IN THIS ISSUE:
- Community-Level Indicators for Understanding Health and Human Services Issues
- Addressing the Nation's Changing Need for Biomedical and Behavioral Research Personnel
- Evaluation of Family Preservation and Reunification Programs
- Disability Research Synthesis: Assessment of Past Agency Activities on Disabilities
Community-Level Indicators for Understanding Health and Human Services Issues
Computer technology advances over the past decade have enabled many government and private sector organizations to develop and use timely local-level data for policy development, planning and program implementation. The local indicator systems that have been created have become fundamental tools for tracking and understanding community viability, health and social functioning.
The notion of assessing and monitoring the aggregate-level of health and human services in specific communities or neighborhoods is not new. For decades social science researchers have sought to identify and measure key characteristics of small areas that distinguish them from one another with respect to health, safety, and quality of life. Recent interest in the use of indicators can be attributed to the combination of the computer information revolution, the devolution of power from the federal to state and local governments, and a renewed emphasis on service integration.
This report, commissioned by the Office of Program Systems in the Office of the Assistant Secretary for Planning and Evaluation (ASPE), is a user-friendly tool that showcases an interesting and diverse selection of indicator systems and resource organizations. The compendium is intended to facilitate information sharing among those who are doing local indicator work and to provide background information for those who are new to this area of interest. It is also hoped that this publication will increase awareness of current data resources and inform discussions of strategies for improving the availability, quality and applicability of local indicator data.
Important to understanding this evolving field is a description of the terminology used to describe it. There are three terms that are fundamental to the community-level indicators movement:
- Social Indicator. A measure reflecting the status of the population (e.g., age range, income level, education attainment), and contextual influences (e.g., social, economic, ecological, and political influences).
- Community-Level Social Indicator. A social indicator that can be collected, reported and meaningfully interpreted for geo-political units such as neighborhoods, towns or cities, metropolitan areas, or regions.
- Community-Level Social Indicator System. A compilation based on sources such as archival, surveillance, or administrative data developed for other purposes.
The systems featured in this report illustrate the diversity of organizations that are relying on local-level indicators in their work. There are three major types of entities using indicators for policy and program implementation: government agencies, civic betterment organizations and service providers, and advocacy organizations. They use indicators to help achieve an increasing number of objectives including assessing long and short-term needs, tracking progress in meeting goals, and evaluating their efforts and reflective practice.
The report also illustrates the diversity in existing community-level indicator systems and describes the five areas that are among the most common at this time:
Public Health
The public health field relies on indicator data for planning, resource allocation and assessment of need.
Education
The education field extensively uses social indicators to track the overall and individual progress in student achievement. Most of the indicator systems featured in the compendium include some focus on public health and education issues.
Environment
Hundreds of local-level “sustainable community” projects have been developed over the past decade, many of which manage a social indicator system to support their work. For example, the Sustainable Seattle project, the Livable Tucson Vision Program, and the Redefining Progress resource organization are leaders in the field of environmental-focused community indicators.
Children, Youth and Families
Many of the public and private-supported community indicator projects emphasize the well being of children, youth, and families. For example, KIDS COUNT, which is a network of state-based organizations, regularly releases county-level trend data on child and youth well being.
Comprehensive Community Change Initiatives
These projects attempt to rebuild the social and economic fabric of a community or neighborhood by implementing a holistic strategy involving a full range of resources. Their core philosophical tenant is that all aspects of a community are closely inter-related, and therefore, in order to bring about lasting change, many of those inter-related components must be tackled simultaneously.
This report was prepared by the Research Triangle Institute and Child Trends, Inc. The project officer, Mary Ellen O'Connell, can be reached at (202) 260-0391. Copies of the final report, PIC ID#7459, are available from the PIC or on the internet at: http://aspe.hhs.gov/progsys/community/index.htm.
Addressing the Nation's Changing Need for Biomedical and Behavioral Research Personnel
This report is the eleventh in a series on national needs for biomedical, behavioral, and clinical research scientists. The report examines the needs for training in the health-related sciences and how the NIH research training and career development programs address those needs. This study responds to the congressional directive that appears at Section 489 of the Public Health Service Act. As required by this legislation, the National Institutes of Health (NIH), contracts with the National Academy of Sciences (NAS) to form the Committee on National Needs for Biomedical and Behavioral Scientists. This Committee then estimates future needs for health related researchers, in particular the need for research personnel in the biomedical, behavioral, and clinical sciences. The Committee also examined the influence of the National Research Service Award (NRSA) program on the quality and quantity of training that takes place in those fields.
