (NEXT)

ABSTRACT: The Nationwide Evaluation of X-Ray Trends (NEXT) is a collaborative program conducted jointly between the FDA and state radiation control agencies. Data from this program are used to estimate the radiation dosage from diagnostic x-ray examinations associated with different types of x-ray examinations. The data are used by public health and professional organizations in setting policy.

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Orhan Suleiman

PHONE NUMBER: 301-594-3533

PIC ID: 4984

PERFORMER ORGANIZATION: Center for Devices and Radiological Health, FDA, Rockville, MD

PROJECTED DATE OF COMPLETION: 12/20/99

Crosscutting

TITLE: Real-Time PMA Supplement Program Evaluation

ABSTRACT: The Office of Device Evaluation (ODE), Food and Drug Administration (FDA) is implementing the "Real-Time" program for pre-market application (PMA).

AGENCY SPONSOR: Center for Devices and Radiological Health

FEDERAL CONTACT: Maryann Munson

PHONE NUMBER: 301-594-1284

PIC ID: 6732

PERFORMER ORGANIZATION: Office of Systems and Management, FDA, Rockville, MD

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: Laboratory Support Services for FDA Compliance and Surveillance

ABSTRACT: This initiative of the human drug program involves multiple evaluative aspects. Two examples are: (1) conducting the hormones surveillance program, and (2) developing analytical methods for drug fingerprinting in the assessment of drug quality. The anticipated outcome of this effort will support the Food and Drug Administration's (FDA's) regulatory actions by providing laboratory support for the agency's compliance and methods development functions. In addition, drug fingerprint profiles will provide forensic assessments of drug manufacturing origin in support of FDA investigational efforts in deterring drug counterfeiting.

AGENCY SPONSOR: Center for Drug Evaluation and Research

FEDERAL CONTACT: Joe Hanig

PHONE NUMBER: 301-594-5026

PIC ID: 7107

PERFORMER ORGANIZATION: Center for Drug Evaluation and Research, FDA, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/00

Health Care Financing Administration

Evaluation Program
The research arm of the Health Care Financing Administration (HCFA), the Office of Strategic Planning (OSP), performs and supports research and evaluations of demonstrations (through intramural studies, contracts and grants) to develop and implement new health care financing policies and to provide information on the impact of HCFA's programs. The scope of OSP's activities embraces all areas of health care: costs, access, quality, service delivery models, and financing approaches. OSP's research responsibilities include evaluations of the ongoing Medicare and Medicaid programs and of demonstration projects testing new health care financing and delivery approaches. These projects address the following major themes:

Medicare Health Plans: Enrollment, Delivery, and Payment--Highlights of these research, demonstration and evaluation (RD&E) efforts include research demonstrating favorable selection in enrollment, the development of systems for measuring beneficiary risk that can be used for refining capitated payments, and demonstrations that have tested and evaluated the effectiveness of a wide range of capitated health plan arrangements.
Provider Payment and Delivery Innovations in Traditional Fee-for-Service Medicare--Current RD&E projects include attempts to better align providers' incentives to deliver cost-effective care, either through payment innovations such as bundled payment models or prospective payment systems for post-acute care. Other initiatives include competitive bidding and experiments to foster coordinated care.
Research on the Future of Medicare--HCFA requires more information in order to assess the impact of longer term structural reforms of the Medicare program necessary to deal with the dramatic increase in the number of beneficiaries. Analyses to support the development of proposals for Medicare reform for congressional consideration will be required. In addition, we anticipate that there will be a need for demonstration and evaluation activities related to future of Medicare reform.
Outcomes, Quality and Performance--HCFA's RD&E agenda involves the development and testing of improved information resources that will enable consumers to choose among health plans and providers based on their relative value and quality. One part seeks to better understand how choices are made so that beneficiaries can use information most effectively. The complementary part of the agenda aims to develop better tools for measuring health care outcomes and quality, as well as the performance of health plans and providers.
Vulnerable Populations and Dual Eligibles--A special focus of RD&E in this area is the demonstration of coordinated care models that integrate the range of services available to persons dually eligible for Medicare and Medicaid. Development of a risk adjustment system that would support capitated payment for dual eligibles is a key element.
State Programs--This demonstration authority is used to provide expanded eligibility or additional services to individuals. In return for greater flexibility, States commit to a policy experiment that can be evaluated.
Research & Development Support Services--HCFA's research budget supports a variety of activities to increase the efficiency of our research and demonstration program and meet the crosscutting research needs of HCFA and the wider health research community.

Fiscal Year 1998 Evaluations

Medicare

TITLE: Access in Managed Care

ABSTRACT: This project developed and tested a set of performance indicators for Medicare managed care plans. The focus of this study was to develop a monitoring system that can be implemented using claims and encounter data from managed care plans, and was intended to serve as a pilot for determining what measures can be constructed and meaningfully interpreted. Using data from a managed care plan known to have high quality information systems already in place, a set of indicators can be constructed, and meaningful comparisons can be made between managed care and the fee-for-service sector. However, differences in databases can substantially complicate construction and interpretation of specific indicators. The final report contains a detailed discussion of the implications for developing a monitoring system such as the one tested during this study. The Health Care Financing Administration (HCFA) has begun the process of collecting encounter data from managed care plans. As the quality of the encounter data from managed care plans improves, the framework developed and tested through this project will serve as a foundation in future efforts to monitor and evaluate performance of the managed care sector relative to the fee-for-service sector.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Renee Mentnech

PHONE NUMBER: 410-786-6692

PIC ID: 7189

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

TITLE: Developing Cost Control Policies for Medicare Outpatient Services

ABSTRACT: This project involved an evaluation of the Ambulatory Patient Group (APG) Version II grouper. First, the grouper was evaluated for its ability to group 100 percent of Medicare outpatient department claims for the year 1993. No significant problems were encountered in grouping the outpatient claims using the grouper software. Secondly, charges were converted to costs and these data were then utilized to determine the homogeneity within and among the 290 groups. It should be noted that large cost coefficients of variation within and among the APGs are attributable to two primary causes. One is the grouping of unlike procedures into a single APG category. The other is variation in costs per unit at the procedure code level. The results of this analysis indicate that both factors are at work in varying degrees across the range of APGs. This analysis served to highlight those APG categories where additional refinement of the groupings might result in increased homogeneity of resource use. The third and final component of the project involved the calculation of cost-based payment weights and the performance of a financial impact simulation with the hospital as the unit of analysis. The findings are a cross-sectional, retrospective analysis that does not incorporate any behavioral offset response. They suggest there are almost no differences, on average, between the full packaged ancillary option and no packaging. However, adoption of an APG system will have varying impacts on different categories of hospitals. Hospitals in the Middle Atlantic, New England and Pacific regions and large urban facilities demonstrated losses. Hospitals in the other geographic areas and rural facilities showed gains relative to costs.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mark Krause

PHONE NUMBER: 410-786-6683

PIC ID: 7166

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

TITLE: Disenrollment and Selection Experience Under the Medicare HMO Risk Program

ABSTRACT: This project consisted of a series of analyses comparing Medicare health maintenance organization (HMO) joiners and disenrollees to beneficiaries in fee-for-service (FFS). The purpose was to make several different estimates of the degree of biased selection in enrollment and disenrollment. Biased selection in Medicare HMOs is taken to mean the enrollment (or disenrollment) of beneficiaries whose average costs are not equal to the average costs of like beneficiaries in the fee-for-sector. Among differences measured were prior use characteristics such as hospitalization and costs, mortality and occurrence of selected procedures after disenrollment. The methodology included logistic models for probability of joining an HMO conditioned on prior use, and probability of an event after disenrollment. Data used were for counties with at least 1,000 HMO enrollees in the years 1993 and 1994. One set of analyses compared 1993 pre-enrollment data on utilization and expenditures for persons who joined an HMO in 1994, to those who stayed in the FFS sector. The subset of 1994 HMO joiners who then disenrolled was examined separately and compared to the same sample of FFS beneficiaries. The study found that, in every case, reimbursements and utilization measures were lower in 1993 for persons who joined HMOs in 1994 than persons who remained in the FFS sector.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mel Ingber

PHONE NUMBER: 410-786-1913

PIC ID: 6294

PERFORMER ORGANIZATION: University of Minnesota Minneapolis, MN

TITLE: Evaluating Alternative Risk Adjusters for Medicare: Final Report

ABSTRACT: This project looked at the merit of alternative survey and claims-based risk adjusters for the Medicare population. It used multiple years (1991-1994) of the Medicare Current Beneficiary Survey to evaluate alternative demographic, survey, and claims-based risk adjusters for Medicare capitation payment. The investigators found that survey health status models have three to four times the predictive power of the demographic models. The claims-based models performed better than the survey models in predictive power and across most non-random groups. The combined claims/survey models were only modestly better than the claims diagnostic models alone. No single model predicted average expenditures uniformly well for all beneficiary subgroups of interest, suggesting a combination model may be appropriate. Substantial redundancy existed among the survey adjusters, indicating that reduction of survey questions is possible and necessary. More data are needed to obtain stable estimates of model parameters before a risk-adjustment payment methodology can be implemented. In conclusion, risk adjustment should improve risk selection problems.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Sherry Terrell

PHONE NUMBER: 410-786-6601

PIC ID: 6989

PERFORMER ORGANIZATION: Center for Health Economics Research Waltham, MA

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

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 each month. 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, 201 Filbert Street, San Francisco CA 94133

TITLE: Evaluation of Version Two of the Ambulatory Patient Group System

ABSTRACT: Medicare hospital outpatient department claims are evaluated employing 3M/Health Information Systems Ambulatory Patient Group (APG) Version II software. The evaluation of a Medicare Prospective Payment System (PPS) for hospital outpatient departments was based on the universe of claims submitted in 1993. This analysis focused on: (1) the ability of the grouping software to group outpatient claims, (2) the relative distribution of the respective groups, (3) the calculation of payment weights, and (4) the simulated effects of moving to an APG payment system when compared to outpatient facility costs.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mark Krause

PHONE NUMBER: 410-786-6683

PIC ID: 6986

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

TITLE: Market Research for Providers and Other Partners: Final Report on Hospital Communication (February 9,1998)

ABSTRACT: The information needs of a hospital and the process by which these needs may be met are largely dictated by hospital characteristics. Several trends in the hospital market affect the way hospitals acquire knowledge and adapt operations, including: (1) the increasing prevalence of Medicare managed care; (2) consolidations, acquisitions, and mergers within the hospital market; and (3) the integration of hospital services with other types of care to form health systems and community networks. There are over 5,100 Medicare-certified short stay hospitals in the United States. The Health Care Financing Administration (HCFA) has initiated a comprehensive strategy to coordinate existing communication activities within HCFA and develop innovative, effective approaches that make information accessible to all program participants. This study addresses two central questions: (1) What information do hospitals need and want from HCFA? (2) How can this information be most effectively made available? Information on these issues was obtained from an expert Hospital Advisory Panel, Professional Review Organizations (PROs), and interviews with hospital staff, hospital associations and HCFA staff in the Central Office and Regional Offices. Additionally, reviews and content analyses of existing HCFA communication processes and written materials were conducted. Suggested areas for improvement include: (1) currency and accuracy of materials, (2) timeliness of communications, (3) consistency and coordination, (4) simplification, (5) availability, (6) dissemination, and (7) consultation with the hospital industry. Suggested changes would expand the use of some types of communication strategies, diversify communication methods and make certain specialized information more accessible. (final report is 110 pages)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Sherry Terrell

PHONE NUMBER: 410-786-6601

PIC ID: 6992

PERFORMER ORGANIZATION: Barents Group, KPMG Peat Marwick LLP Washington, D.C.

TITLE: Medicare Cataract Surgery Alternate Payment Demonstration: Final Evaluation Report

ABSTRACT: This report evaluates the demonstration of an innovative payment approach, known as package payment or bundled pricing, for cataract surgical episodes in the Medicare program. Officially known as the Medicare Cataract Surgery Alternate Payment Demonstration, the project sought to employ market forces to select providers and negotiate discounted prices for a package or bundle of specified pre-operative, operative and post-operative services associated with an episode of cataract surgery. The primary objective of the demonstration was to assess the potential benefits of a negotiated package pricing arrangement for cataract removal with an intraocular lens (IOL) implant. By testing this alternate payment system, the Health Care Financing Administration (HCFA) sought to: (1) allow provider flexibility in managing the mix and type of services used, (2) provide incentives to manage patient care so that cost efficiencies are realized and the procedure can be performed at a lower total cost, (3) reduce Government involvement in the pricing of individual services and in the providers' decision making, (4) provide insight into appropriateness indicators and effective quality assurance and utilization review mechanisms for cataract surgery, and (5) provide information regarding factors influencing providers' decisions to participate and beneficiaries' decisions to select designated providers under a demonstration that is completely voluntary. To test this approach, HCFA decided that the demonstration would be implemented in three geographic locations and would operate for a period of three years. Despite its modest savings impact, the demonstration was remarkably successful in meeting most of its original objectives. (final report is 129 pages)

AGENCY SPONSOR: Center for Health Plans and Providers

FEDERAL CONTACT: Cynthia K. Mason

PHONE NUMBER: 410-786-6680

PIC ID: 6998

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

TITLE: Medicare Participating Heart Bypass Center Demonstration Evaluation

ABSTRACT: This project was the second and final evaluation of the negotiated bundled payment demonstration, implemented in May 1991 to assess the benefits of a negotiated package pricing arrangement for heart bypass surgery. Under the demonstration, 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. The demonstration was implemented at four sites in May 1991. An initial three year evaluation was completed and a second extended evaluation was started in 1994 for the remaining two years of the demonstration. At the end of the demonstration, 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 resulted in high quality, efficient patient care delivery and lower costs. The demonstration led 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

Medicaid

TITLE: Evaluation of Drug Use Review Demonstration Projects Final Report

ABSTRACT: The purpose of this project was to test the effectiveness of the drug use review (DUR) demonstration projects in improving drug use and reducing the negative consequences of drug misuse. Since 1990, the Medicaid program has been mandated to operate prospective and retrospective drug use review programs. In 1992, the Health Care Financing Administration (HCFA) funded two experiments managed by Iowa and Washington State Medicaid agencies. Project C.A.R.E., a joint effort between Washington's Department of Social and Human Services and the University of Washington School of Pharmacy, was evaluated to test the effects of paying pharmacists to provide cognitive services (CS). The Iowa Medicaid OPDUR Demonstration Project, involving Iowa's Department of Human Resources, together with researchers from the University of Iowa, Drake University and the Iowa Pharmacists Association, tested online prospective drug use review (OPDUR). Maryland and Georgia were included for experimental and comparative purposes. Both evaluations sought to improve drug prescription by influencing pharmacists' behavior. Findings indicate that prospective drug use review had no measurable effects on the frequency of drug problems, the utilization and expenditures on prescription drugs and other medical services. Further analysis revealed no behavioral changes in pharmacists who received OPDUR messages. Instead, the cognitive services most often provided by pharmacists involved counseling and educating patients, rather than interactions with prescribers or other pharmacists. Pharmacists who received payment for cognitive services provided more of this service than those who did not receive payment. These findings will be used to assess current DUR requirements for possible changes.

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

TITLE: Examination of the Medicaid Expansions for Children

ABSTRACT: This project looked at changes in Medicaid legislation as a result of the Omnibus Budget Reconciliation Acts of 1989 and 1990. Analyses on the impact of the expansions included: (1) examination of enrollment and expenditure trends from 1988 to 1992; (2) assessment of the extent to which the expansions penetrated the target population; and (3) multivariate analysis to examine the impact of State policies and the eligibility group on enrollment, expenditures, and utilization of services. The examination of access to care and utilization of services included the development of a theoretical model, an analysis plan and items that could be incorporated into an established national survey.

AGENCY SPONSOR: Center for Beneficiary Services

FEDERAL CONTACT: Suzanne Rotwein, Ph.D.

PHONE NUMBER: 410-786-6621

PIC ID: 6300

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

TITLE: Service Utilization Patterns for Preventive Care for Undocumented Alien Children Under California's Medi-Cal Program

ABSTRACT: This project provides an analysis of service utilization and expenditure patterns for preventive and illness-related care for undocumented alien children under California's Medi-Cal program. The contractor initially developed a database of undocumented alien children covered by Medi-Cal. The analysis was conducted using State-specific eligibility codes for the years 1989-1992. They will then provide descriptive analyses of enrollees, utilization and payments, the proportions of total Medicaid child enrollees, utilization and payments that these children represent, and a descriptive analysis of the classification of services, including emergency, preventive and non-emergency, and service sites were examined. Also examined were the magnitude of expenditures for this group of undocumented alien children and the average expenditures per child and per person for month of eligibility.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Paul W. Eggers

PHONE NUMBER: 410-786-6691

PIC ID: 7167

PERFORMER ORGANIZATION: Medstat Group Washington, DC

TITLE: The Evolution of the Oregon Health Plan: First Interim Report

ABSTRACT: Implemented in February 1994, the Oregon Health Plan (OHP) extends health insurance coverage (Medicaid eligibility) to uninsured State residents below the poverty level. 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) and revenues generated by a cigarette tax earmarked for OHP. The program evaluation addresses both the implementation process and program impacts, using qualitative and quantitative approaches. Additionally, the evaluation focuses on the evolution of the OHP, its problems and challenges, and is based on State data and three site visits conducted in November 1994, October 1995 and June 1996. (final report is 226 pages)

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

Crosscutting

TITLE: Evaluation of Customer Service Projects

ABSTRACT: This project involves a series of evaluations focusing on customer service projects. Current examples of such projects are the Western Consortium Trailblazers and Correspondence Tracking. There were four types of evaluations: (1) Formative, (2) Process, (3) Outcome and (4) Impact. The specific projects to be evaluated will be designated during the process of the contract.

AGENCY SPONSOR: Center for Beneficiary Services

FEDERAL CONTACT: Elizabeth Goldstein, Ph.D.

PHONE NUMBER: 410-786-6665

PIC ID: 7201

PERFORMER ORGANIZATION: Booz, Allen and Hamilton Bethesda, MD

TITLE: Evaluation of Rural Health Clinics

ABSTRACT: The Rural Health Clinic Services Act of 1977 authorized a new type of provider for certification and licensure. A rural health clinic (RHC) must be located in a rural health professional shortage area, medically underserved area, or Governor-designated shortage area, and it must make use of mid-level practitioners. The legislation provides for cost-based reimbursement for the clinics for Medicare and Medicaid. After a slow start in certifying clinics in the first years of the program, there has been rapid growth in the numbers of these clinics in the past few years. According to a count by the Health Care Financing Administration (HCFA), there were 3,067 RHCs listed nationwide in September 1996, compared to 1,157 certified clinics in August 1993. This contract evaluated the program, and focused on several broad issues that have implications for rural health policy at the Federal and State levels. These overall issue areas were: (1) What are the reasons for the growth in the numbers of the RHCs? (2) What has been the impact on access to health care for rural populations as a result of the growth in these clinics, especially the Medicare, Medicaid, and otherwise underserved populations? (3) What have been the costs to the Federal Government and the States for the program? Other broad questions pertinent to the entire spectrum of rural health policy were also addressed, such as whether these clinics increased the supply of physicians in rural areas, what implications the growth in clinics had for Federal policy for rural hospitals and other providers, and whether these clinics should be protected in the development of State managed care plans.

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

TITLE: Evaluation of the Demonstration to Improve Access to Care for Pregnant Substance Abusers

ABSTRACT: The evaluator examined access to prenatal care and substance abuse treatment services and assessed the effects of these services on the health of drug-addicted pregnant women and birth outcomes of their infants. This report evaluates demonstration project effectiveness in: (1) outreach and assessment; (2) expansion, integration and coordination of program services; and (3) improvement of client case management. The evaluation showed that the number of abusers enrolled in the demonstrations were low relative to all pregnant substance abusers in the area, since women were reluctant to be identified. The project found higher enrollment rates in States which implemented broad-based outreach efforts and higher levels of retention in substance abuse treatment, resulting in higher birth weight infants. (Final report 104 pages plus appendices.)

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, D.C.

TITLE: PACE Rate Work: Final Report

ABSTRACT: The Program for All-Inclusive Care of the Elderly (PACE) is a voluntary program that coordinates all acute and long-term care services and coordinates multiple sources of funding (usually Medicare and Medicaid), for elders who are deemed to be "nursing home certifiable" (NHC) under the laws of their State. The Balanced Budget Act of 1997 makes PACE a permanent provider category and mandates that future Medicare payment be based upon the rate structure of the new Medicare + Choice program. This study revisits the calculation of an appropriate frailty adjuster for use in this expanded setting. In particular, the study samples several State NHC definitions and summarizes the similarities and differences. Using data from the National Long Term Care Survey and the Medicare Current Beneficiary Survey, cost and population models are developed to explain and predict the monthly fee-for-service expenditures that Medicare would be expected to pay for these NHC individuals if they do not enroll in PACE. A capitation model assembles the results of these models, providing a tool for deriving capitation rates for an NHC population of interest over a specified rating period. The report also discusses the determination of an appropriate frailty adjuster for PACE.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Nancy Miller

PHONE NUMBER: 410-786-6648

PIC ID: 6309

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

TITLE: State-Administered Programs for HIV- Related Care

ABSTRACT: This study describes and analyzes a range of State-administered programs which cover and finance health care for people infected with the human immunodeficiency virus (HIV). The study focused on: (1) Title II programs of the Ryan White CARE Act; (2) Medicaid 2176 home and community-based care waiver programs; (3) State-funded, non-Medicaid, medical assistance programs; and the actions of State health departments that address the incidence of tuberculosis, especially among people with HIV illness. The research also presents assessments that administrators of AIDS service organizations at the State and local level have about how well each State-administered public program (as well as the Federal Medicare program) addresses the health care needs of people with HIV. The project collected data on these State-administered public programs with a series of nine separate surveys which were mailed to program administrators in each State. Successful innovations developed by individual States implementing a comprehensive range of State-administered programs can serve as models to guide other States in developing AIDS-related policies to assure that all people with HIV have access to necessary health and care-related services. (final report is 223 pages)

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Michael Kendix

PHONE NUMBER:

PIC ID: 6993

PERFORMER ORGANIZATION: Department of Health Administration and Health Policy Harborview Office Tower, Charleston, SC

Consumer Choice

TITLE: Information Needs for Consumer Choice

ABSTRACT: This contract examined the types of information consumers find most useful in selecting health insurance plans, providers and practitioners, and in making the chosen health care plan/system work best for them. The study determined how to present this type of information in a user-friendly way, and developed and tested these consumer information approaches in given markets. The project addressed consumer information issues and needs in both the current health care system and in proposals for health care system reform, especially as they relate to three broad consumer groups: (1) Medicare beneficiaries, (2) Medicaid beneficiaries, and (3) the remaining U.S. population under 65 years of age. The project was conducted through the use of 24 focus groups, nine case studies of innovative consumer information projects, and by developing and testing information materials in two different media for six subgroups of the Medicare and Medicaid populations.

AGENCY SPONSOR: Center for Medicaid and State Operations

FEDERAL CONTACT: Maria Friedman

PHONE NUMBER: 410-786-9915

PIC ID: 7200

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

Fiscal Year 1998 Evaluations

Community Health Centers

TITLE: ACSC Experience by Usual Source of Health Care: Comparing Medicaid Beneficiaries Who Rely on CHCs with Medicaid Beneficiaries Who Rely on Other Primary Care Providers

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. Medicaid claims data for 1992 from five States were used to provide data on inpatient services, outpatient visits, clinical information and demographics. ACSCs were coded for hospitalization and a list of ICD-9 codes was developed for outpatient ACSC visits. The study sample comprised 16,145 CHC users and 32,594 other Medicaid beneficiaries from the same community as a comparison group. 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 primary providers 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. The study focused on the impact of the first year of Medicaid waiver program implementation on two FQHCs in five States. Site visits were conducted at 10 centers. In addition, data from health plans, primary care associations and State Medicaid programs contributed to the analysis. An exit interview was conducted at some centers, in order to gain consumer perspectives. The study showed that: (1) FQHCs experienced widely varying amounts of change in their population of Medicaid users, 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, in other centers, expanding capacity increased access to services; (5) the financial impact is complex, and is 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) consumers were generally satisfied with FQHC services despite changes resulting from managed care. Study results are being used as a source for identifying factors that will affect health centers in future waiver programs, and to inform 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: The purpose of this study was to examine and compare different managed care participation strategies among 36 federally qualified health centers (FQHCs) in eight markets, focusing on how FQHCs are responding to Medicaid managed care, their reasons for forming plans and/or networks, and factors contributing to their success in plans and networks and under different participation strategies. The study focused on three strategies: (1) being part of an FQHC-owned or sponsored health plan, (2) being a member of an FQHC network, and (3) being an individual contractor with non-FQHC plans. Findings are based mainly on site visits to four FQHC-sponsored plans, eight FQHC networks, and 24 individual health centers. Market-level information from secondary sources and program data were also used. The study found that: (1) nearly all of the centers in the study had 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, 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, strengthening their ties with local hospital systems, and expanding their involvement in Medicare and managed care contracts. The manner in which FQHCs chose to participate in managed care did not, in itself, appear to make a difference in effects on the center. During the study period, however, many FQHC plans and networks were just becoming operational. Study results are helping to shape policies for participation of centers in managed care, and for the Health Resources and Services Administration's (HRSA's) technical assistance strategies concerning managed care.

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, D.C.

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. It is critical that C/MHCs be successful participants in the managed care market in order to be financially viable sources of care for the uninsured and other vulnerable populations. Visits were made to one site in each of seven States. On-site and telephone interviews with key personnel at managed care organizations (MCOs) that had contracted with the C/MHCs formed the basis of the performance assessment of these centers. On-site interviews with key C/MHC staff were used to develop an organizational assessment, which concerned the effect of managed care on C/MHC decision-making, strategic planning, administrative and financial management practices, demands for information and data collection systems, and clinical operations. 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 being used in discussions with managed care associations and networks, 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

TITLE: Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior

ABSTRACT: In recent years, the Health Resources and Services Administration's (HRSA's) primary 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, as well as to help link the community with the providers. Community health workers provide informal community-based health-related services, establishing vital links between community-based health providers and persons in the community. The main purposes of this study were to provide information on the use of CHWs in HRSA-funded primary care projects , and to determine the effects of using CHWs on patients' access to, and proper use of, services, and on patient knowledge and behavior. An annotated bibliography of studies of CHWs was prepared, and documents on 60 HRSA-funded projects utilizing CHWs were reviewed. Fourteen projects were profiled and seven were site visited. During the visits, focus groups were held with clients. 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 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. Study results have been widely distributed and are being used to inform policy on use of CHWs in HRSA-funded programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Remy Aronoff

PHONE NUMBER: 301-443-7577

PIC ID: 6355

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

Expanding Access to Care

TITLE: Pacific Partnerships for Health: Charting a New Course for the 21st Century

ABSTRACT: The U.S.-Associated Pacific Basin consists of six island jurisdictions. Three of these--American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), and Guam--are considered U.S. flag territories. The other three--Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), and Republic of Palau--are independent countries, but are freely associated with the United States. The total population of all these jurisdictions is 454,118. Although the health system and health status measures vary within and among the islands, almost all health indicators for islanders are worse than those for mainland Americans. The purposes of this study were to examine these issues and suggest possible approaches to improve the situation. The study concluded that four approaches should be used simultaneously to improve health: (1) adopt and support a viable system of community-based primary care and preventive services; (2) improve coordination within and between the jurisdictions and the U.S.; (3) increase community involvement and investment in health care; and (4) promote education and training of the health care workforce. The first two of these were given the highest priority. The Health Resources and Services Administration (HRSA) convened the Pacific Basin Health Summit in March 1998 to discuss the agency's role in improving health care in the region. Subsequently, HRSA has implemented several study recommendations including: (1) creation of an intra-agency to improve jurisdictional coordination; (2) use of military hospitals in Guam for care coordination; (3) provision of continuing provider education in epidemiology, substance abuse, mental health, and HIV prevention and treatment; and (4) expansion of community involvement in planning federally-supported projects. Activities stemming from the report and the summit continue with HRSA participation.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: 301-594-4425

PIC ID: 7157

PERFORMER ORGANIZATION: Institute of Medicine, Washington, D.C.

Health Professions

TITLE: Assessing Ambulatory Primary Care Training: Costs, Methods and Quality

ABSTRACT: The purpose of this study was to create a meaningful data set to estimate the cost of primary care medical education, including training costs for nurse practitioners and physician assistants, in the ambulatory care setting. Although well-developed educational and financial infrastructures support hospital-based education of the health professions, a similar infrastructure for ambulatory care training is nascent. This study addressed whether teaching ambulatory sites have higher costs than non-teaching sites, and whether the productivity of clinicians engaged in ambulatory teaching differs from that of clinicians who are not teaching. An advisory panel of leading investigators and teaching clinicians helped to guide a literature review of the costs of ambulatory training and related data collection analysis. Site-level cost and operations information was obtained from HRSA and external sources. In addition, a survey of 98 ambulatory teaching sites was conducted. The study found that operating costs of teaching ambulatory care sites are about 36 percent higher than costs of similar non-teaching sites. Of this cost differential, about 65 percent is due to costs that are attributable to education, while 35 percent stems from educational infrastructure costs. Like their hospital counterparts, teaching ambulatory care sites tend to be larger and more organizationally complex than non-teaching sites, offering more specialty care and seeing more patients. Educational experiences were diverse, including clinical training, core clerkships, lectures and seminars, and community service projects. Ambulatory care educators identified the following as conditions needed to assure quality in ambulatory training: a strong and interested faculty, a clinically diverse patient base, and the integration of training into day-to-day operations. This study has led to a preliminary project to determine a method for assessing the value added to ambulatory care settings by educational activities.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Emily De Coster

PHONE NUMBER: 301-443-6920

PIC ID: 6358

PERFORMER ORGANIZATION: Northeastern Ohio Universities, Rootstown, OH

TITLE: Consortium Development for Health Professions Training in Community-Based Settings

ABSTRACT: The development of academic/community consortia for education and training in the health professions can increase opportunities for students and trainees, enhance the relevancy of training experiences, and benefit both the consortium's academic and community-based participants. This project focused on consortia that train a variety of health professionals in an interdisciplinary manner in community-based settings. The goals of the project were to: (1) identify consortia, (2) determine what types of community-based and academic organizations make up these consortia, (3) determine the extent to which health professions education and training carried out by these consortia are done in an interdisciplinary manner, and (4) identify some of the challenges that face these consortia. This study identified consortia that not only educate and train disciplines other than, or in addition to, physicians, but that also include community-based providers and organizations as partners. The study found that academic-community consortia for health professions education vary considerably in their missions, types of participating organizations, governance structure, educational approaches, and professional disciplines of the trainees. Commonalities among the consortia included shared goals for both education and service delivery, use of a legally binding agreement to finalize commitment from partners, significant funding from Federal, State and private sources, and encouragement of trainees to practice in underserved areas. In addition, several factors that might impede the success of a consortia were identified. Findings are being used to guide program planning to encourage interdisciplinary training. Findings will also be used in providing technical assistance to applicants or grantees regarding important factors to consider in developing consortia.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Jennifer Burks

PHONE NUMBER: 301-443-6865

PIC ID: 6251

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

TITLE: Strategies for the Recruitment, Retention, and Graduation of Hispanics into the Baccalaureate Level of Nursing

ABSTRACT: The Healthy People 2000 objectives for the Nation specify an increase in the proportion of all degrees in the health professions and allied and associated health professional fields awarded to minorities, from the 1985-1986 baseline of three percent to 6.4 percent by the year 2000. Recent data suggest that fewer than two percent of the 2.5 million Americans with current licenses to practice as registered nurses in March of 1996 were of Hispanic background, and Hispanics are seriously underrepresented in baccalaureate nursing programs. Only very slight gains in the admission of Hispanic students into nursing schools have been made since 1972, when the National League for Nursing first began collecting ethnic classification data. The admission rate for Hispanic nursing baccalaureate students has almost consistently remained below three percent. Based on a literature review and in-depth interviews with administrators, faculty and students at eight schools of nursing, this study has developed a model that can be used as a conceptual framework by Institutions of Higher Education (IHEs) seeking to increase the proportion of Hispanic Americans admitted to baccalaureate programs as their initial entry into nursing education. The model explicates promising strategies for the recruitment of Hispanics into baccalaureate nursing programs, retaining them after they are recruited, and assuring their graduation from those programs. It also suggests implementation issues that may arise when these strategies are put into practice.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Ernell Spratley

PHONE NUMBER: 301-443-1915

PIC ID: 6249

PERFORMER ORGANIZATION: CDM Group, Inc. Chevy Chase, MD

HIV/AIDS Services

TITLE: A Review and Synthesis of HIV/AIDS-Related Client Level Evaluation Activities Among Ryan White CARE Act Grantees

ABSTRACT: The purpose of this study was to gather information about whether and how Ryan White Comprehensive AIDS Resources Emergency (CARE) Act grantees were evaluating client satisfaction, and how the grantees were improving delivery systems in response to client needs and concerns. The development of new, clinically effective therapies that present challenges in their use has intensified the need for the re-design of HIV services and the increased involvement of people living with HIV/AIDS in managing their own health. A mail survey about assessment of client satisfaction was mailed to 480 grantees in September, 1997. Subsequently, site visits were made to six grantees. An advisory board including representatives of a wide spectrum of HIV/AIDS organizations helped guide the design of the survey and developed criteria for selecting the sites for the six case studies. The study found that grantees assessed client satisfaction most commonly through self-administered surveys, but some conducted group sessions or focus groups. Grantees using the latter methods reported making changes in their delivery systems more frequently than those using surveys. Ninety-three grantees reported making a wide range of changes in response to clients, including involvement of clients in policy and information development, and provision of sensitivity training for clinical and non-clinical staff. The Health Resources and Services Administration (HRSA) is using the findings in its technical assistance concerning client satisfaction and access to care. The National Association of People with AIDS (NAPWA) is using the results in a privately funded project to demonstrate the benefits of consumer involvement in the design and implementation of services.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Moses B. Pounds, Ph.D.

PHONE NUMBER: 301-443-2894

PIC ID: 6362

PERFORMER ORGANIZATION: National Association of People with AIDS, Washington, D.C.

TITLE: Data Collection and Budget Forecasting Strategies: A Primer for State AIDS Drug Assistance Programs

ABSTRACT: State-administered AIDS Drug Assistance Programs (ADAPs), funded by the Health Resources and Services Administration (HRSA) under Title II of the Ryan White CARE Act, along with other State and private sector resources, have been thrust to the forefront of the public debate over the cost-efficient provision of public health care services to individuals in this country. Over the last two years, ADAPs in most States have experienced significant growth, both in the number of clients served and in monthly expenditures on pharmaceuticals. This rapid growth has strained the limited resources of these programs and has resulted in many ADAPs being forced to limit access to life-sustaining HIV/AIDS medications by capping overall program enrollment, capping or limiting access to expensive new drug therapies, or developing more restrictive financial and medical program eligibility criteria. The rapidly changing fiscal and treatment environments in which ADAPs now operate have raised many challenges for the State-level or State-contracted administrators of these programs. Good data and good data collection systems are necessary to develop accurate budget projections and to aid in program planning. The purposes of this study were to provide directors of ADAPs with information necessary to assess their current data collection program and to provide practical tools to assist in developing an appropriate budget forecasting model. This study developed a primer on basic data collection and forecasting strategies. The primer addresses the fundamental program need for data to estimate expected monthly expenditures and the cost impact of adding a specific new drug to the ADAP formulary. The products of this study will enable ADAPs to assume greater accountability by streamlining data management strategies and enhancing forecasting capacity.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Annette Byrne

PHONE NUMBER: 301-443-6745

PIC ID: 7159

PERFORMER ORGANIZATION: National Alliance of State and Territorial AIDS Directors, Washington, D.C.

