Performance Improvement 1998. Foreword


Performance Improvement 1998: Evaluation Activities of the U.S. Department of Health and Human Servicesis the third annual report summarizing evaluation efforts by the Department's agencies and offices during the past fiscal year. This report is intended to help those interested in evaluations of health or social services to locate information on study results, recommendations, or applications of program improvement or policy development. Generally, the audience for this report includes decisionmakers who need information on program results; program managers who want to know how other service programs are operating and how their own performance can be improved; and the community of researchers, advocates, and practitioners who use the program information and evaluation tools.

The mission of the Department of Health and Human Services (HHS) is to enhance the health and well-being of Americans by providing for effective health and human services and by fostering strong, sustained advances in the sciences underlying medicine, public health, and social services. To accomplish this mission, the Department manages an array of programs in basic and applied science, public health, and child and adolescent development; programs that foster economic self-sufficiency and support working families; and programs that finance or regulate health, mental health, and social services.

Through departmentwide strategic planning and performance management, HHS programs are continuously improving and redirecting to meet new needs of customers, beneficiaries, and other constituencies. The 1990's trend toward results-oriented management of HHS programs makes evaluation an important resource for producing knowledge to measure program performance, develop and improve programs, and analyze and develop policy.

For example, last year the Substance Abuse and Mental Health Services Administration in HHS completed one of the largest and most rigorous studies of drug treatment programs (Chapter II, page 12). Among the key findings were that clients of HHS-supported drug treatment significantly reduced their alcohol and other drug use; that treatment has had lasting benefits for clients; and that clients reported increases in employment and income, as well as decreases in criminal behavior, risk for human immunodeficiency virus/acquired immuno-deficiency syndrome (HIV/AIDS), and homelessness. This evaluation gives us new knowledge about what works in substance abuse treatment and the cost, which can be applied to improving current programs and designing new programs to advance future treatment.

Evaluations also are useful for implementing or operating programs. One such evaluation completed last year by the Centers for Disease Control and Prevention on syphilis control programs is helping local health departments in the Southern States to expand syphilis prevention efforts, increase access to services, and improve program operations and methods of contact tracing and notification (Chapter II, page 19). The evaluation findings offered new information on population groups at risk, barriers to reaching those at greatest risk, how best to reach those at risk through community institutions, and innovations in sexually-transmitted disease control and prevention programs. This study illustrates how HHS officials can effectively use evaluation resources to produce information useful for working with our partners in State and local communities to improve public health systems.

Assessing the environmental or external factors that affect HHS program or policy development is another major application of HHS evaluation activity. This past year, the Office of the Assistant Secretary for Planning and Evaluation completed a policy study on informal and formal kinship care of children and its importance for the child welfare system (Chapter II, page 26). Children living with relatives but away from parents, either informally or through formal foster care placements, is a growing phenomenon. This study provides new knowledge that will help shape future policy and program development in foster care services.

Performance Improvement 1998 contains information on HHS agency and office evaluation projects completed and in progress during fiscal year (FY) 1997. The report is organized into three Chapters. Chapter I describes the organization of HHS evaluations--activities, resources, and planning and management. Chapter II highlights the results from nine FY 1997 evaluations, selected by an outside review panel for their potential use by the larger health and human services community. Chapter III presents the evaluation activities of the 11 HHS agencies and the Office of the Secretary, including information on their evaluation programs, evaluations completed in FY 1997, and evaluations in progress. A complete inventory of the 155 HHS evaluation projects completed in FY 1997 is provided in Appendix A, and the 335 HHS agency projects currently in progress are listed in Appendix B.

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

Donna E. Shalala
U.S. Department of Health and Human Services

Margaret A. Hamburg, M.D.
Assistant Secretary for Planning and Evaluation