The report includes a demographic analysis of the research workforce, considering such factors as: the age of current investigators in the biomedical and behavioral sciences, the number of Ph.D.s expected to join the workforce in the years ahead, the likely effect of retirements and deaths, and prospects for research funding and growth in the future.
The report documents a research enterprise that is robust and productive. It predicts continuing growth at close to current rates and that there will be an increasing need for individuals with high quality training in the health related sciences. The demographic analysis suggested that Ph.D. production rates in the biomedical and behavioral sciences exceed demand but the study committee recommended stability in current rates of training perhaps reflecting concerns about the importance of students and postdoctorates to the research enterprise and the reliability and validity of this type of analytical approach. The study committee assessed the contribution of NIH research training programs and recommended a substantial expansion of NRSA programs, provided it was carried out with concomitant reductions in other sources of support for graduate students. The study committee also recommended increases in stipends provided to trainees, increases in the number of clinicians conducting health-related research, increases in the participation of underrepresented racial and ethnic groups in the research workforce, and more education and training related to health disparities. The NIH has already issued a plan to begin implementing recommendations in the biomedical sciences and plans to issue similar statements about behavioral and clinical sciences in the near future. A statement about these plans can be found at http://grants.nih.gov/training/nas_report.
Findings
The committee found that the number of new Ph.D.s awarded annually in the basic biomedical sciences is well above that needed to keep pace with growth in the U.S. economy and to replace those leaving the workforce.
The committee recommends stability in the research training and overall Ph.D. production in these fields.
The Committee found that the number of new Ph.D.s awarded annually in the behavioral and social science workforce is also sufficient to keep pace with the growth in the U.S. economy and to replace those leaving the workforce.
The Committee recommends stability in the research training and overall Ph.D. production in these fields. Also, they found no reason for an increase in the number of clinical science Ph.D.s but clear evidence of additional needs for M.D.s and other clinicians in health related research.
The Committee recommends that efforts to train and retain physicians be intensified until the decline the numbers has been reversed and the clinical research workforce incldues substantially more M.D.s than is now the case.
As well, the Committee recommends that: (1) substantial expansion of predoctoral and postdoctoral positions funded by NRSA training grants and fellowships with concomitant reductions in funding of graduate research assistantships; and (2) examination of programs designed to increase the participation of underrepresented groups, including the need for activities to improve opportunities for minority students in secondary schools.
This report was prepared by the National Academy of Sciences. The project officer, Dr. Walter Schaffer can be reached at (301) 435-2667. Copies of the final report can be found at http://grants.nih.gov/training/outcomes.htm.
Evaluation of Family Preservation and Reunification Programs
Family preservation and reunification programs are intended to prevent the placement of children in foster care when it can be avoided. This report focuses on such programs in Louisville, Kentucky, several counties in New Jersey and, Memphis, Tennessee. These three states were chosen because they had implemented well regarded family preservation programs based on the "Homebuilders" service model, a foster care placement prevention program developed in 1974 in Tacoma, Washington. This approach involves short-term, time-limited services provided to the entire family in the home, based on the crisis intervention theory that families experiencing a crisis will be more amenable to receiving services and learning new behaviors. Key program characteristics include: contact with the family within 24 hours of the crisis, caseload sizes of one or two families per worker, service duration of four to six weeks, provision of both concrete services and counseling, and up to 20 hours of service per family per week.
This evaluation was undertaken to provide information to Congress for deliberations on reauthorization of the Promoting Safe and Stable Families Program. The evaluation will assist states in making decisions about child welfare programs and program planners and practitioners in developing responses to significant social problems.
The evaluation focused on the impact of family preservation programs on the safety of children, changes in child and family functioning, and rates of foster care placement.
The design for this evaluation was an experiment in which families were randomly assigned to either a Homebuilders family preservation program (the experimental group) or to other, "regular," services of the child welfare system (the control group). Information was collected through interviews with caseworkers and caretakers to examine parenting practices, interaction with children, discipline, social networks, economic functioning, housing, abuse and neglect, psychological functioning, child well-being, and caseworker/caretaker interactions. Staff attitudes and characteristics were collected through a self-administered questionnaire.
Findings
The major findings of this evaluation were:
- No significant differences were found between the experimental and control groups on family level rates of foster care placement, case closing, or subsequent maltreatment.
- Family preservation programs in two states resulted in higher assessments by clients of the extent to which goals have been accomplished and of overall improvement in family life.
- In several areas of family functioning, (household condition, child care practices, caretaker depression, child behavior, and caretaker functioning), families in the experimental group appeared to be doing better toward the end of the period of implementing the program services. Those differences, however, were not consistent across states and were not maintained.