TITLE: Evaluating HIV Case Management: Invited Research & Evaluation Papers

ABSTRACT: The purpose of this study is to report on the papers and recommendations of a conference on approaches for evaluating the effectiveness of HIV case management. Case management for HIV services is eligible for funding under the Ryan White Comprehensive AIDS Resources Emergency Act Amendments of 1996 (CARE Act). The expansion of case management has not been accompanied by consistent standards for service delivery, validation of its aims and purposes, comparative analysis of its multiple forms, or systematic investigation of its various service configurations and outcomes. There is evidence that HIV case management is a highly needed service that leads to problem resolution, and that clients who receive case management have high levels of satisfaction with their case manager. However, health services research data about the effectiveness of HIV case management are generally lacking. For this project, a group of health services researchers, case managers, and Federal representatives met to discuss the evaluation and study of the effectiveness of HIV case management. Ten papers were commissioned for presentation at the meeting that, together with a summary introduction, constitute this final report.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Gloria Weissman

PHONE NUMBER: 301-443-3478

PIC ID: 7158

PERFORMER ORGANIZATION: Sociomedical Resources Associates, Inc. Westport, CT

Maternal and Child Health

TITLE: The Implementation of Healthy Start: Lessons for the Future

ABSTRACT: The Healthy Start program was begun in 1991 to demonstrate innovative ways to reduce infant mortality by 50 percent over five years (later changed to 6 years) in areas with some of the highest rates. The National Evaluation of the program includes a cross-site process component and an outcome study of the initial 15 sites. The report summarized here is the final product from the process component. This report 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.) Qualitative data from site visits and focus groups of clients and providers were used in conjunction with a client data set and interviews with postpartum women. The study found that program elements include: (1) community involvement through a consortium and other community empowerment strategies; (2) outreach and case management, generally using lay workers for many functions; (3) nontraditional support services, such as transportation and nutrition education; (4) enhanced clinical services, building on an existing delivery system; and (5) community-wide public information campaigns. Clients and providers gave positive feedback about Healthy Start services. This process study found that local communities can, with substantial Federal funding, develop and implement innovative approaches to reducing infant mortality. The extent to which projects were able to manage effectively--that is, to develop and execute sound administrative procedures, recruit and retain a strong staff (especially senior staff) and monitor contractors--made the difference between successful and less-than-successful implementation. The final report of the National Evaluation, due in March 2000, will discuss the issue of whether these projects have led to a measurable reduction in infant mortality. (See PIC ID 5610)

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

State Children's Health Insurance Program

TITLE: Sampling the States: Local Reflections on State Implementation of State Children's Health Insurance

ABSTRACT: The State Children's Health Insurance Program (SCHIP) was signed into law as Title XXI of the Social Security Act as part of the Balanced Budget Act of 1997. Title XXI provides $24 billion for child health over five years and $50 billion over 10 years in block grants to the States. This study was funded to obtain a grassroots perspective from local advocates, providers, and public health leaders on the impact SCHIP may have on children's health. A formative discussion, using qualitative research methods, was conducted with almost 40 individuals in 10 States which represent more than half of all uninsured children in the Nation. Perspectives were obtained on: (1) State plans for outreach and enrollment; (2) benefits package and design; (3) target populations; (4) the role of local coalitions and the respondent's role; (5) emerging service delivery system issues; (6) the role of safety net providers and linkages among providers; (7) quality of care/quality standards; and (8) thoughts on the program's promise, local concerns and vision. The study found that major system capacity issues, especially for dental and mental health care, were not being addressed aggressively by the States. Care for rural and migrant populations, enrollment of immigrant populations, services for adolescents, and benefit coverage and system redesigns to serve children with special needs or who are chronically ill also will require more attention. In addition, the study found that innovation in the enhancement of service delivery may require greater technical and financial support from the Federal Government, such as through issuance of Federal guidelines that offer increased flexibility and waiver options.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 7068

PERFORMER ORGANIZATION: Coalition for Healthier Cities and Communities, Health Research and Educational Trust, Chicago, IL

Crosscutting

TITLE: Are Consortia/Collaboratives Effective in Changing Health Status and Health Systems? A Critical Review of the Literature

ABSTRACT: The purposes of this study were to: (1) review the evidence of consortium effectiveness; (2) identify factors and developmental stages associated with effective consortia; (3) discuss challenges in, and tools available for, measuring consortium performance; and (4) assess the potential implications for Health Resources and Services Administration (HRSA) programs. The study found few examples of consortia or coalitions that can claim to have effected change in health status or health systems, and that conditions such as strong leadership, excellent planning, community commitment and well-defined goals are needed. However, collaborative efforts may have such valuable byproducts as: (1) expansion of the ability of individuals and organizations to work together, (2) increased levels of trust, and (3) enhanced responsiveness of the organizations to community needs. The study indicated a need for further research to determine how collaborative efforts achieve long-term outcomes, given the requirements for consortia and other collaborative efforts in many Federal programs.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 7062

PERFORMER ORGANIZATION: Health 2000, Inc., Atlanta, GA

Evaluations in Progress

Community Health Centers

TITLE: Analysis of CHC User/Visit Survey: Selected Conditions

ABSTRACT: This study is analyzing portions of the User/Visit Study (See PIC ID 5737) data in order to describe the process of care and outcome measures for Community Health Center (CHC) users with selected health conditions, in relation to their insurance status. The data on CHC users and visits are nationally representative and were gathered so as to be comparable to national estimates maintained by the National Center for Health Statistics (NCHS) through two periodic surveys: The National Health Interview Survey, and the National Ambulatory Medical Care Survey. Data collection was completed in 1995. In the current project, CHC users with diabetes and hypertension are being compared to users who do not have these conditions, and to the general population. Quality of care rendered by the CHC is also being assessed. A third analysis concerns care of CHC users who are uninsured. The Health Resources and Services Administration (HRSA) will use the findings in shaping program policy. An article based on each analysis will be submitted to a peer reviewed journal to facilitate broad dissemination of the results.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301-594-4283

PIC ID: 6805

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

PROJECTED DATE OF COMPLETION: 2/4/99

Community Health Centers and National Health Service Corps

TITLE: Construction and Pretest of the Year 2000 User/Visit Survey

ABSTRACT: In 1997, the Health Resources and Services Administration (HRSA) completed a study (PIC ID 5737) to obtain nationally representative data about the users of Community Health Centers (CHCs) and the services provided to them. This study permitted a comparison of the CHC estimates with estimates derived from the National Health Interview Survey and the National Ambulatory Medical Care Survey administered by the National Center for Health Statistics (NCHS). The current study is developing the sampling frame and revising and pilot testing questionnaires in preparation for a second User/Visit Survey in the year 2000. The year 2000 survey will be the first in which information will be collected on National Health Service Corps (NHSC) users and visits. The HRSA's intent is to conduct this survey every few years to evaluate change over time within the CHC and NHSC programs, and in comparison with the general U.S. population as reflected in the NCHS estimates. Findings from the year 2000 survey itself will be used to measure program performance as required by the Government Performance and Results Act (GPRA).

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301-594-4280

PIC ID: 7128

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Effect of Medicaid Managed Care Beneficiary Enrollment and Autoassignment Practices on FQHCs and Their Patients

ABSTRACT: Under most Medicaid managed care programs, beneficiaries who do not select a plan are automatically assigned to one. This study is describing the impact of enrollment and autoenrollment (automatic assignment) policies and practices under mandatory Medicaid managed care on federally qualified health centers (FQHCs), FQHC networks and plans, and their patients. Autoenrollment practices are of interest to the Health Resources and Services Administration (HRSA) because of their possible implications for cultural and linguistic competence of providers, and for existing patient/provider relationships. This study is reviewing autoenrollment rates experienced across the U.S. in Medicaid waiver programs, and is examining Medicaid service areas where FQHCs have experienced high levels of patient dislocation due to State autoassignment and enrollment policies. Potential uses of the findings are: (1) to improve the accuracy and helpfulness of information on plans and providers given to beneficiaries, so that they will be better able to choose a plan; (2) develop strategies for improving the enrollment process; (3) identify common interests among the States, managed care plans, FQHCs and beneficiaries; and (4) generate collaborative problem solving between public and private policymakers.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Dana Jones

PHONE NUMBER: 301-594-4058

PIC ID: 6803

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Evaluation of the Effectiveness and Impact of Community and Migrant Health Centers: Implementation Phase

ABSTRACT: This comprehensive evaluation of the effectiveness and impact of Community Health Centers (CHCs), begun in 1994, has two components. The content of care component will assess CHC clinical performance and suggest indicators of targets of opportunity for improving patient health status. The Medicaid analysis portion of the study is using Medicaid claims data from seven States (one with Medicaid managed care) to examine three questions: (1) Is there a difference in case mix between Medicaid beneficiaries using CHCs and beneficiaries using other providers of primary care? (2) Are there differences in utilization and expenditures between CHC users and non-users, and what is the effect of adjusting for case mix on these differences? (3) How do CHC characteristics contribute to differences in use and expenditures among CHC users? The findings from this study will identify opportunities and challenges for health centers in both fee-for-service and managed care settings. (See PIC ID 4918)

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Elizabeth Darling

PHONE NUMBER: 301-594-4308

PIC ID: 4918.1

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

PROJECTED DATE OF COMPLETION: 8/31/99

TITLE: Evaluation of the Relationship Between Enabling Services and Patient Access and Outcomes

ABSTRACT: Community and Migrant Health Centers (C/MHCs) provide extensive enabling services to facilitate access to care for vulnerable populations. These services, which include transportation, translation, case management, health education, nutrition counseling and outreach, are not typically reimbursed under managed care. The purpose of this study is to analyze the types and levels of enabling services provided by C/MHCs, how these services have changed over time, and whether enabling services improve outcomes and reduce costs. Study findings will be used to inform national program expectations and to guide C/MHCs in structuring their enabling services to maximize access to primary care and preventive services.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Vilma Cokkinides, Ph.D.

PHONE NUMBER: 301-594-3730

PIC ID: 7126

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

PROJECTED DATE OF COMPLETION: 12/15/99

TITLE: Health Status Outcomes for the Bureau of Primary Health Care: A Pilot Study Assessing Physiologic Measures Through Medical Record Review

ABSTRACT: Through a review of medical records, this study will assess changes in health status among a sample of adult patients of Community Health Centers (CHCs). The conditions selected for evaluation are hypertension and diabetes mellitus. The methodology addresses: (1) the definition of a CHC "user"; (2) confirmation of a diagnosis; (3) patient stratification by severity and/or onset of the condition; (4) expected attrition rates; (5) inclusion of insurance/payer status as a control variable; (6) the time frame in which the two conditions will be measured; (7) protocol for sampling medical records; (8) development of an index of co-morbidities; (9) preparation of a taxonomy of CHC site characteristics; and (10) the appropriate instrument for extracting pertinent data. This project continues the HRSA's systematic effort to identify health status outcomes that may be used to measure the effectiveness of primary care programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 6802

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 10/31/99

TITLE: Health Status Outcome Measures for the Bureau of Primary Health Care: Examination of Episodes of Care for Diabetes, Hypertension, Asthma and Other Ambulatory Care Sensitive Conditions Using State Medicaid Research Files

ABSTRACT: A consensus conference in December, 1995 recommended the use of Medicaid data to examine changes in utilization patterns for Community Health Center (CHC) patients diagnosed with ambulatory care sensitive conditions (ACSC). These are conditions which frequently can be managed with timely and effective treatment in outpatient settings, thus preventing the need for hospitalization. The purpose of this study is to compare episodes of ambulatory care for CHC users to those of non-CHC users when both have been hospitalized with a primary diagnosis of diabetes, hypertension, asthma, or other ACSC, as well as when neither has been hospitalized. A previous study (See PIC ID 6001) showed that Medicaid beneficiaries who received most of their care from CHCs had a lower hospitalization rate for ACSCs than did non-CHC users. Findings of the current study will improve understanding as to why CHC users experience lower hospitalization rates for ACSCs, and may have different patterns of ambulatory care use. Findings should also identify the major strengths and limitations of the State Medicaid Research Files for examining episodes of care for a comparison of CHC users and non-CHC users.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 7127

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

PROJECTED DATE OF COMPLETION: 6/30/00

Health Professions

TITLE: Design for Evaluation of the NY Medicare Graduate Medical Education Payment Demonstration and Related Provisions in P.L. 105-33. BBA of 1997

ABSTRACT: The purpose of this study, which is jointly sponsored by the Health Resources and Services Administration (HRSA) and the Health Care Financing Administration (HCFA) and managed by HCFA, is to develop: (1) a design for evaluating a demonstration financed by the HCFA in 1997 in selected New York State teaching hospitals, and (2) recommendations for evaluating Phase II of the demonstration, along with related provisions of the Balanced Budget Act (BBA). The 42 hospitals in the current demonstration volunteered to reduce the number of resident physicians in training by 20 percent or more over a five-year period, while maintaining or increasing the proportion in their primary care program. In return, the HCFA provides transition payments of $400 million over six years. The hospitals repay the payments if they fail to meet their reduction targets. The BBA provides similar options for hospitals in other States and modifies the transitional payment policies by eliminating payment for the first five percent reduction in the full-time equivalent residents. Evaluation objectives include: (1) performance in meeting targets for reductions, (2) impact on access and efficiency, and (3) potential spillover effects on non-participating hospitals.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 7132

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

PROJECTED DATE OF COMPLETION: 6/1/99

TITLE: Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program

ABSTRACT: Professional Nurse Traineeship (PNT) grants are awarded to eligible institutions for the support of students in advanced nursing education. Traineeships are then awarded by the institutions to individuals enrolled in masters and doctoral programs to prepare for practice as advanced practice nurses. These funds are distributed to institutions based on a formula that incorporates three statutory funding factors. The factor to be studied is the statutory general funding preference which is given to institutions that demonstrate either (1) a high rate of placing graduates in medically underserved communities (MUCs), or (2) a significant increase in the rate of placing graduates in such settings. Comparisons of employment sites of graduates in school receiving the preference with those of graduates in schools not receiving the preference will indicate the significance of a funding preference in promoting program objectives of increasing access to care in underserved communities. The data collected through this study will help to formulate programmatic and policy recommendations designed to strengthen and increase the effectiveness of the PNT program.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Ayah E. Johnson, Ph.D.

PHONE NUMBER: 301-443-6315

PIC ID: 7130

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

PROJECTED DATE OF COMPLETION: 4/28/00

TITLE: Effectiveness of Diverse Methods of Technical Assistance to Historically Black Colleges and Universities

ABSTRACT: The participation of Historically Black Colleges and Universities (HBCUs) in program activities is vital to the mission of the Health Resources and Services Administration (HRSA), given the traditional focus of HBCUs on providing outreach to low-income and minority communities for a wide range of educational and professional opportunities. However, HBCUs have often reported the need for a clearer understanding of the requirements associated with HRSA solicitations and approaches to meeting those requirements. This study will assess the relative merits of providing programmatic technical assistance through regional workshops, against provision through institution-specific guidance on site. This evaluation will help to highlight those technical assistance approaches that can enhance the participation of HBCUs in HRSA grant/contract programs.

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Roscoe Dandy, Dr.P.H.

PHONE NUMBER: 301-443-6582

PIC ID: 7123

PERFORMER ORGANIZATION: Institute for College Research Development and Support, Silver Spring, MD

PROJECTED DATE OF COMPLETION: 12/31/99

HIV/AIDS Services

TITLE: Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources

ABSTRACT: The purpose of this study is to compare demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Increasing demands for accountability, shifts in the populations affected by the HIV epidemic, and the development of effective combination therapies have been associated with increases in the number of people living with HIV who will need care for longer periods of time. While a great deal is known about the types of services and providers supported under the CARE Act, the demographic characteristics of, and services used by, patients are less clear because of a lack of client-level reporting mechanisms. The findings of this study will help to develop an empirical basis for program accountability and performance measurement.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Richard Conviser, Ph.D.

PHONE NUMBER: 301-443-3075

PIC ID: 7123

PERFORMER ORGANIZATION: Johns Hopkins Medical Institutions, Baltimore, MD

PROJECTED DATE OF COMPLETION: 7/31/99

TITLE: Development of Estimates of Unduplicated AAR Client Counts Based on Client Level Demonstration Projects

ABSTRACT: This study is developing a method for estimating unduplicated counts of clients served by Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Title I and Title II grantees. Grantees use the Annual Administrative Report (AAR) to submit data about the demographic characteristics of organizations providing services under these Titles. Grantees obtain these data directly from providers, who provide unduplicated counts of the people they serve. However, since clients often visit multiple providers, duplication in counts inevitably results as grantees aggregate data across providers. Reliable estimates of unduplicated counts of CARE Act clients will provide a basis for preparing accurate budgets, performance plans, and other documents, and will provide a clearer picture of the scope of the population served by the CARE Act.

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: John Milberg

PHONE NUMBER: 301-443-8729

PIC ID: 6808

PERFORMER ORGANIZATION: Harvard Pilgrim Health Care Boston, MA

PROJECTED DATE OF COMPLETION: 7/31/99

Managed Care

TITLE: Evaluation of Managed Care and Vulnerable Populations

ABSTRACT: This study concerns participation in and impact of Medicaid managed care on providers (and the populations they serve) funded under two Health Resources and Services Administration (HRSA) programs: the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, and the Maternal and Child Health Block Grant. The findings will be used to improve technical assistance and develop policies to better support these providers in managed care settings.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, Sc.D.

PHONE NUMBER: 301-443-1512

PIC ID: 6816

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/1/99

TITLE: Managed Care and the Safety Net Providers

ABSTRACT: This study is examining the impact of Medicaid managed care and other systemic changes in health care coverage on the future integrity and viability of safety net providers operating in primary care settings, including those funded by the Health Resources and Services Administration (HRSA). These HRSA programs include Community and Migrant Health Centers, Maternal and Child Health programs, and the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act programs. The study also includes public hospitals and health departments. Findings and recommendations will be disseminated nationally through a variety of mechanisms, including publication of the report and a series of public forums and workshops.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, Sc.D.

PHONE NUMBER: 301-443-1512

PIC ID: 6815

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/1/99

Maternal and Child Health

TITLE: National Evaluation of the Healthy Start Program

ABSTRACT: The Healthy Start program was launched in 1991 by the Health Resources and Services Administration (HRSA) of the U.S. Public Health Service to demonstrate innovative ways to reduce infant mortality in areas with some of the highest rates. The National Evaluation consists of a cross-site process study and an outcome study of the 15 original sites. The final report of the process evaluation, "The Implementation of Healthy Start: Lessons for the Future," was completed in FY 1998 (See PIC ID 5610.1). The outcome evaluation is assessing infant mortality and birth outcomes, including improvements in the adequacy of prenatal care, and the incidence of low and very low birth weight and pre-term deliveries compared to matched comparison communities. The final report will also include findings from a Survey of Postpartum Women, and from special reports on Fetal and Infant Mortality Reviews, Health Education, and Case Management. Study results will be used to improve the Healthy Start projects funded subsequently, and will be shared with the public health community for application in other settings.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 5610

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/30/00

National Health Service Corps

TITLE: Effectiveness of the National Health Service Corps

ABSTRACT: The purpose of this project is to evaluate the effectiveness of the National Health Service Corps (NHSC), including examination of the various mechanisms for training and recruiting providers, placing them in underserved areas, and retaining them in primary care and related professions. Prior studies have tended to define NHSC "effectiveness" narrowly, e.g., using retention at a particular site as a measure. Current and alumni clinicians and administrators of sites staffed with NHSC clinicians are providing information for the study. Study findings will be used in policy development and program management, and in developing the proposal for new authorizing legislation, needed as of October 2000.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Richard Niska, M.D.

PHONE NUMBER: 301-594-4204

PIC ID: 6357

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/30/00

State Children's Health Insurance Program

TITLE: An Analysis of Implementation Issues Relating to CHIP Cost-Sharing Provisions for Certain Targeted Low-Income Children

ABSTRACT: Title XXI of the Social Security Act permits State Children's Health Insurance Programs (CHIP) to impose cost sharing on beneficiaries, when the program is not an expansion of the State's Medicaid program. Under Medicaid, cost-sharing for services to children is prohibited. This project analyzes cost-sharing models that can be used by States to track cumulative out-of-pocket expenditures for State CHIP activities and employer-based health insurance plans that participate in CHIP; and reviews findings from studies that examine the relationships among health insurance premiums, cost-sharing arrangements, and enrollment and utilization by low income families. Findings will inform guidance for States in designing cost-sharing provisions for the CHIP plans.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Marcia K. Brand, Ph.D.

PHONE NUMBER: 301-443-4619

PIC ID: 7129

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: The Impact of the State Children's Health Insurance Program on Selected Community Health Centers and Maternal and Child Health Programs

ABSTRACT: This study is assessing: (1) the effect of the State Children's Health Insurance Program (CHIP) on the insurance status of children served by selected Community Health Centers (CHCs) and Maternal and Child Health (MCH) programs, and (2) the impact on the extent to which these children enter or remain in care at selected CHC and MCH sites. Issues to be addressed include: (1) the insurance history of children who have used or are new to the site; (2) the continuous nature and time span of the coverage; (3) insurance characteristics of, and source of care for, children who are no longer users; and (4) the characteristics of sites relative to their ability to enroll and/or retain newly insured children. Previous analysis of CHC encounter files documented significant volatility in coverage, with patients going on and off coverage as many as five times in a given year. Study findings will provide a framework for future investigation, develop a transferable methodology for use by States and sites, and help to assess the extent to which CHIP has affected the insurance coverage of children served by CHCs and MCH programs.

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Vilma Cokkinides, Ph.D.

PHONE NUMBER: 301-594-3730

PIC ID: 7125

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/30/00

Crosscutting

TITLE: A Pilot Study to Identify Infrastructure Building Across HRSA Programs

ABSTRACT: This pilot study has two purposes: (1) to describe how Health Resources and Services Administration (HRSA) programs contribute to the development of a health care infrastructure at the local level, and (2) to test the use of a site visit methodology to gather this information. Site visits to Boston, Cleveland and Phoenix are providing information on interactions among HRSA programs--that is, whether multiple programs combine in a mutually reinforcing fashion, operate independently, or work at cross-purposes. Among other topics, the study is also exploring whether the impact of HRSA investments is larger due to the presence of several programs, and is seeking suggestions from the field about ways that HRSA program management may be improved. Findings will improve HRSA's understanding of the interaction and effects of its programs in the context of health care system changes and shifting population needs, and will contribute to performance measurement.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 6814

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Crosscutting HRSA-Wide Performance Strategy

ABSTRACT: Beginning in 1995, the Health Resources and Services Administration (HRSA) has conducted an extensive series of projects to identify meaningful performance indicators and develop related data sources as required by the Government Performance and Results Act (GPRA). Building on earlier program-specific work, this study is developing a structure for arraying performance goals and accompanying measures across the agency. Results will be used initially in drafting the FY 2001 performance plan and budget.

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 7131

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/30/99

Evaluations in Progress

Medicare

TITLE: Design for Evaluation of the New York Medicare Graduate Medical Education Demonstration and Related Provisions in Public Law 105-33

ABSTRACT: This contract provides recommendations for designing an evaluation of the waivers provided to several New York State teaching hospitals in 1997. These hospitals volunteered to reduce the number of resident physicians in training by 20 percent or more over a five-year period. This is in return for transition payments for a portion of the Medicare payments that are foregone when the numbers of full time equivalent interns and residents declines.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: William Sobaski

PHONE NUMBER: 410-786-6588

PIC ID: 7178

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

PROJECTED DATE OF COMPLETION: 3/29/99

TITLE: Evaluating Alternative Risk Adjusters for the Medicare Risk Program

ABSTRACT: This project developed a risk adjuster that is based on: (1) a history of serious Disease (including cancer, heart Disease or stroke) and severity of illness; (2) the length of time since the last hospital stay; and (3) comorbidities. The predictive power from using history of serious illness will be compared to the predictive power of two existing risk adjusters--the diagnostic-cost-group and ambulatory-care-group models. Both predictive accuracy and operational features will be compared.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Levy, Jesse

PHONE NUMBER: 410-786-6600

PIC ID: 7190

PERFORMER ORGANIZATION: Virginia Commonwealth University, Dept of Health Administration Richmond, VA

PROJECTED DATE OF COMPLETION: 3/30/99

TITLE: Evaluation of Phase II of the Home Health Agency Prospective Payment Demonstration

ABSTRACT: This demonstration is testing two alternative methods of paying home health agencies (HHA) on a prospective basis for services furnished under the Medicare program: (1) per visit by type of HHA visit discipline (Phase I), and (2) payment per episode of Medicare-covered home health care (Phase II). The evaluation will combine estimates of program impacts on cost, service use, access and quality, with detailed information on how agencies actually change their behavior to produce a full understanding of what would happen if prospective payment replaced the current cost-based reimbursement system nationally.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Ann Meadow

PHONE NUMBER: 410-786-6602

PIC ID: 7203

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

PROJECTED DATE OF COMPLETION: 9/29/99

TITLE: Evaluation of the Community Nursing Organization Demonstration

ABSTRACT: This demonstration tests a capitated, nurse-managed system of care. The two fundamental elements of the CNO are capitated payment and nurse case management. The evaluation tests the feasibility and effect on patient care of this capitated, nurse case-managed service delivery model. Both qualitative and quantitative components are included.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Melissa Hulbert, M.P.S.

PHONE NUMBER: 410-786-8494

PIC ID: 7205

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Decision Making in Managed Care Organizations

ABSTRACT: This project examines a broad range of managed-care decision making strategies, their implications for the development and diffusion of new technologies, and their impact on future health care costs, especially Medicare program costs.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Brigid Goody

PHONE NUMBER: 410-786-6640

PIC ID: 7170

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

PROJECTED DATE OF COMPLETION: 1/28/00

TITLE: NAS/Institute of Medicine Study on Preventive Services

ABSTRACT: This is an analysis of the expansion or modification of preventive or other services covered by Medicare. The study includes coverage of: (1) nutrition therapy, including parenteral and enteral nutrition; (2) skin cancer screening; (3) medically necessary dental care; (4) routing patient care costs for beneficiaries enrolled in approved clinical trial programs; and (5) elimination of time limitation for coverage of immunosuppressive drugs for transplant patients. The IOM will consider both short-term and long-term benefits and costs to the Medicare program.

AGENCY SPONSOR: Office of Clinical Standards and Quality

FEDERAL CONTACT: Kathy Pirotte

PHONE NUMBER: 410-786-6774

PIC ID: 7174

PERFORMER ORGANIZATION: National Academy of Sciences Washington, D.C.

PROJECTED DATE OF COMPLETION: 2/28/00

TITLE: Evaluation of the Medicare Choice Demonstration

ABSTRACT: The HCFA is in the process of implementing the Medicare Choice Demonstration to test the feasibility and desirability of new types of managed care plans for Medicare, such as integrated delivery systems and preferred provider organizations. The purpose of this evaluation project is to provide a detailed assessment of the overall demonstration project, which looks specifically at beneficiary experiences in the demonstration, cost and use of services within the demonstration sites and quality of care issues.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Renee Mentnech

PHONE NUMBER: 410-786-6692

PIC ID: 6292

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

PROJECTED DATE OF COMPLETION: 6/30/00

TITLE: Evaluation System for Medicare + Choice

ABSTRACT: The purpose of this task order is to design and implement a strategy for tracking and evaluating the performance of managed health care organizations, both nationwide and within specific markets. Dimensions of performance to be tracked include beneficiary access to managed care, as well as the cost and quality of services delivered to beneficiaries by managed care organizations.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Brigid Goody

PHONE NUMBER: 410-786-6640

PIC ID: 7169

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

PROJECTED DATE OF COMPLETION: 9/15/00

TITLE: Normative Standards for Medicare Home Health Utilization

ABSTRACT: This task order will develop a model that uses scientifically based, normative standards to determine thresholds for payment authorization within home health service categories, and will test the model to determine the extent of its validity and reliability. The contractor will also recommend an appropriate demonstration design to evaluate the use of the model by fiscal intermediaries prior to full implementation.

AGENCY SPONSOR: Office of Clinical Standards and Quality

FEDERAL CONTACT: Mary Wheeler

PHONE NUMBER: 410-786-6892

PIC ID: 7175

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 9/24/00

TITLE: Evaluation of Medicare CAHPS/Bulletin/Medicare & You

ABSTRACT: The purpose of the study is to learn how effective print materials are in informing beneficiaries about the Medicare program. This study will cover the new Balanced Budget Act health plan choices and the quality of care provided by local health care plans as rated by their peers. It will be confined to about 2,400 randomly selected residents of the Kansas City area.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Sherry Terrell

PHONE NUMBER: 410-786-6601

PIC ID: 7168

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: Evaluation of the Evercare Demonstration Program

ABSTRACT: The major goals of the Evercare demonstration are to reduce medical complications and dislocation trauma resulting from hospitalization, and to save the expense of hospital care when patients can be managed safely in nursing homes with expanded services. The EverCare evaluation will combine data from site case studies, a network analysis of nurse practitioners, participant and caregiver surveys and participant utilization data to examine: (1) a comparison of enrollees and non-enrollees; (2) the process of implementation and operation of EverCare changes in the care process, as well as quality of care; (3) effects of the demonstration on enrollees' health and health care utilization; (4) satisfaction of enrollees and their families; and (5) effects of the demonstration on the costs of care, as well as payment sources.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Edgar Peden

PHONE NUMBER: 410-786-6594

PIC ID: 7185

PERFORMER ORGANIZATION: University of Minnesota Minneapolis, MN

PROJECTED DATE OF COMPLETION: 3/30/01

TITLE: Department of Defense Subvention Demonstration Evaluation

ABSTRACT: Under this demonstration, enrollment in the Department of Defense's (DoD's) Senior Prime plan is offered to military retirees over age 65 who live within 40 miles of the primary care facilities of one of the six sites, have recently used military health facility services and are enrolled in Medicare Part B. Medicare makes a capitation payment to the DoD for each enrollee, but the DoD must maintain a level of effort for health care services to all retirees who are also Medicare beneficiaries, whether or not they choose to enroll. The evaluation will examine issues in four basic areas: (1) enrollment demand, (2) enrollee benefits, (3) cost of the program, and (4) impacts on other DoD and Medicare beneficiaries.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: William Sobaski

PHONE NUMBER: 410-786-6588

PIC ID: 7171

PERFORMER ORGANIZATION: Rand Corporation Santa Monica, CA

PROJECTED DATE OF COMPLETION: 3/2/02

TITLE: End Stage Renal Disease (ESRD) Capitation Demonstration

ABSTRACT: This project will use survey, claims and medical records data to evaluate the efficacy and cost effectiveness of permitting Medicare beneficiaries with end stage renal Disease (ESRD) to enroll in managed care.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Michael Kendix

PHONE NUMBER: 410-786-6631

PIC ID: 7182

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 5/13/02

TITLE: Evaluation of the Medical Savings Account Demonstration

ABSTRACT: This evaluation of the Medical Savings Account (MSA) demonstration will compare the experiences of MSA enrollees with other Medicare beneficiaries. The evaluation will address access to care and determine if MSAs promote an inappropriately low use of services.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Michael Kendix

PHONE NUMBER: 410-786-6631

PIC ID: 7172

PERFORMER ORGANIZATION: Barents Group, KPMG Peat Marwick LLP Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/27/03

Medicaid

TITLE: Evaluation of the Municipal Health Services Program

ABSTRACT: The Services Program (MHSP) is a four-site demonstration (Baltimore, Maryland; Cincinnati, Ohio; San Jose, California; and Milwaukee, Wisconsin) to improve access to primary care in underserved urban areas, and to reduce the costs of health care. Since 1979 the program has undergone two evaluations. The project focuses on: (1) consideration of costs to Medicaid and other payers if the MHSP is terminated; (2) access to care, (3) outcomes, (4) beneficiary satisfaction, and (5) utilization differences among different populations being served by the MHSP sites. Because of the long length of this mandated demonstration, three additional questions are also being addressed: (1) What can be learned from the MHSP experience about the demand for managed systems of care for the elderly? (2) How critical are copay-exempted pharmacy and dental benefits for low-income elderly in encouraging enrollment in systems of care that limit choice of primary care physician? (3) What is the future of community-based systems of care? The project is being carried out primarily through case studies. Cost report data will be used and supplemented with Medicare program data.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Spike Duzor

PHONE NUMBER: 410-786-1794

PIC ID: 7211

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Comparison of Pharmaceutical Quality of Care for Pediatric Asthma

ABSTRACT: This project examines the quality of care in the treatment of asthma in Medicaid children in Alabama and Michigan. It assesses the extent of prescribing problems for pediatric asthma in these Medicaid programs.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mary E. Benedict

PHONE NUMBER: 410-786-7724

PIC ID: 7192

PERFORMER ORGANIZATION: University of Alabama, School of Public Health Birmingham, AL

PROJECTED DATE OF COMPLETION: 3/30/99

TITLE: Evaluation of Oregon Medicaid Reform Demonstration

ABSTRACT: The Oregon Medicaid Reform Demonstration seeks to increase the number of individuals with access to affordable health care services and to contain State and Federal expenditures for health care. Under the demonstration, Medicaid coverage is made available to all State residents with family incomes less than, or equal to, the Federal poverty level (FPL) and who meet an assets test. The objectives of the evaluation are to determine the impact on: (1) access to care, (2) quality of care, (3) enrollee satisfaction, and (4) the cost of care, for both new enrollees and those previously enrolled in Medicaid. To the extent possible, the impact of the prioritized list and the increased use of managed care will be identified separately. Other areas of interest include: (1) the impact of the demonstration on the number of uninsured in the State, (2) provider participation and satisfaction, and (3) the number of private employers who offer health insurance as a fringe benefit.

AGENCY SPONSOR: Office of Strategic Planning

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

PHONE NUMBER: 410-786-6629

PIC ID: 6166

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

PROJECTED DATE OF COMPLETION: 9/29/99

TITLE: Evaluation of the Diamond State Health Plan

ABSTRACT: The original purpose of this project was to evaluate the Delaware Health Care Partnership for Children, specifically the effectiveness of the demonstration in reaching its goal of improving access to, and the quality of, health care services delivered to Medicaid-eligible children in a cost-effective way. In May 1996, the contract was modified to focus more generally on the impacts of the Diamond State Health Plan (DSHP) on children, including children with special health care needs (the original evaluation had been limited to the Nemours Children's Clinics). The goal of the evaluation was broadened to assess whether this section 1115 demonstration's objective of increased access to high-quality, cost-effective care for Medicaid children is being met.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine

PHONE NUMBER: 410-786-7718

PIC ID: 7207

PERFORMER ORGANIZATION: Research Triangle Institute Washington, DC

PROJECTED DATE OF COMPLETION: 9/29/99

TITLE: Evaluation of the Home & Community-Based Services Waiver Program

ABSTRACT: The Home and Community-Based Services (HCBS) waiver program has been operating since 1981 and has experienced tremendous growth in recent years. The percent of Medicaid long-term care spending devoted to HCBS has increased from 10 percent to 19 percent (between the financial and beneficiary-level impacts of the program) in over a decade. The aim of this task order is to gain a better understanding of the broader HCBS waiver program and determine what programmatic mechanisms have been successful.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Melissa Hulbert, M.P.S.

PHONE NUMBER: 410-786-8494

PIC ID: 7208

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/29/99

TITLE: Evaluation of the Demonstration Entitled Delaware Health Care Partnership for Children

ABSTRACT: This project will evaluate whether the demonstration is reaching its goal of improving access to, and the quality of, health care services to Medicaid-eligible children in a cost-effective way. The State believes that, by enrolling children in a managed care system operated by the Nemours Foundation, patients will reap the benefits from a higher level of coordinated care, while the State and Federal government will benefit from lower Medicaid costs.

