Performance Improvement 2002. Office of the Assistant Secretary for Planning and Evaluation

01/01/2002

Mission

To provide analytical support and advice to the Secretary on policy development and assist the Secretary with the development and coordination of department wide program planning and evaluation activities.

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.

Through the departmental evaluation planning process, ASPE has the capacity to identify crosscutting program or policy issues of particular concern to the Secretary and specific program and policy areas not covered by the HHS Agency evaluation plans. In these instances, ASPE initiates evaluations or collaborates with the agencies to conduct evaluations or policy assessments.

Another continuing evaluation objective of ASPE is to support and promote the development and improvement of databases 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 chairs the Research Coordination Council (RCC), which will evaluate Department-wide research priorities to ensure that efficiencies are realized and research funding priorities are consistent with the Administration’s priorities. The ASPE also 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.

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.

Completed Evaluations

A Study of Screening and Assessment in TANF and Welfare to Work

This study, jointly funded with the Administration for Children and Families, highlights critical issues in the development and use of screening and assessment tools designed to identify TANF and/or welfare-to-work (WtW) recipients who experience barriers to employment. The barriers of specific interest for this study include substance abuse, mental health or illness, low basic skills, physical/developmental disabilities (including learning disabilities), and domestic violence. The project provided information about: (1) The screening and assessment tools used by experts in the field to identify each of the barriers to employment; 2) The screening and assessment process states and localities are using to identify and serve the target populations and how and why the states chose particular screening and assessment tools; and 3) The linkage between screening and assessment and referral to services, and the types of coordinated services that are being provided to TANF/WtW recipients. Question one notes the lack of a common terminology between TANF agencies and their partners. Question two provides an overview of incentives to screen or assess clients within TANF as well as a review of prevalence estimates for these barriers. Question three builds on this discussion, outlining key aspects of TANF policy that provide TANF agencies flexibility in how they meet the needs of TANF clients. Questions 4 ‑ 10 are as follows: (4) How can the case management process aid in identifying unobserved barriers to employment? (5) Are there tools that can be used to identify barriers to employment? (6) When should screening or assessment (S&A) occur? (7) Who should conduct the S & A? (8) What training issues are related to S&A? (9) What issues related to privacy and confidentiality should be considered? (10) What other questions should be asked? This paper is a first step in identifying barriers to employment. The second phase of the study will consist of conducting case studies to further explore how these issues are addressed in a select number of localities.
http://aspe.hhs.gov/daltcp/reports/scrnasmt.pdf
PIC ID: 7553; CONTACT: William Marton, 202-690-6443; PERFORMER: Urban Institute, Washington, DC

Indicators of Welfare Dependence: Annual Report to Congress 2001

The Welfare Indicators Act of 1994 requires the Department of Health and Human Services to prepare annual reports to Congress on indicators and predictors of welfare dependence. Each annual report on Welfare Indicators is developed with the advice and recommendations of the bipartisan Advisory Board on Welfare indicators, the assistance of the U.S. Department of Agriculture, the Social Security Administration and the U.S. Bureau of the Census. The purpose of this report, as stated in the law, is “to provide the public with generally accepted measures of welfare receipt so that it can track such receipt over time and determine whether progress is being made in reducing the rate at which and, to the extent feasible, the degree to which, families depend on income from welfare programs and the duration of welfare receipt.” Drawing on various data sources, including the Current Population Survey (CPS), this report provides a number of key indicators of welfare recipiency, dependence, and labor force attachment. Selected highlights from the many findings include: (1) In 1998, 3.8 percent of the total population was dependent in the sense of receiving more than half of total family income from TANF, down from 5.8 percent in 1993. (2) The drop in dependency parallels the more well-known drop in AFDC/TANF and food stamp caseloads. (3) In an average month in 1998, more than half (56 percent) of TANF recipients lived in families with at least one family member in the labor force. (4) Long-term dependency is relatively rare. Only 4 percent of those who were recipients in 1982 received more than 50 percent of their income from AFDC and food stamps in nine or more years over a ten-year period.
http://aspe.hhs.gov/hsp/indicators01/index.htm
PIC ID: 7281; CONTACT: Julia Isaacs, 202-690-6805; PERFORMER: Office of the Assistant Secretary for Planning and Evaluation

Supportive Health Services Needs of Children with Disabilities

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 overall 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. This study focused on a subset of health-related services that are used almost exclusively by children with disabilities, namely, supportive services. The major finding is that policies focused on low-income children will reach the majority of children with disabilities who have unmet supportive service needs. These needs range widely across types of services, however. Reaching these children is dependent on how comprehensive the service coverage is. If policymakers wish to target the largest group of children with disabilities, they will do so by focusing on the nearly 90 percent of children with disabilities who have a learning limitation. Policies focusing on this group could potentially reach 3.5 million children, almost 13 percent of whose need for supportive services is unmet. Such policies would also potentially reach a proportion of children with other types of disabilities as well, since 30 percent of children with learning limitations have other functional limitations as well.
http://aspe.hhs.gov/daltcp/reports/suphsnd.htm
PIC ID: 7153; CONTACT: William Marton, 202-690-6443; PERFORMER: Urban Institute, Washington, DC

Clarifying the Definition of Homebound and Medical Necessity Using OASIS Data: Final Report

The purpose of this project was to develop and test a set of uniform and reliable indicators that can be systematically used to document and monitor two Medicare home health care coverage criteria: the “Homebound” and the “Medical Necessity” criteria. The indicators will be linked to items from the Outcome and Assessment Information Set (OASIS) in a decision tree algorithm (or a logic model). Two decision algorithms will be developed for the two criteria. The algorithms will represent a major step toward helping providers, CMS, and the intermediaries in administering the home health benefit. Findings from the study show that the two OASIS algorithms successfully identify patients highly likely to meet the homebound and medical necessity criteria for medicare home health care. Using OASIS data alone, almost 90% of the 600 patients in the sample were classified as meeting the medical necessity criterion. The figure for the homebound criterion is lower (48.5%). It should be noted, however, that individuals may be clearly eligible for home care benefits even though they are not captured by the OASIS algorithms. Nurses who were experts in chart review, in fact, concluded that over half of the patients who were not captured by the homebound algorithm did meet the requirement based on a careful review of patients’ medical records.
http://aspe.hhs.gov/daltcp/reports/OASISfr.htm
PIC ID: 7557; CONTACT: Kamal Hijjazi, 202-690-6443; PERFORMER: Visiting Nurse Service, New York, NY

Private Payers Serving Disabled Individuals and Research Synthesis on Managed Care for Persons with Disabilities