The report states that the findings from this study are not new. Previous evaluations have also failed to produce evidence that family preservation programs with varying approaches to service have had more than minimal benefits in improved family or child functioning. The results can be seen as a challenge to find new ways to deal with the problems of families in the child welfare system. The accumulation of findings suggests that the functions, target group, and characteristics of services in programs such as this should be rethought.
Relatively intensive and relatively short-term services such as those provided by family preservation programs are an important part of the continuum of child welfare services. However, this report points to the need for a range of service lengths and service intensities to meet the needs of child welfare clients. For example, families with chronic difficulties can benefit from short-term, intensive services, but those services are unlikely to have a long-term effect. The report calls for policy makers, planners, and program providers to maintain realistic expectations of the effects of short-term family preservation programs.
This report was prepared by Westat, Inc. on behalf of the Assistant Secretary for Planning and Evaluation (ASPE). The project officer, Laura Radel, can be reached at (202) 690-5938. Copies of the final report, PIC ID# 5337.3 can be obtained from the PIC or viewed on the web at: http://aspe.hhs.gov/hsp/hspyoung.htm.
Disability Research Synthesis: Assessment of Past Agency Activities on Disabilities
This report is a summary of the disabilities-related research sponsored by the Agency for Healthcare Research and Quality (AHRQ) over the past ten years, and it contains a synthesis of the AHRQ and non-AHRQ sponsored health services research conducted on disabilities over the same time period.
The report defines persons with disabilities to include any individual who, because of a chronic health condition, injury, or congenital condition, faces a limitation when performing daily activities or expected social roles. Using this comprehensive definition of disability, the Survey of Income and Program Participation (SIPP) data estimates there are 54 million Americans (20.6 percent of the population) with some level of disability.
This research synthesis is intended to help AHRQ identify gaps in the research and propose a set of priority research questions that new AHRQ-sponsored research on disabilities should address. This report will also be used to guide such activities as expert meetings, grant solicitation development, and the planning of other AHRQ program activities.
The synthesis utilized a number of sources of information to help identify disability-related research such as the Computer Retrieval of Information on Scientific Projects (CRISP), the National Technical Information Services (NTIS) database, AHRQ's Research Activities newsletters, the Medline database and the AHRQ web site. Based on that review, a summary is provided on the six areas of emphasis in AHRQ-sponsored research. Namely, managed care; elderly/long term care; infants and children; disability measures; disease/condition-specific research; and health care cost, access, and utilization.
The report concludes by identifying several gaps in the research and many potential priority research questions. Information for the final section comes from both the published literature and interviews with experts at AHRQ and at other research institutions.
Research Gaps
Children's Issues.
The impact of managed care on health care services and outcomes of care for disabled children has yet to be studied. The effect of socioeconomic status and the outcomes of disability for children is another area for research. Finally, more information is needed on the effects of rehabilitation for children and young adults, particularly outcomes associated with such services as occupational therapy, physical therapy, and durable medical equipment and the cost-effectiveness of these services.
Managed Care Issues. Studies on the disabled in managed care settings need to be done on issues such as coordination of care, overall satisfaction with care, utilization of services, access to services, and the impacts of different models of managed care. Research is needed to determine the best methods for organizing, delivering, and financing services for the disabled in managed care settings.
Women's Issues. New research could focus on the impact of the reliance of disabled women on care from specialists, physician attitudes toward the provision of care to disabled women, and disabled women and reproductive health. Research should facilitate the design and development of innovative delivery systems for the provision of primary care to disabled women and demonstrations of the delivery system's effectiveness.
Quality of Care Issues. For those who are institutionalized, little appears to be known about the quality of care provided in nursing homes and its affect on the functional decline of residents. Access to and the quality of acute care provided to nursing home residents is another issue for the institutionalized population. The quality of prescribing for the disabled is another aspect of the quality of care that needs to be examined as is the use of rehabilitative services to minimize decline in those with degenerative diseases.
This report was prepared by the Center for Health Policy Studies (CHPS). The project officer, Chris Peterson, can be reached at (301) 594-7173. Copies of the final report, PIC ID#7481, can be obtained from the PIC.
SERVICES AVAILABLE FROM THE PIC
The Policy Information Center (PIC) is a centralized source of information on in-process, completed, and on-going evaluations; short-term evaluative research and; policy-oriented projects conducted by HHS as well as other Federal departments and agencies. The PIC on-line database provides project descriptions of these studies. It is available on-line at http://aspe.hhs.gov/pic/. Inquiries regarding PIC services should be directed to Juanita Butler, Technical Information Specialist, at 202-690-6445. Or E-mail PIC at: webmaster.aspe@hhs.gov.