AGENCY SPONSOR: Center for Medicaid and State Operations

FEDERAL CONTACT: Joan Peterson

PHONE NUMBER: 410-786-0621

PIC ID: 6288

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Evaluation of the District of Columbia's Demonstration Project: Managed Care System for Disabled and Special Needs Children

ABSTRACT: This project tests the efficacy of a managed care service delivery system designed for children and adolescents under the age of 22 who are eligible for Medicaid and are classified as disabled according to Supplemental Security Income (SSI) Program guidelines. The study represents a unique opportunity to examine the experiences of a managed care system with voluntary enrollment of children with disabilities.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Paul W. Eggers

PHONE NUMBER: 410-786-6691

PIC ID: 7187

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 3/24/00

TITLE: Impact of Welfare Reform on Medicaid Populations

ABSTRACT: This project will develop data and examine the impact of welfare reform on Medicaid eligibility, utilization and payments for various populations. It will study the effects of the following four changes: (1) de-linking Aid to Families with Dependent Children (AFDC) and Medicaid eligibility, (2) terminating access to Medicaid for some legal immigrants because of lost eligibility for Supplementary Security Income (SSI), (3) barring most future legal immigrants from Medicaid, and (4) narrowing Medicaid eligibility for selected disabled children and disabled alcohol and substance abuse populations.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine

PHONE NUMBER: 410-786-7718

PIC ID: 7183

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

PROJECTED DATE OF COMPLETION: 9/29/00

TITLE: Evaluation of the State Health Reform Demonstrations (OH, MN)

ABSTRACT: This project will evaluate Hawaii, Rhode Island, Tennessee, Oklahoma and Maryland State Health Reform Demonstrations. The evaluator is conducting State-specific and cross-State analyses of demonstration impacts on utilization, insurance coverage, public and private expenditures, quality, access and satisfaction.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine

PHONE NUMBER: 410-786-7718

PIC ID: 6289.1

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: Evaluation of the Ohio Behavioral Health Program

ABSTRACT: This project will address the following two components: (1) a focused evaluation of the behavioral health component of OhioCare, and (2) a case study of the implementation of Ohio's section 1115 State health reform demonstration, OhioCare. The case study will complement the focused evaluation by providing a context for findings and supplementing findings.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Penny Pine

PHONE NUMBER: 410-786-7718

PIC ID: 7184

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

PROJECTED DATE OF COMPLETION: 9/14/01

Crosscutting

TITLE: Economic and Cost-Effectiveness Studies for the U.S.

ABSTRACT: This interagency agreement (IAA) provided funds to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to cover the costs of having the coordinating center for the U.S. Renal Data System (USRDS) perform economic and cost-effectiveness studies. The NIDDK contracted with the University of Michigan to be the coordinating center for 5 years. The coordinating center conducts cost or cost-effectiveness components for at least four existing data studies and for one special study focused on economic issues.

AGENCY SPONSOR: Office of Clinical Standards and Quality

FEDERAL CONTACT: Connie Cole

PHONE NUMBER: 410-786-0257

PIC ID: 7198

PERFORMER ORGANIZATION: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD

PROJECTED DATE OF COMPLETION: 6/1/99

TITLE: Performance Assessment of Web Sites

ABSTRACT: This task order: (1) evaluates, (2) sets up an ongoing system for feedback from consumers, and (3) makes recommendations for future changes concerning two web sites sponsored by the Department of Health and Human Services. The web sites include www.medicare.gov, which was developed by the Health Care Financing Administration (HCFA), and www.healthfinder.gov, which was developed by the Office of Disease Prevention Health Promotion in collaboration with other agencies.

AGENCY SPONSOR: Center for Beneficiary Services

FEDERAL CONTACT: Elizabeth Goldstein, Ph.D.

PHONE NUMBER: 410-786-6665

PIC ID: 7212

PERFORMER ORGANIZATION: Barents Group, KPMG Peat Marwick LLP Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/2/99

TITLE: Evaluation of Customer Service Projects

AGENCY SPONSOR: Center for Beneficiary Services

FEDERAL CONTACT: Elizabeth Goldstein, Ph.D.

PHONE NUMBER: 410-786-6665

PIC ID: 7201

PERFORMER ORGANIZATION: Booz, Allen and Hamilton Bethesda, MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Maximizing the Effective Use of Telemedicine: A Study of the Effects, Cost Effectiveness, and Utilization Patterns of Consultation via Telemedicine

ABSTRACT: This project is conducting an evaluation of the Health Care Financing Administration's (HCFA's) medicare payment demonstration. The evaluation examines the medical effectiveness, patient and provider acceptance, and costs associated with telemedicine services, as well as their impact on access to care in rural areas.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Joel Greer

PHONE NUMBER: 410-786-6695

PIC ID: 6303

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 9/28/00

TITLE: Evaluation of Group-Specific Volume Performance Standards Demonstration

ABSTRACT: The goal of the demonstration is to test the feasibility of this partial risk bearing payment arrangement between the Health Care Financing Administration and qualifying physician-based organizations in the fee-for-service (FFS) market. FFS rules apply within the context of a performance target, beneficiaries are not enrolled, and physician-sponsored organizations develop structures and processes to manage the services and cost of care received by FFS patients.

AGENCY SPONSOR: Center for Health Plans and Providers

FEDERAL CONTACT: Teresa De Caro

PHONE NUMBER: 410-786-6604

PIC ID: 7181

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

PROJECTED DATE OF COMPLETION: 6/1/01

TITLE: Evaluation of Competitive Bidding Demonstration for DME and POS

ABSTRACT: This project will test the feasibility and effectiveness of establishing Medicare fees for durable medical equipment (DME) and Prosthetics, Prosthetic devices, Orthotics and supplies (POS) through a competitive bidding process. The evaluation will examine competitive bidding impacts in terms of expenditures, quality, access and product diversity, as well as other impacts of the demonstration.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Ann Meadow

PHONE NUMBER: 410-786-6602

PIC ID: 7173

PERFORMER ORGANIZATION: University of Wisconsin Madison, WI

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Multi-State Evaluation of Dual Eligibles Demonstrations

ABSTRACT: This evaluation is designed to assess the impact of dual eligible demonstrations in the States of Minnesota, Colorado, Wisconsin and New York. Analyses will be conducted for each State and across States.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Noemi Villafranca

PHONE NUMBER: 410-786-6662

PIC ID: 7186

PERFORMER ORGANIZATION: University of Minnesota Minneapolis, MN

PROJECTED DATE OF COMPLETION: 9/29/02

Home Health Care

TITLE: Maximizing the Cost Effectiveness of Home Health Care

ABSTRACT: Rapid growth in home health use has occurred despite limited evidence about the necessary volume of HHC needed to achieve optimal patient outcomes, and whether or not it substitutes for more costly institutional care. The central hypotheses of this study are that: (1) volume-outcome relationships are present in HHC for common patient conditions, (2) upper and lower volume thresholds define the range of services most beneficial to patients, and (3) a strengthened physician role and better integration of HHC with other services during an episode of care can optimize patient outcomes while controlling costs.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Ann Meadow

PHONE NUMBER: 410-786-6602

PIC ID: 7179

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 12/1/98

Quality of Care

TITLE: Development of a Global Quality Assessment Tool for Managed Care Health Plans

ABSTRACT: This project will develop and test a clinically based method for assessing the quality of care delivered for a broad range of services in managed care health plans. It will focus on the quality of care delivered to children and women under 45 years of age.

AGENCY SPONSOR: Office of Strategic Planning

FEDERAL CONTACT: Mary E. Benedict

PHONE NUMBER: 410-786-7724

PIC ID: 7194

PERFORMER ORGANIZATION: Rand Corporation Santa Monica, CA

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Evaluation of the Nursing Home Case-Mix and Quality Demonstration

ABSTRACT: This project will help the HCFA determine the impact of specific ancillary services on the Resource Utilization Groups (RUG). It analyzes and potentially refines the extensive care and other categories to determine the impact on the prospective payment system for skilled nursing homes.

AGENCY SPONSOR: Center for Health Plans and Providers

FEDERAL CONTACT: Don Sherwood

PHONE NUMBER: 410-786-6651

PIC ID: 6307

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 3/29/00

TITLE: Measurement, Indicators, and Improvement of the Quality of Life in Nursing Homes

ABSTRACT: This task order will design an evaluation to examine quality of life (QOL) issues for nursing home residents. It will focus on three topics: (1) measuring and developing indicators of QOL, (2) developing quality improvement programs for nursing home QOL, and (3) evaluating environmental design influences on QOL.

AGENCY SPONSOR: Office of Clinical Standards and Quality

FEDERAL CONTACT: Mary Pratt

PHONE NUMBER: 410-786-6867

PIC ID: 7176

PERFORMER ORGANIZATION: University of Minnesota Minneapolis, MN

PROJECTED DATE OF COMPLETION: 11/30/00

TITLE: Project Demonstrating and Evaluating Alternative Methods to Assure and Enhance the Quality of Long-Term Care Services for Persons with Developmental Disabilities Through Performance Based Contracts with Service Providers

ABSTRACT: This task order will develop and validate a comprehensive set of performance measures and indicators of quality for institutional post-acute and long-term care settings. The post-acute settings involved are: SNF short-stay units, inpatient rehabilitation facilities (which include hospital-based rehabilitation units) and long-term care hospitals.

AGENCY SPONSOR: Center for Medicaid and State Operations

FEDERAL CONTACT: Phyllis Nagy

PHONE NUMBER: 410-786-6646

PIC ID: 6310

PERFORMER ORGANIZATION: Abt Associates, Inc. Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Evaluating the Use of Quality Indicators in the Long Term Care Survey Process

ABSTRACT: The Health Care Financing Administration's (HCFA's) goal is to move towards a regulatory monitoring system that allows for an appropriate use of indicators to evaluate the quality and appropriateness of care provided to residents, and to determine a facility's compliance with the long-term care requirements. This study will develop and test (with volunteering State survey agencies) various options for using a variety of quality indicators to improve the effectiveness and efficiency of the HCFA's facility performance monitoring.

AGENCY SPONSOR: Office of Clinical Standards and Quality

FEDERAL CONTACT: Sue Nonemaker

PHONE NUMBER: 410-786-6825

PIC ID: 7177

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/29/03

Evaluations in Progress

Evaluation Program
The purposes of the Health Resources and Services Administration (HRSA) evaluation program are to enhance strategic and performance planning and reporting, strengthen budget and budget and legislative development, and improve program management. HRSA's evaluation priorities are to (1) develop and support performance measurement, (2) evaluate program effectiveness and impact, (3) assess program implementation, and (4) conduct crosscutting policy analysis, such as environmental assessments.

Performance measurement includes technical assistance and training to strengthen the agency's capacity to respond to the requirements of the Government Performance and Results Act (GPRA), and to lay a foundation for assessing program performance over time. In 1995, HRSA completed a study that established a performance measurement baseline for all operating programs, using a common framework to develop program-specific logic models. HRSA has invested substantial funding over the past four years to provide technical assistance tailored to the needs of individual agency programs. These efforts have been focused on (1) assisting with identification of indicators and measures and development or refinement of data systems; and (2) helping HRSA components to enhance their capacity to plan for, collect, analyze and use the performance information submitted by grantees for program management as well as for preparing GPRA-related documents. One result of this technical assistance was a partnership between the Maternal and Child Health Bureau (MCHB) and the States to develop a set of standard performance measures for the Maternal and Child Health Block Grant that are now being used by MCHB and the States in goal setting, performance reporting, and performance monitoring. Building on these program-specific efforts, work began in 1998 to link the HRSA strategic plan, annual performance plans, and budgets through a set of HRSA-wide performance strategies: eliminate barriers to care; eliminate health disparities; assure quality of care; and improve public health and health care systems. An ongoing project, Crosscutting HRSA-Wide Performance Strategy (PIC 7131), has supported this effort.

Program effectiveness studies assess intermediate and longer-term outcomes or impact of programs in relation to their intended goals. For example, the Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior (PIC 6355) showed that use of community health workers in HRSA-funded programs led to increased access to care for patients, and to increased knowledge of nutrition and other topics to promote a healthy lifestyle. The ongoing study Effectiveness of the National Health Service Corps (PIC 6357) is assessing the program over time, using retention in primary care and related professions as one measure of effectiveness. The National Evaluation of the Healthy Start Program (PIC 5610), also ongoing, is a multi-year study with both outcome and process components. The final report will present findings on the impact of the program on infant mortality and birth outcomes in Healthy Start sites, compared with matched comparison communities. The final report of the process component, The Implementation of Healthy Start: Lessons for the Future (PIC 5610.1), is included among studies completed in FY 1998. Another ongoing project, Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources (PIC 7123), compares demographic characteristics, services needed and provided, and health outcomes between persons receiving CARE Act-funded services and the general treatment population. Finally, the current study, Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program (PIC 7130), is assessing the impact of a funding preference in the grants process on the achievement of the program objective of increasing access to care in underserved communities.

Environmental assessment concerns the ways in which forces in the larger society affect HRSA programs or progress toward achieving crosscutting goals and objectives. For example, the ongoing project Managed Care and Safety Net Providers (PIC 6815) is examining the impact of Medicaid managed care and other changes in health care coverage on the future viability of safety net providers operating in primary care settings, including grantees of HRSA-funded programs such as Community Health Centers. A completed study, Pacific Partnerships for Health: Charting a New Course for the 21st Century (PIC 7157), outlines health status and access issues for the populations of six island jurisdictions and recommends approaches for improvements. Findings from a current project, A Pilot Study to Identify Infrastructure Building Across HRSA Programs (PIC 6814), will improve HRSA's understanding of the interaction and effects of its programs in the context of health system changes and shifting population needs.

Program management studies provide information for developing and implementing a program.

The completed study, Data Collection and Budget Forecasting Strategies: A Primer for State AIDS Drug Assistance Programs (PIC 7159), produced a primer that will enable the State-administered AIDS Drug Assistance Programs to estimate their expenditures more accurately and, consequently, administer the federal funds more efficiently. The Strategies for the Recruitment, Retention, and Graduation of Hispanics into the Baccalaureate Level of Nursing (PIC 6249) developed a model that can be used by institutions of higher education seeking to increase the proportion of Hispanic Americans admitted to baccalaureate programs as their initial entry into nursing education.

In addition, HRSA supports activities to enhance the quality of evaluation agencywide, such as by funding short courses in evaluation for staff, encouraging presentation of HRSA studies at national conferences, and expanding the capacity of agency staff to provide skilled technical assistance on the framing, design and implementation of studies. Broadening of dissemination of study products through a variety of electronic and other approaches also will continue to be a priority for 1999 and 2000.

Summary of Fiscal Year 1998 Evaluations

Community Health Centers

TITLE: ACSC Experience by Usual Source of Health Care: Comparing Medicaid Beneficiaries Who Rely on CHCs with Medicaid Beneficiaries Who Rely on Other Primary Care Providers

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. Medicaid claims data for 1992 from five States were used to provide data on inpatient services, outpatient visits, clinical information and demographics. ACSCs were coded for hospitalization and a list of ICD-9 codes was developed for outpatient ACSC visits. The study sample comprised 16,145 CHC users and 32,594 other Medicaid beneficiaries from the same community as a comparison group. 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 primary providers 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. The study focused on the impact of the first year of Medicaid waiver program implementation on two FQHCs in five States. Site visits were conducted at 10 centers. In addition, data from health plans, primary care associations and State Medicaid programs contributed to the analysis. An exit interview was conducted at some centers, in order to gain consumer perspectives. The study showed that: (1) FQHCs experienced widely varying amounts of change in their population of Medicaid users, 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, in other centers, expanding capacity increased access to services; (5) the financial impact is complex, and is 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) consumers were generally satisfied with FQHC services despite changes resulting from managed care. Study results are being used as a source for identifying factors that will affect health centers in future waiver programs, and to inform 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

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, D.C.

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

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

TITLE: Impact of Community Health Workers on Access, Use of Services and Patient Knowledge and Behavior

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Remy Aronoff

PHONE NUMBER: 301-443-7577

PIC ID: 6355

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

Expanding Access to Care

TITLE: Pacific Partnerships for Health: Charting a New Course for the 21st Century

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Thomas Coughlin

PHONE NUMBER: 301-594-4425

PIC ID: 7157

PERFORMER ORGANIZATION: Institute of Medicine, Washington, D.C.

Health Professions

TITLE: Assessing Ambulatory Primary Care Training: Costs, Methods and Quality

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Emily De Coster

PHONE NUMBER: 301-443-6920

PIC ID: 6358

PERFORMER ORGANIZATION: Northeastern Ohio Universities, Rootstown, OH

TITLE: Consortium Development for Health Professions Training in Community-Based Settings

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Jennifer Burks

PHONE NUMBER: 301-443-6865

PIC ID: 6251

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

TITLE: Strategies for the Recruitment, Retention, and Graduation of Hispanics into the Baccalaureate Level of Nursing

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Ernell Spratley

PHONE NUMBER: 301-443-1915

PIC ID: 6249

PERFORMER ORGANIZATION: CDM Group, Inc. Chevy Chase, MD

HIV/AIDS Services

TITLE: A Review and Synthesis of HIV/AIDS-Related Client Level Evaluation Activities Among Ryan White CARE Act Grantees

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Moses B. Pounds, Ph.D.

PHONE NUMBER: 301-443-2894

PIC ID: 6362

PERFORMER ORGANIZATION: National Association of People with AIDS, Washington, D.C.

TITLE: Data Collection and Budget Forecasting Strategies: A Primer for State AIDS Drug Assistance Programs

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Annette Byrne

PHONE NUMBER: 301-443-6745

PIC ID: 7159

PERFORMER ORGANIZATION: National Alliance of State and Territorial AIDS Directors, Washington, D.C.

TITLE: Evaluating HIV Case Management: Invited Research & Evaluation Papers

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Gloria Weissman

PHONE NUMBER: 301-443-3478

PIC ID: 7158

PERFORMER ORGANIZATION: Sociomedical Resources Associates, Inc. Westport, CT

Maternal and Child Health

TITLE: The Implementation of Healthy Start: Lessons for the Future

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

State Children's Health Insurance Program

TITLE: Sampling the States: Local Reflections on State Implementation of State Children's Health Insurance

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 7068

PERFORMER ORGANIZATION: Coalition for Healthier Cities and Communities, Health Research and Educational Trust, Chicago, IL

Crosscutting

TITLE: Are Consortia/Collaboratives Effective in Changing Health Status and Health Systems? A Critical Review of the Literature

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 7062

PERFORMER ORGANIZATION: Health 2000, Inc., Atlanta, GA

Evaluations in Progress

Community Health Centers

TITLE: Analysis of CHC User/Visit Survey: Selected Conditions

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301-594-4283

PIC ID: 6805

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

PROJECTED DATE OF COMPLETION: 2/4/99

Community Health Centers and National Health Service Corps

TITLE: Construction and Pretest of the Year 2000 User/Visit Survey

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Jerrilynn Regan

PHONE NUMBER: 301-594-4280

PIC ID: 7128

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Effect of Medicaid Managed Care Beneficiary Enrollment and Autoassignment Practices on FQHCs and Their Patients

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Dana Jones

PHONE NUMBER: 301-594-4058

PIC ID: 6803

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Evaluation of the Effectiveness and Impact of Community and Migrant Health Centers: Implementation Phase

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Elizabeth Darling

PHONE NUMBER: 301-594-4308

PIC ID: 4918.1

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

PROJECTED DATE OF COMPLETION: 8/31/99

TITLE: Evaluation of the Relationship Between Enabling Services and Patient Access and Outcomes

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Vilma Cokkinides, Ph.D.

PHONE NUMBER: 301-594-3730

PIC ID: 7126

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

PROJECTED DATE OF COMPLETION: 12/15/99

TITLE: Health Status Outcomes for the Bureau of Primary Health Care: A Pilot Study Assessing Physiologic Measures Through Medical Record Review

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 6802

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 10/31/99

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Barbara Wells, Ph.D.

PHONE NUMBER: 301-594-4463

PIC ID: 7127

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

PROJECTED DATE OF COMPLETION: 6/30/00

Health Professions

TITLE: Design for Evaluation of the NY Medicare Graduate Medical Education Payment Demonstration and Related Provisions in P.L. 105-33. BBA of 1997

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 7132

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

PROJECTED DATE OF COMPLETION: 6/1/99

TITLE: Employment Sites of Nursing Graduates Supported by the Professional Nurse Traineeship Program

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Ayah E. Johnson, Ph.D.

PHONE NUMBER: 301-443-6315

PIC ID: 7130

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

PROJECTED DATE OF COMPLETION: 4/28/00

TITLE: Effectiveness of Diverse Methods of Technical Assistance to Historically Black Colleges and Universities

AGENCY SPONSOR: Bureau of Health Professions

FEDERAL CONTACT: Roscoe Dandy, Dr.P.H.

PHONE NUMBER: 301-443-6582

PIC ID: 7123

PERFORMER ORGANIZATION: Institute for College Research Development and Support, Silver Spring, MD

PROJECTED DATE OF COMPLETION: 12/31/99

HIV/AIDS Services

TITLE: Comparison of Services Received and Health Outcomes for Persons Funded by the CARE Act and by Other Sources

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: Richard Conviser, Ph.D.

PHONE NUMBER: 301-443-3075

PIC ID: 7123

PERFORMER ORGANIZATION: Johns Hopkins Medical Institutions, Baltimore, MD

PROJECTED DATE OF COMPLETION: 7/31/99

TITLE: Development of Estimates of Unduplicated AAR Client Counts Based on Client Level Demonstration Projects

AGENCY SPONSOR: HIV/AIDS Bureau

FEDERAL CONTACT: John Milberg

PHONE NUMBER: 301-443-8729

PIC ID: 6808

PERFORMER ORGANIZATION: Harvard Pilgrim Health Care Boston, MA

PROJECTED DATE OF COMPLETION: 7/31/99

Managed Care

TITLE: Evaluation of Managed Care and Vulnerable Populations

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, Sc.D.

PHONE NUMBER: 301-443-1512

PIC ID: 6816

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/1/99

TITLE: Managed Care and the Safety Net Providers

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Alexander Ross, Sc.D.

PHONE NUMBER: 301-443-1512

PIC ID: 6815

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/1/99

Maternal and Child Health

TITLE: National Evaluation of the Healthy Start Program

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 5610

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/30/00

National Health Service Corps

TITLE: Effectiveness of the National Health Service Corps

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Richard Niska, M.D.

PHONE NUMBER: 301-594-4204

PIC ID: 6357

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/30/00

State Children's Health Insurance Program

TITLE: An Analysis of Implementation Issues Relating to CHIP Cost-Sharing Provisions for Certain Targeted Low-Income Children

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Marcia K. Brand, Ph.D.

PHONE NUMBER: 301-443-4619

PIC ID: 7129

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: The Impact of the State Children's Health Insurance Program on Selected Community Health Centers and Maternal and Child Health Programs

AGENCY SPONSOR: Bureau of Primary Health Care

FEDERAL CONTACT: Vilma Cokkinides, Ph.D.

PHONE NUMBER: 301-594-3730

PIC ID: 7125

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/30/00

Crosscutting

TITLE: A Pilot Study to Identify Infrastructure Building Across HRSA Programs

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Jessica Townsend

PHONE NUMBER: 301-443-0371

PIC ID: 6814

PERFORMER ORGANIZATION: Mathematica Policy Research, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Crosscutting HRSA-Wide Performance Strategy

AGENCY SPONSOR: Office of the Administrator

FEDERAL CONTACT: Karen Thiel Raykovich, Ph.D.

PHONE NUMBER: 301-443-3070

PIC ID: 7131

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/30/99

Indian Health Service

Evaluation Program
The goal of the Indian Health Service (IHS) is to assure that comprehensive, culturally acceptable, personal and public health services are available and accessible to American Indian and Alaska Native people. The importance of evaluation in supporting this goal has increased significantly in recent years and includes American Indians and Alaska Natives as the primary stakeholders in defining the purpose, design, and execution of evaluations. The stakeholders use the end product of the evaluations, and are typically the population or groups most likely to be affected by the evaluation findings. The IHS has formally adopted the principles of a responsive evaluation practice to address the needs and concerns of American Indians and Alaska Natives.

The evaluation program of the IHS is managed by the Office of Public Health, Staff Office of Planning, Evaluation, and Research (OPH-SOPER), which provides national leadership and consultation for IHS and Area Offices on strategic and tactical planning, program evaluation and assessment, public health and medical services, research agendas, and special public health initiatives for the Agency. The OPH-SOPER serves as the principal advisory office on issues of national health policy and coordinates the following four evaluation functions.

Health Program Evaluations - Collect and analyze information useful for assisting IHS officials in determining the need for improving existing programs or creating new programs to address health needs.
Policy Analysis - Conduct analyses when a change in the IHS health service delivery system must be considered, when issues emerge in an area where no policy currently exists, or when current policies are perceived as inappropriate or ineffective.
Health Services Research - Undertake analyses of the organization, financing, administration, effects, and other aspects of the IHS delivery of health services.
Special Studies and Initiatives - Conduct studies and prepare special reports required by Congress in response to pending legislation or policies, often using a roundtable, whenever an issue or a health problem requires immediate action and it is unclear what type of action should be taken.

Each year OPH-SOPER selects high-priority health care and management studies for funding through the submission of proposals to headquarters and Area Offices. These proposals are reviewed and rated by a panel of subject-matter experts, evaluation experts, and IHS staff for concurrence with IHS strategic goals, objectives, and priority areas. The proposals are then prioritized and forwarded to the IHS Director, who reviews the projects that are recommended for funding and determines the respective funding levels.

Fiscal Year 1998 Evaluations

Prevention Services

TITLE: Evaluation of Village-Based Women's Preventive Health Services by Community Health Aides/Practitioners

ABSTRACT: The purpose of this study was to evaluate two related pilot project initiatives recently implemented to increase the prevalence of cervical and breast cancer screening and STD screening, and reduce tobacco use among Native women in isolated villages in Southwest rural Alaska. This project was of highest priority because it was directed toward reducing the excess morbidity and mortality from preventable diseases such as lung cancer, cervical cancer, breast cancer and sexually transmitted diseases. The projects were implemented through Community Health Aides/Practitioners (CHA/Ps) in village-based clinics. Long term, comprehensive evaluation was needed to determine if the Yukon Kuskokwim Health Corporation (YKHC), the largest health corporation in rural Alaska, should expand access to these village-based preventive health services through additional community health training of all CHA/Ps in the region. Approximately 1,400 women over 18 years of age, predominantly Yup'ik Eskimo, in eight out of the 50 remote village communities served by the YKHC, participated. Eight CHA/Ps in four of these communities had training at the end of August, 1995 and the middle of September, 1995 to enable them to acquire skills necessary to provide preventive health services in the clinic, and also received services normally provided by itinerant health workers. Overall, the evaluation of the pilot project initiatives demonstrates that it is feasible to increase access to the selected health services for women in the Y-K Delta by providing carefully planned, advanced training and an ongoing support program for CHA/Ps.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6406

PERFORMER ORGANIZATION: Alaska Native Health Services Anchorage, AK

Substance Abuse Treatment

TITLE: Evaluation of the Indian Health Service Adolescent Regional Treatment Centers, Volume I

ABSTRACT: The goal of this study was to evaluate the effectiveness and efficiency of, and consumer satisfaction with, the nine Regional Treatment Centers (RTCs) which provide alcoholism and substance abuse rehabilitation treatment to American Indian/Alaska Native (AI/AN) youth. The primary objectives of this evaluation include: (1) assessment of the quality and effectiveness of the RTCs as measured by outcomes achieved, (2) determination of what the RTCs have accomplished, and (3) development of recommendations for continuous quality improvement of the RTCs. As part of the assessment of the accomplishments of the RTCs, this study describes the RTCs as they were in 1996, and the clients they served from 1993 through 1995. The findings of this evaluation can serve as a benchmark against which changes and progress can be measured. Thus, this evaluation should be useful to tribes and tribal organizations, the RTCs, IHS administrators, researchers, and to others interested in Indian health and the problem of adolescent alcohol/substance abuse. No RTC clients were interviewed, but all client data were collected by means of in-depth review of client charts maintained at each RTC. Recommendations include the following: (1) improve the continuum of care for adolescents with alcohol and other substance abuse problems, (2) improve RTC effectiveness and efficiency, and (3) improve RTC self-evaluation.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6744

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

Crosscutting

TITLE: Profile of the State of Indian Children and Youth: Final Report

ABSTRACT: This study was conducted in support of a proposed Federal initiative to promote the quality of life (QOL) of American Indian and Alaska Native (AI/AN) youth. The goal of the study was to collect and organize existing information and to develop a set of recommendations to assist in the development of coordinated Federal policy. The study was conducted primarily by means of bibliographic and archival research of information maintained by Federal agencies, libraries, and other institutions. Review of the materials collected in this study resulted in four conclusions: (1) the need exists for an AI/AN youth initiative, (2) previous and ongoing Federal initiatives have proven successful in the past, (3) major changes are needed in the Bureau of Indian Affairs (BIA) and the Indian Health Service (IHS), and (4) better information systems are needed. In light of the study conclusions, three recommendations were proposed: (1) A coordinated, systematic initiative to improve the QOL of AI/AN youth should be developed. Issues such as alcohol and substance abuse prevention and treatment, accident prevention, employment and economic development, education, crime and justice, and housing should be addressed. (2) The planning and execution of the initiative should actively involve the Federal agencies as well as the tribes and Alaska Native villages. (3) The Federal government, in consultation with the tribes and Native villages, should develop and implement a plan to collect, maintain, and make accessible information on AI/AN youth. Included in this information system should be baseline data and appropriate indices that can be used to assess the outcomes associated with the proposed initiative.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7134

PERFORMER ORGANIZATION: Johns Hopkins University, School of Hygiene and Public Health Baltimore, MD

TITLE: Speaking with One Voice IHS, Tribes, Urban

ABSTRACT: The focus of the roundtable, and of this project, was the reauthorization of the Indian Health Care Improvement Act (IHCIA), Public Law 94-437. This Act funds health care services provided to and for American Indians and Alaska Natives (AI/AN) in the United States at the local, area and national levels. The Indian Health Care Improvement Act represents one of the most critically important pieces of legislation affecting Indian health today. Originally enacted in 1976, the IHCIA provides comprehensive statutory authority for a variety of health programs. While there have been substantial improvements in health status, American Indians and Alaska Natives still lag far behind all other races in the U.S., and with shrinking Federal appropriations for the Indian Health Service (IHS), the job of maintaining and improving health status is becoming far more difficult. The results of this discussion will assist the IHS and local tribal and urban health officials define the many issues involved in the pending reauthorization, changes in the health care environment affecting Indian Health today, and an analysis of the opportunities presented through the passage of comprehensive health care legislation. Roundtable participants identified health care issues in two major areas: (1) patient bill of rights for Indian people; and (2) changing health care environment.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7133

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

Health Care Delivery

TITLE: Roundtable Report: Integrating Indian Health Programs Into Medicaid Managed Care Systems

ABSTRACT: This project was convened to identify options to increase Medicaid managed care participation by Indian health programs. These include programs operated directly by the Indian Health Service (IHS), programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act. The overall goal of the roundtable was to determine how to increase participation in Medicaid managed care among Indian health programs while maintaining organizational mission and capacity to provide a comprehensive and culturally sensitive health care system for American Indians and Alaska Natives (AI/Ans). Roundtable participants expressed their beliefs that the IHS must facilitate increasing the participation of Indian health programs in Medicaid managed care in conjunction with the tribes and the urban Indian programs. The Roundtable's recommendations were as follows: (1) discuss and resolve the five issue areas that include: risk adjustments, contracting only for those services that the Indian health program directly provides, taking risk only for the amount the program can afford to lose; off-loading risk; and managing care; (2) inclusion of managed care in all IHS strategic planning; (3) being proactive in discussions with the individual States; and (4) further follow-up work on the development of Indian health programs as Health Maintenance Organizations or networks.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7136

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

TITLE: The Data Policy Roundtable: Exploring the Future of Indian Health Information Systems

ABSTRACT: This project was convened to explore options and develop strategies for future Indian Health Service/Tribal/Urban (I/T/U) program information systems. The focus was on developing strategies to create a new Indian Health information system, one that was not an Indian Health Service (IHS) system, but rather a system designed and supported by the Tribal and Urban health care delivery organizations and the IHS. Roundtable participants represented Tribal and Urban programs, national and regional Tribal Health Boards, IHS statistical, epidemiological and information system divisions, the nursing and clinical professions, and industry experts in new technologies. Recommendations included the following: (1) establish an I/T/U Program Data Consortium; (2) develop a uniform data set; (3) determine a means for aggregating the data; (4) determine how best to account for non-participating I/T/U entities in the presentation of national aggregate data; (5) adopt, along with the data set, data content and transmission standards to ensure that aggregate data are comparable and can be transmitted between systems, independent of hardware and software configurations; (6) develop a means for maintaining and upgrading the Resource and Patient Management System and the Patient Care Component to meet the needs of the I/T/U participants who choose to continue to use it; (7) make greater use of current and new information and communication technologies to improve the Indian health program; (8) establish a clearinghouse to share information models related to specific health problems and conditions; (9) develop an I/T/U finance committee or commission to address funding issues; and (10) establish an environment that fosters an equal partnership among I/T/Us.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7135

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

Evaluations in Progress

Prevention Services

TITLE: Evaluating the Effects of Injury Prevention and Case Management in Reducing the Costs of Workers' Compensation in the Indian Health Service

ABSTRACT: This study will be conducted with an estimated 26 hospitals (23 IHS operated and 3 tribally operated hospitals). The results of the evaluation will be a key feature of the IHS Occupational Safety and Health Annual Report. The study will focus on evaluation, provide injury and cost information and describe if the injury rate and costs have fluctuated over time and, if so, why.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6743

PERFORMER ORGANIZATION: Indian Health Service, Office of Environmental Health and Engineering, Rockville MD

PROJECTED DATE OF COMPLETION: 12/1/98

TITLE: Effectiveness of Evaluation of Systematic Implementation of Clinical Prevention Protocols for Chronic Disease Risk Reduction

ABSTRACT: This project will address health prevention and the reduction of chronic disease complications through development of a tracking system for use by the physicians and patients. This tracking system will serve as a model for tribes with health contracts.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5938

PERFORMER ORGANIZATION: Nashville Area Indian Health Service, Nashville TN

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Impact of Health Programs Among Three United South and Eastern Tribes

ABSTRACT: This project is designed to measure the effectiveness of Indian Health Service (IHS) health promotion and prevention efforts. It will involve tribes and other agencies to fully ensure that the needs of the tribes are met, and that health care services are being targeted appropriately.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5945

PERFORMER ORGANIZATION: Nashville Area Indian Health Service, Nashville TN

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Impact of a Structured, Comprehensive, Multi-Disciplinary Patient Education Initiative--Year 2

ABSTRACT: This study will: (1) promote wellness and prevent disease by providing comprehensive, accurate and understandable education to each patient, (2) study the impact of this multidisciplinary, planned patient education program on the health and wellness knowledge base of the patient population, and (3) document positive lifestyle/behavioral changes as a result of the education provided. The study population encompasses all American Indian/Alaska Native (AI/AN) patients eligible for care at the Service Unit (predominantly Cherokees). The Service Unit covers 12 counties in northeastern Oklahoma with 149,939 outpatient visits, accounting for 32,105 patients. This study will be submitted for publication in current medical journals by the Indian Health Service (IHS) provider. Information generated from this study will be disseminated to all tribes in the service area and all IHS facilities.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7140

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Utilizing the Indian-Specific Health Risk Assessment to Evaluate Community Health Promotion/Disease Prevention Programs

ABSTRACT: This project will: (1) produce a planning and assessment model for rural Alaska villages to develop a community behavior risk profile, (2) plan and implement appropriate intervention strategies, and (3) determine the impact of these interventions. It will collect baseline data through a community-wide health risk appraisal (HRA), and use model results to: (1) identify the most serious health risk behaviors, (2) plan appropriate interventions, (3) re-administer the HRA in the community after a trial period to determine its impact, and (4) conduct a workshop for other communities to facilitate program replication.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 4996

PERFORMER ORGANIZATION: Southeast Alaska Regional Health Corporation, Sitka AK

PROJECTED DATE OF COMPLETION: 12/20/99

TITLE: National Model Adolescent Suicide Prevention Project for the Jicarilla Apache Tribe

ABSTRACT: This project will: (1) develop, implement and monitor networking and response protocols to enhance community systems communications, cooperation and coordination; and (2) provide training and education to community members on youth suicide issues, and evaluate the impact of these activities. It will identify youth and families at high-risk of suicide, and will identify and implement action plans for specific prevention and intervention activities. The project employ use cultural values, traditions and language to devise a community and family systems approach to decrease the incidence of adolescent suicide and suicide attempts. The project is coordinated through the Jicarilla Apache Tribe, the Indian Health Service (IHS) and the Bureau of Indian Affairs (BIA).