This study was undertaken in order to provide a better understanding of the role of private insurance plans in caring for people with chronic conditions and disabilities. It estimates the prevalence of chronic illness, analyzes the factors affecting the choice of indemnity plans versus managed care, and estimates the impact of managed care on service use and expenditures. The study also investigates the leading risk adjustment systems as a possible method for paying plans more appropriately in serving this population. The four major questions answered by this research are: (1) What is the prevalence of chronic illness and disability among the population enrolled in employer-based health insurance plans? (2) Are individuals with chronic illness more or less likely to choose managed care or indemnity plans, if given a choice? (3) What is the impact of health plan type on utilization and expenditures, taking into account differences in the populations that enroll in different types of insurance plans? (4) To what extent can risk-adjustment systems help employers and health plans predict expenditures of their chronically ill and disabled enrollees?
http://aspe.hhs.gov/daltcp/reports/privpay.htm
PIC ID: 6398; CONTACT: John Drabek, 202-690-6443; PERFORMER: MEDSTAT Group, Cambridge, MA

Screening and Assessment in TANF/Welfare-to-Work: Ten Important Questions TANF Agencies and Their Partners Should Consider

Changes to the welfare system brought about by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), carries serious implications for TANF recipients with disabilities and barriers to employment. There is general agreement among TANF agencies that larger proportions of clients with difficulties transitioning from welfare to work are the “Hard-to-serve.” Given the employment focus and time-limited nature of TANF, there is increased interest in screening and assessment approaches that can be used to identify these barriers to employment. The Department of Health and Human Services asked The Urban Institute to explore the issues and challenges related to screening and assessment within the TANF context. This paper identifies ten of the important questions that should be considered by TANF agencies and their partners as they develop approaches to screening and assessing for barriers to employment, such as substance abuse, mental illness, low basic skills, developmental disabilities, and domestic violence. The second phase of this study will consist of conducting case studies to explore how these issues are addressed in a select number of localities. The ten questions include, for example: How can the case management process aid in identifying unobserved barriers to employment? Who should conduct screening or assessment and when should it occur? What issues related to privacy and confidentiality should be considered?
http://aspe.hhs.gov/daltcp/reports/scrnasmt.pdf
PIC ID: 7538; CONTACT: William Marton, 202-690-6443; PERFORMER: Urban Institute, Washington, DC

Understanding Medicaid Home and Community Services: A Primer

This Primer is designed to encourage use of the Medicaid program in a manner that minimizes reliance on institutions and maximizes community integration in a cost-effective manner. It describes the many options states have to use the Medicaid program to fund long-term care services and supports. Its intended audience is policymakers and others who wish to understand how Medicaid can be used--and is being used--to expand access to a broad range of home and community services and supports, and to promote consumer choice and control. In addition to comprehensive explanations of program features states can implement to achieve these goals, the Primer presents examples of state programs that have taken advantage of Medicaid’s flexibility to expand home and community services for people of all ages with disabilities. For every Medicaid service, states must answer two basic questions: (a) how to define medical necessity, and (b) how to manage overall utilization. Federal Medicaid law and policy, however, give states great latitude to offer individuals a wide range of home and community services through the states “regular” Medicaid program. States can offer a more comprehensive service range by operating one or several home and community based services waiver programs. The design of the Primer grew out of a series of discussions among federal officials, state policymakers, service providers, and advocates regarding how to make the document as useful as possible. Each chapter provides an annotated bibliography, with full information on how to obtain each publication. The report is designed to serve as a reference guide.
http://aspe.hhs.gov/daltcp/reports/primer.htm
PIC ID: 7762; CONTACT: Gavin Kennedy, 202-690-6443; PERFORMER: George Washington University, Center for Health Policy Research, Washington, DC

Teen Risk-Taking: A Statistical Portrait

This is the second of two projects that analyzed data from several major Departmental surveys of youth (the National Longitudinal Study on Adolescent Health, the Youth Risk Behavior Survey, and the National Survey of Adolescent Males) regarding the clustering or co-occurrence of youth risky behaviors. Both projects were conducted for ASPE by The Urban Institute. The first project produced three working papers that were synthesized into a single document entitled: “Teen Risk-Taking: A Statistical Portrait” which is available through the Urban Institute web site at www.urban.org (search by first author of the report - Laura Duberstein Lindberg). The second project produced four working papers that are available in the PIC. The objective of this research was to go beyond demographic data to identify vulnerability and protective factors related to profiles of risk which co-occur with health risk behaviors, such as alcohol use, binge drinking, cigarette use, sexual activity, marijuana use, other illicit drug use, fighting, and suicide. The sample includes 12, 578 students in grades 9 throught 12 from the National Longitudinal Study. Results indicate that profiles of risk are related to vulnerability and protective factors in the individual psychosocial adjustment, school, and family domains. Students in the lowest risk profiles reported consistently higher levels of protective factors and lower levels of vulnerability factors than students in any other risk profile. Students in profiles consisting of substance using, sexually active teens reported higher levels of protective factors and lower levels of vulnerability factors than both the highest risk profiles and the profiles distinguished by suicidal thoughts and behaviors.
PIC ID: 7349; CONTACT: Kevin Hennessy, 202-690-7272; PERFORMER: Urban Institute, Washington, DC

Assessing Core Capacity for Infectious Diseases Surveillance

This project was designed to develop an investment plan to improve the nation’s core capacity for infectious diseases surveillance in light of recent changes. These challenges include the changing nature of biological threats--including bioterrorism and emerging infections--the rapid pace of technological development, and changes in the health care delivery system. The investment plan that evolved is based on an analysis of recent literature, interviews with over 50 experts in the field, and validation through direct observation of the capacity currently in place for surveillance in three locations across the country. The researchers present a three pronged strategy for improving core capacity for infectious disease surveillance. Each of the three prongs has two major components along with a package of specific activities that relate to each component. The priority investment areas are: 1) Improve State and Local Preparedness to Identify and Respond to Infectious Disease Threats. (2) Engage the Health Care Delivery System and the Public as Partners in Infectious Diseases Surveillance. (3) Enhance Public and Private Laboratory Support for Infectious Diseases Surveillance.
PIC ID: 7161; CONTACT: Caroline Taplin, 202-690-7906; PERFORMER: The Lewin Group, Fairfax, VA

Assessing the Individual Health Insurance Market in the Post-HIPAA Era: A Review of the Literature

