Performance Improvement 1999. Office of the Assistant Secretary for Planning and Evaluation



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


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


PHONE NUMBER: 202-260-0382

PIC ID: 5789.2

PERFORMER ORGANIZATION: Macro International, Inc., Calverton MD


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


PHONE NUMBER: 202-690-7779

PIC ID: 6345

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


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


PHONE NUMBER: 202-690-6443

PIC ID: 7015

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge MA and 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

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


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


PHONE NUMBER: 202-690-5880

PIC ID: 2771.9

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