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5526

PERFORMER ORGANIZATION: IHS Headquarters West, Dulce NM

PROJECTED DATE OF COMPLETION: 12/20/99

TITLE: Study of the Impact of a Full-Time Community Health Nurse on the Health of Native American (Sioux) Patients with Hypertension

ABSTRACT: This project will study the impact of a full-time community health nurse on the detection and follow-up of hypertension within a specific Native American tribe, the Sioux. The impact of having a full-time community health nurse on the prevention of and education cerebrovascular, cardiovascular and renal disease within this population will also be examined.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6413

PERFORMER ORGANIZATION: Aberdeen Area Indian Health Service Aberdeen, SD

PROJECTED DATE OF COMPLETION: 9/1/01

Substance Abuse Treatment

TITLE: Study of the Interaction of Persons Treated for Alcoholism with the Health Care Delivery System

ABSTRACT: This project will study and evaluate the results of alcohol treatment for Indians who abuse alcohol. The primary physician will focus on the overall health care delivery system. The methodology issues will be worked out initially for the population served by the Crow Agency Service Unit. Data retrieval, audit instruments and analytical strategies will be piloted for one to two years. The methodology will be refined and used in all service units.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6742

PERFORMER ORGANIZATION: Billings Area Indian Health Service Billings, MT

PROJECTED DATE OF COMPLETION: 12/1/98

TITLE: Evaluation of the Impact of Case Staffings and Patient Care Component-Based Reminder System on the Implementation of Treatment Plans for Children Exposed to Alcohol in Utero

ABSTRACT: This project will evaluate the follow-up given to children referred for evaluation by the dysmorphologist, and will evaluate the short-term impact of a follow-up and tracking system for children exposed to alcohol in utero.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5936

PERFORMER ORGANIZATION: Billings Area Indian Health Service Billings, MT

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Evaluation of IHS Supported Alcohol and Substance Abuse Treatment Program for American Indian/Alaska Native (AI/AN) Women

ABSTRACT: This study assesses the Indian Health Service's (IHS) substance abuse and treatment program. It seeks to improve program effectiveness by monitoring behaviors that enhance risk. The study is of critical importance to the IHS because research on alcohol and other drug abuse and related disease among American Indian/Alaska Native women is virtually nonexistent. Information on the effectiveness of treatment among this population is also limited.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6201

PERFORMER ORGANIZATION: Support Services, Inc. Silver Spring MD

PROJECTED DATE OF COMPLETION: 5/30/00

Crosscutting

TITLE: Evaluation of IHS Capacity for Epidemiologic Surveillance

ABSTRACT: The purpose of this evaluation is to describe the epidemiologic surveillance capacity of the IHS/Tribal/Urban (I/T/U) system and make recommendations as to how the capacity could be improved to better meet the needs of the IHS and its stakeholders. As the IHS is reorganized, fewer resources will be available to conduct epidemiologic surveillance.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6745

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Development of a Health Services Research Agenda for American Indian and Alaska Native Populations

ABSTRACT: The Indian Health Service (IHS) and the Agency for Health Care Policy and Research (AHCPR) are joining together to develop a long-term health services research (HSR) agenda that reflects the research needs of American Indian and Alaska Native (AI/AN) communities. As a first step in developing this agenda, a conference was held in Albuquerque, New Mexico in August 1996. The conference, based on the IHS roundtable model, included twenty-five to thirty representing tribes and urban Indian health projects, ten to fifteen people with subject area expertise and a few health policy specialists. Tribal and urban conference participants, as well as the HSR Conference Planning Committee members, were selected in consultation with the Area representatives of the National Indian Health Board. The HSR agenda emerging from the conference will help focus and coordinate efforts for greater efficiency among organizations that fund HSR for AI/AN populations. This includes tribes, Federal and State agencies, universities, foundations and other organizations.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6153

PERFORMER ORGANIZATION: Native American Consultants, Inc. Washington D.C.

PROJECTED DATE OF COMPLETION: 6/1/99

Health Care Delivery

TITLE: Bemidji Area Office Organization Structure

ABSTRACT: This project will assess and challenge existing operational structures in the Bemidji Area Indian Health Service. It will develop an Area Office re-organization model that will follow the guiding principles identified by the Indian Health Service Management Workgroup on Restructuring.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5939

PERFORMER ORGANIZATION: Bemidji Area Indian Health Service Bemidji, MN

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Evaluating the Impact of Primary Intervention Techniques on the Dental Caries Rate in Children Living in Southwest Alaska Native Villages

ABSTRACT: This project will attempt to identify the reason why some communities in Bristol Bay have significantly higher/lower caries rates in children than do other children in other Bristol Bay communities. Children ages six to eight have been selected for the project, and the results of the project will be used to identify the factors that create high-risk communities. A community model will be developed for use in allocating specific resources to address the oral health needs of the villages. The primary activities will continue to be directed towards continuing intervention, which includes dental advocate services, tooth brushing, topical flouride and chemotherapy programs, distribution of children's books, and use of the medical model for dental treatment for one to eight year olds and their mothers.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7138

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Hyperlipidemia and Coronary Heart Disease (CHD) in Native Americans: Evaluation of Lipid Control Through a Pharmacist Managed Lipid Clinic

ABSTRACT: The purpose of this project is to evaluate the results of CV clinic coronary heart disease (CHD) risk management, counseling and aggressive medical nutritional therapy and pharmacological-therapeutic treatment of hyper-cholesterol in primary and secondary prevention in American Indian/Alaska Native (AI/AN) patients. The study will evaluate whether a pharmacist can effectively manage patients with dyslipidemias in comparison to usual care. In order to do this, the study will look at the proportion of patients enrolled in the CV clinic who meet target goals for total cholesterol, LDL cholesterol and triglycerides, compared to those receiving only the usual care. Secondly, the cost-effectiveness of the CV clinic will be evaluated. Lastly, changes in morbidity and mortality will be evaluated. If the findings of this evaluation show that the CV clinic is cost effective and successful in decreasing morbidity and mortality in the native population, this clinic could serve as a national prototype for other Indian Health Service (IHS) facilities.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7139

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Quality Care Project

ABSTRACT: This project will identify existing office management and information systems, or recommend improvements to the existing one. This will enable the Oneida Nation of New York to initiate services at its permanent comprehensive health facility using the most effective: (1) patient scheduling, (2) billing, and (3) medical records systems available. The project will review the Oneida's current information systems and those used by other Native American health centers. It will evaluate ten other systems and recommend a model for integration into the tribal health department's quality assurance and managed care plans.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 4994

PERFORMER ORGANIZATION: Oneida Indian Nation Health Department, Oneida NY

PROJECTED DATE OF COMPLETION: 12/20/99

TITLE: Continuation and Completion of a Study to Analyze Quality Assurance and HP/DP Monitoring, and Analyze Methods Using Patient Care Component

ABSTRACT: This study will analyze quality assurance (QA) and health promotion and disease prevention (HP/DP) monitoring and analysis methods using the Patient Care Component (PCC) and Resource and Patient Management Systems (RPMS). These systems are currently in use at the Indian Health Service (IHS) facilities in the Billings area. The project goal is to improve the health status of Indians living in the Billings area by using the PCC database to monitor quality assurance activities and HP/DP objectives, while improving the database's accuracy and completeness.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5018

PERFORMER ORGANIZATION: IHS Billings Area Office, North Billings MT

PROJECTED DATE OF COMPLETION: 12/20/99

TITLE: Eastern Band of Cherokee Indian Health Care Delivery System Assessment

ABSTRACT: This study will provide the Eastern Band of Cherokees with relative data on their current health care service delivery system. This data is intended for use in a re-design of the system so that it can be more responsive to all client and tribal member needs.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6408

PERFORMER ORGANIZATION: Nashville Area Indian Health Service, Nashville TN

PROJECTED DATE OF COMPLETION: 9/1/01

TITLE: Health Care Reform Evaluation Study-Phase II, Bemidji Area Office

ABSTRACT: This study will permit an assessment of health reform initiatives being developed and initiated in Wisconsin and Michigan.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6409

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 9/1/01

TITLE: Pueble of Zuni End Stage Renal Disease (ESRD) Quality of Life Survey

ABSTRACT: This study will assist the Pueblo of Zuni to measure the level of burden and quality life factors associated with end stage renal disease as it effects tribal members and their families.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6411

PERFORMER ORGANIZATION: Headquarters East IHS, Rockville MD

PROJECTED DATE OF COMPLETION: 9/1/01

Geriatric Services

TITLE: Concurrent Evaluation of the Elders Clinic, a Multidisciplinary Geriatric Assessment Clinic at the Zuni-Ramah Service Unit

ABSTRACT: The purpose of this study is to describe the epidemiologic surveillance capacity of the Indian Health Design Team Indian Health Service (IHS) Provider of Health Care/Tribal Provider of Health Care/Urban Indian Program Provider of Health Care (I/T/U) system. It will also make recommendations as to how the clinical capacity could be improved to better meet the needs of the IHS and its stakeholders. This study is of increasing importance as fewer Federal resources will be available to conduct epidemiologic surveillance.

AGENCY SPONSOR: Indian Health Service

FEDERAL CONTACT: Morgeau, Gary

PHONE NUMBER: 505-248-5665

PIC ID: 6741

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 12/1/98

TITLE: American Indian Family Caregivers and the Provision of Long-Term Care

ABSTRACT: This project is intended to help develop economically feasible and culturally acceptable long-term care modalities to support Native American families in delivering care to frail elders.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5940

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 9/20/99

Mental Health

TITLE: Evaluation of a Day Hospital Program for Seriously Mentally Ill Patients

ABSTRACT: The purpose of this project is to expand an existing pilot Day Hospital program for seriously mentally ill patients, and to evaluate the effects of this form of treatment.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5942

PERFORMER ORGANIZATION: Navajo Area Indian Health Service, Window Rock AZ

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Mental Health Service Delivery Model for Urban Native Americans: An Evaluation of Utilization Rates and Mental Health Treatment Factors

ABSTRACT: This project will address the Indian Health Service (IHS) mental health objective calling for a mental health care delivery system in urban areas. Results of the project will identify a potential model of mental health delivery applicable to urban areas.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 5943

PERFORMER ORGANIZATION: California Area Indian Health Service Sacramento, CA

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Evaluation of the Behavioral Risk Factor Surveillance System's Results and Their Applicability to the Native Population of Anchorage

ABSTRACT: This study will determine the relative accuracy, validity and reliability of the Behavioral Risk Factor Surveillance System (BRFSS) risk estimates of the Anchorage Native population, compared with data collected using other techniques that include: (1) door-to-door household surveys, (2) key informant surveys, and (3) intercept data collection from Natives seeking primary care services in Anchorage from the Alaska Native Medical Center and the Primary Care Center. The analyses are revealing those particular risk factors that appear to be most significantly misrepresented by the BRFSS. This factor, combined with a more clinical analysis of those factors that pose the greatest risks to the health and well-being of the Native community, will be used in determining which questions to include on the key informant survey. Due to the nature of the survey, a relatively concise instrument is required, and only those items holding a high priority on one or both of the selection criteria (i.e., representation problems with the BRFSS and high clinical/medical risk) will be included in the key informant survey instrument.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7137

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/99

Maternal and Child Health

TITLE: Impact of Breast-feeding Education Program on Rates in the Early Postpartum Period and on Duration of Breast-feeding Year 2

ABSTRACT: The purpose of this project is to study the effect of a specific, planned, consistent breast-feeding education program on rates of breast-feeding initiation, and on duration of breast-feeding in the patient population. The study population includes all live births at the Claremore Indian hospital for one year from the onset of the study. The control will be a historical control, and will consist of all live births in the year prior to the onset of the study, inclusive of March 1, 1997 to April 30, 1998. During this period there were 640 live births. The goal of the study will be to reach the Healthy People 2000 goal of having 75 percent of mothers initiating breast-feeding, and keeping 50 percent breast-feeding for five to six months.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 7141

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Evaluating the Effects of Medical Nutrition Therapy on Patient Outcomes Among Native Americans with Newly Diagnosed Type II Diabetes Mellitus

ABSTRACT: This study will: (1) evaluate the effectiveness of medical nutrition therapy (MNT) on clinical/behavioral outcomes in American Indians/Alaska Natives (AI/AN) with newly diagnosed Type II diabetes, (2) create a uniform methodology for collecting nutrition-oriented outcome data that is consistent among participating tribes, service units and urban programs, (3) analyze the type and amount of MNT provided with regard to patient outcomes, and (4) link this information with current clinical data from the IHS Diabetes Program which identifies Continuous Quality Improvement performance measures.

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

FEDERAL CONTACT: Frank Marion

PHONE NUMBER: 301-443-4700

PIC ID: 6746

PERFORMER ORGANIZATION: Indian Health Service, Rockville MD

PROJECTED DATE OF COMPLETION: 11/30/99

National Institutes of Health

Evaluation Program
The National Institutes of Health (NIH) generates scientific knowledge that leads to improved health. This is done by conducting medical research in its intramural laboratories and by supporting research in universities, medical and health professional schools, and other health research organizations. NIH fosters the widespread dissemination of the results of medical research, facilitates the training of research investigators, and ensures the viability of the research infrastructure. The NIH Evaluation Program is an integral part of how NIH sponsors and conducts medical research.

The complexities and challenges of evaluating and assessing fundamental science have become more widely recognized as science agencies have begun implementation of the Government Performance and Results Act (GPRA). The GPRA stresses the use of evaluation to develop measures for reporting on program results. However, measures for evaluating the results of fundamental science have limitations. These are discussed in the March 1997 General Accounting Office report, Measuring Performance: Strengths and Limitations of Research Indicators. The report compares private versus public research and discusses the strengths and limitations of indicators used to measure research. The NIH evaluation program is addressing these challenges as part of its strategy for implementing the GPRA.

Philosophy and Priorities. The NIH Evaluation Program provides information to assist the NIH Director and the NIH Institute and Center (IC) Directors in determining whether NIH goals and objectives are being achieved and to help guide policy development and program direction. Evaluations are planned and conducted from two sources of funds: 1-percent set-aside evaluation funds used to fund trans-NIH projects, and IC program funds used for program evaluations for use by various committees, working groups, task forces, workshops, conferences, and symposia to assist the IC in program management and development. This approach ensures that planning and priority setting specific to the mission of each IC are fully developed and implemented and that there is central leadership for developing crosscutting initiatives and promoting collaboration among the ICDs.

NIH's major evaluation priority areas fall within three broad program areas: basic research, research training and career development, and facilities. These broad program areas form the basis for the strategies and activities that NIH undertakes to achieve the goals identified in the GPRA planning process.

Policies and Operations. A distinguishing feature of the NIH Evaluation Program is the utilization of a variety of evaluation strategies that include the use of national advisory councils, boards of scientific counselors, consensus development conferences, and ad hoc committees that help to chart scientific directions and select the most promising research to support.

A two-tier system is used to review project requests that will use 1-percent evaluation set-aside funding. The first tier involves a review and recommendations by the NIH Technical Merit Review Committee (TMRC) on the technical aspects of project proposals and whether a project fits within HHS guidelines for use of the set-aside fund. The second tier involves the NIH Evaluation Policy Oversight Committee (EPOC), which considers TMRC recommendations, conducts policy level reviews, and makes final funding recommendations to the NIH Director or his designee.

Fiscal Year 1998 Evaluations

Research

TITLE: Defining a Comprehensive School Health Program: An Interim Statement

ABSTRACT: An Institute of Medicine (IOM) committee has begun a study of comprehensive school health programs in grades K-12. These programs propose to combine health education, health promotion and disease prevention, and access to health and social services, at the school site. While earlier generations of school health programs were predominantly concerned with stemming the threat of infectious disease, such problems have now to a large extent been superseded by the "new morbidities"--injuries, violence, substance abuse, risky sexual behaviors, psychological and emotional disorders, poverty--and by concerns about many students' lack of access to reliable health information and health care. Comprehensive school health programs may be a promising approach for addressing many of these health-related problems of today's children and young people. This project examines the structure, operation, and possible outcomes of comprehensive school health programs and considers their status and potential for wider implementation. The final report will present findings and recommendations, which should be of interest to educators, professionals in health-related fields, families and policymakers. This interim statement sets forth a provisional definition of a comprehensive school health program, to serve as the basis for further work. To provide a general context for this definition, the interim statement reviews briefly the history of school health programming and examples of previous definitions and models for these programs. The interim statement also identifies additional questions and issues that emerged in the process of formulating the definition.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: William Harlan

PHONE NUMBER: 301-496-1508

PIC ID: 5586

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine Washington, D.C.

TITLE: Evaluation of the International Cooperative Biodiversity Groups (ICBG)

ABSTRACT: This report evaluates the International Cooperative Biodiversity Groups (ICBG) program. Funded by the National Institutes of Health (NIH) and the National Science Foundation (NSF), the ICBG is a program designed to protect human health, advance the conservation of biologically diverse ecosystems and promote sustainable economic development through the search for drugs to control diseases of concern to both developed and developing countries. Since 1993, the program has funded five individual cooperative biodiversity groups around the world. The study design attempts to: (1) accommodate the varied and non-standard implementations of the ICBG concept, (2) obtain broad coverage in terms of respondents, (3) maximize response rates and data quality, (4) minimize burden on ICBG Group Leaders and other respondents, and (5) incorporate cost and time efficiencies wherever possible. Among the benefits for source countries, the report finds: (1) scientific capacity has been developed through training and equipment, (2) development of economic activities, (3) equitable financial return and the protection of intellectual property rights (IPR) of source-country people, and (4) the potential sustainability of the individual ICBG projects is one of the strengths of the overall program. The report recommends that: (1) the ICBG program develop systems of technical assistance based on a combination of outside expertise and lessons learned across programs, (2) improve communications among the ICBGs, (3) consider developing a cross-ICBG database that includes work being done in collection, extractions, and drug development techniques, and (4) bring in the expertise of social scientists and source-country legal experts to the ICGB to ensure that the consensus-building, benefit sharing, and economic goals of this project are achieved. (Final report 177 pages, appendices bound separately.)

AGENCY SPONSOR: Fogarty International Center

FEDERAL CONTACT: J. Kirby 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 (NHLBI) developed and implemented a unique grant initiative, titled "Programs of Excellence in Molecular Biology" (POEMB). The objectives established for POEMB are to: (1) stimulate the use of molecular biology approaches in areas consistent with the mission of the NHLBI where the new techniques of molecular biology have been underutilized, and (2) provide opportunities for investigators who have the potential for establishing or redirecting research careers. This report evaluates the extent to which the initiative has realized the Institute's objectives and its appropriateness as a model for promoting the application of new research techniques and methodologies to existing areas of research. Research activity is characterized in cardiovascular and pulmonary research using the techniques of molecular biology in terms of research grant activity and publications, both before and after implementation of the POEMB, produced by groups who are supported by the POEMB and those who are not. Qualitative data were also collected on the effectiveness of the POEMB approach and on research accomplishments by POEMB applicants. The results of this study are applicable to the entire National Institutes of Health community because they explore innovative approaches to stimulating research interest in, and developing research resources for, future efforts in designated scientific areas.

AGENCY SPONSOR: National Heart,Lung,and Blood Institute

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

PHONE NUMBER: 301-496-3620

PIC ID: 5584

PERFORMER ORGANIZATION: Battelle Human Affairs Research Centers Seattle, WA

Training

TITLE: Evaluation of the National Heart, Lung and Blood Institute's Short-Term Training for Minority Students Program

ABSTRACT: In recognition of the need to increase the number of under-represented minority individuals pursuing advanced degrees in the biomedical and behavioral sciences, the National Heart, Lung, and Blood Institute (NHLBI) established the Short-Term Training for Minority Students Program (STMSP). The STMSP is designed to accomplish the following three goals: (1) Provide 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) Attract highly qualified minority students into biomedical and behavioral research careers in the areas of heart, lung and blood health, transfusion medicine, and sleep disorders. (3) Bolster the already short supply of qualified minority investigators. This project presents evaluation results of the STMSP to determine its effectiveness and identify ways in which the program might be improved. (See also PIC ID 6118)

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

TITLE: Evaluation of the National Institute of Mental Health Training Programs for Minority Students

ABSTRACT: To addresss the training needs related to minority scientists in the mental health fields of behavioral science and neuroscience, the National Institute of Mental Health (NIMH) established training programs for talented honors undergraduate, racial/ethnic minority students to encourage them to choose research careers in mental health disciplines. Other approaches to facilitating the training of racial/ethnic minority behavioral and neuroscience undertaken by NIMH include short-term summer research training and predoctoral training that supports the Minority Fellowship Program at National Professional Associations in nursing, sociology, psychology, and social work. An evaluation of these various mechanisms was conducted to assess their impact on the numbers of students who participate in early career training, their contributions to the conduct of the research-related mission of the NIMH, and to identify, the program elements that have most heavily influenced these outcomes. The purpose of this contract is to provide guidance to the Office for Special Populations on appropriate evaluation strategies based on NIMH program records, available databases and consultation with program staff, and to design and demonstrate the feasibility of a tracking system for such information.

AGENCY SPONSOR: National Institute of Mental Health

FEDERAL CONTACT: Sherman L. Ragland

PHONE NUMBER: 301-443-2847

PIC ID: 6282

PERFORMER ORGANIZATION: Jones, James M., Ph.D. Silver Spring, MD

Evaluations in Progress

Research

TITLE: Full-Scale Evaluation of the Regional Primate Research Centers (RPRC) Program

ABSTRACT: The Regional Primate Research Center (RPRC) program represents a commitment by the National Institutes of Health (NIH) to the development and support of regional and National non-human primate research resources for biomedical and behavioral studies. This evaluation is intended to determine the optimum configuration of resources for non-human primate research programs.

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Barbara Perrone

PHONE NUMBER: 301-435-0871

PIC ID: 6045.1

PERFORMER ORGANIZATION: Helen H.. Gee, Potomac, MD

PROJECTED DATE OF COMPLETION: 12/20/98

TITLE: Planning Phase for an Evaluation of the NIDR Center Program

ABSTRACT: This project developed a study design for an evaluation of the National Institute of Dental Research (NIDR) center program.

AGENCY SPONSOR: National Institute of Dental Research

FEDERAL CONTACT: James G.Corrigan, Ph.D.

PHONE NUMBER: 301-496-6705

PIC ID: 5578

PERFORMER ORGANIZATION: National Institute of Dental Research Bethesda, MD

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Full-Scale Evaluation of the NCRR Research Centers in Minority Institutions (RCMI) Program

ABSTRACT: The Phase II Research Centers in Minority Institutions (RCMI) program evaluation has been designed to enhance program accountability. The results of the RCMI program evaluation will be useful to minority and non-minority academic institutions in strengthening their biomedical and behavioral research capacities.

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Patricia A.Vorndran

PHONE NUMBER: 301-435-0866

PIC ID: 5580.1

PERFORMER ORGANIZATION: National Institutes of Health Bethesda, MD

PROJECTED DATE OF COMPLETION: 1/1/99

TITLE: Surgeon General's Report on Oral Health

ABSTRACT: The Surgeon General's (SG's) report will provide an opportunity to describe oral health and provide the backdrop to present the case for the critical inter-relationship between oral health and general health.

AGENCY SPONSOR: National Institute of Dental Research

FEDERAL CONTACT: Dushanka Kleinman, M.D.

PHONE NUMBER: 301-496-7716

PIC ID: 6861

PERFORMER ORGANIZATION: National Institutes of Health Bethesda, MD

PROJECTED DATE OF COMPLETION: 1/31/99

TITLE: Baltimore Project

ABSTRACT: This project will evaluate the impact of the NICHD national teen pregnancy research program on the prevention of adolescent pregnancy. This project will provide a "real world" evaluation of a number of theoretically sound intervention program models, which are based on NICHD's research, thereby giving an indication of the impact of the research on such measures as changes in sexual activity, increased use of contraception and rates of pregnancy and birth.

AGENCY SPONSOR: National Institute of Child Health & Human Development

FEDERAL CONTACT: Susan Newcomer

PHONE NUMBER: 301-496-1174

PIC ID: 4467

PERFORMER ORGANIZATION: Johns Hopkins University School of Medicine Baltimore, MD

PROJECTED DATE OF COMPLETION: 12/20/99

TITLE: Vaccine Development: Establishing Priorities for the United States for the 21st Century

ABSTRACT: This evaluation will undertake a detailed assessment of vaccine research and development needs and priorities for the upcoming decade. The committee will then apply the model to general priorities for domestic vaccine development for the next ten to twenty years.

AGENCY SPONSOR: National Institute of Allergy and Infectious Diseases

FEDERAL CONTACT: D. Regina Rabinovich, M.D.

PHONE NUMBER: 301-402-2126

PIC ID: 5984

PERFORMER ORGANIZATION: National Academy of Sciences Washington, D.C.

PROJECTED DATE OF COMPLETION: 12/31/99

TITLE: Evaluation of Simplification of Human Resources Management System at the Nation Institutes of Health

ABSTRACT: The NIH will engage the services of an expert organization to develop criteria, conduct evaluations and provide program development support. The Secretary, DHHS, and the director, NIH, will jointly appoint a panel of distinguished scientists and administrators to review the contractor evaluations and the impact of these delegations on the NIH research programs.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Stephen C. Benowitz

PHONE NUMBER: 301-496-3592

PIC ID: 6862

PERFORMER ORGANIZATION: National Academy of Public Administration Washington, D.C.

PROJECTED DATE OF COMPLETION: 10/30/01

Training

TITLE: Study of National Needs for Biomedical and Behavioral Research Personnel

ABSTRACT: The National Academy of Sciences (NAS) is establishing a study committee which will direct activities related to the development of estimates of future needs for biomedical and behavioral research personnel. Using estimates of future needs, the committee will make recommendations concerning the size and composition of the National Research Service Awards (NRSA) research training programs.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Walter Schaffer, Ph.D.

PHONE NUMBER: 301-435-2770

PIC ID: 4664.1

PERFORMER ORGANIZATION: National Academy of Sciences Washington, D.C.

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Evaluation of the National Research Service Training Programs

ABSTRACT: The objectives of this evaluation are to provide information on: (1) the characteristics of the National Research Service Awards (NRSA) pre-doctoral recipients, (2) the effectiveness of the program in reaching its intended recipients, (3) the extent to which NRSA programmatic requirements are being met, (4) the effectiveness of NRSA programs, and (5) the relationships between NRSA program characteristics and outcomes.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Walter Schaffer, Ph.D.

PHONE NUMBER: 301-435-2770

PIC ID: 6095

PERFORMER ORGANIZATION: Vanderbilt University, Vanderbilt Institute for Public Policy Nashville, TN

PROJECTED DATE OF COMPLETION: 1/31/99

TITLE: Follow-Up Study of Young Investigators in the Biological and Biomedical Sciences

ABSTRACT: The National Research Council (NRC) will perform a follow-up study to explore findings of the report, "The Funding of Young Investigators in the Biological and Biomedical Sciences." The committee that prepared this report found that the number of persons 36 years of age and younger who are applying for National Institutes of Health (NIH) individual investigator awards has decreased by more than half, from 1985 to 1993.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Walter Schaffer, Ph.D.

PHONE NUMBER: 301-435-2770

PIC ID: 6098

PERFORMER ORGANIZATION: National Academy of Sciences, National Research Council Washington, D.C.

PROJECTED DATE OF COMPLETION: 1/31/99

TITLE: Evaluation of NIH Post-doctoral Trainees and Fellows

ABSTRACT: This study is part of a long-term evaluation effort directed at examining the extent to which the objectives of the National Institutes of Health (NIH) National Research Service Award (NRSA) pre-doctoral and post-doctoral training programs are being achieved. Using extant data, the focus of this project is to develop a profile of NRSA post-doctoral award recipients and determine what portion of former NRSA post-doctoral trainees and fellows successfully pursue health-related research or training careers.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Walter Schaffer, Ph.D.

PHONE NUMBER: 301-435-2770

PIC ID: 6285

PERFORMER ORGANIZATION: Vanderbilt University, Institute for Public Policy Studies Nashville, TN

PROJECTED DATE OF COMPLETION: 5/30/99

TITLE: Evaluate Current and Future Human Resource Needs in the Biomedical, Behavioral, and Social Sciences in the Drug Abuse Research Field

ABSTRACT: This project is a companion study to a National Institutes of Health (NIH)-sponsored study that examines general trends and needs related to the training of biomedical and behavioral scientists. This companion study focuses on the unique training needs of staff in the drug abuse research field. The report will: (1) assess the current status and effectiveness of the National Institute on Drug Abuse's (NIDA's) research training efforts, (2) assess future training needs for researchers in those fields most important to drug abuse and addiction research, and (3) make recommendations that will enhance program responsiveness.

AGENCY SPONSOR: National Institute on Drug Abuse

FEDERAL CONTACT: Harold Jones

PHONE NUMBER: 301-443-6071

PIC ID: 6040

PERFORMER ORGANIZATION: Tonya, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Evaluation of Psychiatry Research Trainees and Research Training Programs

ABSTRACT: This project represents Phase III of an effort to study psychiatric research trainees. Information from this final phase will: (1) provide the Center for Mental Health Services (CMHS) leadership with information to improve Federal programs that support research training; and (2) train site staff to improve curricula, faculty assignments and the trainee selection process.

AGENCY SPONSOR: National Institute of Mental Health

FEDERAL CONTACT: David H.Tilley

PHONE NUMBER: 301-443-8803

PIC ID: 6041

PERFORMER ORGANIZATION: Tonya, Inc. Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/20/99

Facilities

TITLE: Survey of Scientific and Engineering Research Facilities at Colleges and Universities

ABSTRACT: Since 1986 and every two years subsequently, the National Science Foundation (NSF) and the National Institutes of Health (NIH) have conducted the Survey of Scientific and Engineering Research Facilities. The availability and condition of biomedical research space directly affects the scope and quality of the biomedical research conducted at the Nation's colleges, universities, medical schools, hospitals and other research organizations. To address the need for information on the amount and quality of S&E research space, Congress mandated that the NSF gather this information and report it to Congress.

AGENCY SPONSOR: National Center for Research Resources

FEDERAL CONTACT: Fred W. Taylor

PHONE NUMBER: 301-435-0766

PIC ID: 6863

PERFORMER ORGANIZATION: National Science Foundation Washington, D.C. and National Academy of Sciences Commission on Life Sciences Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/30/99

Office of the Assistant Secretary for Planning and Evaluation

Evaluation Program
The Assistant Secretary for Planning and Evaluation (ASPE) functions as a principal advisor to the Secretary on policy development and, in this capacity, conducts a variety of evaluation and policy research studies on issues of national importance. ASPE also is responsible for department wide coordination of legislative, planning, and evaluation activities. In its evaluation coordination role, ASPE has the following tasks:

Provide annual guidance to all HHS agencies and staff offices regarding evaluation priorities, procedures, and review requirements.
Review evaluation priorities proposed by HHS agencies, providing advice about the focus or method of proposed projects and identifying opportunities for collaboration, and effective use of resources.
Prepare planning and summary reports on evaluation activities as required by Congress.

Another continuing evaluation objective of ASPE is to support and promote the development and improvement of data bases that HHS agencies and ASPE use to evaluate health care programs and health trends. For example, ASPE has been the major initiator in collaboration with the National Center for Health Statistics at the Centers for Disease Control and Prevention of the first comprehensive survey of people with disabilities in the United States. The first component of these new data was completed in FY 1996, and national prevalence data on disability are now available. The ASPE co-chairs and provides support to the HHS Data Council, which is charged with integrating key national surveys, such as linking health status indicators with indicators of well-being. The Department needs more comprehensive data sources to assess anticipated transformations in health and human services.

Finally, ASPE uses evaluation funds to promote effective use of evaluation-generated information in program management and policymaking. The latter is accomplished through the dissemination of evaluation findings and other activities, such as providing technical assistance to agencies in the development of performance measures.

Fiscal Year 1998 Evaluations

Disability, Aging, and Long-Term Care Policy

TITLE: Children with Severe Chronic Conditions on Medicaid

ABSTRACT: Many children with special health care needs depend on the health and supportive services provided by Medicaid. It is important that policymakers have a sound understanding of these children's patterns of health care use, especially given the shift to managed care. Previous studies of children on Medicaid with severe disability and/or chronic illness have focused on "SSI-related" children, or children with extremely high health care costs. This study provides further analysis of Medicaid expenditures for SSI children, and adds to the literature by applying diagnostic and utilization-based criteria to claims data to identify children with severe chronic illness. This methodology enables analysis of the service use patterns and expenditures for children with severe chronic conditions who are receiving Medicaid, but are not enrolled in SSI. Three data sources were used in the analysis: (1) Medicaid administrative records extracted from the Health Care Financing Administration's (HCFA's) database provided data on Medicaid service utilization and expenditures. (2) The 1992 MarketScan database, a proprietary database of integrated claims and population data of individuals enrolled in private insurance plans, was used to compare the prevalence of children with chronic conditions and private health insurance coverage, to the prevalence of children with chronic conditions enrolled in Medicaid. (3) For SSI children, data on the principal disabling condition (as identified by the disability determination process) were obtained from Social Security Administration records. Results of the study indicate that there are many more children with severe chronic conditions receiving Medicaid coverage than simply those who become eligible for Medicaid through the SSI program.

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

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 5758

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

TITLE: Consumer-Directed Personal Assistance Services: Key Operational Issues for State CD-PAS Programs Using Intermediary Service Organizations

ABSTRACT: This study was initiated by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to identify best practices for implementing consumer-directed personal assistance (CD-PAS) programs through the use of various intermediary service organization (ISO) models. Twenty-three State and Medicaid-funded CD-PAS programs that used ISOs in eleven States were examined. The term personal assistance services (PAS) refers to a range of human and mechanical assistance provided to persons with disabilities of any age who require help with routine activities of daily living. Consumer-directed modes of financing and delivering PAS permit the consumer (as opposed to medical or social work professionals) comparatively greater choice and control over all aspects of service provision including: (1) recruiting, hiring, and training attendants; (2) defining attendants' duties and work schedules; (3) supervising attendants regarding how specific tasks are to be performed; (4) managing the payroll functions, including paying attendants; and (5) disciplining and discharging attendants. When a third party payor is involved in financing PAS (e.g., private insurance or publicly-funded programs such as Medicaid), certain limitations may be placed on the consumer's ability to exercise choice and control over his or her PAS. Because of these issues, States have begun to develop a variety of intermediary service organization (ISO) models to facilitate the use of CD-PAS programs by persons with disabilities and chronic conditions, and to assist government policymakers in achieving an appropriate balance among competing goals. ISO models seek to provide appropriate PAS that affords consumers choice and control, while assuring program and fiscal accountability, regulatory, compliance, protection from liability, service quality and consumer health and safety. This report examines several ISO models.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6164

PERFORMER ORGANIZATION: Systemetrics, Inc. Washington D.C.