This paper reviews the available literature describing the individual health insurance market and the impact of state regulation on this market. By any measure, the individual health insurance market is much smaller than the group market. The number of people under age 65 who report individual coverage (about 16 million) is only about 10 percent as many as those who report employer group coverage (158 million). Despite its small size, the individual health insurance market plays an important role in a voluntary, private-public “system” of health insurance. For people without access to either employer coverage or public coverage, the individual market is their only source of insurance. Prices in this market are notoriously high. Administrative costs for individual coverage (measured as insurance loadings on medical benefits) are commonly a multiple of (according to one estimate, three times) those in the group market. The small size of the individual market allegedly makes it “fragile.” In light of the importance of the individual market to consumers who rely on it, its fragility is highly problematic. In addition, the cost of coverage in this market remains a principal problem. The study makes these recommendations: Potential areas for reform--guaranteed issue and some constraints on insurer products and pricing to ensure stability--may offer the most significant opportunities to assist consumers in the individual health insurance market. By guaranteeing access to coverage and making coverage more understandable, they would greatly improve consumers’ ability to compare insurance policies and prices.
PIC ID: 7758; CONTACT: Stephen Finan, 202-690-7387; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Assessment Approaches to Evaluating Telemedicine Programs and Projects

The purpose of the study was to extend the 1996 Institute of Medicine framework for telemedicine evaluation as it applies to teleconsultations. The purpose of this study was not to evaluate telemedicine, but rather to identify the different kinds of issues on which telemedicine evaluations can focus, and the kinds of information that such evaluations can yield. This report is intended to guide evaluators and policy makers in selecting the questions that they want to answer regarding the value of telemedicine programs, and in designing evaluations that will best serve their interests and purposes. There are a number of major findings, including: 1) A fundamental consideration in evaluating a telemedicine application is specifying a minimum set of elements such as purpose, target audience, and the scope or focus of the evaluation; 2) Patient satisfaction with telemedicine has consistently been demonstrated to be high. As such, resources for future evaluations may be better allocated to areas of higher priority. 3) Lack of reimbursement for telemedicine services has been a significant confounder in past evaluations of telemedicine. Future evaluation efforts should seek to establish comparable reimbursement environments for telemedicine and the usual care comparators whenever differences in reimbursement might affect study results.
PIC ID: 7340; CONTACT: Tom Hertz, 202-690-7779; PERFORMER: The Lewin Group, Falls Church, VA

Construction of an Integrated Measure of the Burden of Disease: Final Report

This study examined one of the main challenges in measuring the burden of disease: the fact that the burden of disease has multiple components (medical costs, reduced quality of life, reduced longevity, productivity loss, etc). The report includes a review of relevant literature, some discussion of various empirical approaches to measuring trade-offs between the various components of the burden of disease within health systems, and consideration is given to the problem of comparing performance across health systems when the outcome has multiple components. The report sums up as follows: It seems critical to recognize that the observed relationship between the multiple components of healthcare outcomes, including cost, are a product of the interplay between production and consumer preference factors when considering the burden of disease. The entire relationship is of relevance when comparing the effectiveness of health systems, not just individual outcomes. Yet our ability to understand how this relationship is determined, in theory, and to appropriately estimate it in practice is limited. Because costs are jointly determined with other outcomes, estimation of cost regressions is not the right approach. Approaches that treat cost and other outcomes symmetrically yield different answers, but there are many such approaches and no clear criteria to select among them.
PIC ID: 7142; CONTACT: Kevin Hennessy, 202-690-7272; PERFORMER: The Lewin Group, Fairfax, VA

Decliners of Employer Based Health Insurance: An Analysis Using the National Health Interview Survey

The purpose of this study was to examine the characteristics of workers who decline offers of health insurance coverage from their employers (“decliners”) and remain uninsured. Using the National Health Interview Survey (NHIS), this project focused on how decliners compare to other relevant employee groups (e.g., uninsured workers not offered health insurance coverage) and how the decliner population changed during the 1990’s. In addition to comparing the usual socioeconomic variables (such as age, sex, etc.), this analysis looks at decliners’ health status, health conditions and utilization of health care services. According to the NHIS, both employer-based insurance (ESI) offer and take-up rates fell between 1993 and 1997, which appears to imply that decliners of ESI have become, and will continue to be, more important in the pool of the uninsured. Length of spells of uninsurance seem to be decreasing for those decliners without coverage and their spell lengths are significantly shorter than those of workers who are uninsured and have no ESI offer. Still, in 1997, 57 percent of uninsured decliners had been without coverage of any kind for at least a year. Over time, decliners appear to be getting somewhat older, and less likely to be married or to have children. Oddly, they also seem to be getting more highly educated. In terms of health status, the decliners fell between ESI takers and those not offered in terms of the probability that at least 1 person in their family was in fair or poor health, although the probability of a sick family member was decreasing over the time period studies. Interestingly, decliners were less likely than those not offered to have had a recent doctor’s visit, and more likely to have not had one in 3 or more years. Finally, decliners were substantially more likely than ESI takers to report problems related to mental health conditions.
PIC ID: 7345; CONTACT: Bernadette Fernandez, 202-401-8398; PERFORMER: Urban Institute, Washington, DC

Evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Grant Program

PATH is a formula grant program that provides funds to States and Territories for flexible, community-based services for persons with serious mental illnesses who are homeless or at imminent risk of becoming homeless. The findings are as follows: 1) Grantees demonstrated that PATH monies are used in a manner that is fully consistent with the authorizing federal legislation. Provider agencies use the PATH dollars, in combination with other state and local funds, to offer a wide array of appropriate services to members of the target population. 2) The evaluation confirmed the importance of PATH’s contribution to the overall service delivery system for people who are homeless and have serious mental illnesses. 3) Funding application material indicates that in FY 1999, 90 percent of the sample agencies offered outreach services with the support of PATH funds. 4) PATH-supported outreach contacted 115,217 individuals in FY 1999. 5) Annual report data indicate that 37 percent (42,441 clients) of the 115,217 individuals contacted became enrolled PATH clients.
PIC ID: 7210; CONTACT: Kevin Hennessy, 202-690-7272; PERFORMER: R.O.W. Sciences, Inc., Rockville, MD

Factors Influencing Effective Dissemination of Prevention Research Findings by DHHS: Final Report

Disease prevention and health promotion activities are receiving increased attention by the Department of Health and Human Services and its partners. This report addresses both primary and secondary prevention efforts. Primary prevention denotes interventions taken to prevent the development of a disease in individuals who do not have the disease in question. Secondary prevention denotes the identification of individuals who have developed a disease at an early stage in the disease’s natural history, followed by early intervention to prevent mortality or complications of the disease. Four major tasks and deliverables of this project, including a literature review, discussions with technical advisors (personnel from federal government agencies involved in prevention) and dissemination partners (representatives of professional groups, foundations, and communications media partnering with federal agencies), case study reports, and an expert panel meeting, served as inputs into this report. HHS roles in prevention activities are described based upon these inputs. The report then identifies factors critical to processes for the effective translation of research findings into clinical and public health practice and into individual behaviors that promote health.