TITLE: Evaluation of the District of Columbia's Demonstration Program, "Managed Care System for Disabled and Special Needs Children"

ABSTRACT: This project evaluates the District of Columbia's managed care demonstration program for disabled and special needs children. The demonstration program relies on a Medicaid-financed managed care system for children in the District's Supplemental Security Income (SSI) program, and is offered to eligible children as an alternative to the traditional Medicaid fee-for-service system. Enhanced Medicaid benefits through the demonstration program include individual treatment plans, respite care, van transportation and taxi vouchers, care management services and limited-use phones. The Medicaid payment system includes risk sharing based on 85 percent risk corridors (as defined by medical loss ratios) between the District's Medicaid office and the non-profit health plan operating the demonstration, a capitated payment system for the health plan, and negotiated fee schedules for providers. This evaluation considers access and cost issues, placing considerable emphasis on issues related to quality of care and satisfaction. The research design centers on three main activities: (1) analyses of the implementation of the demonstration; (2) analyses of enrollment which will describe which children enroll and disenroll in this type of system; and (3) outcomes analyses that document the experiences of the District, plan, providers, children and families. The study of the implementation of the demonstration is based on interviews, a series of site visits to the District's Medicaid office and HSCSN, and review of the documentary record. This project was co-funded by the Health Care Financing Administration (HCFA).

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.

TITLE: Exploratory Study of Health Care Coverage and Employment of People with Disabilities

ABSTRACT: Most policymakers agree that the current structure of the Social Security Administration's disability programs creates substantial work disincentives for people with disabilities. One set of policy options concerns changing the links both between Medicare and the Social Security Disability Insurance (DI) program, and between Medicaid and the Supplemental Security Income (SSI) program. More generally, reforms that expand access to health insurance for people with disabilities who are not DI or SSI recipients could have an impact on both employment and program participation. The purpose of this study is to examine empirical evidence on the relationships among health insurance, employment and program participation of people with disabilities. Specifically, it presents the findings of an analysis of expansions in the income threshold for the SSI work incentive program established by Section 1619 of the Social Security Act. These expansions have allowed many working SSI recipients to maintain Medicaid eligibility even after their incomes rise above the level that makes them ineligible for SSI payments. This report also presents findings from an analysis of the employment, insurance and program participation status of people with disabilities using the 1993 Survey of Income and Program Participation (SIPP) and the 1994 National Health Interview Survey (NHIS). This analysis focuses on groups of people with disabilities who would most likely be affected by expansions in public health insurance.

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

FEDERAL CONTACT: Kathleen Bond

PHONE NUMBER: 202-690-6443

PIC ID: 6240

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

TITLE: International Evidence on Disability Trends Among the Elderly

ABSTRACT: Recent studies indicate that disability rates among the elderly may be declining. The data for these findings come from the National Long-Term Care Survey. Currently, over forty programs assist persons with disabilities. Information on trends in elderly disability rates could help in estimating the size of the population eligible for these programs, as well as their projected costs. This project attempts to: (1) assemble the evidence regarding trends in disability rates among the elderly; (2) critique the evidence from a scientific perspective; (3) carry out additional analyses and expand the evidence on trends, especially on differences of age, gender, and other subgroup status; and (4) assess the implications for disability policy and expenditure trends.

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

FEDERAL CONTACT: William Marton

PHONE NUMBER: 202-690-6443

PIC ID: 6719

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

TITLE: Meeting The Challenge of Serving People With Disabilities: A Resource Guide for Assessing the Performance of Managed Care Organizations

ABSTRACT: This Resource Guide is designed to support efforts to measure and improve Medicaid Managed Care Organization (MCO) performance for people with disabilities. The purpose of the guide is threefold: (1) To provide an overview of the issues to be considered in measuring the performance of MCOs; (2) To bring together in one volume, key information about measures that now exist, or are about to be made available, that can be counted on to support efforts to measure and improve the care provided by MCOs to people with disabilities; and (3) To make clearer the areas where technically strong measures do not exist, in order to encourage further measurement development in these areas. Additionally, the guide presents the results of an extensive search for existing performance measures that can be used for quality measurement and improvement by: (1) State Medicaid agencies; (2) managed care organizations; (3) providers within MCOs; and (4) people who advocate for the health care needs of the disabled.

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

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7060

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

TITLE: Report on In-Depth Interviews with Developers

ABSTRACT: This report is intended to supplement ongoing research being conducted as part of The National Study of Assisted Living. In this supplementary study, detailed interviews were conducted with 29 individuals from 21 States who are involved in various aspects of the development of assisted living facilities (e.g., architects, builders, developers and consultants to the development industry). The report provides preliminary information concerning barriers to the development of assisted living and future trends in the industry, as well as the potential for assisted living to serve a larger lower income and Medicaid-eligible population. The study focuses on the following issues: (1) trends in the supply and demand for assisted living; (2) barriers to the development of assisted living; (3) scope and status of the regulatory and quality assurance systems for assisted living; (4) ways in which the current assisted living industry embodies the principles of consumer choice and autonomy, and the extent to which the industry matches the conceptual model of assisted living; and (5) the effects of different models of assisted living on consumer and worker satisfaction, resident length of stay, affordability, and its potential substitutability for nursing home care. The findings of the report are designed to provide a context for the larger study and provide information about emerging trends.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 4719.5

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

TITLE: State Assisted Living Policy: 1998

ABSTRACT: This study reviewed the assisted living and board-and-care policies in each of the 50 States. States reported a total of 28,131 licensed facilities with 612,063 units or beds. Over 25 percent of the beds are located in three States: California (123,238); Florida (66,293); and Pennsylvania (62,241). Twenty-two States have existing licensing regulations using the term assisted living, up from 15 in the previous study. Wisconsin has re-named their assisted living regulations as residential-care apartment complexes. Draft regulations using the term assisted living have been developed by an additional nine States, including Maryland, which is significantly expanding the scope of an earlier program, previously termed, "assisted living". Four States are revising existing assisted living regulations. West Virginia is developing rules for a new category and New Hampshire revised rules which took effect in 1998. Thirty-five States reimburse, or plan to reimburse, services in assisted living or board-and-care facilities as a Medicaid service. Eleven States had created a task force or a process within a State agency to make recommendations for developing assisted living rules. While a common or standard definition of assisted living is still unlikely, State approaches share some common components. This new model for long-term care is developing as a residential, rather than institutional, model. The major issues addressed by State policies concern requirements for the living unit, for tenant admission/retention, level of services allowed, and for administrator and staff training. This report describes the primary approaches States are taking to license assisted living, discusses Medicaid reimbursement and other selected areas, and summarizes each State's licensing rules.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 4719.6

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

TITLE: The Role of Home and Community-Based Services in Meeting the Health Care Needs of People with AIDS: Final Report

ABSTRACT: Home- and community-based services, such as assistance with daily living activities and the provision of home-delivered meals, have long been an integral part of AIDS care. However, improved health and functioning have broadened the scope of these services. Changes in AIDS treatment and in the characteristics of the AIDS population have had profound and interrelated effects on the use of home- and community-based services by people with AIDS and increased life expectancy has increased the duration of needed services. Improved treatment has also improved health and decreased levels of functional impairment for many people, which in turn appears to have led to a decrease in the use of traditional home- and community-based services (such as home-delivered meals and personal care). At the same time, this treatment has led to a greater need for other types of support, such as assistance with treatment adherence and return to work. Meanwhile, the increased incidence of AIDS among people with low incomes, people with substance abuse problems, and women with families has led to an increased need for home- and community-based service providers to interact more often with substance abuse treatment, mental health, family services and public assistance systems. The goal of this project was to assist in the development of a research agenda for studying home- and community-based service use among people with AIDS. The project had three components: (1) a review of the literature describing the delivery and financing of home- and community-based services for people with AIDS, (2) case studies of service provision in New York City and Los Angeles, and (3) an analysis of use and reimbursement patterns for New Jersey Medicaid beneficiaries with AIDS.

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

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 6418

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

Health Policy

TITLE: A Framework for Research and Evaluation Into the Effects of Managed Care on the Pharmaceutical Marketplace

ABSTRACT: The growing influence of managed care has had a profound effect on the pharmaceutical marketplace, and has highlighted a number of long-standing concerns among those involved in providing pharmaceutical services, including the industry, purchasers, providers, third-party payers and the government. The goal of this project, therefore, was to improve the quality and accessibility of information used to make decisions in the public and private sectors about how to deal with the revolutionary changes in the pharmaceutical marketplace and the impact of managed care on pharmaceutical services. The project also developed information on how managed care has affected consumer access to pharmaceutical services. The principal product of the project describes a framework for research and evaluation that serves the information needs of all the stakeholders, public and private, providing a common basis for discussion and decision making. The principal report is supported by a series of study papers that synthesize the best current research on the evolution of key elements of the health care delivery system. These study papers do not focus on solutions to problems or recommendations for change. Instead, their purpose is to analyze and synthesize the existing research into a comprehensive, balanced portrait of the system.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 6049

PERFORMER ORGANIZATION: The George Washington University and Urban Institute, Washington, D.C.

TITLE: Assessment of Access to Liability Insurance for Tribes and Tribal Organizations with Self-Determination Contracts/Compacts

ABSTRACT: This study examines issues surrounding tribal experiences with private liability insurance and the Federal Tort Claims Act (FTCA). The primary purposes of the study are to: (1) examine access to private liability insurance by tribes and tribal organizations operating programs under the Indian Self-Determination and Education Assistance Act (ISDEAA), and the coordination of that insurance with the immunity from tort liability for self-determination contractors and compactors and their employees provided under the FTCA; (2) identify 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 reduce the need for private liability insurance, as well as its cost. The grant of immunity from tort claims provided under the FTCA for P.L. 93-638 activities should have resulted in tribes and tribal organizations paying less for private insurance. However, a lack of awareness of the applicability of the FTCA and/or full understanding of its scope appear to have prevented some tribes from doing so. One of the most important steps that tribes can take to lower their private liability costs is to become better informed about the fundamentals of the FTCA and the types of commercial insurance they need to supplement the immunity from tort claims that the FTCA provides. The Federal government can assist tribes and tribal organizations by providing more accessible information about the FTCA in a form that is simple and useful to laypersons. Tribes and tribal organizations can help each other by sharing information about their experiences in obtaining appropriate and reasonably priced insurance.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Tom Hertz

PHONE NUMBER: 202-690-7779

PIC ID: 6345

PERFORMER ORGANIZATION: The George Washington University, Washington, D.C.

TITLE: Children's Health Insurance Expansions: State Experience in Developing Benefit Packages and Cost-Sharing Arrangements

ABSTRACT: This project reviews the experiences of nine States that either utilized Medicaid expansions or developed stand alone programs to expand health insurance for children prior to the enactment of Title XXI. The enactment of the State Children's Health Insurance Program (CHIP), under Title XXI of the Social Security Act, is providing $24 billion in funding to States over a five-year period to expand health insurance coverage to uninsured children. Under CHIP, States have the option of expanding their existing Medicaid programs, developing stand alone programs or some combination of the two. As States select their approaches, design of the benefit package, including cost-sharing features, is one of the critical considerations States are facing. While the legislation defines standards for benefit packages and limits the extent to which States can impose premiums or cost-sharing (i.e., deductibles and copayments), the States maintain a fair amount of flexibility in program design. The nine States interviewed for this study are divided into two broad categories: Medicaid expansion programs and stand alone insurance programs. Generally, the survey revealed that States debated over whether to provide a more limited insurance product for more children, or include inpatient benefits and therefore serve fewer children. In terms of cost sharing, results of the survey indicated that program directors believed that by instituting moderately priced premiums and copayments, families were more willing to enroll, and did not view the program as a form of welfare. Several States identified the affordability of employer-sponsored insurance as an important consideration in the implementation of mechanisms to limit crowd out. Related to issues of price sensitivity is the decision of whether to implement a flat fee premium for all participants, or one that is based on a sliding scale.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: 202-690-7794

PIC ID: 6729.1

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

TITLE: Children's Health Insurance Patterns: A Review of the Literature

ABSTRACT: Policymakers are currently considering a number of proposals aimed at reducing the number of children without health insurance. This report attempts to address the lack of information about the uninsured child population. This literature review focuses on (1) uninsured children: how many there are, their characteristics, how long are they uninsured, and why are they uninsured; and (2) Medicaid eligibility, enrollment, participation rates, program dynamic, and measurement issues. The review found that: (1) the uninsured are found in every age group of children, even among the very young supposedly covered by past expansion efforts under Medicaid; (2) over two-thirds of uninsured children live in families with a family income of less than 200 percent of poverty; (3) about 70 percent live in two-parent families and 64 percent have one parent working full-time; (4) the vast majority (80 percent) of uninsured children have one parent who is also uninsured; (5) even though a majority of uninsured children are white, minorities (especially Hispanics) are disproportionately represented; (6) uninsured children include a disproportionate number of noncitizens (10 percent versus 4 percent in the general population of children); and (7) there are inconsistencies in the research concerning how long children are insured. Also identified are topics for further investigation. (Final report 72 pages.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6721

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

TITLE: Deriving State Level Estimates from Three National Surveys: A Statistical Assessment and State Tabulations

ABSTRACT: This report assesses the statistical issues involved in the production of State-level estimates related to health and welfare issues from three national surveys: the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), and the National Health Interview Survey (NHIS). With the devolution of many welfare programs from the Federal Government to the States, there is a strong interest in being able to track the health and welfare of the population in each State. This would allow for examination of the effects of various State welfare initiatives that are to be implemented in the next few years. Ideally, the CPS, SIPP and NHIS would be able to provide "direct" estimates of adequate precision for every State, as opposed to the "indirect" estimates derived from statistical models. The surveys, however, are not large enough to produce accurate direct estimates for every State, and there are great disparities in sample size. The relevant statistical issues involved in making State-level estimates from the three surveys include State stratification, non-sampling errors and precision of the estimates. For this report, the most current databases for two of the three surveys were examined: March 1996 for the CPS and the 1993 panel for the SIPP. In 1995, the NHIS sample was completely redesigned, so examining the 1994 data would yield little information on the ability of future years to provide State-level estimates. For all three surveys, the allocation of sample size to the States is made with the aim of balancing the precision requirements of both State and national estimates. As a result, disparities exist. Approaches to overcome the sample size limitations of these surveys include the following: (1) increase State samples, (2) combine data from multiple years of the same survey, and (3) combine data from two or more surveys. These methods can both increase the size, and improve the accuracy of, State samples.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: 202-690-7794

PIC ID: 6380

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

TITLE: Examining Substitution: State Strategies to Limit Crowd Out in the Era of Children's Health Insurance Expansions

ABSTRACT: In recent years, State initiatives to provide health insurance for low-income children have raised a new set of concerns regarding the actual and potential impact of employer and individual-based substitution. As a number of States elected to expand Medicaid in the late 1980s, researchers began to explore the possibility that Medicaid was substituting private coverage. As Federal and State governments seek to increase the proportion of people with health coverage, it is critical to understand the nature and extent of substitution. Concerns focus on the potential that, if Medicaid and other public expansions are responsible for shifting individuals from employer-sponsored insurance to public programs, the effectiveness of public funds to expand insurance coverage might be limited. As programs minimize the effects of substitution, States will then have the ability to target funding specifically to children who do not have access to affordable health coverage. Several States have suggested that the coverage issue, in most cases, is not employers dropping coverage, rather individuals choosing to opt out of private insurance coverage for State subsidized programs. Research has attempted to assess the amount of substitution, suggested ways to limit its effects, and weighed the benefits and costs of expanding Medicaid with the potential of crowding out private insurance. State strategies to address substitution include nine mechanisms that either purposefully or inadvertently limit two types of substitution: individual-based and employer-based. The extent to which States deliberately institute mechanisms limiting substitution varies by program and State.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Cheryl Austein-Casnoff

PHONE NUMBER: 202-690-6102

PIC ID: 6729

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

TITLE: Public Health Laboratories and Health System Change

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. The study identifies aspects of the public health infrastructure critical for developing assessment and evaluation tools. The report includes a literature review, interviews with stakeholders, an informal poll of state PHL directors and detailed case studies of three States that have PHLs and relationships with MCOs and/or private laboratories. The report concludes that: (1) PHLs are part of the broader public health infrastructure and must respond to changes in the health care marketplace; (2) services that are not commercially viable within the private sector, and those that are critical to identifying emerging diseases, should remain in the domain of PHLs; (3) assurance of quality and consistency of laboratory testing are critical functions of PHLs; and (4) policy development in laboratories needs 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. (Final report variously paginated.)

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: Resource Evaluation of the FDA Food Additive Petition Review Process Executive Summary

ABSTRACT: This project analyzes the food additive petition process in the Food and Drug Administration (FDA) to determine the resources needed to achieve a petition processing time frame of 180 days. The Food Additives Amendment to the Food, Drug and Cosmetics Act requires the Food and Drug Administration to provide premarket approval for food additives prior to inclusion in food. Premarket approval is sought via the petition process and the statute requires the FDA to complete its petition review within 90 days of filing, with a possible extension of another 90 days and an extended processing period of 180 days. The FDA had been unable to consistently meet these statutory time frames. This project quantifies the resources required for each of the Office of Premarket Approval's (OPA's) various responsibilities, and details the impact of competing requirements on the petition review system. Conclusions state that the statutory time frames are unrealistic for most petitions. The ability to meet the time frames is not a question of staffing or personnel availability. The only way to address the statutory time frames is to either change the time frames, or completely rethink the entire functioning of OPA and the types of review it should be performing.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Laina Bush

PHONE NUMBER: 202-205-5271

PIC ID: 6342

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

Human Services Policy

TITLE: Building and Sustaining Community Partnerships for Teen Pregnancy Prevention: A Working Paper

ABSTRACT: This report stresses lasting community partnerships as a strategy for teen pregnancy prevention. Factors influencing teens' sexual and contraceptive behavior include characteristics of the teens themselves, their peers and sexual partners, their families and communities. Since no single factor is highly related to behavior, the establishment of comprehensive community partnerships will, it is believed, reduce teen pregnancy rates. The advantages of community partnerships include: (1) pooled resources, shared risks and increased efficiency; (2) integrated and coordinated services; (3) strengthened communities through partnerships. The report covers the process, as well as the importance of, partnership development.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Sonia Chessen

PHONE NUMBER: 202-690-8471

PIC ID: 7016

PERFORMER ORGANIZATION: Cornerstone Consulting Group, Inc. Washington, DC

TITLE: Aid to Families with Dependent Children: The Baseline

ABSTRACT: On August 22, 1996, President Clinton signed into law the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). PRWORA replaced the Aid to Families with Dependent Children (AFDC) program. The purpose of this report is to provide an overview of the AFDC program prior to the enactment of PRWORA. The report: (1) traces the historical origins and evolution of the program over the past sixty years and provides detailed national and state data since the mid 1960s; (2) traces the trends in the caseload for the basic AFDC program and the unemployed parent component; (3) provides some descriptive statistics regarding the family and household characteristics; (4) examines the level of Federal and State spending on the program; (5) discusses the eligibility thresholds and the AFDC benefit levels; (6) reviews the research and the length of stays on AFDC, and the factors associated with entering and leaving the program; and (7) describes the Food Stamp Program and provides data from the Food Stamp Quality Control system that are relevant to describing the characteristics of the AFDC caseload up to the end of 1996. (Final report 123 pages plus appendix.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Gilbert Crouse

PHONE NUMBER: 202-401-6616

PIC ID: 6944

PERFORMER ORGANIZATION: Office of Human Services Policy, Washington D.C. 20201

TITLE: Ancillary Services to Support Welfare to Work

ABSTRACT: This project provides information on ancillary services, such as addiction treatment, housing needs, legal services, medical needs (including services such as eye and dental care) and mental health services, for both policymakers and State and local program operators. The project synthesizes and interprets existing research in a non-technical format, identifies gaps in knowledge, identifies service needs that are not being met and their potential impact, and highlights promising program practices that incorporate ancillary services into a long-term strategy to improve employment outcomes of welfare recipients.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Richard Silva

PHONE NUMBER: 202-401-6638

PIC ID: 6740

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

TITLE: Approaches to Evaluating Welfare Reform: Lessons from Five State Demonstrations (Two Volumes)

ABSTRACT: Most States obtained waivers from Aid to Families with Dependent Children (AFDC) and Food Stamp Program rules in order to implement welfare reform. Between 1993 and 1996, the Clinton administration approved waivers for 43 States. This project examined waiver demonstration projects in five States (California, Colorado, Michigan, Minnesota and Wisconsin). Four of the five used an experimental evaluation design, while the fifth was quasi-experimental. The report addresses issues in five areas: (1) the choice between an experimental and quasi-experimental evaluation design, (2) sample design, (3) implementation of experimental evaluations, (4) data collection, and (5) analysis methods. The report found that: (1) most evaluations of State welfare reform demonstrations used an experimental design which involved random assignment of cases to an experimental group subject to welfare reform, or to a control group subject to pre-reform policies; (2) only one waiver (Wisconsin's) was approved with a quasi-experimental design, but this may become more common in a block grant environment; and (3) when designing a study sample, evaluation planners should ensure that the sample size is adequate and should design the sample so that applicant and recipient subgroups can support separate impact estimates. The sample should also be representative of the State as a whole. The report also found that four aspects of the implementation of an experimental evaluation require special care, including: (1) the timing of the random assignment, (2) the method of the random assignment, (3) ensuring that control group policies remain unchanged, and (4) preventing experimental and control group cases from changing status. The report also discusses data collection and analysis. (Final report Volume I 128 pages plus appendices, Volume II 8 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6050

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

TITLE: Building an Employment Focused Welfare System: Work First and Other Work-Oriented Strategies in Five States

ABSTRACT: The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 made dramatic changes to the Nation's welfare system. States are now translating PRWORA's goal of a work-oriented , transitional assistance program into an operational reality. This report reviews the policy choices and experiences of six sites in five States that are engaged in making the transition from the more traditional welfare focus on cash assistance, to the new Work First focus on employment. Work First programs in Indiana, Massachusetts, Oregon, Virginia and Wisconsin exemplify a range of strategies being used to achieve increased employment among welfare recipients. Among these States there are two distinct Work First models in place: (1) The Work First, Work Mandate model (Massachusetts and Virginia) mandates employment participation as a requirement for continued cash assistance only a few months after initial receipt of benefits. (2) The Work First, Participation Mandate model (Oregon, Indiana, and Wisconsin) includes job search, education and training as allowable forms of participation throughout the period of cash receipt. Data were collected from site visits to State and local welfare offices between January and March of 1997. Since the passage of the PRWORA, Indiana and Wisconsin have implemented new work-based reforms, while the remaining States have made few changes. Thus, although the report measures State experiences at one point in time, it reflects States at different stages in their own evolution towards an employment-focused welfare system. (Executive summary 45 pages; final report 97 pages bound separately.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Elizabeth Lower-Basch

PHONE NUMBER: 202-690-6808

PIC ID: 6227

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

TITLE: Evaluating Two Welfare-to-Work Program Approaches: Implementation, Participation Patterns, Costs and Two-Year Impacts of the Portland (Oregon) Welfare-to-Work Program

ABSTRACT: This report is one of several in a series from an evaluation of mandatory welfare-to-work programs in seven sites, and 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 Aid to Families with Dependent Children (AFDC) caseload, who were 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. 5,547 single-parent AFDC applicants over the age of 21were randomly assigned to either a program group or a control group. 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 enrollment in the program. 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. See also PIC ID 6576, 6576.1, 6576.2, 6576.4.

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: 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, the Department of Health and Human Services (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 abilities to pursue continued education, training, or employment. Failure to participate could result in sanctions, until the teenage parent complies with the program. This evaluation assesses the impact of the program on welfare use, education, literacy, employment, income, family formation, child care use, repeat pregnancies, and many other outcomes of current policy interest. The results of the program have informed State JOBS and other programs with teen cohorts. A five year follow-up has been completed, and includes information about impacts on the children. The child outcomes portion of the study analyzes the impact of the demonstration on the cognitive, emotional, social, and health well-being of the children of these young mothers. The data are comparable to the child impacts component of the JOBS evaluation.

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

TITLE: National Evaluation of Welfare-to-Work Strategies: Evaluating Two Welfare-to-Work Program Approaches: Two Year Findings on the Labor Force Attachment and Human Capital Development in Three Sites

ABSTRACT: This report is part of a larger study called the National Evaluation of Welfare-to-Work Strategies, formerly known as the JOBS Evaluation, which has randomly assigned more than 55,000 individuals in seven sites to groups eligible for specific welfare-to-work programs, and to control groups that do not participate in these programs. This study compares two distinct welfare-to-work strategies, labor force attachment (LFA) and human capital development (HCD), at each of three of sites: Atlanta, GA; Grand Rapids, MI; and Riverside, CA. At each site, Aid to Families with Dependent Children (AFDC) applicants were randomly assigned to one of three groups: (1) a group subject to the LFA program, (2) a group subject to the HCD program, or (3) a control group not subject to any welfare-to-work program. This report presents findings on the implementation, participation patterns and costs of the two types of programs operated at each site. Additionally, the report assesses the two program approaches in promoting employment and reducing welfare expenditures after two years. The study finds that: (1) The LFA programs increased participation in the job search and the HCD programs increased participation in adult basic education. (2) Welfare sanction rates for nonparticipation were higher in the LFA and HCD programs than in previously studied programs, although higher sanction rates were not associated with higher rates of eventual participation in program activities. (3) The HCD programs cost approximately twice as much as the LFA programs. (4) Both programs increased individuals' two-year cumulative employment and earnings. (5) Both programs reduced welfare expenditures within the two-year follow-up period. The report concludes that a period of two years is insufficient to make a credible comparison between the two approaches. See also PIC ID series 5776. See PIC ID 6576 and 6576.2. (Executive summary 36 pages; Final report 276 pages plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576.1

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

TITLE: The Health and Well-Being of Children in Immigrant Families

ABSTRACT: The well-being and development of children are a priority for all America, because they are our future and because the rapid growth in the number of children who live in immigrant families gives them special prominence. The Board on Children, Youth, and Families of the Commission on Behavioral and Social Sciences and Education (CBASSE) of the National Research Council (NRC) and the Institute of Medicine (IOM) established the Committee on the Health and Adjustment of Immigrant Children and Families in March, 1996. The committee was composed of 19 members with expertise in public health, pediatrics, child psychiatry, developmental psychology, population studies, anthropology, sociology, economics, public policy, law and history. The committee reviewed relevant research and literature and provided demographic descriptions of immigrant children and families. They characterized the development of immigrant children, providing information on the risks and protective factors associated with differential health and well-being of different immigrant groups, and about the delivery of health and social services to these groups. Although no conclusions were drawn concerning recent policy changes, the research offered a critical "baseline" portrait of immigrant children prior to welfare reform against which their status could be compared in the coming years. Specific recommendations were made concerning research, data collection and information dissemination that are intended to expand scientific knowledge about children in immigrant families, and help inform future public policy deliberations.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: David Nielsen

PHONE NUMBER: 202-401-6636

PIC ID: 6752

PERFORMER ORGANIZATION: National Academy of Sciences, Board on Children and Families Washington, D.C.

TITLE: The Number and Cost of Immigrants on Medicaid: National and State Estimates

ABSTRACT: The Personal Responsibility and Work Opportunity Act (PRWORA) of 1996 established new rules for the Medicaid eligibility of non-citizen immigrants. Under the Act, most immigrants entering the U.S. after August 1996 are not eligible for federally-funded health insurance, with the exception of emergency benefits, under the Medicaid and CHIP programs. Prior to this welfare reform legislation, immigrants were eligible for the same Medicaid benefits as U.S. citizens. This report provides national and State estimates of the number of pre-welfare reform, non-citizen Medicaid beneficiaries, and their cost to the program. Information for analyses came from the Medicaid Quality Control (QC) database from the first half of 1994, and was supplemented with data from the Social Security Administration (SSA) on Supplemental Security Income (SSI) participants. The report found that prior to welfare reform: (1) One in 13 Medicaid beneficiaries were non-citizen immigrants; and (2) PRWORA did not affect the majority of immigrants receiving Medicaid benefits in 1996, but will have a greater impact as the number of new immigrants increases. The report concludes that the new eligibility restrictions are likely to increase the number of immigrants who are uninsured, although many factors will determine how these numbers will change in the future. States may replace, either wholly or partially, the lost federally-funded health insurance with state-funded assistance. New immigration policies will affect the rate of immigration and the composition of new immigrants. Additionally, an increase in the number of immigrants seeking naturalization may, in part, be attributed to apprehension surrounding welfare reform. Once the immigrants are citizens, they will again be eligible for Medicaid benefits. The impact of this potential increase in Medicaid caseloads is unclear. The future costs of increasing the number of low-income immigrants without Medicaid also remains to be seen. (Final report 47 pages plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: David Nielson

PHONE NUMBER: 202-690-6636

PIC ID: 6791

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

TITLE: Trends in the Well-Being of America's Children and Youth: 1998

ABSTRACT: This is the third edition of an annual report from the Department of Health and Human Services (HHS) on trends in the well-being of America's children and youth. The report presents the most recent and reliable estimates on more than 90 indicators of well-being. It is intended to provide the policy community, the media, and all interested citizens with an accessible overview of data describing the condition of children in the U.S. The indicators have been organized into five broad areas: (1) population, family and neighborhood; (2) economic security; (3) health conditions and health care; (4) social development, behavioral health, and teen fertility; and (5) education and achievement. For each indicator, the report provides graphics to highlight key trends and important population subgroup differences, and tables to provide more detailed information for the interested user. These are accompanied by text that briefly describes the importance of each indicator, and highlights the most salient features of the data.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Matthew Stagner

PHONE NUMBER: 202-690-5653

PIC ID: 6170.2

PERFORMER ORGANIZATION: Child Trends, Inc. Washington, D.C.

Program Systems

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. At the time of this study, 19 historically black colleges and universities (HBCUs) were participating in this 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 committed on or by minority males. The contractor: (1) performed an extensive literature review; (2) collected and analyzed relevant program documentation and materials; (3) conducted focus groups; (4) examined target populations; (5) developed a site visit discussion guide; (6) selected 10 HBCUs for site visits; (6) developed and executed an analysis plan; (7) interpreted analyses findings, defined program models and analyzed HBCUs' organizational capacity; (8) held briefings with Consortium leaders, members, and government personnel; (9) reviewed the overall organization, design, and implementation of the programs; and (10) evaluated prevention strategies adopted by the HBCU/FLCs. Violence prevention programs suffer from an inability to produce valid performance data demonstrating that prevention investments pay off in the long run. The report recommends that: (1) without completely centralizing the design process, 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) constraints should be introduced as to which program models are implemented by which schools. See also PIC ID Nos. 5789 and 5789.1. (Final report 68 pages plus appendices.)

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

TITLE: Health Performance Measurement in the Public Sector: Principles and Policies for Implementing an Information Network

ABSTRACT: The Panel on Performance Measures and Data for Public Health Performance Partnership Grants was assembled in fall 1995 at the request of the Department of Health and Human Services (DHHS) to assess performance measurement for the specific block grant programs included in the original Performance Partnership Grant (PPG) proposal, recommend measures that could be used to monitor the proposed PPG agreements to be negotiated between each State and the Federal government, and recommend steps to improve performance measures and performance measurement for health-related programs. In this report, the panel addresses broader data and information system issues that require attention at the Federal, State and local levels to advance the practice of performance measurement for publicly funded health programs. This report broadens the discussion begun in the first report by looking beyond the Federal-State PPG framework and beyond the specific program areas covered by the PPG proposal. Although the discussion focuses on the public sector perspective, closely related private sector interests and developments in clinical health care are also considered. (See PIC ID 6176)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: James Scanlon

PHONE NUMBER: 202-690-7100

PIC ID: 6176.1

PERFORMER ORGANIZATION: National Academy of Sciences, Committee on National Statistics Washington, D.C.

Evaluations in Progress

Disability, Aging, and Long-Term Care Policy

TITLE: Institute on Consumer Directed Services (Long-Term Care Infrastructure)

ABSTRACT: This research, technical assistance and dissemination project, jointly funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Administration on Aging (AOA), is designed to: (1) facilitate the ability of people with disabilities to exercise choice and control over the provision of the home and community based care (HCBC) they receive; (2) educate consumers or their representatives who want to use independent providers of personal assistance services, (PAS) about effective strategies for recruiting, training and managing independent providers; (3) educate consumers, their representatives and program personnel about consumer participation in care planning, on-site supervision of agency-employed workers and ways to work with case managers and agency personnel to modify care plans; and (4) provide information to States and communities to help them evaluate the outcomes and costs of strategies involving consumer choice and consumer directed services, and to develop and implement cost-effective policies and programs.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6162

PERFORMER ORGANIZATION: National Council on Aging, Inc. Washington D.C.

PROJECTED DATE OF COMPLETION: 10/20/98

TITLE: Client-Directed In-Home Care/Personal Assistance Services

ABSTRACT: This project will conduct a survey of personal assistance services clients, workers and case managers in order to compare measures of quality of care, quality of life, client satisfaction and worker satisfaction across modes of service provision. The modes of service provision to be compared include: (1) independent and supported-independent providers (client-directed modes), and (2) agency-employed providers (professionally-managed modes). The study will also compare the outcomes associated with use of family, friends and neighbors as independent providers, as compared to services provided by aides previously unknown to the client. The study is being carried out in the context of California's In-home Supportive Services program with the assistance of State officials.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6173

PERFORMER ORGANIZATION: University of California at Los Angeles, Los Angeles CA

PROJECTED DATE OF COMPLETION: 3/1/99

TITLE: National Study of Assisted Living for the Frail Elderly

ABSTRACT: The aging of America has significant implications for the nation's long-term care system. Assisted living is seen by many as one logical response, at least conceptually, to this population growth, which is likely to be accompanied by an increasing need for assistance with chronic diseases and disabilities. This study will focus on how assisted living fits in the long-term care system and its potential for addressing the needs of the elderly and persons with disabilities. It will examine the role of assisted living from the perspective of consumers, owners, workers, regulators, developers and investors, and others who have a stake in the nation's long-term care system. Issues to be addressed are: (a) the supply of assisted living facilities, (b) barriers to development, (c) existing regulatory structures, (d) principles of consumer autonomy and choice in supportive residential settings, and (e) impact on persons who live and work in assisted living facilities.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 4719.7

PERFORMER ORGANIZATION: Research Triangle Institute Washington, DC

PROJECTED DATE OF COMPLETION: 12/31/99

TITLE: Study of Private Long-Term Care Insurance Claims

ABSTRACT: This study will examine formal and informal home and community-based long-term care (LTC) services use among private insurance policy holders "in claim" (i.e., those who are receiving insurance benefits). It will compare patterns of formal and informal services use among these insurance claimants with those of a nationally representative sample (from the 1994 National Long-Term Care Survey) of disabled elders living in the community. Statistical processes will be employed to match claimants with particular characteristics (e.g., age, marital status, disability level) to elders in the national sample. The purpose of the comparison will be to measure the effects of private long-term care insurance on access to formal home care services and to determine whether or to what extent insurance-financed formal services supplement or substitute for informal family care. The study will also examine the interaction between insurance financed home care and the use of Medicare home health services.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6399

PERFORMER ORGANIZATION: Lifeplans, Waltham MA

PROJECTED DATE OF COMPLETION: 3/1/99

TITLE: Study of Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

ABSTRACT: This project will study the experiences of elderly Medicare beneficiaries with disabilities and chronic illnesses in a managed delivery system (MDS) at four separate sites. An MDS is broadly defined as a health care system that integrates the financing and/or delivery of primary, acute and long-term care of persons for the purpose of controlling costs and improving access to, and coordination of, services across a continuum of providers. The specific goals of the study are to: (1) foster a better understanding of the unique characteristics and health/long-term care needs of elderly persons with disabilities and chronic illnesses among health plan administrators, providers and policymakers; (2) assess how managed care delivery systems meet the needs of this population and the factors that promote or impede success; and (3) describe the health care experiences of disabled elderly Medicare beneficiaries in MDS.