This research effort determined that to develop and advance its prevention initiative, HHS must consider demographic, social, economic, and technological trends, and anticipate how these will affect priorities for prevention research translation, dissemination, and intervention. Further, HHS must account for the effects of these trends on the identity, needs, and means for reaching at-risk populations and other target audiences for these initiatives. In order to increase the likelihood of success, HHS must look for potential partners in the federal government, state governments, and the private sector who can provide market access, financial support, and other complementary advantages. Finally, ongoing evaluation of these functions will enable continued improvement of each prevention initiative and building a growing knowledge base of what works to improve the processes and health outcomes of preventive services.
PIC ID: 7347; CONTACT: Andrea Pernack, 202-690-7807; PERFORMER: The Lewin Group, Falls Church, VA

America’s Children: Key National Indicators of Well-Being 2001

This report was developed by the Federal Interagency Forum on Child and Family Statistics. It is the fifth annual synthesis of information on the status of the Nation’s most valuable resource, our children. This report presents 24 key indicators of the well-being of children. These indicators are monitored through official federal statistics covering children’s economic security, health, behavior and social environment, and education. The report also presents data on eight key contextual measures and includes two indicators as special features: asthma prevalence and youth employment. The 20 agencies of the Forum have also introduced improvements in the measurement of several of the indicators presented last year. The report is intended to stimulate discussions by policy-makers and the public, exchanges between the data and policy communities; and improvements in federal data on children and families.
http://www.childstats.gov/americaschildren/
PIC ID: 6170.5; CONTACT: Martha Moorehouse, 202-690-6939; PERFORMER: Westat, Inc., Rockville, MD

Children and Welfare Reform: A Guide to Evaluating the Effects of State Welfare Policies on Children

In the last 10 years, policymakers and researchers have expressed a growing interest in understanding how and to what extent welfare policies affect children’s health, cognition, school achievement, and social and emotional development. The purpose of this guidebook is to share the results of a unique project designed to assist States in measuring child outcomes in the context of welfare reform programs. The Project on State-Level Child Outcomes consisted of representatives of State welfare agencies, federal government representatives, and researchers working together to identify an important set of child outcomes and ways to measure them. The project proceeded in two phases: The Planning Phase - the primary goal of this phase was the selection of a common design and a common set of family and child well-being outcomes that could be measured in state welfare evaluations. Several meetings were organized and facilitated by Child Trends, Inc. Twelve States participated in this phase (California, Connecticut, Florida, Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio, Oregon, Vermont, and Virginia). The second phase, The Operational Phase, began in the fall of 1997 and will continue for at least three years. Five States are participating in this phase (Connecticut, Florida, Indiana, Iowa, and Minnesota). They are diverse in their welfare policies and programs, recipient populations, geography, and political climate. This guidebook condenses and integrates the materials, discussions, and products from each phase of the project to provide the tools needed to initiate or augment a study of child well-being in the context of welfare reform.
PIC ID: 7590; CONTACT: Martha Moorehouse, 202-690-6939; PERFORMER: Child Trends, Inc., Washington, DC

Evaluating Two Approaches to Case Management: Implementation, Participation Patterns, Costs, and Three-Year Impacts of the Columbus Welfare-to-Work Programs

This is the latest in a series of evaluations of 11 welfare-to-work programs in seven sites across the nation. This report presents results from Columbus (Franklin County), Ohio. Two case management approaches (traditional with two case workers, one for income maintenance, the other for employment and training) and integrated case management (one case manager for both income maintenance and employment-related issues) were evaluated. The report provides information on how the integrated and traditional programs were implemented, how they affected participation in employment-related activities, and the costs of providing employment-related services in the two programs. To facilitate this assessment, from 1992 to 1994 over 7,000 single-parent welfare applicants and recipients were randomly assigned for the evaluation. The key findings include, but are not limited to, the following: 1) Integrated case managers provided more personalized attention than traditional case managers and more closely monitored participation in program activities; 2) The integrated program engaged more people in welfare-to-work activities than the traditional program; 3) Both Columbus approaches increased earnings by about $1,000, or 10 percent, relative to the control group average; 4) Neither program increased sample members’ average combined income from earnings, cash assistance, and Food Stamps; and, 5) For sample members who did not have a high school diploma or GED when they entered the study, the integrated program produced larger earnings gains and welfare reductions than the traditional program.
http://aspe.hhs.gov/hsp/NEWWS/columbus01/index.htm
PIC ID: 7089.6; CONTACT: Audrey Mirsky-Ashby, 202-401-6640; PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Evaluation of Family Preservation and Reunification Programs: Interim Report

This is a report of an evaluation of programs intended to prevent the placement of children in foster care when it can be avoided. This report focuses on programs in three states, using a particular approach to family preservation, Homebuilders, thought by many to be the most promising approach. Homebuilders, a foster care placement prevention program developed in 1974 in Tacoma, Washington, calls for short-term, time-limited services provided to the entire family in the home. 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. The programs evaluated were in Louisville, KY; seven counties in New Jersey; and Memphis, Tennessee. Did the study meet the goals of reducing foster care placement, maintaining the safety of children, and improving family functioning? No significant differences were found between the experimental and control groups on family level rates of placement, case closings, or subsequent maltreatment. It was also found that 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 their families' lives.
http://aspe.hhs.gov/hsp/hspyoung.htm
PIC ID: 5337.3; CONTACT: Martha Moorehouse, 202-690-6939; PERFORMER: Westat, Inc., Rockville, MD

Providing Mental Health Services to TANF Recipients: Program Design Choices and Implementation Challenges in Four States

This report profiles the efforts of four States (Florida, Oregon, Tennessee, and Utah) to address the mental health needs of welfare recipients. This study was designed (1) to identify and provide detailed information about the design and structure of mental health services developed by state and local welfare offices to address the mental health needs of welfare recipients, (2) to highlight service delivery options in designing and implementing these services, and (3) to discuss the key implementation challenges and lessons learned in providing mental health services to welfare recipients. The researchers visited one rural and one urban site in each state. The sites provided services in a variety of ways, and the research did not collect any evidence that suggests that one model for providing mental health services is better than any other. Rather, the project was designed to draw attention to the key design and implementation choices made by policymakers and managers in providing mental health services for welfare recipients.
http://aspe.hhs.gov/hsp/TANF-MH01/
PIC ID: 7618; CONTACT: Elizabeth Lower-Basch, 202-690-6808; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Trends in the Well-Being of America’s Children and Youth 2000

This report presents the fifth edition of a collection of national estimates of child and youth well-being. Trends are presented from the 1970s through the 1990s. The report presents the most recent and reliable estimates on more than 80 indicators which have been organized into these 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. Some sections of this report, mostly sections one and two, have been significantly revised since the 1999 edition of this report. Some indicators have been combined while others have been rewritten or replaced with new sources of data. A new indicator has been added on the number of births in the US, while several have been removed. The indicators that have been removed are: children as a percentage of the dependent population; long-term childhood poverty; effect of government cash and near-cash transfer programs on poverty among persons living in families with children under 18; long-term welfare dependence; parental labor force detachment; secure labor force attachment; and lead exposure.
http://aspe.hhs.gov/hsp/00trends/index.htm
PIC ID: 6170.4; CONTACT: Martha Moorehouse, 202-690-6939; PERFORMER: Westat, Inc., Rockville, MD

EZ/EC Health Planning Capacity Survey

This study consisted of a survey of directors or acting directors in 141 Empowerment Zones and Enterprise Communities/EZ/ECs) during he summer of 2000. The survey asked about their interest in and capacity to engage in health improvement activities (defined as planned activities to address health issues) as well as their desires for technical assistance (TA) in this area. An 84% response rate was achieved. The survey findings are organized by five factors of EZ/EC health planning capacity and an additional section focusing on EZ/EC desires for technical assistance. The five factors are: 1) Interest and commitment to health - 88% reported interest in health issues, and 39% consider health issues among their top priorities. 2) Experience in various health improvement roles - Half of the respondents had participated in or had planned a health improvement activity during the past year. 3) Availability of expertise and data - Half reported they have access to regularly published information on local health statistics. (4) Existence and stability of local administrative structures and site advisory organizations - 89% of respondents have a general community advisory group and 5) Established relationships with community officials, business representatives, and health departments - 90% of respondents have business people they can call upon for advice, and 57% have conversed with business people about health issues. Regarding technical assistance, more than three-quarters of the respondents said they would use TA if offered for the participation of residents and community groups in EZ/EC-led activities. These responses show, according to the report, that many EZ/ECs already have the basic level of readiness to undertake and sustain successful health improvement efforts and to benefit from technical assistance.
http://www.phf.org/research.htm
PIC ID: 7341; CONTACT: Barbara Greenberg, 202-401-8279; PERFORMER: Public Health Foundation, Washington, DC

In-Progress Evaluations

1999 NLTCS/ICS: File Preparation and Preliminary Data Analysis

The purpose of this project is to prepare the 1999 NLTCS/ICS data file for analysis and to perform some preliminary descriptive analyses. This is a necessary prerequisite for more detailed analyses, which will be used to update the ASPE booklet, “Informal Caregiving: Compassion in Action” (published in 1988, based on 1995 NLTCS data).
PIC ID: 7761; EXPECTED COMPLETION: FY 2002; CONTACT: Pamela Doty, 202-690-6443; PERFORMER: Medstat Group, Washington, DC

A Comparative Study of the Outcomes and Costs Associated with Medicare Post-Acute Services in Skilled Nursing Facilities, Rehabilitation Hospitals/Unit

This project will study the cost-effectiveness of Medicare post-acute care services for Medicare beneficiaries with certain conditions, within and across post-acute care settings and over episodes of care. The study will examine: (1) demographic and health-related characteristics of Medicare beneficiaries who use post-acute services following a hospital stay to determine how much overlap there is in the patient populations treated by each provider type and across provider types; (2) patterns of service use and costs associated with the treatment of similar patients in each setting and across episodes of care; (3) outcomes for similar Medicare beneficiaries by each post-acute provider type and across episodes including those in which multiple providers are used; (4) relationship between outcomes for similar patients and differences in the mix and intensity of services provided, and level of reimbursement across post-acute care providers and episodes of care; and (5) core measures that are most useful to incorporate into on-going reporting requirements to monitor outcomes in each post-acute care setting and across episodes of care.
PIC ID: 6836; EXPECTED COMPLETION: FY 2004; CONTACT: Jennie Harvell, 202-690-6443; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Analyses of Changes in Elderly Disability Rates: Implications for Health Care Utilization and Costs

The purpose of this project is to conduct analyses using the 1984 to 1999 National Long-Term Care Survey (NLTCS) and the Medicare Current Beneficiary Survey (MCBS) to understand the nature of recent declines in elderly disability rates and their implications for health care utilization and costs. Specifically, researchers are (1) decomposing changes in elderly disability rates using the 1984 to 1999 NLTCS and exploring possible reasons for the decline, and (2) linking changes in elderly disability rates to the use of specific medical procedures (e.g., cataract surgery, coronary and joint replacement surgeries) and/or assistive technology. The MCBS is the primary data set for the latter analyses.
PIC ID: 7554; EXPECTED COMPLETION: FY 2002; CONTACT: William Marton, 202-690-6443; PERFORMER: Urban Institute, Washington, DC

Analysis of the Disability Supplement to the National Health Interview Survey

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.
PIC ID: 7153; EXPECTED COMPLETION: FY 2002; CONTACT: William Marton, 202-690-6443; PERFORMER: Urban Institute, Washington, DC

Analyses of Residential Transition of Older Americans

There are four main questions to be addressed in this project: (1) How do characteristics (both individual and environmental) of elderly persons residing in institutional settings differ from those residing in community-based settings? (2) How do these characteristics vary over time? (3) Are there differences in these characteristics between subgroups of institutionalized and non-institutionalized elderly? (4) What is the relationship between selected individual and environmental factors and the transition of the elderly between community and institutional residential settings? Data from six years of the Medicare Current Beneficiary Survey will be used to answer these questions. Understanding residential transitions will help staff in the Department improve surveys that monitor acute health and long-term care use in different settings (e.g., the Medical Expenditure Panel Survey) and address outstanding long-term care policy issues (e.g., allocation of resources between community and institutional settings).
PIC ID: 7555; EXPECTED COMPLETION: FY 2002; CONTACT: Hakan Aykan, 202-690-6443; PERFORMER: Urban Institute, Washington, DC

Case Studies and Technical Assistance for Medicaid Buy-Ins for People with Disabilities