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

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 6391

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

PROJECTED DATE OF COMPLETION: 6/30/99

TITLE: Analysis of Employer-Group Long-Term Care Insurance

ABSTRACT: This project will first survey employers offering their employees long-term care insurance benefits, identifying the existing group market and how if functions. Because most of the long-term care insurance market is composed of individual products--and because much of the employer information on long-term care insurance is fairly recent and not well explored--not much is known about the benefit packages, price, or design of these group products. The goal here is to identify quantitatively the "best practices" in the industry. Secondly, the project will examine designs for possible long-term care insurance benefits for Federal employees (and presumably their spouses, parents and retirees as well). Reviewing market survey data to identify important elements of existing employer groups, several long-term care insurance coverage options for Federal employees will be developed. The project will inform the primary Federal policy makers (such as the Office of Personnel Management) as to progress on this research and the accompanying design options.

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

FEDERAL CONTACT: John Cutler

PHONE NUMBER: 202-690-6443

PIC ID: 6718

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 6/30/99

TITLE: A Primer for States and Consumers on Medicaid Home and Community-Based Services

ABSTRACT: Medicaid, the principal source of financing for long-term care services, has frequently been said to have an "institutional bias," because State spending on nursing homes and institutions outweighs spending on home and community-based supports by a ratio of approximately 80 to 20. Many States have, however, demonstrated that it is possible to work within a Medicaid framework to expand home and community-based services, (HCBS) providing consumers with greater choice and control. Decreased dependence on unnecessary institutional long-term care and the expansion of consumer responsive home and community-based long-term care options are important policies of both the White House and the Secretary for the Department of Health and Human Services. To address this priority, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) proposes to develop a "primer" on existing long-term care options in Medicaid that promote consumer choices in long-term care. The primer will be an important and useful development tool for State Medicaid and aging policy and program staff, consumers and their representatives, and providers interested in the expansion of choices in long-term care, including the promotion of home and community-based options.

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

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7162

PERFORMER ORGANIZATION: The George Washington University Medical Center, Center for Health Outcomes Improvement Research, Washington, D.C.

PROJECTED DATE OF COMPLETION: 7/20/99

TITLE: Synthesis and Analysis of Medicare Hospice Benefit

ABSTRACT: The rapid rise in Medicare hospice expenditures, particularly on behalf of nursing home residents, has drawn the attention of a wide variety of health policymakers and the Office of the Inspector General (OIG). The OIG has advanced recommendations to modify how Medicare and Medicaid will pay for these services. However, a larger study is needed to examine key hospice trends nationally and in selected States. Additional information on the Medicare hospice benefit, including trends in utilization and expenditures, who is covered, and where, will help inform health policymakers as they consider alternative hospice benefit and payment designs. This project will describe trends and issues with the Medicare hospice benefit, particularly with respect to nursing home residents who elect this benefit. Information will be gathered through a review of the literature, discussion with key informants, and an analysis of claims, assessment and provider data. This project will: (1) examine trends in Medicare and Medicaid hospice and non-hospice utilization and expenditures for hospice and other similar beneficiaries; and (2) compare the quality of care for hospice beneficiaries.

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

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 7154

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/20/99

TITLE: Evaluation of Five State Health Reform Demonstrations

ABSTRACT: The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of Medicaid 1115 waiver demonstrations in five States attempts to add a disability focus to the State of Tennessee. This supplement will focus on the experiences of disabled adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) and disabled children enrolled in the TennCare and TennPartners programs. The project will conduct: (1) in-depth qualitative analyses of the State's experience in enrolling individuals with disabilities into managed care systems, and (2) quantitative analyses to examine costs and utilization data for these populations. In addition, the supplement will conduct a survey of disabled consumers to examine issues of satisfaction, quality, health status and functioning. See PIC ID 6289, 6289.1, 6166, and 6166.1.

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

FEDERAL CONTACT: Hunter McKay

PHONE NUMBER: 202-690-6613

PIC ID: 6289.2

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

PROJECTED DATE OF COMPLETION: 8/31/99

TITLE: Data Analytic Support for the Review of Long-Term Care Policy Options

ABSTRACT: This project will analyze data from the 1994 National Long-Term Care Survey to assist Health Care Financing Administration (HCFA) actuaries in estimating costs of the potential effects of eliminating or redefining the requirement that Medicare beneficiaries be "homebound" in order to access the Medicare home health benefit. It will also analyze data from the Community Caregiver Supplement to the 1996 Medical Expenditures Panel Survey Nursing Home Component. The purpose of this analysis is to understand the factors influencing decisions by severely disabled persons and their family members as to whether or not the disabled person should enter a nursing home. This analysis will guide the work of the HCFA/ASPE Task Force on Promoting Home and Community-Based Alternatives to Nursing Home Care. In particular, the analysis will help design a major demonstration project and technical assistance program for the States.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6677

PERFORMER ORGANIZATION: MEDSTAT Group Washington, DC

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Analysis of Patterns of Post-Acute and Chronic Care Services Use Among Disabled and Non-Disabled Medicare Beneficiaries: 1989-1994

ABSTRACT: This study uses the 1989 and 1994 National Long-Term Care Surveys to analyze factors that predicted growth in Medicare post-acute (i.e., home health and skilled nursing facility) benefits from the late 1980s through the mid-1990s.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6768

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

ABSTRACT: The FY 1997 contract modification allows a more focused review of how Medicare managed delivery systems address the needs of elderly persons with disabilities. This is accomplished in part through this contract modification which: (1) adds a longitudinal survey of elderly enrollees with targeted conditions, (2) limits the cross-sectional to elderly persons with disabilities, (3) adds a focus group of physicians, and (4) requires interviews with long-term care providers serving this population.

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

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 7155

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

PROJECTED DATE OF COMPLETION: 12/20/99

TITLE: Analysis of the Disability Supplement to the National Health Interview Survey

ABSTRACT: The disability supplement to the National Health Interview Survey (NHIS-D) is the first comprehensive survey on disability in the United States. The survey is unique in that it focuses on several populations of persons with disabilities who are generally omitted or under-represented in national survey efforts: children, persons with mental retardation and other developmental disabilities and the working-age population. The goal of this project is to conduct a series of analyses and produce both short-term products and final reports that will inform ongoing Assistant Secretary for Planning and Evaluation (ASPE) departmental and administrative research and policy initiatives. The analyses will address a specific set of questions in four topical areas using the NHIS-D: (1) welfare receipt and disability (including chronic illness); (2) disability and chronic illness among low income populations; (3) childhood disability and chronic illness; and (4) employment and disability.

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

FEDERAL CONTACT: William Marton

PHONE NUMBER: 202-690-6613

PIC ID: 7153

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/27/00

TITLE: Medicare Home Health Practice Variations

ABSTRACT: The main goal of this study is to examine how patient, provider, agency and market/regulatory forces relate to variations in Medicare home health care practices and outcomes. Three key questions form the basis of the study: (1) What is the actual practice of home health care in terms of amount, type and decision-making? (2) How are decisions about care made in light of the Health Care Financing Administration's (HCFA) Medicare home health care coverage rules? and (3) What elements of practice are associated with long lengths of stay in the home health benefit? The study will use a range of quantitative and qualitative methods to address these questions, including longitudinal data collection on samples of home health agencies and home health patients at those agencies, focus groups, case studies and analyses of secondary data.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6720

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 3/31/00

TITLE: Research on Employment Supports for People with Disabilities

ABSTRACT: The objective of this study is to collect detailed information on the experiences of people with disabilities, their knowledge of work incentive policies and provisions, the events and factors affecting their employment decisions, the relative importance of specific factors, and the reasons for successful and unsuccessful employment attempts. The purpose to gain a better understanding of the supports people with significant disabilities currently use to successfully participate in employment, supports that would improve their employment outcomes, and supports that would improve the employment outcomes of those who are not employed. The collection of this information is intended to advance the understanding of the effect of supports and programs on the employment of people with disabilities. The project is designed to provide information that may be used by Federal agencies, states, social service agencies, advocates for people with disabilities, and consumers with disabilities to develop and inform policies that will promote the employment of people with significant disabilities.

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

FEDERAL CONTACT: Floyd Brown

PHONE NUMBER: 202-690-6613

PIC ID: 4917.2

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 4/20/00

TITLE: Evaluation of Practice in Care (EPIC)

ABSTRACT: From 1989 to 1992, there was a 210 percent increase in Medicare expenditures for home health services. This increase in utilization has generated policy interest in measures to control expenditures without compromising quality. Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. This study will: (1) analyze "episodes" of care under the Medicare home health benefit, (2) assess the actual practice of care, (3) determine the extent to which there is variation in practice between acute and long-term care patients, and (4) uncover the factors accounting for that variation. The study will also examine decision-making processes between patients, providers and physicians. The events that take place during a visit and between visits as "actual practice" have never been measured. Furthermore, the function of decision-making by various parties has not been observed in "actual practice". This effort to understand issues surrounding regional and practice variations of home health care delivery will aid the Department of Health and Human Services and the industry in combating fraud and abuse, as well as contribute valuable data to a future prospective payment system.

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

FEDERAL CONTACT: Ruth Katz

PHONE NUMBER: 202-690-6613

PIC ID: 5888

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 6/30/00

TITLE: Private Payers Serving Individuals with Disabilities and Severe Chronic Conditions

ABSTRACT: This project examines the experiences of persons with disabilities or severe chronic conditions in health insurance plans sponsored by selected large employers. A methodology was developed to identify such individuals using diagnoses from health care claims and encounter databases. This methodology was applied to data from the health plans of two large employers. The prevalence of disabilities and severe chronic conditions was estimated among employees, their dependents, and retirees. The choice of indemnity versus managed care plans, and associated service utilization and expenditures were analyzed. The performance of various risk adjustment models was tested for physical and mental conditions. This project will provide information on the factors influencing the choice of insurance plans, and the effect of managed care on service utilization and expenditures. It also estimates the extent of adverse selection across plans, and indicates how various risk sharing strategies can mitigate its effects.

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

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 6398

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/28/00

TITLE: The Long Term Care Financing Model

ABSTRACT: The Long-Term Care Financing Model is a resource which has been extensively used by ASPE to project future long- term care utilization and expenditures and simulate various long term care policy options. These include expansions of public financing, such as those proposed during health care reform, as well as changes to Medicaid and Medicare. The model has also been used extensively to study private sector policy options, such as the impact of further growth on private long-term care insurance and the impacts of changing trends in disability rates on long-term care use and expenditures. Recent data on disability rates, nursing home use, and home care use will be used to update existing portions of the model. In addition, the model will be expanded to include acute care use, thereby increasing the Assistant Secretary for Planning and Evaluation's (ASPE's) ability to simulate a wide range of policy options. ASPE will use this computer model for projections and policy simulation and a series of policy simulations from the revised model will be presented in reports. In addition to its previous long-term care policy uses, the revised model will enable ASPE to address acute care issues, such as the combined burden of acute and long-term care spending on the elderly. Since the model simulates the income and assets of the population, including pension and Social Security payments, the model will also be used to study other aging-related issues, such as the impact of changes in employer-sponsored health insurance for retirees.

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

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 7143

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/30/00

TITLE: A Study of Home Health Practice Variations Study

ABSTRACT: Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. What takes place during a visit and between visits as "actual practice" has never been measured. Furthermore, the extent to which various parties participate in the decision making process, is also unknown. Such information is needed to improve understanding about actual practice and explain its variations. This study will analyze variations in home health care services, focusing on patient characteristics, provider characteristics, agency characteristics and market characteristics. Primary data will be collected at the patient and agency levels. Data from this study and the Health Care Financing Administration's (HCFA) Outcomes of Home Care Study will be used to assess the relationships between the process of home health care and its outcomes and resource use.

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

FEDERAL CONTACT: Ruth Katz

PHONE NUMBER: 202-690-6613

PIC ID: 6168

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 12/20/00

TITLE: Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation

ABSTRACT: This study will employ a classical experimental research design (i.e. random assignment of participants to treatment and control groups) in order to test the effects of "cashing out" Medicaid-funded personal assistance services for the disabled. Arkansas and New York are expected to participate in the demonstration, with an option to expand to include New Jersey and Florida. Control group members will receive "traditional" benefits in the form of case-managed home and community-based services where payments for services are made to vendors. Treatment group members will receive a monthly cash payment in an amount roughly equal to the cash value of the services that they would have received under the traditional program. It is hypothesized that cash payments will foster greater client autonomy and that, as a result, consumer satisfaction (particularly among disabled persons under age 65) will be greater. It is also hypothesized that States will save Medicaid monies (mostly in administrative expenses) from cashing out benefits.

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

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6161

PERFORMER ORGANIZATION: University of Maryland, Center on Aging, College Park MD

PROJECTED DATE OF COMPLETION: 1/20/01

Health Policy

TITLE: Enabling Services Methodology Workshop

ABSTRACT: This project seeks to address enabling services issues by: (1) exchanging information regarding what is known and unknown about enabling services in primary care settings, particularly in managed care environments, costs, efficacy, cost-effectiveness and new research efforts; (2) identifying key policy questions related to enabling services, particularly as used in managed care settings; (3) identifying major methodological questions that studies of these services present, both generally and in managed care settings, and strategies for overcoming them; and (4) developing a broad-based research agenda for consideration by the many public and private sector organizations which pay for, or otherwise have interests in, these services.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6750

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 10/1/98

TITLE: State Linked Data Meeting and Monograph

ABSTRACT: Data from a single source is frequently inadequate to examine effectively the relationships between and among costs, services and health outcomes. As a result of research and other efforts by the Federal government, foundations and States, a pool of experienced researchers and program administrators have created the linked data sets needed to examine the complicated relationships between and among programs. Sharing lessons learned in a meeting with the Federal research and data community will improve the Department of Health and Human Services (HHS) studies and help focus data initiatives. Sharing this information with the broader research and data community through a monograph will help encourage additional efforts, and may make such projects less daunting for those who follow.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6346

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 11/1/98

TITLE: Evaluating the Effects of Direct-to-Consumer Advertising on Consumers

ABSTRACT: The goal of this project is to improve our understanding of direct-to-consumer (DTC) advertising. The relation of this kind of advertising to aspects of public health will be examined through a survey of selected consumers and the Food and Drug Administration (FDA) Center for Drug Evaluation and Research's (CDER) analysis of that survey. This analysis will yield an initial broad description of some possible associations between DTC advertising and consumer knowledge, attitudes and behaviors. The survey and CDER's descriptive analysis will lay the foundation for the long- term task of determining what effects DTC advertising may have on overall consumer knowledge, attitudes and behaviors concerning prescription drugs and the overall effects of this practice on the public health.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Susannah Bruns

PHONE NUMBER: 202-690-7996

PIC ID: 6343

PERFORMER ORGANIZATION: Market Facts, Inc. McLean VA

PROJECTED DATE OF COMPLETION: 1/1/99

TITLE: Preventing Abusive Intimate Relationships Among Adolescents

ABSTRACT: The role of abusive relationships in the lives of adolescents is not as well researched or understood as either adult domestic violence or child abuse. A recent study found that 60 percent of young women who had sex before age 15 were involved in coercive sexual relationships. Apart from this study there is little research on coercive, controlling, or abusive relationships among teenagers. A new source of data in this area, the National Longitudinal Study of Adolescent Health (Add Health) has just been made available to the public. This project will examine the issue of abusive relationships among teenagers through a literature review, analysis of available data, identification of data needs, focused discussion groups, a summary of promising approaches to prevention and intervention and recommendations for further research and discussion.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Sandra Howard

PHONE NUMBER: 202-690-7778

PIC ID: 6751

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 1/1/99

TITLE: Innovative Coverage of Health Promotion, Clinical Preventive Services, and Other Coverage Issues in the Private Sector

ABSTRACT: Despite the important private sector employers play in shaping the current health care market, the views of this group concerning the provision of a variety of clinical preventive services and what their health plans currently provide have not been adequately described. In addition, the factors which influence their decisions to include or exclude such services have not been characterized. In collaboration with the Office of Disease Prevention and Health Promotion (ODPHP), and the Office of the Assistant Secretary for Planning and Evaluation (ASPE), researchers are forming a partnership with Partnership for Prevention to support the commissioning of a set of expert papers on the clinical preventive service benefits offered by employer-sponsored health plans. These papers are intended to meet two objectives: (1) to characterize the trends and decision processes occurring within the private sector; and (2) to evaluate the impact of government information on this issue in the private sector. As the government is investing its resources in producing and disseminating information designed to encourage the appropriate use of clinical preventive services, it is important to know how its customers in the private sector perceive and use such information.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6347

PERFORMER ORGANIZATION: Partnership For Prevention, Washington D.C.

PROJECTED DATE OF COMPLETION: 1/30/99

TITLE: Analysis of Prescription-To-Over-The-Counter Switch Movement

ABSTRACT: There are now more than 600 over-the-counter (OTC) drugs which would have required a prescription only twenty years ago. These products are now available without a prescription because the Food and Drug Administration (FDA), determined that they could be used safely and effectively without a doctor's supervision. In the last few years alone, several important and widely used drugs have been switched to OTC status: Children's Motrin (ibuprofin), (2) Orudis KT (ketoprofen) for pain relief and fever reduction, (3) Femstat 3 (butoconazole nitrate) for vaginal yeast infection, and (4) several heartburn medications like Pepcid AC (famotidine). Consumers have responded enthusiastically, turning OTCs into a $19 billion a year industry, with the total retail market value of four billion dollars. Despite the far-reaching effects on the switch movement, there is a relatively sparse study of this trend. If it can be assumed that consumers will continue to self-medicate and that this trend will continue, factors determining the impact on public health need to be examined. This project will provide a comprehensive review and analysis of the prescription-to-over-the-counter switch movement, through several analytical methods, and with an overall emphasis on the impacts of the switches on public health, consumer information, choice and decision making, the doctor-patient relationship, pharmaceutical pricing, profits, health care costs and managed care policy.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Laina Bush

PHONE NUMBER: 202-205-5271

PIC ID: 6723

PERFORMER ORGANIZATION: Northwestern University, Center for Health Services and Policy Research, Evanston IL

PROJECTED DATE OF COMPLETION: 4/1/99

TITLE: An Inventory of Federal HIV-Related Databases

ABSTRACT: This project will develop an inventory of major Federally sponsored HIV-related databases. The inventory will describe the relevant databases and review their potential applications for administrative, clinical research, epidemiologic, financing, policymaking, or program administration purposes. It will also identify key research questions that could be addressed by these databases and identify opportunities for cross-agency collaboration in data collection or analysis. The project will produce a final report including an annotated inventory, as well as the relevant database assessments that point to key research issues and opportunities for interagency collaboration and cross-cutting analyses.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Leslie Hardy

PHONE NUMBER: 202-690-7858

PIC ID: 7146

PERFORMER ORGANIZATION: The George Washington University Medical Center Washington, D.C.

PROJECTED DATE OF COMPLETION: 6/20/99

TITLE: Statistical Linkage of Data Files for Evaluation: National Health Interview Survey and Survey of Income and Program Participation

ABSTRACT: This project, jointly sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the National Center for Health Statistics (NCHS), will establish analytical and modeling databases derived from statistical matches of the National Health Interview Survey (NHIS) and the Survey of Income and Program Participation (SIPP). The resulting analytical database will also be useful for analysis of inter-relationships between health status and health care use, socioeconomic factors and a range of income and program participation data from SIPP. The linked database will support sophisticated analyses to aid in understanding the interrelationships between health and human services variables. It will also support policy analyses through microsimulation modeling and other analytical techniques.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Joan Turek

PHONE NUMBER: 202-690-6141

PIC ID: 6419

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 6/30/99

TITLE: Consequences and Cost of Intimate Partner Violence

ABSTRACT: This project will apply the methodology developed in "The Cost of Domestic Violence to the Health Care System" (PIC ID No. 4528) to prevalence and other data related to violence committed by adult intimate partners. The study will document the incidence of violence against women by intimate partners, estimate economic costs of related injuries and develop preliminary recommendations for reducing incidence and related injuries. It will form the basis for a report to Congress, authorized under the Crime Act. This project will be jointly funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Centers for Disease Control and Prevention (CDC). See also PIC 4528.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Sandra Howard

PHONE NUMBER: 202-690-7778

PIC ID: 4528.1

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

PROJECTED DATE OF COMPLETION: 7/1/99

TITLE: Evaluation of the Oregon Medicaid Reform Demonstration

ABSTRACT: The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of the Oregon Medicaid Reform Demonstration attempts to add a disability focus to the Statewide evaluation. This supplement will focus on the experiences of disabled children and adults (physically disabled, mentally retarded, or developmentally disabled) who are enrolled in the Oregon Health Demonstration. The disability supplement will examine cost and utilization data, and will link this data to functional data collected by State agencies and managed care plans. In addition, the supplement will conduct a survey of consumers and providers to examine issues of satisfaction, access, quality, health status and functioning. See PIC ID 6166 and the 6289 series.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 6166.1

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

PROJECTED DATE OF COMPLETION: 8/31/99

TITLE: The Changing Structure of Health Insurance Markets

ABSTRACT: This project will result in two research papers evaluating the following: (1) insurance market changes relating specifically to State laws complying with the Health Insurance Portability and Accountability Act of 1996, and (2) the relationship between health insurance market structure and health insurance coverage of the population. This study builds on an ongoing effort funded by the Robert Wood Johnson Foundation to compile an expanded and updated insurer database and to conduct several basic analyses of health insurance market structure, change and performance. State insurance markets are not well understood and have seldom been systematically studied in a manner that can inform public policy discussions and development. These products will contribute significantly to the public's understanding of how insurance markets are changing.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Stephen Finan

PHONE NUMBER: 202-690-7387

PIC ID: 7160

PERFORMER ORGANIZATION: Alpha Center Washington, DC

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Developing a Framework for Domestic Infectious Diseases Surveillance

ABSTRACT: The purpose of this study is to develop an analytic framework that can be used to help create consensus on core capacities needed at each level of government for effective national infectious diseases surveillance. Emphasis will be placed on several areas including: (1) defining the relative roles of each level of government, and of the public and private sectors; (2) analyzing resource issues with particular attention to sources of funding, and to categorical versus integrated funding streams; (3) translating surveillance activities into meaningful public health responses; (4) evaluating surveillance activities; and (5) identifying training needs. The study will take into account the rapidly changing environment, especially the role of local health departments, and the changing nature of infectious diseases. The work will consist of: (1) collecting and analyzing data and information from the literature and from experts; (2) using this information to develop an initial framework describing what is needed for effective surveillance; and (3) establishing an expert panel which will use the framework as a tool to reach consensus on the minimum core capabilities needed at each level of government, and the relative roles of the public and private sector for more effective national infectious diseases surveillance.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 7161

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Access and Utilization of New Antidepressant and Antipsychotic Medications

ABSTRACT: The proposed project involves a collaboration with the National Institute of Mental Health (NIMH). Very little is known about how and why decisions are made regarding insurance coverage for many of the newer antidepressant and antipsychotic medications. The proposed study will provide important insight and knowledge from multiple perspectives (and with regard to multiple programs) concerning the often complex processes related to access, utilization and coverage of newer psychotropic medications. This new knowledge will serve to inform the department in efforts to evaluate existing and proposed policies.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 7193

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/20/99

TITLE: Construction of an Integrated Measure of the Burden of Disease

ABSTRACT: The burden of disease in a population consists of the morbidity and disability experienced by its members, their psychological perception of the adequacy and effectiveness of the care they receive, and resources expended for health maintenance. The essence of medical care is to determine the balance among these components that will most enhance overall health. The objective of the proposed project is to develop and evaluate analytic techniques that will permit: (1) the construction of an integrated measure of the burden of disease based on the explicit assessment of what trade-offs are currently accepted; and (2) identify changes in strategies to optimize the mix.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 7142

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/27/99

TITLE: Safety Net Framework Project

ABSTRACT: The Nation's health care provider safety net consists of: (1) hospitals, (2) primary care facilities, (3) specialized service providers such as family planning clinics, HIV service providers, community mental health centers, drug and alcohol treatment clinics, and (4) individual practitioners. These providers operate under both public and private auspices. As a group they are diverse, with varied funding sources including: (1) Medicaid and Medicare patient revenues and other payments, (2) Federal grant support from multiple sources, (3) other grants, (4) State and local public funding, (5) limited private third party insurance, (6) patient fees (often sliding scale), and (7) private philanthropy. Federal policy affects these providers in several ways. Products from this project will include a series of working papers, a workshop summary and a final "framework" document. The project is intended to result in new ways of shaping the Department's views concerning safety net providers. In particular, the Department plans to have a structure which considers how Federal grant programs, payment policies and other Federal policies affect these providers as they interact among each other at the community level.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 7156

PERFORMER ORGANIZATION: Northwestern University, Evanston IL

PROJECTED DATE OF COMPLETION: 9/28/99

TITLE: Impact of Medicare HMO Enrollment on Health Care Costs in California

ABSTRACT: The Office of the Assistant Secretary for Planning and Evaluation (OASPE) is supporting a time series study of the relationships between competition in hospital markets and the prices of hospital care, hospital revenues and hospital costs. The project began in the late 1980s and was extended in 1994 to investigate how health maintenance organization (HMO) enrollment affects changes in Medicare payments on behalf of beneficiaries. The project will collect time series data on California Hospitals (cost reports supplemented by a small survey on selective contracting by the hospital) to investigate whether competition continues to depress hospital prices, revenues and costs. In addition, several smaller projects are underway to investigate whether hospital mergers result in increased prices and a series of investigations (individual and county level) to determine if HMO enrollment leads to a decline in Medicare costs when other appropriate variables are held constant. California is particularly important in this study, because it tends to be a trend-setting State.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: 202-690-7794

PIC ID: 6889

PERFORMER ORGANIZATION: RAND, Santa Monica, CA

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program

ABSTRACT: The proposed project involves a collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA) to conduct an evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program. The objectives of the proposed evaluation are to: (1) assess whether PATH-funded expenditures are consistent with the authorizing legislation; and the adequacy of program controls; (2) develop a typology for better understanding the delivery of local PATH-funded services and assess whether the typology adequately characterizes meaningful differences in process-level variables, such as outreach and engagement activities with clients; (3) provide background information useful in interpreting data collected to meet the Government Performance and Results Act (GPRA) requirements; and to suggest measures that may be used in conjunction with the GPRA mandate; and (4) examine, where possible in site visit programs, existing administrative or client-level data to describe relevant outcomes for a sample (albeit non-representative) of PATH program participants.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 7210

PERFORMER ORGANIZATION: Westat, Inc. Rockville, MD

PROJECTED DATE OF COMPLETION: 8/20/00

Human Services Policy

TITLE: Mandatory Review and Modification in TANF Cases

ABSTRACT: The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 made the review and modification of child support awards for those receiving welfare assistance optional, a change from prior law which required such reviews every three years. Given that States now have a policy choice, this project seeks to inform that choice by developing national estimates of the financial impacts of not reviewing child support awards for welfare recipient families on State child support collections. This project seeks to provide estimates of the financial impacts to the Federal and State governments (how such a discontinuance would impact child support offsets to cash assistance payments.) The financial impacts on families are to be estimated, paying particular attention to those who have left the welfare rolls.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Don Oellerich

PHONE NUMBER: 202-690-5877

PIC ID: 6749

PERFORMER ORGANIZATION: Institute for Research on Poverty, Madison WI

PROJECTED DATE OF COMPLETION: 11/10/98

TITLE: Child Health and Development Programs in the Context of Welfare Reform

ABSTRACT: This project will identify and present profiles of promising Federal, State and/or community-based health and human services programs believed to be enhancing the health and development of children in the context of welfare reform. Targeted activities include case management strategies, child assessment programs, links between pre-kindergarten and child care programs, school-readiness programs and the use of formal child care versus informal child care arrangements.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Martha Moorehouse

PHONE NUMBER: 202-690-6939

PIC ID: 6754

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

PROJECTED DATE OF COMPLETION: 06/30/99

TITLE: Diagnosed Health Conditions and Health Care Service Utilization of Children in Foster Care

ABSTRACT: This project will conduct a study of health care issues regarding children in foster care. The study will use State Medicaid Research Files (SMRF) for three States to examine the extent of diagnosed illness and disability among children in foster care and the receipt of health care by these children. SMRF data includes information on health care claims made through the Medicaid program as well as information regarding the diagnoses associated with those claims. The study will examine questions regarding: (1) the extent of diagnosed illness and disability among children in foster care as compared to other children on Medicaid; (2) receipt of health care services including acute care, care for chronic health conditions and preventive services; (3) receipt of health care services following transitions into and out of foster care; and (4) subgroups of children in foster care, such as adolescents' use of substance abuse treatment and/or pregnancy-related services.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: 202-690-5938

PIC ID: 7149

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

PROJECTED DATE OF COMPLETION: 2/20/99

TITLE: Domestic Violence and Welfare: An Early Assessment

ABSTRACT: This project will study early implementation of the Temporary Assistance for Needy Families (TANF) Family Violence Option and child support enforcement program responses, including the use of good cause waivers for battered women. Evidence suggests that some battered women seek employment and child support while others need specialized assistance in addressing partner abuse. To address domestic violence, States may have policies regarding screening and other forms of identification, assessment of a battered woman's needs, service provision, confidentiality, corroboration required, staffing arrangements, agreements with community resources and other considerations. The study will provide information about these policy issues, the status of program implementation and descriptions of useful models.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Gerald Silverman

PHONE NUMBER: 202-690-5654

PIC ID: 6724

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/1/00

TITLE: Wisconsin Data Project on Former AFDC Recipients

ABSTRACT: This project will provide early results on the economic and employment outcomes of women who leave the Aid to Families with Dependent Children (AFDC) rolls in Wisconsin, a State that has experienced a rapid decline in caseloads over the past ten years. While no data are available on women who leave the rolls under Temporary Assistance for Needy Families (TANF), this project will examine women as they make the transition from welfare to work in a State that began many TANF-like welfare reforms before the passage of Personal Responsibility and Work Opportunities Restoration Act (PRWORA). The analysis will be conducted using linked administrative data from the State of Wisconsin including: (1) AFDC data, Food Stamps data and Medicaid data from the Client Assistance for Re-Employment and Economic Support administrative database (CARES); (2) earnings data from the Unemployment Insurance records database (UI); and (3) income and family status data from the State tax record database. This project will not explain caseload decline; rather, it will describe the characteristics and outcomes of two groups of women who have left the AFDC program in Wisconsin. The first group will be composed of recipients who left AFDC during 1995, and the second group will be composed of recipients who left AFDC in 1990. The project will include: (1) a descriptive analysis of those who left the rolls, (2) a descriptive comparison of the economic status of women before and after leaving welfare, and (3) a detailed comparison of both the characteristics and outcomes of those who left AFDC in 1995 and 1990.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Susan Hauan

PHONE NUMBER: 202-690-8698

PIC ID: 6727

PERFORMER ORGANIZATION: Institute for Research on Poverty, Madison WI

PROJECTED DATE OF COMPLETION: 1/1/99

TITLE: Welfare Reform and Changing Program Participation Patterns in Four States

ABSTRACT: The purpose of this study is to understand how families' use of a variety of safety net programs changes over time as welfare reform is implemented. This will be an early look at how welfare waivers and the welfare reform law influenced families' program participation. Using administrative data in four States from 1994-1997, the study will examine a series of questions regarding whether families' program participation patterns change in response to program eligibility changes and policy shifts. It will examine the child and family outcomes in such areas as family self sufficiency, child living arrangements and child abuse and neglect reports. The study's unique contribution will be its effort to look at families' pathways across a series of safety net programs.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: 202-690-5938

PIC ID: 7148

PERFORMER ORGANIZATION: Chapin Hall Center for Children, University of Chicago, IL

PROJECTED DATE OF COMPLETION: 3/20/99

TITLE: Fixing to Change: The Role of One-Stop Job Centers Working with Welfare Recipients

ABSTRACT: One-stop job centers have become an important part of the welfare-to-work effort. These one-stop centers can take on many forms and provide a variety of services. This project looks at implementation issues for one-stop job centers serving welfare recipients. The study focuses on five cities, describing the range of program models used in the cities, and identifying those approaches that seem to be working well, as well as those issues posing challenges to one-stop centers. The study incorporates background information supplied by the one-stop centers, summary data on employer and welfare recipient characteristics, staffing information and responses from focus groups conducted among one-stop officials, one-stop staff, current recipients, previous recipients and employers.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 7152

PERFORMER ORGANIZATION: University of Washington, Fiscal Policy Center Seattle, WA

PROJECTED DATE OF COMPLETION: 3/20/99

TITLE: Paper Series on the Low Wage Labor Market

ABSTRACT: While research exists regarding the low-wage labor market, it is often not in a format that is useful to policymakers at the State and local levels. It is difficult and time-consuming to review the extensive volume of research papers that have been published in numerous sources. Furthermore, much of the research on the low-wage labor market is written from an academic perspective, focusing on statistical findings but not interpreting these findings in terms of policy implications. This project will synthesize important findings on major topics related to the low-wage labor market.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 6717

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/31/99

TITLE: Adolescent Decision Making Workshop

ABSTRACT: Efforts to reduce teen marijuana use, smoking and pregnancy are not new, but they are now being debated in a policy climate characterized by frustration at past attempts to address teen behavior and renewed efforts to take strong actions to reduce these behaviors. The role of decision making processes in these interventions is a topic that has generated a substantial core of new research. This project will convene a January workshop and prepare a summary report to: 1)identify the major lessons learned from the last decade of research on adolescent decision making, particularly as they bear on efforts to reduce behavior among adolescents; 2)discuss the results of research on efforts to intervene in adolescent behaviors; and 3)discuss the implications of this research for alternative approaches to reducing behavior among the Nation's youth, particularly in the areas of substance abuse and sexuality.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Elisa Koff

PHONE NUMBER: 202-690-5932

PIC ID: 6877

PERFORMER ORGANIZATION: National Academy of Sciences, Board on Children and Families Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Labor Market Conditions, Job Search Strategies, and Welfare-to-Work Transitions

ABSTRACT: This study examines the effects of local low wage market conditions on the duration of welfare enrollment periods. While various studies have looked at the impact of employment conditions on welfare duration, employment conditions have often been measured using State-level indicators and/or indicators for the labor market as a whole. This study collects detailed information on the local labor market conditions for low-skilled workers and estimate the impact of such conditions, thus providing a more accurate picture of how labor market opportunities affect a recipient's ability to leave the welfare roles.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 6892

PERFORMER ORGANIZATION: University of North Carolina at Chapel Hill, School of Public Health, Chapel Hill, NC

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Pregnancy Prevention Programs Targeting Boys and Young Men: Policy Information Dissemination Strategy

ABSTRACT: This project will develop a research and policy information strategy to inform regional, State, and local policy officials and community-based organizations serving children and youth of the program models, primarily directed at boys and young men, that can be implemented to help teenagers avoid premature sexual activity and unintended pregnancies. Project staff will: (1) review activities within the Department of Health and Human Services (HHS) and outside the Federal government to collect information about pregnancy prevention activities targeted at boys and young men; (2) meet with national, State, and community leaders to determine information needs; (3) develop information packets; and (4) test strategies to get information to State and community decision makers in a timely and usable format. This project is an integral part of the National Strategy to Prevent Teen Pregnancy and the Clinton Administration's Fatherhood Initiative, which promotes delaying fatherhood until a man is emotionally and financially ready, and encourages fathers to take a more active role in providing support and guidance to their children. It is also being undertaken in collaboration with the activities of the non-profit, non-partisan National Campaign to Prevent Teen Pregnancy.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Linda Mellgren

PHONE NUMBER: 202-690-6806

PIC ID: 6766

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/1/99

TITLE: Home Visitor Services Demonstration: Home Visiting for Teen Parents Required to Participate in JOBS

ABSTRACT: This demonstration tests the effectiveness of combining the Job Opportunities and Basic Skills Training (JOBS) program with weekly home visiting services provided by paraprofessionals to teen parents. The teens participating will be welfare recipients who are required to participate in education, training and employment-related activities through the JOBS program, including participation with the home visiting component. They will be first-time teen parents on public assistance and, based on past research, about one-half will be living on their own. The controlled experimental design evaluates whether the home visitors help participants increase participation in JOBS activities, improve parenting, experience fewer repeat pregnancies and births and increase use of preventive health care. A main focus of this project is obtaining appropriate health care, including preventive care, for teen parents and their children. Health outcomes such as immunizations for children will be measured.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6160

PERFORMER ORGANIZATION: University of Pennsylvania Philadelphia, PA

PROJECTED DATE OF COMPLETION: 4/30/99

TITLE: Making Ends Meet: How Mothers Manage When Their Welfare Grants Are Cut

ABSTRACT: This study will describe how family life adjusts to sanctions, through collection of in-depth qualitative data from mothers who are currently experiencing a cut in their welfare budget due to an imposed sanction. The data will include details on: (1) changes in financial resources, (2) how family members are affected, (3) where families turn for additional support, (4) additional reported and unreported employment activity, (5) mothers' perceptions about conflicts between work and family responsibilities, and (6) perceptions about the availability of affordable child care.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 6893

PERFORMER ORGANIZATION: Teachers College Columbia University, New York, NY

PROJECTED DATE OF COMPLETION: 8/1/99

TITLE: National Evaluation of Welfare-to-work Strategies

ABSTRACT: The Department of Health and Human Services is undertaking a study of the effectiveness of welfare-to-work programs. As part of the National Evaluation of Welfare-to-Work Strategies, the effects of two approaches to preparing welfare recipients for employment will be compared in three sites (Atlanta, Grand Rapids, and Riverside). In one approach, the human capital development approach, individuals are directed to avail themselves of education services and, to a lesser extent, occupational training before they seek work, under the theory that they will then be able to get better jobs and keep them longer. In the other approach, the labor force attachment approach, individuals are encouraged to gain quick entry into the labor market, even at low wages, under the theory that their work habits and skills will improve on the job and they will thereby be able to advance themselves. Note that the study does not focus on the effects of postsecondary education.