In an effort to encourage more States to provide Medicaid to working individuals with disabilities, and to give States additional options for providing Medicaid to those individuals, Congress permitted States to expand their Medicaid programs (through a Medicaid “buy-in”) and allow people with disabilities to continue to receive Medicaid services even if they return to work and have earnings greater than 100% of the Federal Poverty Level. The goals of this project are to: (1) examine the early implementation experiences of States that have opted for a Medicaid buy-in for people with disabilities, and (2) offer technical assistance to States on developing cost models, design features of a buy-in, as well as implementation and administration considerations for a buy-in. The project represents a unique opportunity to compare the design and implementation experiences of different States, and use the information gathered to inform both State and federal policy makers about strategies for improving systems that support the employment of people with disabilities.
PIC ID: 7556; EXPECTED COMPLETION: FY 2002; CONTACT: Andreas Frank, 202-690-6443; PERFORMER: George Washington University, Washington, DC

Characteristics of Nursing Home Residents

Caring for persons with disabilities in the least restrictive setting is a major long-term policy objective. It is important to identify nursing home residents who could be discharged to the community if appropriate home and community-based services were available. This project will analyze data from the Minimum Data Set (MDS). The MDS consists of assessments which have been conducted on all nursing home residents in selected states as part of a CMS demonstration (and starting the summer of 1998, the data will be collected in all 50 States). Using this new data set will provide more information about the medical conditions, functional needs, and specific services used by nursing home residents than was possible with previous data sets. It will also be possible to study important subpopulations, especially the nonelderly.
PIC ID: 6275; EXPECTED COMPLETION: FY 2002; CONTACT: John Drabek, 202-690-6443; PERFORMER: Hebrew Rehabilitation Center for the Aged, Boston, MA

Design Options for Modeling Policy Impacts on Working Age Adults and Children with Disabilities

The Department currently has a limited ability to model the impacts of alternative health, long-term care and employment related policies on the program participation of younger individuals with disabilities and public and private costs, both in the short and long run. For example, none of the current models were capable of generating estimates about the cost and impact of the Kennedy-Jeffords proposal to extend Medicaid and Medicare coverage to SSI and/or SSDI disabled adults who return to work. The purpose of this project is to develop preliminary design options for constructing a microsimulation model of children, working age adults and their families. Such a model would age a sample of persons over time, keeping track of changes in their disability status, income, education, living arrangement, program participation, employment, health insurance status, health and long-term care service use, including personal assistance services/equipment.
PIC ID: 7764; EXPECTED COMPLETION: FY 2002; CONTACT: John Drabek, 202-690-6443; PERFORMER: Lewin Group Fairfax, VA and The Johns Hopkins University, Baltimore, MD

Developing Concise Measures of Child Disability

This project will support Network activities related to the development of a set of concise measures of childhood disability. The project will capitalize on recent conceptual and methodological developments in the demographic, social and biomedical study of disability. Specifically, the project will use data from the 1994 and 1995 disability supplements to the National Health Interview Survey (NHIS-D), the 1997 National Health Interview Survey (NHIS), and the 1992 and 1993 panels of the Survey of Income and Program Participation to develop concise measures of disabilities in children. The method of development will use two leading conceptual models of disability: that of the National Center for Medical Rehabilitation Research (NCMRR) and that of the World Health Organization (WHO). The intent of these concise measures is to provide reliable sets of indicators that are sensitive to subgroups of children to be used in population sample surveys and survey-based surveillance systems.
PIC ID: 7558; EXPECTED COMPLETION: FY 2002; CONTACT: John Drabek, 202-690-6443; PERFORMER: National Institute of Child Health and Human Development, Bethesda, MD

Disability Supplements to CMS Evaluation of Medicaid Managed Care in Tennessee

This project adds a disability component to an existing CMS evaluation of Medicaid 1115 waiver demonstrations in five states, with a focus on the Tennessee evaluation. The study will follow the experiences of SSI disabled children and adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) enrolled in the TennCare and TennPartners Programs. The project will conduct in-depth qualitative analyses of the State’s experience in enrolling individuals with disabilities into managed care systems, and will conduct quantitative analysis to examine cost and utilization data for these populations. The supplement will also include a survey of disabled consumers to examine issues of satisfaction, quality, health status, and functioning.
PIC ID: 6166.2; EXPECTED COMPLETION: FY 2002; CONTACT: Hunter McKay, 202-690-6443; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Evaluation of Practice in Care (EPIC)

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.
PIC ID: 5888; EXPECTED COMPLETION: FY 2002; CONTACT: Floyd Brown, 202-690-6443; PERFORMER: University of Colorado, Denver, CO

Long Term Care Microsimulation Model

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 ability to simulate a wide range of policy options. ASPE will use this computer model for projections and a series of policy simulations which 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.
PIC ID: 7143; EXPECTED COMPLETION: FY 2002; CONTACT: John Drabek, 202-690-6443; PERFORMER: The Lewin Group, Fairfax, VA

Longitudinal Study of Welfare Reform and Its Implications for Persons with Disabilities

This project will explore how welfare reform affects the well-being of persons with disabilities. Relevant questions to be addressed in this study include: How will welfare reform affect the well-being of adult TANF recipients with disabilities? What types of accommodations are being made to increase the work capacity of individuals with disabilities? Are persons with disabilities receiving appropriate job training that would enable them to move into the workforce? How will the well-being of children or adults with disabilities be affected if their primary caregiver has to work? How do families that contain persons with disabilities adapt to the new welfare environment? What types of changes in support systems occur to maintain the medical and other care needs of dependents with disabilities? What role do programs for persons with disabilities, such as early intervention programs and Supplemental Security Income (SSI), play following welfare reform?
PIC ID: 7362; EXPECTED COMPLETION: FY 2003; CONTACT: William Marton, 202-690-6443; PERFORMER: Johns Hopkins University, Baltimore, MD

Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

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.
PIC ID: 6391; EXPECTED COMPLETION: FY 2002; CONTACT: Jennie Harvell, 202-690-6443; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Medicare Post-Acute Care: Quality Measurement

This project will specify performance measures that can be used to determine the cost-effectiveness of post-acute care (PAC) services. The specific measures and data elements will apply to patient conditions that are prevalent within and across PAC settings. In addition, this project will identify the data collection methods that could be used with respect to these elements. Finally, this project will identify issues that need to be considered in applying these measures, including whether there is the need to engage in validity and reliability testing, and, if so, how.
PIC ID: 7363; EXPECTED COMPLETION: FY 2002; CONTACT: Jennie Harvell, 202-690-6443; PERFORMER: Urban Institute, Washington, DC

Monitoring the Health Outcomes for Disabled Medicare Beneficiaries

The Balanced Budget Act (BBA) of 1997 mandated major changes in home health payment requiring the implementation of a Prospective Payment System (PPS) by October 1999 (later delayed until October 2000) and an Interim Payment System (IPS) prior to the implementation of PPS. It also contained changes in eligibility and coverage for home health services. These changes, while intended to reduce Medicare home health costs, run the risk of reducing beneficiaries’ access to appropriate care and adversely affecting health outcomes, especially for beneficiaries needing the most care. Disabled Medicare beneficiaries are most vulnerable. The purpose of this project is to study the impact of recent payment policy changes on disabled Medicare beneficiaries’ satisfaction and quality of life with a view toward formulating inferences that will inform national home health care policy for the disabled. The study will build on a research project recently funded by the Home Care Research Initiative of The Robert Wood Johnson Foundation that examines the direct and indirect effects of the BBA changes. The main focus is to examine BBA impacts on Medicare beneficiaries’ access to care, costs, satisfaction, and quality of care.
PIC ID: 7364; EXPECTED COMPLETION: FY 2002; CONTACT: Pamela Doty, 202-690-6443; PERFORMER: Laguna Research Associates, San Francisco CA

National Resource Center on Home and Community-Based Services

The purpose of this project is to develop and test the effectiveness of a National Consortium and Resource Center (NCRC) to improve access to consumer responsive home and community-based long-term care for people with disabilities of all ages. The long range purpose of such a center would be to foster long-term care policies and practices. Barring a fundamental shift in public financing that few expect, the Medicaid program will continue to be the principal purchaser of public long-term care services well into the next century. Several factors offer new opportunities and pose new dilemmas for long-term care policy and program development in the 21st century. Clearly, consumers, policy makers, and providers are experiencing some tensions in their relationships as a result of several of the above factors. The Department of Health and Human Services, along with several other federal agencies is committed to facilitating the development of a common agenda among the stakeholders in long-term care policy and program development at all levels, one that supports consumer decision making and choice.
PIC ID: 7767; EXPECTED COMPLETION: FY 2002; CONTACT: Pamela Doty, 202-690-6443; PERFORMER: MEDSTAT Group, Cambridge, MA

Personal Assistance Services “Cash and Counseling” Demonstration/Evaluation

This study will employ a classical experimental research design (i.e. random assignment of participants to treatment and control groups) to test the effects of “cashing out” Medicaid-funded personal assistance services for the disabled. The demonstration sites are located in Arkansas, 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.
PIC ID: 6161; EXPECTED COMPLETION: FY 2004; CONTACT: Pamela Doty, 202-690-6443; PERFORMER: University of Maryland, Center on Aging, College Park MD

Preliminary Analysis of the 1988 MCBS Institutional Drug File

It is very important that ASPE be able to have a reliable source of drug utilization data for the elderly and disabled in long-term care facilities as well as in the community. The 1988 MCBS Cost and Use files are the most up-to-date, publicly available, person-level data available to address drug use and expense questions for community-dwelling Medicare beneficiaries. However, these files contain no drug use data for facility residents (despite the fact that MCBS surveyors have collected this information since 1997). The objective of this task is to create a research-ready file of 1998 drug use data for facility respondents and link it to the 1998 Cost and Use file data on facility residents. We have selected the 1998 facility drug file for this task order in order to facilitate linking with the latest available MCBS Cost and Use files. This linked file will serve as the primary data source to address policy questions of interest to ASPE.
PIC ID: 7768; EXPECTED COMPLETION: FY 2002; CONTACT: Andreas Frank, 202-690-6443; PERFORMER: University of Maryland, College Park, MD

Prescription Drug Coverage and the Medicare Disabled Population

This project proposes to complete a detailed descriptive study of prescription drug coverage among Medicare beneficiaries with a disability. Specifically, the contractor will focus on how disability in combination with income, race, gender and other factors may impact prescription drug coverage.
PIC ID: 7769; EXPECTED COMPLETION: FY 2002; CONTACT: Andreas Frank, 202-690-6443; PERFORMER: Pennsylvania State University, University Park, PA

Research on Employment Supports for People with Disabilities

Employment rates for people with disabilities have remained low despite advances in legislation (especially the Americans with Disabilities Act), the availability of technology which can assist with everyday activities and work-related functions, and an increase in positive societal attitudes toward the integration of people with disabilities into mainstream social institutions. Only about 25 percent of people with significant disabilities between the ages of 16 and 64 are employed. Most of the policy research on the employment of people with disabilities has relied on statistical data from national surveys. Detailed information on individuals’ experiences was needed to augment the survey data. This project will fill that need as it will: (1) gather descriptive data about public and private sector employment programs, (2) examine successful employment supports, and (3) investigate the factors that affect the ability of people with significant disabilities to work. Focus groups, examining the supports important to people with disabilities who are competitively employed, will be conducted in three cities. Policy papers, summarizing the results of the focus groups, will be completed by March 2001. The topics of the policy papers will include: transitions to employment, supports for employment, role of health insurance, role of employers, and supports used by individuals with mental disabilities.
PIC ID: 4917.2; EXPECTED COMPLETION: FY 2002; CONTACT: Andreas Frank, 202-690-6443; PERFORMER: The Lewin Group, Fairfax, VA

Study of Fair Hearing Adaptations

The purpose of this task order is to conduct a qualitative study that describes in detail selected aspects of four adaptations to the Medicaid Fair Hearing process for beneficiaries enrolled in managed care. The adaptations include evidentiary hearings, ombudsman programs, external review organizations and expedited review of appeals. Descriptive information will be gathered through case studies on the mechanics of each adaptation and the perceptions of state Medicaid staff, managed care organization administrators and advocacy organizations regarding issues related to their use by Medicaid beneficiaries. A policy meeting will be held to discuss the project’s findings and the potential for using the findings to improve the Medicaid Fair Hearing process.
PIC ID: 7559; EXPECTED COMPLETION: FY 2002; CONTACT: Hunter McKay, 202-690-6443; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Synthesis of Research on Disability and Managed Care

Since the mid-1990s, a number of research institutions initiated projects to assess how well disabled persons are cared for in managed care settings. The research focused on many different aspects of managed care and disability, and used a wide variety of research designs. The purpose of this delivery order contract is to: (1) synthesize recent research on the performance of managed care plans in caring for persons with disabilities, (2) summarize research on current trends in enrollment of disabled persons into Medicaid managed care programs, and, (3) recommend areas for future research.
PIC ID: 7560; EXPECTED COMPLETION: FY 2002; CONTACT: Hunter McKay, 202-690-6443; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

The Contribution of Changes in Medication Use to Improvements in Functioning Among Older Adults