The evaluation uses a random assignment design in order to get reliable results. Sample members are being followed for five years from the time they entered the study. Comprehensive data on economic outcomes, including information on quarterly Unemployment Insurance-reported earnings and monthly TANF and Food Stamp payments is being collected. A broad range of data is being collected through surveys including data on educational attainment, family composition, housing status, wage progression, employment, child care, depression, and total family income. In addition, effects on the well-being of the children of the mothers in the study is being evaluated. Four types of child outcomes are being measured: cognitive development and academic achievement; safety and health; problem behavior and emotional well-being; and social development. Assessments in each of these area will be compared across research groups two and five years after the mothers entered the study sample.

The study is being conducted by the Manpower Demonstration Research Corporation. The project period is 1989-2000.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576

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

PROJECTED DATE OF COMPLETION: 6/30/00

TITLE: Child Outcome Study of the National Evaluation of Welfare-to-work Strategies: Two-Year Impacts

ABSTRACT: The Child Outcomes Study is a substudy of the National Evaluation of Welfare-to-Work Strategies (NEWWS), a longitudinal evaluation of a set of welfare-to-work strategies implemented under the Job Opportunities and Basic Skills Training (JOBS) Program as a part of the 1988 Family Support Act. In the three sites selected for the Child Outcomes Study--Atlanta, GA; Grand Rapids, MI; and Riverside, CA--the evaluation is examining the impacts of two types of welfare-to-work approaches. The "labor force attachment (LFA) approach" encourages a rapid transition into the labor force, whereas the "human capital development (HCD) approach" follows a long-term strategy of investing in recipients' basic education, with the aim of increasing qualifications for higher wage jobs. The Child Outcomes Study seeks to evaluate the impacts of each strategy on children's development and behavior in three domains: (1) cognitive development and academic achievement, (2) behavioral and emotional adjustment, and (3) physical health and safety. It will examine which maternal, family, and contextual characteristics help to explain these impacts on children. Background information is included on such topics as: (1) mothers' educational attainment, (2) current and previous employment, (3) welfare history, (4) household composition, (5) psychological well-being, and (6) welfare-related attitudes. This and other information (e.g., parenting, child care, father involvement) was collected at two and five years after random assignment from administrative records and in-home surveys. In addition, the five-year follow-up will survey teachers about children's school progress and behavior.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576.4

TITLE: The Role of Intermediaries in Welfare to Work

ABSTRACT: Moving millions of welfare recipients into the workforce is the cornerstone of the recently enacted welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. Efforts to employ welfare recipients under PRWORA will not be successful without the involvement and support of private sector employers. Across the country, businesses are getting involved to varying degrees in welfare-to-work, including more than 2,500 member companies of the Welfare to Work Partnership who have pledged their commitment to hire welfare recipients. Many of these businesses are in turn relying on intermediaries to help them hire welfare recipients. The role of intermediaries varies significantly, from providing referrals or assistance with filing for tax credits, to providing extensive pre and post-employment services. While the importance of intermediaries is growing rapidly, little is known about them. This study provides two types of information on intermediaries. The first is a broad description of the types of intermediaries currently participating in welfare-to-work efforts in several sites across the country. This information will be presented for a large number of intermediaries, but will be fairly general, focusing on the basic characteristics of the intermediaries and the types of services provided. The second part of the project will present in-depth information on implementation issues based on site visits to the communities of approximately ten of these intermediaries.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 7151

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

PROJECTED DATE OF COMPLETION: 10/20/99

TITLE: Integration of Welfare and Workforce Development Systems

ABSTRACT: This study will: (1) build on research which examined State-level coordination and integration, and (2) provide an examination, using a case study approach, of the ways in which welfare agencies are working with other organizations involved in workforce development at the local level. It will provide additional insights into possible implications of various approaches to integration for individuals who are receiving public cash assistance through the Temporary Assistance to Needy Families (TANF) program, and who must seek employment and move toward economic self-sufficiency in a time-limited welfare environment. In addition to providing current information for policymakers and program administrators regarding the challenges to coordination and integration and lessons learned by local officials, the study will help to identify issue areas requiring in-depth study.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 7144

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/31/99

TITLE: Disaggregating the TANF Child-Only Caseload in Three States

ABSTRACT: The purpose of this study is to give the Department of Health and Human Services more detailed information about the make-up and trends of the Temporary Assistance for Needy Families (TANF) child-only population three States. Child-only cases are those in which benefits are paid only on behalf of minor children, and there are no adults in the household receiving assistance. In some cases the children are living with adults other than their parents. In such a case, the caretaker receives assistance on behalf of the child, but not for himself/herself. In other cases, a parent is in the household but is ineligible for benefits for one of several reasons, including: (1) receipt of SSI, (2) unqualified alien status, or (3) imposed sanctions. Such cases currently make up 21 percent of the TANF caseload, a proportion which has grown significantly in recent years. This study will use administrative data, case file reviews, and interviews with program and policy staff in three States to provide a better understanding of the issues regarding child-only TANF cases.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: 202-690-5938

PIC ID: 7188

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 12/20/99

TITLE: Review of Family Preservation and Family Reunification Programs

ABSTRACT: This mandated evaluation attempts to document the impacts of a variety of family preservation programs on children and families. For the purposes of this evaluation, family preservation programs include: (1) placement prevention services aimed at preventing children from entering substitute care; (2) broader family preservation services that may be less intensive and of longer duration than placement prevention services; and (3) reunification services to speed the return of children to their homes after entering substitute care. Measures of program success include: (1) prevention of placement into substitute care (for pre-placement services), (2) successful reunification (for reunification services), (3) reduction of the recurrence of child abuse and neglect, (4) improved child psychological well-being, (5) improved child behavior, and (6) improved family functioning. A rigorous random assignment design is being used to assess differences between families who receive family preservation services and those who do not. The study examines five sites with existing family preservation and reunification programs: Louisville and Lexington, Kentucky; Memphis, Tennessee; Philadelphia, Pennsylvania; New York City, New York; and eight counties in New Jersey. Field work is underway in all five sites. See PIC ID 5337 and 5337.1.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Matthew Stagner

PHONE NUMBER: 202-690-5653

PIC ID: 5337.2

PERFORMER ORGANIZATION: Westat, Inc. Rockville, MD

PROJECTED DATE OF COMPLETION: 12/31/99

TITLE: Economic and Health Status of Immigrants, Their Communities, and the Organizations that Serve Them

ABSTRACT: This project will conduct research on the economic and health status of immigrants, their communities and the organizations serving them. The research will profile the status of immigrants with regard to health, employment and participation in programs administered by public and private agencies, with special attention to distinguishing categories of immigrants and drawing comparisons with the Native population. The project will also explore the impacts of welfare reform on immigrants and organizations, with special attention to both individual and institutional adaptations. Since the loss of food stamps appears to be the most far-reaching and permanent change affecting current legal immigrants, its impact on immigrants and their families will be a particular focus of the study. The project will supplement an examination of existing secondary data with intensive secondary data collection in Los Angeles and New York, the two cities that together account for one-fourth of the immigrant population. Primary data collection in the two cities has been designed to develop profiles of immigrants in these cities and the agencies serving them. This effort has several components, including: (1) interviews with 1,200 immigrant households in each city; (2) telephone interviews with most of the non-profit agencies providing services to immigrants; (3) in-depth interviews with 100 immigrants who lose Food Stamps and with additional immigrants who retain food stamps in each city; and (4) in-depth interviews with administrators and staff in public and private agencies.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: David Nielson

PHONE NUMBER: 202-401-6642

PIC ID: 6747

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 10/1/00

TITLE: Welfare Outcomes Panel Study

ABSTRACT: The Office of the Assistant Secretary for Planning and Evaluation (OASPE) is conducting a panel study with the National Academy of Sciences (NAS) to evaluate the design of current, proposed and future studies of the effects of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. This panel study will assist the department in: (1) reviewing existing research efforts on the effects of welfare reform; (2) examine the appropriate data sources, research designs and statistical methods for analyzing welfare reform outcomes; and (3) identify research gaps and data needs for the continued study of welfare reform. Specific topics to be covered by the panel of experts include: (1) the appropriate outcome measures needed to effectively evaluate the outcomes of welfare reform; (2) the appropriate population of study; (3) the design and usefulness of existing national-level surveys (e.g., the Survey of Program Dynamics and the Survey of Income and Program Participation); (4) data needs for monitoring State and sub-State variation in outcomes; (5) potential uses and limitations of administrative data; and (6) integration of survey and administrative data. Over the course of the study, the NAS expert panel will address the above mentioned tasks through workshops, quarterly panel meetings and the publication of both an interim report and a final report. The interim report will include early recommendations of the panel and the final report will document the comprehensive list of final recommendations to the department.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Susan Hauan

PHONE NUMBER: 202-690-8698

PIC ID: 7145

PERFORMER ORGANIZATION: National Academy of Sciences Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/2/01

TITLE: The National Evaluation of the Welfare to Work Grants Program

ABSTRACT: The Balanced Budget Act of 1997 authorized the Department of Labor to award $3 billion in welfare-to-work grants to States and local communities to promote job opportunities and employment preparation for the hardest-to-employ recipients of Temporary Assistance for Needy Families (TANF), and for non-custodial parents of children on TANF. This project will evaluate the effectiveness of welfare-to-work initiatives, including those undertaken by the welfare-to-work grantees and by American Indian and Alaska Native (AI/AN) tribal organizations. The Department of Health and Human Services (DHHS), in conjunction with the Departments of Labor and Housing and Urban Development, has designed an evaluation to address five key questions: (1) What are the types and packages of services provided by welfare-to-work grantees? (2) What are the net impacts of various welfare-to-work program approaches on employment and on family well-being? (3) What challenges are confronted as grantees implement and operate the programs? (4) Do the benefits of the programs outweigh the costs? and (5) How well do private industry councils and other non-TANF organizations meet the challenges of implementing the programs for the hard to employ? The evaluation study includes four main components: (1) a descriptive assessment of all welfare-to-work grantees based on mail surveys and site visits; (2) in-depth impact and cost-effectiveness study; (3) in-depth process and implementation study; and (4) a special process and implementation study focusing on tribal welfare and employment systems.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Alana Landey

PHONE NUMBER: 202-401-6636

PIC ID: 7147

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

PROJECTED DATE OF COMPLETION: 10/03/02

Program Systems

TITLE: Community Programs: Performance Measurement and Program Innovation Series

ABSTRACT: The purpose of this project is to conduct two performance measurement and program innovation seminars to: (1) improve the understanding of performance measurement among DHHS and State and local staff members; (2) stay abreast of current performance developments at the State and local levels; and (3) increase knowledge of potentially promising State and local innovations. The seminars will also allow the DHHS staff to interact with State and local officials on a variety of performance measurement and program innovation questions. Two themes for the seminars are Local Innovative Programs and Performance Measurement for Community Programs. (See PIC ID 7209)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Margaret Price

PHONE NUMBER: 202-260-0382

PIC ID: 7209.1

PERFORMER ORGANIZATION: Howard University, School of Social Work, Washington D.C.

PROJECTED DATE OF COMPLETION: 5/20/99

TITLE: Research Consultation on Review of HHS Services Research, Demonstrations, and Evaluations Targeted to Hispanic/Latino Americans

ABSTRACT: The purpose of this project is to obtain consultation for a review of the various health services and social services research programs, demonstration grant programs, policy studies and evaluation projects targeted toward Hispanic/Latino Americans. Consultants with research expertise in Hispanic/Latino health and human service needs and delivery system issues will conduct a review to determine gaps in knowledge and make recommendations for future research priorities.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Paul Johnson, Ph.D.

PHONE NUMBER: 202-401-8277

PIC ID: 6698

PERFORMER ORGANIZATION: Interuniversity Program for Latino Research, Austin TX

PROJECTED DATE OF COMPLETION: 5/31/99

TITLE: State Telephone Survey Estimates for Evaluation and Monitoring

ABSTRACT: This project, funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and carried out by the National Center for Health Statistics (NCHS), develops and evaluates an integrated survey mechanism to collect broad State-based health and human services data. It also evaluates the quality and utility of State-level estimates developed from telephone surveys alone and in conjunction with, estimates obtained from the National Health Interview Survey (NHIS). A variety of health and human services data estimates for a selected number of States will be obtained through a telephone interview survey based on the NHIS questionnaire and selected supplemental data.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: James Scanlon

PHONE NUMBER: 202-690-7100

PIC ID: 6420

PERFORMER ORGANIZATION: National Center for Health Statistics, Hyattsville MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Estimating an Analytical Framework for Assessing Insurer Response to the Health Care Market

ABSTRACT: This project will result in a conceptual paper that establishes a framework for analyzing insurer behavior, responses to insurance market reforms and the likely effect of insurer behavior on the availability and cost of insurance. The objectives are to: (1) identify potential data sources and data needs to facilitate empirical work based on identified important characteristics; and (2) provide the Department of Health and Human Services (HHS) staff with a better understanding of the operation of insurance markets, including how insurers make business decisions based on the demand for insurance from employers and individuals. The paper will survey existing literature on insurer behavior and decision making, develop an analytical framework which can be applied to a variety of questions, and discuss potential data sources that could be used in conjunction with the analytical framework to assess insurer response to change. The focus of the paper will be on insurer product line decisions.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Dale Hitchcock

PHONE NUMBER: 202-690-5882

PIC ID: 6429

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: State and Regional Programs: Performance Measurement and Program Innovation Series

ABSTRACT: The purpose of this project is to plan and conduct, in collaboration with the Department of Health and Human Services (DHHS), four performance measurement and program innovation seminars, which will help the department to: (1) improve understanding of performance measurement among the DHHS and State and local staff members; (2) stay abreast of current performance developments at the State and local levels; and (3) increase knowledge of potentially promising State and local innovations. The seminars will also allow the DHHS staff to interact with State and local officials on a variety of performance measurement and program innovation questions. Themes for the seminars are as follows: (1) Welfare Reform and the Homeless; (2) Regionalism; (3) Performance Measurement and Evaluation; and (4) State Innovative Programs. (See PIC ID 7209.1)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Margaret Price

PHONE NUMBER: 202-260-0382

PIC ID: 7209

PERFORMER ORGANIZATION: South Carolina State University, Orangeburg SC

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: Mississippi Community Works HELP DESK - (MS-CWHD)

ABSTRACT: The DELTA project will establish an interactive, multi-sectoral Help Desk in Jackson, Mississippi, to assist and support the EZ/EC/Champion Communities in furthering their strategic plans. The Help Desk will provide access to, and technical assistance with, tested strategies and model programs, best practices and lessons learned related to a variety of economic and social development issues. It will also provide information about, and access to, external resources, both funding and programmatic, to serve as partners in the implementation of development initiatives planned by these communities. An evaluation will be conducted during the course of the Help Desk project to include site visits, client surveys and telephone interviews, in order to determine impact and track progress on established outcomes for these communities. An interim evaluation report is due to be completed in October 1999.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: James K. Gatz

PHONE NUMBER: 202-260-0397

PIC ID: 7213

PERFORMER ORGANIZATION: Delta/Tides Center, Bethesda, MD

PROJECTED DATE OF COMPLETION: 9/30/99

Office of Public Health and Science

Evaluation Program
The Office of Public Health and Science (OPHS) provides advice, policy and program coordination, and leadership in the implementation, management, and development of activities related to public health and science, as directed by the Secretary. OPHS helps HHS conduct broad-based public health assessments to better define public health problems and solutions. It assists other components of HHS in anticipating future public health issues and problems and helps ensure that HHS designs and implements appropriate approaches, interventions, and evaluations that will maintain, sustain, and improve the health of the Nation. OPHS provides leadership and policy recommendations on population-based public health and science and, at the Secretary's direction, leads or coordinates initiatives that cut across agencies and operating divisions. In addition, OPHS communicates and interacts, on behalf of the Secretary, with national and international professional and constituency organizations on matters of public health and science. Finally, OPHS's unique role allows it to use its resources to link important HHS programs or fill gaps in areas needing better policy formulation and coordination.

In keeping with its role within the Department, OPHS has developed an evaluation plan that avoids duplication of efforts that might more appropriately and effectively be undertaken by operating divisions of HHS or by the Assistant Secretary for Planning and Evaluation (ASPE). Thus, the FY 1998 evaluation strategy for OPHS focuses on public health and science issues that cut across multiple interests of the operating divisions, and requires a coordinated approach to achieve the most effective results. In addition, OPHS will continue its commitment to carry out every project proposed as part of this year's strategy in collaboration with relevant operating divisions.

OPHS conducts evaluations requested of the Secretary by Congress that are most appropriately managed by staff with medical or health science credentials, and that cannot be assigned to an operating division. Further, evaluations will be conducted to support the Surgeon General and the Assistant Secretary for Health in their respective roles as the Nation's top doctor and senior advisor for public health and science to the Secretary. These roles include the responsibility to assist the Secretary in developing a policy agenda for the Department to address major population-based public health, prevention, and science issues and to provide leadership and a focus for coordination of population-based health, clinical preventive services and science initiatives that cut across operating divisions. In addition, OPHS will conduct evaluations specific to the needs of the programs operated from the offices located within OPHS, such as Women's Health, Minority Health, Disease Prevention and Health Promotion, International Health, and Emergency Preparedness. A portion of the evaluation funds will be made available to the ten HHS Regional Health Administrators.

Fiscal Year 1998 Evaluations

Health Promotion

TITLE: Enabling Performance Measurement Activities in the States and Communities

ABSTRACT: The Department of Health and Human Services (DHHS) views performance measurement as a means for moving an organization into a results-oriented management approach based on cooperation and partnerships with and among stakeholders. In the course of deepening its understanding of performance measurement and advancing this results-oriented approach, the DHHS has learned that its leadership must be informed by an understanding of the barriers that organizations, particularly those in the public sector, encounter in implementing performance measurement activities. The research conducted included a literature review and interviews. A review of these sources revealed two observations concerning what is known about barriers to performance measurement and strategies for addressing them: (1) barriers and strategies are usually site neutral, having little relation to the organizational setting; and (2) people working with performance measurement in public health organizations have encountered the same barriers as those identified in the broader literature. The report provides seven recommendations on ways in which the U.S. Department of Health and Human Services can enable performance measurement activities through partnerships with States and local communities. The researchers completed the following: (1) identified activities, as well as barriers, related to successful implementation of performance measurement;(2) identified activities which can minimize barriers; and (3) developed protocols to promote partnerships between State and local agencies.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Linda Bailey

PHONE NUMBER: 202-205-4872

PIC ID: 6876

PERFORMER ORGANIZATION: University of Washington, School of Public Health and Community Medicine, Seattle, WA

TITLE: Environmental Health Data Needs: An Action Plan for Federal Public Health Agencies

ABSTRACT: This project develops and analyzes an inventory of data systems, both within the Department of Health and Human Services (DHHS) and outside the department, related to environmental and occupational health issues. The project identifies data gaps, recommends ways to link data sets, and specifies methods to make more data useful for a variety of public health customers at Federal, State and local levels. The project was conducted in coordination with the HHS Environmental Health Policy Committee (EHPC) and its Subcommittee on Data Needs.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Dalton Paxman

PHONE NUMBER: 202-205-5829

PIC ID: 6322

PERFORMER ORGANIZATION: Public Health Foundation, Washington, D.C.

TITLE: Report of Commission on Dietary Supplement Labels

ABSTRACT: The Secretary of Health and Human Services, in order to meet the intent of the Dietary Supplement Health and Education Act of 1994, P.L. 103-417, established the Commission on Dietary Supplement Labels to develop recommendations for the regulation of label claims and statements for dietary supplements. The Commission was charged with how best to provide truthful, scientifically valid, and non- misleading information to consumers, so that they may make appropriate health care choices for themselves and their families. This document is the final report of the Commission. The report obtained advice from individuals, consumer organizations, the dietary supplement industry and scientific organizations through written submissions and public hearings. The report contains the Commission's recommendations for regulations and provides guidance to government agencies and to the dietary supplement industry with regards to safety, label statements, health claims, substantiation of claims and botanical supplements. The report emphasizes the need for public access to the information on which label statements are based, so that consumers can make informed decisions about the use of dietary supplements. (Final report 84 pages plus appendices.)

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Linda D. Meyers, Ph.D.

PHONE NUMBER: 202-205-5757

PIC ID: 6193

PERFORMER ORGANIZATION: Office of Disease Prevention and Health Promotion, Washington D.C.

TITLE: Retrospective Study of the Preventive Health Practices of Former Title X Clients

ABSTRACT: This study analyzes the influences of health education and counseling on the preventive health care and health care choices 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 identified. Using a qualitative descriptive design and drawing on a representative sample from the grantees in all six States in region VIII, the study analyzed focus group discussions of persons who received services from a Title X clinic for at least three years, but who were no longer considered active clients. These clients received services to 1995 and the Title X clinic was their primary point of access to organized health care. The study measured: (1) the type of care, if any, participants were receiving at the time of the study; (2) whether the former clients were receiving annual pap smears, breast exams and other preventive services at the time of the study; and (3) the influence of past Title X counseling and education on health care choices and decisions. In general, the women who participated in the focus groups had high praise for the personnel, providers, clinics and services. Many of the educational messages were retained, and some participants continued to rely on the clinic, rather than a private physician, for advice and education. Although many women admitted they did not get annual examinations and pap smears as frequently as when they used the clinic, that laxity was not a result of knowledge deficit. Suggestions for improvement include: (1) increased promotion of services, (2) expansion of services, and (3) more education.

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

TITLE: WHERE ( Women for Healthcare Education, Reform and Equity): Managed Care and Women's Health Survey

ABSTRACT: This evaluation of major health maintenance organizations (HMOs) and preferred provider organizations in Washington State was conducted to determine the extent to which these organizations provide coverage for women's health initiatives. A survey of six plans shows that while there has been progress in some areas, such as coverage for routine mammograms and Pap smears, significant gaps in women's health care remain. The survey examined coverage areas ranging from domestic violence to senior health issues. While all the plans covered mammograms and Pap smears, they varied significantly in what they recommended for heart disease, menopause and adolescent health. The survey found that the plans had no established guidelines and wide discrepancies existed as to the age at which women should get their first Pap smear. Other plans didn't agree on the age at which routine cholesterol screening should begin. Of the plans surveyed, three stated that cholesterol screening was part of an annual exam, but the ages of initial screening varied from age 35 to 50. Three plans stated that they routinely counseled women on various forms of hormone replacement therapy. Four plans indicated such therapies were covered. One plan stated that it used the National Osteoporosis Foundation's guidelines for assessing a woman's risk for osteoporosis, while two of the plans indicated they had other internal guidelines for assessing risk. This study is important because it broadens the scope of women's health issues, providing a road map that managed care plans, employers, researchers, public policy officials and consumers can use to identify issues that need more attention. (Final report 47 pages.)

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

FEDERAL CONTACT: Karen Matsuda

PHONE NUMBER: 206-615-2469

PIC ID: 6679

PERFORMER ORGANIZATION: Women for Healthcare Education Reform and Equity Seattle, WA

Healthy People 2010

TITLE: Measuring Health Objectives and Indicators: 1997 State and Local Capacity Survey

ABSTRACT: The Department of Health and Human Services (DHHS) is laying the foundation for Healthy People 2010, the Nation's plan for health promotion and disease prevention in the first decade of the next century, which is based on Healthy People 2000. The report is a survey conducted by the Public Health Foundation, working with the Office of Disease Prevention and Health Promotion (ODPHP), and the National Center for Health Statistics (NCHS), to obtain information from States and large local jurisdictions on their ability to track their own health promotion and disease prevention objectives. Initial discussion of the survey took place at a national meeting, "Use of Healthy People 2000 at State and Local Levels--Lessons for 2010," and the survey instrument was developed with extensive input from the field, and in collaboration with various public health groups. The survey: (1) characterizes infrastructure at the State and local levels for tracking health objectives and indicators; (2) obtains methods and innovations for assisting Federal, State, and local agencies in setting and tracking future objectives; and (3) ensures that the Healthy People 2010 objectives-setting process is sensitive to data collection capabilities at State and local levels. The study's limitations included: (1) some of the questions allowed for an estimate of numbers and proportions, which allowed for responses based on personal perceptions rather than hard data; (2) States have varied organizational structures, management systems and delivery systems, so comparisons are seldom equally weighted; (3) many of the States had developed Healthy People 2000 objectives at differing timetables; and (4) the comprehensiveness and the scope of objectives could vary considerably across States and within a States' list of objectives. (Final report 49 pages plus appendices.)

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Jacquelyn Williams

PHONE NUMBER: 301-443-4493

PIC ID: 6488

PERFORMER ORGANIZATION: Public Health Foundation, Washington, D.C.

TITLE: Summarizing Population Health: Directions for the Development and Application of Population Metrics

ABSTRACT: An Institute of Medicine Committee convened a workshop for ethicists, health status measurement experts, and public and private administrators of public health and Medicare care programs to explore the technical and ethical issues inherent in the development and use of summary measures of the health of populations. The proceedings from the workshop encourage methodologists, ethicists, and policymakers to learn from each other and to work together to identify the strengths, limitations, and appropriate uses of summary measures. The proceedings recommend that the U.S. Department of Health and Human Services take the following measures: (1) initiate a process of analysis and public discussion to clarify ethical assumptions and value judgments embedded in different measures of population health, and assess the critical ethical and policy implications of different designs, implementation approaches and uses of these measures; (2) create a process to establish standards for population health metrics, and investigate the value and practicality of a compatible set of summary measures of population health that could be used for different descriptive and decision making purposes; and (3) invest in the education and training of public health and medical professionals to promote their understanding of the interpretation and appropriate use of summary measures of population health.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Linda Bailey

PHONE NUMBER: 202-205-4872

PIC ID: 6875

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine Washington, D.C.

Minority Health

TITLE: Assessment of Culturally and Linguistically Appropriate Community Health Promotion Programs in Local Health Departments.

ABSTRACT: The purpose of this project was to conduct a study of services provided by local health departments (LHDs) to address the health needs of racial and ethnic minority populations within their jurisdictions. Special attention was paid to the provision of culturally and linguistically appropriate community health promotion programs by those LHDs serving racially/ethnically diverse communities as a means of obtaining baseline data needed as a proxy measure for Healthy People 2000 objective 8.11 (i.e., increase to at least 50 percent the proportion of counties that have established culturally and linguistically appropriate community health promotion programs for racial and ethnic minority populations). The project was supported by OMH funds under a cooperative agreement between CDC's Public Health Practice Program Office with the National Association of County and City Health Officials (NACCHO). A set of questions were formulated through key informant interviews, and included in NACCHO's detailed stratified sample surveys of LHDs to determine the nature and extent of the interventions under study provided by a random sample of LHDs with at least 10% racial or ethnic minority populations. The study found that most LHDs provide some sort of culturally sensitive and linguistically appropriate intervention in the areas of health promotion and preventive services. However, these culturally and linguistically appropriate interventions do not necessarily constitute formal, structured "community health promotion programs" and, in any event, fall far below the 50 percent target set in the Healthy People objective.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Guadalupe Pacheco

PHONE NUMBER: 301-443-5084

PIC ID: xxxx

PERFORMER ORGANIZATION: National Association of County and City Health Officials Washington, DC

TITLE: An Assessment of Effective Strategies and Models that Promote Positive Messages Towards Girls in Region IX

ABSTRACT: In 1996, Secretary Shalala launched Girl Power! at the Annual Meeting of the American Public Health Association. Girl Power is a national public education campaign sponsored by the Department of Health and Human Services (DHHS) to help encourage and empower girls between the ages of 9-14 to make the most of their lives. This assessment determines the kinds of programs in four States (Arizona, California, Hawaii and Nevada) that promote positive self-images in girls ages 9-14, in order to determine how Region IX will participate in the Girl Power! initiative. Organized into categories, the resulting resource directory is organized under the following headings: Career and Life Planning, Culture and Heritage, Health and Sexuality, Leadership and Community Action, Self-Reliance and Life Skills, and Sports and Recreation. The directory includes a table which displays the number of entries in each category. This report recommends that: (1) a revised directory be undertaken to update the current document and expand it's scope to include the other Region IX components; (2) additional categories will prove necessary given the cultural diversity of the region; (3) develop a Girl Power! initiative Region IX that will focus sharing effective models that deliver positive messages to girls; (4) given the findings in States by categories, California programs could be utilized as a model to effectively serve other jurisdictions with sensitivity to cultural issues; and (5) the directory should be widely distributed by the Office on Women's Health to organizations and programs that have a direct impact on girls and their activities, as well as to regional and State directors of girl-oriented programs. (Final report unpaginated.)

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

FEDERAL CONTACT: Kay A. Strawder

PHONE NUMBER: 415-437-8119

PIC ID: 6689

PERFORMER ORGANIZATION: GJD Associates, Austell GA 30106

TITLE: Comparative Analysis of U.S. and U.K. Strategies and Approaches for Addressing Racial/Ethnic Minority Health Concerns: Selected Papers

ABSTRACT: The purpose of this project was to conduct a comparative analysis of U.S. and U.K. efforts aimed at addressing the health concerns of racial and ethnic minorities in the U.S. and the U.K., and to identify and share best practices, model approaches and lessons learned. Expert consultants developed issue papers and conducted comparative analyses on six theme/issue areas, which served as the organizational basis for an international conference between the U.S. and U.K., held in London, England in September, 1997. The theme/issue areas were: (1) provider/purchaser Issues, (2) assuring quality of care, (3) developing primary care, (4) data surveillance, (5) research and development, and (6) informal care and empowerment of minority communities. Some notable crosscutting findings and observations included, but were not limited to: (1) having universal health care coverage and ensuring financing are not enough to adequately and accurately address the health care needs of racial and ethnic minority populations; (2) policies must actively and substantively seek, develop and include input from non-governmental entities, especially from the communities and grass roots sectors, if ownership and responsibility for implementation of these policies are to extend beyond the government and be meaningful to the populations such policies are designed to serve; (3) health systems largely designed to serve homogenous white populations need to be modified to provide culturally and linguistically appropriate health care; (4) staff training and development at all levels must be informed by the particular requirements of racial and ethnic minority communities in their service jurisdictions; (5) changes in the curricula of medical and health professions schools are required to promote cultural competency in health care; and (6) a strong research agenda needs to be developed and implemented regarding how to maintain and promote behaviors that are conducive to good health.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Gerrie Maccannon

PHONE NUMBER: 301-443-5084

PIC ID: 6676

PERFORMER ORGANIZATION: Office of Minority Health, Rockville, MD

TITLE: Study of the Implementation of the OMH Bilingual/Bicultural Service Demonstration Grant Program, FY 1993-1995

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 (LEP). The evaluation examined FY 1993 and 1994 one-year project grants and three-year grants made in FY 1995. In stage one, a mail survey was sent to a selected sample of 32 FY 1993 and 1994 grantees, accompanied by telephone contacts to ensure clarification and completion of the survey. In stage two, nine site visits were conducted, resulting in case studies of FY 1995 grantees. 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: (1) Did the program build capacity? (2) Did it increase health professionals' skills to address cultural and linguistic barriers? (3) 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 requiring 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 the strongest areas of impact. Barriers to project implementation and successful strategies to address these problems are also 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

Evaluations in Progress

Health Promotion

TITLE: Science Panel on Interactive Communication and Health

ABSTRACT: The Science Panel on Interactive Communication and Health is comprised of 14 national experts from a variety of disciplines related to interactive technologies and health, including: (1) medicine, (2) human-computer interaction, (3) public health, (4) communication sciences, (5) educational technology, and (6) health promotion. The major planned products of the panel include a series of journal articles targeted to specific audiences, a website about evaluation and a final report. The general goal of these products is to accelerate the appropriate development, adoption, use and evaluation of interactive health communication applications. The panel will develop strategies for the various stakeholders regarding critical activities to ensure quality applications through appropriate evaluation, and will develop tools/guidelines such as an evaluation reporting template for developers, and evaluation tutorials for consumers and other stakeholders. The panel will also provide a framework for the evaluation of interactive health communication applications, focusing on the elements of evaluation.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Mary Jo Deering

PHONE NUMBER: 202-260-2652

PIC ID: 6327

PERFORMER ORGANIZATION: Social and Health Services, Ltd. Rockville MD

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Scientific Evaluation of Dietary Reference Intakes

ABSTRACT: The National Academy of Sciences, Institute of Medicine/Food and Nutrition Board is conducting a multi-phase scientific evaluation of human nutrient requirements that: (1) evaluates requirements and dietary and supplement intake data for nutrients and non-nutrient food components, (2) develops Dietary Reference Intakes where data are available, (3) provides guidance for how these values should be used in various applications of clinical and public health importance, and (4) identifies the research needed to enhance the accuracy of the DRIs and provide a basis for public health policies. Multi-agency participation is facilitated by an OS/OPHS requirements contract and interagency steering committee. Task Order 1 (September 30, 1996 to March 31, 1998) addresses folate and other B vitamins. Task Order 2 (September 30, 1996 to December 1999) focuses on Dietary Antioxidants and Related Compounds, and Task Order 3 (September 30, 1998 to March 29, 2000) focuses on micronutrients. Multiple agencies support the project.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Linda D. Meyers, Ph.D.

PHONE NUMBER: 202-205-5757

PIC ID: 6323

PERFORMER ORGANIZATION: National Academy of Sciences, Institute of Medicine Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/29/00

Healthy People 2010

TITLE: Developing Leading Health Indicators for Healthy People 2010

ABSTRACT: Healthy People is well established as the Nation's prevention agenda and as a scorecard for monitoring health status. The development of new national goals and objectives for 2010 provides an opportunity to build upon Healthy People by identifying a small set of leading health indicators that can be used to reflect and draw public attention to progress. The development of these indicators will increase the usefulness of Healthy People 2010 as a focus of national attention, and as a tool for monitoring America's health. Because the leading health indicators will form a highly visible and potentially actionable part of the Nation's health objectives for 2010, it will be important that the indicators reflect the input of the scientific community as well as policymakers and the public. Utilizing input from 9-12 experts with backgrounds in public health practice (Federal, State and Local governments; nonprofit organizations, and academia), epidemiology, data sources, performance monitoring, statistics, public policy and other relevant areas, criteria for the leading health indicators for Healthy People 2010 and two or more candidate sets of leading health indicators will be developed.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Linda Bailey

PHONE NUMBER: 202-205-4872

PIC ID: 7030

PERFORMER ORGANIZATION: Institute of Medicine, Washington, D.C.

PROJECTED DATE OF COMPLETION: 5/31/99

HIV/AIDS

TITLE: Evaluation of Models to Integrate HIV Prevention and Treatment Services within PHS Supported Programs

ABSTRACT: The merging of prevention and treatment services for individuals may afford a real opportunity to decrease the number of new HIV seroconversions in a defined metropolitan area. Identifying a high risk population, entering the population in a continuum of medical care and support services, and merging prevention messages into primary clinical care and other health care access points is anticipated to result in changes in high risk behavior that will yield decreases in seroconversion rates for that population. Maximizing coordination among all funding sources and service delivery systems increases program efficiency. This project involves convening a steering committee of experts on: (1) HIV medical delivery systems, (2) HIV prevention, (3) substance abuse and mental health care (4) demographic and census tract analysis, and (5) behavioral research experts. These experts will define the necessary elements to conduct a pilot project in one to three large metropolitan statistical areas.

AGENCY SPONSOR: Office of HIV/AIDS Policy

FEDERAL CONTACT: Deborah von Zinkernagel

PHONE NUMBER: 202-690-5560

PIC ID: 6321

PERFORMER ORGANIZATION: John Snow, Inc. Boston MA

PROJECTED DATE OF COMPLETION: 9/30/99

Minority Health

TITLE: Support for the Development of a Research Agenda to Address Issues of Cultural Competency Measurement and Linkages to Patient and Health Outcomes

ABSTRACT: This project will support a pre-conference workshop to prepare for a special session at the First National Conference on Cultural Competence in Health Care. The special session for the conference will address the issues of measurement and linkages to health and patient outcomes. The workshop will be to: (1) examine the consumer, regulatory, and market forces surrounding the needs of Diverse populations, and emphasize the importance of providing culturally appropriate and quality health care services; (2) discuss model programs and practices that attempt to link linguistic and cultural competence to health and patient outcomes; and (3) develop an evaluation and research agenda on issues pertaining to the development of linguistic and cultural competence health outcome measures. The final report will describe an evaluation and research agenda that can be undertaken by the Department of Health and Human Services (HHS) for the development of linguistic and cultural competence health care outcome measures.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Guadalupe Pacheco

PHONE NUMBER: 301-443-5084

PIC ID: 6675

PERFORMER ORGANIZATION: Center for the Advancement of Health Washington, D.C.

PROJECTED DATE OF COMPLETION: 12/31/98

TITLE: Data Analysis and Support for the President's Initiative on Race

ABSTRACT: The President's Advisory Board on Race submitted a report of its deliberations to the President in the Summer of 1998. A "chart book" on the state of race relations formed the introductory chapter(s) of the Advisory Board's report. In addition, the White House commissioned the National Academy of Sciences to prepare detailed summaries of the research literature related to race and health. To support the Department's Initiative to Eliminate Racial and Ethnic Disparities in Health and its community demonstration grant program, the project will identify relevant departmental data systems and perform preliminary analyses to support the grant program.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Olivia Carter-Pokras, Ph.D.

PHONE NUMBER: 301-443-9923

PIC ID: 7014

PERFORMER ORGANIZATION: Office of Minority Health, Rockville, MD

PROJECTED DATE OF COMPLETION: 3/31/99

TITLE: Assessment of State Minority Health Infrastructure and Capacity to Address Issues of Health Disparity

ABSTRACT: This project will examine the nature and extent of the minority health infrastructure within nine State public health agencies. The goal is to determine: (1) those factors that contribute to, or detract from, the establishment and sustained support for such entities; (2) effects on State capacity to address the needs of racial and ethnic minorities in carrying out the essential services of public health; (3) disparities in health status; and (4) risks to health. Barriers and concerns that may be studied include: (1) perceptions of the nature and scope of the mission, role and responsibilities of established State Offices of Minority Health (SOMHs); (2) levels of resources allocated to address minority health issues; and (3) the positioning within public health agencies of organizational entities focused on minority health issues. An attempt will be made to collaborate with the CDC, the HRSA, the PHS agency minority health offices and public health partners who deal most prominently with the State health agencies (such as the Association of State and Territorial Health Officials).

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Gerrie Maccannon

PHONE NUMBER: 301-443-5084

PIC ID: 7013

PERFORMER ORGANIZATION: Office of Minority Health, Rockville, MD

PROJECTED DATE OF COMPLETION: 6/30/99

TITLE: Evaluation of the Office of Minority Health Resource Center--Phase I, Phase II and Phase III

ABSTRACT: The purpose of Phase I of this project is to develop and field test a research protocol including an information collection method and instrument that could be used to evaluate the Office of Minority Health Resource Center (OMHRC). Phase II of this project is to implement the research protocol developed in Phase I, intended to evaluate OMHRC. Phase III of this project is to analyze collected data and prepare analytical reports on data from a survey of actual and potential users of the OMHRC. Specifically, Phases I, II and III of this project will collect, analyze and report data concerning: (1) functions of OMHRC; (2) target audiences and services provided to these audiences; (3) how OMHRC assesses user and target audience needs, ability of the center to meet those needs, and satisfaction of users with center services, and ways to improve these assessments; (4) how OMHRC relates to other Federal and nonfederal information sources, including Federal clearinghouses, Federally supported health or human service offices, and Federal, State and local minority health offices; and (5) gaps in information dissemination that are not being addressed by Federal information sources.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Howard L. Kelley, D.D.S.

PHONE NUMBER: 301-443-5224

PIC ID: 6244

PERFORMER ORGANIZATION: Moshman Associates, Inc. Bethesda MD

PROJECTED DATE OF COMPLETION: 9/30/99

TITLE: A National Assessment of Culturally and Linguistically Appropriate Services (CLAS) in Managed Care Organizations (MCOs) Serving Racially and Ethnically DIVERSE

ABSTRACT: This project will conduct a survey of a national random sample of managed care organizations (MCOs) serving racially/ethnically Diverse communities. The survey will identify the nature and extent of culturally and linguistically appropriate services (CLAS) being provided by these health plans. It is intended to inform and educate health service executives and managers about the nature and importance of CLAS, encourage policies and practices in support of CLAS for all Americans, and establish meaningful national baseline data on the nature and extent of CLAS being provided across the country. This is especially important in communities where language and cultural differences create access barriers and barriers to quality of care. It is expected that the end products will include an analysis and report of the range of such services, an identification of best practices and model approaches, and an explication of the community and organizational factors conducive to the provision or inhibition of CLAS.

AGENCY SPONSOR: Office of Minority Health

FEDERAL CONTACT: Betty Hawks

PHONE NUMBER: 301-443-5084

PIC ID: 6674

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

PROJECTED DATE OF COMPLETION: 9/30/99

Public Health Infrastructure

TITLE: County-Level Tracking of Public Health Functions and Policy Issues

ABSTRACT: This project will assure that documentation of budget and workforce capacity performance of essential public health services will be available regarding the twelve cities studied by the Center for Studying Health Systems Change's "Longitudinal Community Study." The longitudinal study is funded by the Robert Wood Johnson Foundation (RWJ) for at least four years, and will identify changes in the public health system over the same period.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Linda Bailey

PHONE NUMBER: 202-205-4872

PIC ID: 6325

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

PROJECTED DATE OF COMPLETION: 12/15/98

TITLE: Role of Health Plans in Community-Level Health Improvement

ABSTRACT: The purposes of this project are to identify the potential for health plans' participation in community-level health improvement activities, and to examine the incentives and barriers that will affect their decisions to take part in community-based health efforts.

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Matthew Guidry

PHONE NUMBER: 202-401-7780

PIC ID: 6492

PERFORMER ORGANIZATION: Partnership For Prevention, Washington D.C.

PROJECTED DATE OF COMPLETION: 2/28/99

TITLE: Develop Local Department Early Detection Capabilities for the Health and Medical Consequences of the New Welfare Reform

ABSTRACT: The Regional Health Administrator, Public Health Service (PHS) Region V, in collaboration with the Public Health Practice Program Office of the Centers for Disease Control and Prevention (CDC), will provide partial support for a project entitled, "Welfare Reform: Early Detection, Prevention, and Health Promotion Interventions for Local Health Departments in Alabama". The University of Alabama School of Public Health, in collaboration with the Alabama Department of Public Health, conducted a one-day conference at the Sheraton Civic Center in Birmingham on April 9, 1998 for 155 sub-State public health administrators, supervisory nursing and social work personnel, and senior state staff. The conference ensured that participants: (1) understood provisions of the new welfare legislation affecting public health systems, (2) recognized events and trends in the health status of local populations affected by the new welfare legislation, (3) employed appropriate prevention and health education strategies to mitigate negative effects of the new welfare legislation, and (4) assessed the effects of their interventions. Satellite downlinks extended the conference to staff of most county health departments in the state. Pre- and post-test questionnaires assessed gains in participant knowledge. A post-conference survey identified improvements in job performance and public health practice relative to conference objectives.

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

FEDERAL CONTACT: Beaumont .Hagebak, Ed.D.

PHONE NUMBER: 404-331-2317

PIC ID: 6686

PERFORMER ORGANIZATION: University of Alabama, School of Public Health Birmingham, AL

PROJECTED DATE OF COMPLETION: 4/1/99

TITLE: Analysis of State and Local Public Health Policy and Program Activities

ABSTRACT: This project will identify, describe and analyze State and local efforts to address public health infrastructure issues and their potential impacts on Office of Public Health and Sciences (OPHS) policies and programs. The project serves as a communications conduit enabling OPHS to obtain timely information for informing decision making concerning the impact of Federal policies on States and localities, and for coordinating Federal, State and local initiatives. Examples of projects undertaken with this contract include an analysis of State laws related to AIDS and confidentiality, as well as State implementation of the model law for tobacco control. The Public Health Functions Working Group and Steering Committee, with representatives from all of the former agencies of the Public Health Service, provide guidance to the project. (See PIC ID 6326.1, 6326.2)

AGENCY SPONSOR: Office of Disease Prevention and Health Promotion

FEDERAL CONTACT: Deborah R. Maiese

PHONE NUMBER: 202-401-5809

PIC ID: 6326

PERFORMER ORGANIZATION: Public Health Foundation, Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/28/99

Substance Abuse and Mental Health Services Administration

Evaluation Program
The Substance Abuse and Mental Health Services Administration (SAMHSA) is committed to evaluating its overall programs and individual grant projects to assess the effectiveness of prevention, treatment, and rehabilitation approaches and systems of care; the accountability of Federal funds; and the achievement of SAMHSA's programmatic and policy objectives.

To the greatest extent appropriate and feasible, SAMHSA encourages the use of comparable data elements and instruments across its evaluations in order to work toward a comprehensive evaluation system and to minimize respondent burden.

SAMHSA conducts grant programs under a variety of legislative authorities. These authorities can generally be grouped into two types: (1) services and (2) knowledge development and application (KDA). The evaluation required for a particular grant program is dependent on the type and purpose of the program. SAMHSA evaluates each of its service programs so as to provide information to program managers about the accountability of Federal funds. In addition, the evaluations of KDA programs will generate new knowledge to lead the field in the development of policies that improve services.

The two types of grant programs (service delivery and KDA) represent the two facets of SAMHSA's mission. SAMHSA's leadership in the field depends on the successful interaction of these two facets. Through KDAs, SAMHSA must identify effective approaches to prevention, treatment, and rehabilitation. Through service delivery funds, SAMHSA must provide incentives to the field to implement effective approaches. Major emphases of SAMHSA's mission are to develop, identify, and disseminate effective strategies and systems for prevention, treatment, and rehabilitation.

SAMHSA is implementing an integrated model of evaluation and planning. Strategic planning identifies priorities, such as managed care, that drive the development of grant programs and evaluations. In compliance with the Government Performance and Results Act (GPRA), SAMHSA is improving performance management by identifying annual performance objectives and measures. The formulation of programmatic and evaluation priorities includes consultation with SAMHSA, Center Advisory Councils, and with other experts in the fields of evaluation and service delivery. Early and continuous coordination of program planning and evaluation design will result in the articulation of program objectives that may be evaluated. Evaluations will demonstrate the extent to which the grant programs have achieved their overall objectives, and SAMHSA will translate these results into information that can be used for program and policy development. The strategic planning and policy development processes will then use these results to refine SAMHSA's priorities and performance objectives.

This evaluation policy will help SAMHSA achieve its goal of continually informing policy and program development with knowledge culled from past performance. In this way, SAMHSA can best serve its customers by enhancing the quality of publicly-funded substance abuse and mental health services.

In compliance with the Public Health Service (PHS) guidelines for the technical review of evaluations, SAMHSA has established a standing committee of PHS staff who are evaluation specialists. Representatives of the Office of the Assistant Secretary for Planning and Evaluation serve as ex officio members of the committee. The SAMHSA evaluation officer is the committee chair. The committee does not generally review the evaluation proposals of individual grantees; rather, it reviews proposals for broader, more comprehensive evaluations, such as the cross-project evaluations of grant programs.

Evaluation project proposals are generally prepared by SAMHSA program staff in the various Centers. The standing committee reviews each proposal on the following criteria: clarity of evaluation objectives and research questions, appropriateness and feasibility of the specifications for evaluation design and methods, appropriateness of the plans for dissemination of results, and use of previous relevant evaluations and existing program data systems. Each proposal must clearly state the relationship of the evaluation to SAMHSA's overall policies, priorities, and evaluation program.

Fiscal Year 1998 Evaluations

Substance Abuse Treatment

TITLE: Services Research Outcomes Study

ABSTRACT: The Services Research Outcomes Study (SROS), the first nationally representative study of substance abuse treatment outcomes, confirms that both drug use and criminal behavior are reduced following drug abuse treatment--inpatient, outpatient and residential. The purpose of the study was to determine whether or not drug treatments are effective. These findings were determined through a survey of 1,799 (71.4 percent male and 28.6 percent female) persons. Substance abuse histories on each of the clients were provided by a nationwide sample of 99 drug treatment facilities. All 1,799 clients were interviewed five years following discharge from drug abuse treatment and are representative of the 976,012 individuals discharged from treatment in 1990. The SROS is the first among a series of outcome studies to include a nationally representative sample of drug treatment programs located in rural, suburban and urban locations. Major findings include: (1) the overall drop in the use of any illicit drug following treatment was 21 percent; (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. Further findings include the impact of substance abuse treatment on criminal behavior and lifestyle changes.

AGENCY SPONSOR: 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

TITLE: Outcome Evaluation for the Community Partnership Program

ABSTRACT: This 48-community study was the largest Federally-funded, community-based substance abuse prevention and health promotion trial ever conducted. This rigorous, large-scale evaluation collected outcome data from a random sample of more than 83,000 adults and youth (i.e. 8th and 10th graders). The primary objective of this study was to determine if community partnerships are an effective means by which to prevent substance abuse among both young people and adults. Using both sophisticated analyses and field-based case studies, researchers compared the outcomes of 24 community partnership programs funded by the Center for Substance Abuse Prevention (CSAP), with 24 comparison communities without partnerships. The study identified the following characteristics of effective community partnerships: (1) a comprehensive, widely-shared vision, (2) a strong core of committed partners, (3) an inclusive and broad-based membership, (4) avoidance or resolution of severe conflict, (5) decentralized units that encourage implementing prevention programs, (6) low staff turnover, and (7) extensive prevention activities and support for local prevention policies. The report also found that community partnerships also promoted environmental change by: (1) supporting local policies aimed at reducing drug availability or increasing penalties for drug use; (2) influencing coverage of local events by mass media to emphasize constructive and positive images of local life; (3) coordinating a comprehensive array of services that are delivered in a "one-stop" shopping model; and (4) using slogans, posters, billboards, T-shirts, cultural events, and hotlines to raise community awareness of the hazards of drug use. (Final report and appendices bound separately; variously paginated.)

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Shakeh Kaftarian, Ph.D.

PHONE NUMBER: 301-443-9136

PIC ID: 4997

PERFORMER ORGANIZATION: Cosmos Corporation Bethesda, MD

Evaluations in Progress

Substance Abuse Treatment

TITLE: National Evaluation Data and Technical Assistance Center

ABSTRACT: The National Evaluation Data and Technical Assistance Center (NEDTAC) provides a variety of centralized data management and analysis services in support of the evaluation of several large demonstrations targeted to special populations including criminal justice, women, rural, and culturally distinct and adolescent populations. NEDTAC represents part of an overall evaluation strategy that builds upon prior findings and seeks to identify a set of consistent evaluation questions that can be applied across similar substance abuse treatment programs targeted to special populations. It seeks to identify data elements to provide uniform information across sites so that comparisons of effectiveness can be made. A variety of reports encompassing program results as well as technical and methodological topics will be produced.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Ron Smith, Ph.D.

PHONE NUMBER: 301-443-7730

PIC ID: 5994

PERFORMER ORGANIZATION: Caliber Associates Fairfax, VA

PROJECTED DATE OF COMPLETION: 5/20/99

TITLE: State Substance Abuse Managed Care Evaluation Program

ABSTRACT: The State Substance Abuse Managed Care Evaluation Project will evaluate the effects of managed care on mental health and substance abuse services in five States. Each of these five State studies will inform future behavioral health care policy.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Joan Dilonardo

PHONE NUMBER: 301-443-8555

PIC ID: 6454

PERFORMER ORGANIZATION: Brandeis University Waltham, MA

PROJECTED DATE OF COMPLETION: 12/1/00

TITLE: Treatment Improvement Protocols Field Evaluation

ABSTRACT: The purpose of TIPs is to transfer protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, evaluation and administrative experts to the nation's AOD treatment field. Institution of a field evaluation is needed to: (1) assess the extent to which target audiences realize, read and implement TIPs; (2) learn ways to strengthen the development, formatting, marketing, dissemination, use and evaluation of TIPs to ensure effective use of future Federal resources devoted to TIPs.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Kevin Mulvey, Ph.D.

PHONE NUMBER: 301-443-9472

PIC ID: 6737

PERFORMER ORGANIZATION: Johnson, Bassin and Shaw, Inc. Silver Spring, MD

PROJECTED DATE OF COMPLETION: 9/1/01

TITLE: Evaluation of Opioid Treatment Program Accreditation Project

ABSTRACT: The Center for Substance Abuse Treatment (CSAT) and other federal agencies are developing a regulatory framework for opioid substitution therapy that will change the current regulatory system for monitoring opioid treatment programs (OTPs) to an accreditation/regulatory approach. Over a five year period, CSAT will conduct and evaluate a phase-in program to obtain information that will aid in the full implementation of the new system.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT:, Herman Diesenhaus, Ph.D.

PHONE NUMBER: 301-443-6575

PIC ID: 6739

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 9/29/02

TITLE: Persistent Effects of Treatment Studies (PETS)

ABSTRACT: The purpose of PETS is to evaluate the long-term effectiveness (up to thirty-six months) of substance abuse treatment services provided through a series of CSAT grants and cooperative agreements, and to conduct a number of special studies and policy analyses that address specific drugs of abuse, methods of treatment, populations, or policy issues. The primary follow-up studies will involve obtaining information at selected follow-up periods for persons who have completed the index treatment episode and for whom historical, intake and treatment exit data are available.

AGENCY SPONSOR: Center for Substance Abuse Treatment

FEDERAL CONTACT: Roger Straw, Ph.D.

PHONE NUMBER: 301-443-3706

PIC ID: 6738

PERFORMER ORGANIZATION: Westat, Inc. Rockville, MD

PROJECTED DATE OF COMPLETION: 9/30/02

Substance Abuse Prevention

TITLE: Evaluation of High Risk Youth Substance Abuse Prevention Initiatives Funded in 1994 and 1995

ABSTRACT: This project is designed to conduct an evaluation of the 48 High Risk Youth Substance Abuse Prevention Initiatives funded by the Center for Substance Abuse Prevention (CSAP) in 1994 and 1995, especially in regard to the following areas: (1) female adolescents, (2) high risk youth (HRY), and (3) replication of model programs for the prevention of alcohol, tobacco and other drug (ATOD) use among high risk youth. The purpose of the evaluation is to: (1) assess the impact of all programs in preventing or reducing the use of ATOD among youth at high risk for such behaviors, and (2) assess the effectiveness of specified intervention strategies in reducing the risk factors or enhancing the protective factors on which the specific programs are focused.

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Soledad Sambrano, Ph.D.

PHONE NUMBER: 301-443-9136

PIC ID: 6044

PERFORMER ORGANIZATION: EMT Associates St. Louis, MO

PROJECTED DATE OF COMPLETION: 4/30/00

TITLE: Cross-site Evaluation of the Community Prevention Coalitions Demonstration Grant Program

ABSTRACT: This project will conduct a cross-site evaluation of the Community Prevention Coalition (CPC) grant program over a five-year period. The goals of the evaluation are to assess: (1) the extent to which coalitions of service organizations created by the program are able to implement comprehensive and coordinated alcohol, tobacco, and other drug (ATOD) prevention programs through an expanded and non-duplicative service delivery base; (2) the extent to which coalitions are able to achieve measurable reductions in the incidence and prevalence of ATOD use, and improvements in ATOD-related social, health and safety consequences among all age, ethnic and vulnerable groups within grantee communities; (3) the contributions of various prevention strategies to site-specific outcomes and to general prevention outcomes in those sites where measurable changes are made; and (4) those characteristics common to coalitions where measurable changes are achieved, as well as those that differentiate successful coalitions from unsuccessful ones. The contractor will be required to collect process and outcome data for analysis from coalitions. In addition, data collected locally by grantees and archived community-wide indicators will be used.

AGENCY SPONSOR: Center for Substance Abuse Prevention

FEDERAL CONTACT: Shakeh Kaftarian, Ph.D.

PHONE NUMBER: 301-443-9136

PIC ID: 6042

PERFORMER ORGANIZATION: Cosmos Corporation Bethesda, MD

PROJECTED DATE OF COMPLETION: 5/31/00

Mental Health Services

TITLE: Evaluation of the HHS Access to Community Care and Effective Services and Supports (ACCESS) Program

ABSTRACT: The ACCESS Program is a five year demonstration program that provides grants to nine States to develop integrated systems of treatment and supportive services and housing for homeless persons with serious mental illnesses. The goal of the program is to identify strategies for developing integrated service systems and to evaluate their effectiveness in providing services to homeless persons with serious mental illnesses. The evaluation of the ACCESS Program has two major components: The system-level evaluation identifies the different systems integration approaches, documents how they are implemented, and measures their impact on system capacity and system barriers. The client-level evaluation determines whether systems integration efforts result in improved service delivery, improvements in mental health and health status, rehabilitation, quality of life and permanent exit from homelessness.

AGENCY SPONSOR: Center for Mental Health Services

FEDERAL CONTACT: Frances Randolph

PHONE NUMBER: 301-443-3706

PIC ID: 4980.1

PERFORMER ORGANIZATION: R.O.W. Sciences, Inc. Rockville, MD

PROJECTED DATE OF COMPLETION: 7/31/00

Appendix A - Description of the HHS Evaluation Program

Evaluation plays an integral role in carrying out the HHS mission. Assessing various aspects of agency program performance allows staff to identify means of improving that performance. The HHS evaluation function has three goals: (1) to provide information on HHS programs that helps government officials and members of the Congress make decisions related to programs, policies, budgets, and strategic planning; (2) to help HHS managers improve program operations and performance; and (3) to disseminate evaluation results and methodological tools useful to the larger health and human services community of State and local officials, researchers, advocates, and practitioners for improving the performance of their programs.

This chapter describes the organization and operation of evaluation at HHS. It first provides an overview of the kinds of evaluation activities supported by HHS agencies and then describes the resources and funding mechanisms used to support them. The chapter details HHS evaluation management, including planning procedures, project management, quality assurance, and dissemination of results. The chapter concludes with a discussion of effective uses of HHS evaluations, with illustrations from projects completed in the past year.

HHS EVALUATION ACTIVITIES

HHS defines evaluation as the assessment of program performance (efficiency, effectiveness, and responsiveness) through the analysis of data or information collected systematically and ethically, and the effective use of resulting information in program or policy decisionmaking and program management. This definition encompasses a range of evaluation activities, such as those listed below.

Outcome evaluations measure the immediate or intermediate effects of a program with respect to the stated goals or objectives.
Impact evaluations look at the broader and long-term results, intended or unintended, of a program on populations or institutions involved.
Implementation or process evaluations assess the nature of program inputs and outputs and their relationship to the stated goals and objectives.
Policy assessments examine health policies with respect to their development, implementation, or their impact on public health or program activity.
Cost-benefit or cost-effectiveness analyses develop methodology and its application to assess the relationship of program results to program costs (direct and indirect), often in comparison with alternative programs.
Survey data analyses evaluate the results of HHS programs or policies by analyzing data obtained from surveys.
Performance measurement and data systems identify and test the validity and reliability of process, output, and outcome indicators to measure the performance of programs and develop data systems supporting implementation of the Government Performance and Results Act (GPRA) of 1993.
Simulations and models use computer simulations and modeling techniques to analyze the impact of policy changes on service delivery systems and beneficiaries.
Management studies examine the effectiveness or efficiency of the administration or operation of HHS programs and offices.
Evaluation syntheses integrate the results from multiple independent evaluation studies within a defined program or policy area in a fashion that improves the accessibility and application of those results.
Evaluation feasibility studies assess the clarity and importance of program goals and objectives, the consensus of program stakeholders on the potential utility of evaluation information, and the availability of relevant performance data before committing to a full-scale program evaluation.
Evaluation design projects procure assistance developing of an evaluation design, measurement tools, or analytic models in preparation for fully implementing an evaluation.
Instrument development projects develop evaluation instruments (design, measurement, or analytic) for a specific HHS program or for general use by the health and human services community.
Evaluation technical assistance helps HHS officials and grantees with any aspect of evaluation planning, project design implementation analysis, or use of results.
Evaluation dissemination identifies target audiences and mechanisms to inform program constituencies and evaluation stakeholders about evaluation results.
Evaluation training/conferences maintain the professional skills and expertise of evaluation staff through training opportunities, and promote the dissemination of HHS evaluations through conferences.

EVALUATION RESOURCES

The second mechanism for evaluation funding is the legislative set-aside authority which permits the Secretary of HHS to use a proportion of overall program funds for evaluation purposes. The largest of such set-aside authorities is one established for evaluations conducted by several agencies of the U.S. Public Health Service (AHCPR, CDC, HRSA, NIH, and SAMHSA), ASPE, and the Office of Public Health and Science in the Office of the Secretary. The mechanism is called the 1-percent evaluation set-aside legislative authority, which is provided for in Section 241 of the Public Health Service (PHS) Act. This authority was established in 1970, when the Congress amended the Act to permit the HHS Secretary to use up to 1 percent of appropriated funds to evaluate authorized programs. Section 241 limits the base from which 1 percent of appropriated funds can be reserved for evaluations of programs authorized by the PHS Act. Excluded are funds appropriated for FDA, IHS¹, and certain other programs that are managed by PHS agencies but not authorized by the Act (e.g., HRSA's Maternal and Child Health Block Grant and CDC's National Institute for Occupational Safety and Health). In FY 1998, HHS invested more than $35 million in 1-percent evaluation funds to carry out evaluation activities related to relevant public health programs. The FY 1998 Labor, HHS, and Education Appropriations Act provided that an additional $115 million in 1-percent evaluation funds be used to support data collection and analysis activities in AHCPR and CDC's National Center for Health Statistics.

EVALUATION MANAGEMENT
The management of HHS evaluations, which are carried out on a regular basis by the HHS agencies and offices and coordinated by ASPE, involves four basic functions: (1) evaluation planning and coordination, (2) project management, (3) quality assurance, and dissemination of evaluation reports. A description of each function in general terms follows. Additional information on the individual HHS agencies, ASPE, and OPHS evaluation functions is found in chapter III.

Evaluation Planning and Coordination
The HHS agencies, ASPE, the Office of the Inspector General (OIG), and OPHS develop evaluation plans annually in concert with HHS's program planning, legislative development, and budgeting cycles. Plan development is coordinated by ASPE. Each agency or office plan generally states the evaluation priorities, or projects under consideration for implementation. Typically, HHS evaluation priorities include congressionally mandated program evaluations, evaluations of Secretarial program or policy initiatives, and assessments of new programs, programs that are candidates for reauthorization, or programs for which key budget decisions are anticipated.

More specifically, HHS evaluation planning activities involve preparing two reports to the Congress. First, those agencies and offices that use the PHS 1-percent evaluation set-aside authority--AHCPR, CDC, HRSA, NIH, ASPE, OPHS, SAMHSA--submit a formal plan to ASPE, which coordinates and develops the individual plans into the HHS report to the Congress on the use of the PHS 1-percent authority. This report must be submitted to the Congress before HHS can implement the plan.

Second, the Congress requests that HHS coordinate all of its research, demonstration, and evaluation programs to ensure that the results of these projects address HHS program goals and objectives. ASPE and the Assistant Secretary for Management and Budget work together with HHS agencies to provide the Congress with a special annual research, demonstration, and evaluation budget plan that coincides with the preparation of the President's fiscal year budget. The plan outlines each HHS agency's research, demonstration, and evaluation priorities as related to its strategic goals and objectives.

Project Management
The design and management of evaluation projects at HHS is principally decentralized--the HHS agencies, OIG, and ASPE all are responsible for executing annual evaluation plans, developing evaluation contracts, and disseminating and applying evaluation results. Even within agencies-- while there is some oversight responsibility and execution capability in the Office of the Director or Administrator--the various subunits (centers, institutes, and bureaus) conduct much of the day-to-day evaluation activity.

The OIG performs independent evaluations through its Office of Evaluations and Inspections (OEI). The OEI's mission is to improve HHS programs by conducting inspections that provide timely, useful, and reliable information and advice to decisionmakers. This information (findings of deficiencies or vulnerabilities and recommendations for corrective action) is usually disseminated through inspection reports issued by the Inspector General. A summary of individual inspection reports and other OIG reports can be viewed on the Internet at http://www.sbaonline.sba.gov/ignet. OEI also provides technical assistance to HHS agencies in conducting their evaluations.

Quality Assurance
Most evaluation projects are developed at the program level. The initial quality review is generally conducted by a committee of agency- or office-level policy and planning staff members. Before a project is approved, however, it is also reviewed for technical quality by a second committee with expertise in evaluation methodology. Technical review committees follow a set of criteria for quality evaluation practice established by each agency. Some HHS agencies also have external evaluation review committees composed of evaluation researchers and policy experts from universities and research centers. More details on the quality assurance procedures for the various HHS agencies, ASPE, and OPHS are presented in chapter III.

Dissemination of Evaluation Reports
Maintaining report libraries and distributing information on evaluation results is an important component of HHS evaluation management. Project information and reports are continuously submitted to the HHS Policy Information Center (PIC)--the departmental evaluation data base and library maintained by ASPE. As an information data base and library resource, the PIC contains nearly 7,000 completed and in-progress evaluation and policy research studies conducted by the Department, as well as key studies completed outside of HHS by the U.S. General Accounting Office (GAO) and private foundations.

Typically, the results of HHS evaluations are disseminated through targeted distribution of final reports, articles in refereed journals, and presentations at professional meetings and conferences. Although individual HHS agencies have primary responsibility for disseminating results, there is a departmentwide effort under way to expand dissemination to the larger research and practice communities through centralized computer communications and publications. Abstracts of all studies maintained in the PIC evaluation data base are now accessible on the Internet at http://www.hhs.gov. Information is available on completed projects, including the name and telephone number of an HHS official responsible for the project.

In addition, HHS widely distributes copies of the annual evaluation report series, beginning with Performance Improvement 1995 and continuing to this report, through the HHS website. For convenience, these reports can be accessed on the Internet at: http://aspe.hhs.gov/PIC/gate2pic.htm.

FDA programs are principally authorized by legislation other than the PHS Act, specifically the authority of the Agriculture, Rural Development, Food and Drug Administration and Related Agencies Appropriations Act. IHS programs are authorized under the Indian Health Care Improvement Act and the Indian Self-Determination Act, and appropriated under the Department of the Interior and Related Agencies Appropriations

Appendix B - Evaluation Review Panel's Criteria for Assessing Program Evaluations

OVERALL SIGNIFICANCE

The study addresses a significant issue of policy relevance.
Evaluation findings are likely to be useful.

CONCEPTUAL CRITERIA
Conceptual Foundations

A literature review is included.
The project is shown to be logically based on previous findings; the report uses either theory, or models, or both.
The program assumptions are stated.
The evaluation draws from any previous evaluation.
The report is linked with a program and describes the program.
The report presents multiple perspectives.
Multiple relevant stakeholders are consulted and involved.
The timing is appropriate because the program is ready for evaluation.

Questions for Evaluation

The aims of the evaluation are clear, well-specified, and testable.
The questions are feasible, significant, linked to the program, appropriate for the resources and audience, and derive logically from the conceptual foundations.
The questions show ingenuity and creativity.

Findings and Interpretation

The conclusions are justified by the analyses.
The summary does not go beyond what the data will support.
The appropriate qualifiers are stated.
The conclusions fit the entire analysis.
Equivocal findings are handled appropriately.
The initial questions are answered.
The interpretation ties in with the conceptual foundation.
The report notes that the findings are either consistent with or deviate from the relevant literature.
The presentation is understandable.
The results have practical significance.
The extent of program implication is assessed.

Recommendations

The recommendations follow from findings, are worth carrying out, and are affordable, timely, feasible, useful, and appropriate.
The recommendations are shown to be relevant to the questions asked.
The breadth of specificity of the recommendations is addressed.
Any recommendations for either future evaluations, or improvements, or both are clearly presented.

METHODS
Evaluation Design

Design considerations include overall appropriateness, soundness, feasibility, funding and time constraints, generalizability, applicability for cultural diversity, assessment of the extent of program delivery, validity, feasibility for data collection, reliability of selected measurements, use of multiple measures of key concepts, and appropriateness of the sample.
Variables are clearly specified and fit with the questions and concepts.
The design permits measurement of the extent of program implementation and answering of the evaluation questions.

Data Collection

Data are collected using appropriate units of measurement for analysis, controls for participant selection and assignment bias, and proper handling of missing data and attrition.
Data collection is characterized by use of an appropriate comparison group of control; adequate sample size, response rate, and information about the sample; a data collection plan; data collection that is faithful to the plan; attention to and cooperation with the relevant community; project confidentiality; and consistency.
The quality of the data (including the quality of any extant data sets used in the study) and the efficiency of sampling are addressed.
The data collection is appropriate to evaluation questions.

Data Analysis

The data analysis addresses the handling of attrition, the matching of the analysis to the design, the use of appropriate statistical controls, the use of methodology and levels of measurement appropriate to the type of data, and estimation of effect size.
The analysis shows sensitivity to cultural categories.
The analysis makes appropriate generalizability of inferences.
The chosen analysis type is simple and efficient.

CROSS-CUTTING FACTORS
The following are cross-cutting factors that are likely to be important at all stages of a report: clarity, presentation, operation at a state-of-the-art level, appropriateness, understandability, innovation, generalizability, efficiency of approach, logical relationships, and discussion of the report's limitations. The report should also address ethical issues, possible perceptual bias, cultural diversity, and any gaps in study execution.

Topics

Program Evaluation | Modeling & Simulation | Key Indicators