Drug treatment has become an increasingly important aspect of medical care for older Americans with approximately nine out of ten older Americans currently taking one or more prescription drugs daily. During the 1980s and early 1990s there have been major shifts in the classes of drugs prescribed for some of the more debilitating chronic conditions. For example, for arthritis, increased availability of disease modifying anti-rheumatic drugs, non-steroidal anti-inflammatory drugs, and, for women, estrogen replacement therapy may be associated with fewer debilitating effects. New classes of psychotropic agents have become available to treat depression and other psychiatric conditions, which have been identified as a major cause of premature disability among the elderly. Drug treatments for diabetes and hypertension have also expanded significantly during this period. This project supplements an existing National Institute on Aging grant to Vicki Freedman of the Philadelphia Geriatric Center. Under the grant Dr. Freedman is examining the role of changes in the use of medications in explaining aggregate changes in functioning in the U.S. population aged 51-61. The data sets for the analyses are the first (1992) and fourth (1998) waves of the Health and Retirement Survey (HRS), which provide nationally representative cross-sections of the noninstitutionalized population in this age range.
PIC ID: 7770; EXPECTED COMPLETION: FY 2002; CONTACT: William Marton, 202-690-6443; PERFORMER: Philadelphia Geriatric Center, Philadelphia, PA

Congressionally Mandated Evaluation of the State Children’s Health Insurance Program

ASPE is conducting a three-year, Congressionally mandated evaluation of the State Children’s Health Insurance Program (SCHIP). The evaluation will provide an opportunity to learn how effective the variety of state programs created under Title XXI have been in reducing the number of uninsured, and also help Congress, DHHS, and the States to take stock of the program’s first few years and provide information to guide future policies for children’s health insurance. Key topics to be examined through this evaluation include SCHIP’s impact on uninsurance rates; reasons why states designed their SCHIP programs as they did; enrollment and disenrollment trends; reasons for disenrollment and non-participation; barriers to enrollment; the impact of cost-sharing on enrollment, retention, and utilization of services; effectiveness of outreach approaches; SCHIP’s impact on access to care and enrollee satisfaction; and the relationships between SCHIP, Medicaid, and private coverage. The overall evaluation design includes both quantitative and qualitative research components, focusing on the experience of 10 States that represent a wide range of program designs and geographic regions.
PIC ID: 7730; EXPECTED COMPLETION: FY 2003; CONTACT: Stephen Finan, 202-690-7387; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Development and Validation of a Performance Measure Set for the Evaluation of Medicaid Services Rendered to People with Developmental Disabilities

Many public policies seek to influence the decisions employers make about whether and how to offer health benefits to their employees. The process of how employers make such decisions, however, is largely unknown. The Office of the Assistant Secretary for Planning and Evaluation convened two panels of senior corporate managers to discuss how firms make decisions about health benefits. The purpose was to help the office formulate a more comprehensive view of employer decision-making by posing common questions to a cross-section of knowledgeable people, and to identify issues that may be empirically measured. The long-term goal is to be able to better determine how public policies affect or influence the decisions made by employers and unions regarding health coverage. The first meeting focused on the “strategic” trends and issues affecting employer health coverage, addressing such questions as, “What is the role of the employer in shaping health care markets?” The second meeting focused on the internal and operational issues of how employers make health benefit decisions, addressing such questions as: “At what level of the corporate structure are health benefit decisions made?”
PIC ID: 7391; EXPECTED COMPLETION: FY 2002; CONTACT: Elizabeth Couchoud, 410-786-6722; PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Evaluating the Effects of Direct-to-Consumer Advertising on Consumers

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.
PIC ID: 6343; EXPECTED COMPLETION: FY 2002; CONTACT: Susannah Bruns, 202-690-7996; PERFORMER: Market Facts, Inc., McLean VA

Impact of Medicare HMO Enrollment on Health Care Costs in California

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.
PIC ID: 6889; EXPECTED COMPLETION: FY 2002; CONTACT: George Greenberg, 202-690-7794; PERFORMER: Rand Corporation, Santa Monica, CA

Innovative Coverage of Health Promotion, Clinical Preventive Services, and Other Coverage Issues in the Private Sector

Despite the important role 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.
PIC ID: 6347; EXPECTED COMPLETION: FY 2002; CONTACT: Caroline Taplin, 202-690-7906; PERFORMER: Partnership For Prevention, Washington, DC

Medicare Supplement Insurance: Structure, Change & Implications

The purpose of this research project is to determine whether or how the Medicare Supplement Insurance market has changed. Better information about how this market behaves and how it is changing over time can help the Department develop policies that will ensure stable health care financing for the elderly. This project is proposed to develop three research papers: (1) an examination of variation of the Med-supp market among states; (2) the effect of HMO penetration on Med-supp markets; and (3) the demand for prescription drug benefits in the Med-supp market. Collectively, these papers should provide a much better understanding of how this market has been operating, and thereby provide a better understanding of how new Medicare policies might affect it.
PIC ID: 7348; EXPECTED COMPLETION: FY 2002; CONTACT: Stephen Finan, 202-690-7387; PERFORMER: Alpha Center, Bethesda, MD

Safety Net Framework Project

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.
PIC ID: 7156; EXPECTED COMPLETION: FY 2002; CONTACT: Caroline Taplin, 202-690-7906; PERFORMER: Northwestern University, Evanston IL

Safety Net Project: Exploring State Use of Medicaid Disproportionate Share Funds to Enhance Provision of Care to Uninsured

This project will study the cases in which States redirected or changed their use of Medicaid Disproportionate Share Funds (DSF) funding streams to strengthen safety net infrastructure in communities within their States; used DSF to increase the services available to uninsured populations; or provided insurance to previously uninsured individuals through DSF.
PIC ID: 7352; EXPECTED COMPLETION: FY 2002; CONTACT: George Greenberg, 202-690-7794; PERFORMER: Urban Institute, Washington, DC

State Activity Monitoring Medicaid Managed Care for Children with Special Health Care Needs

The purpose of this project is to investigate how States are monitoring and evaluating the experience of children with special health care needs enrolled in Medicaid Managed care. Research findings will be used to refine the standards CMS requires States to meet in order to enroll children with special health care needs into capitated Medicaid managed care plans, and to assess States’ ability to meet these standards. Policy makers are interested in addressing the issue of whether Medicaid plans and providers are meeting the complex needs of Supplemental Security Income (SSI) children, for example, but the lack of concrete data or information related to the experience of this population in Medicaid managed care hamper their efforts. In response, CMS has developed interim review criteria that will be applied to all upcoming 1915(b) waiver applications and renewals from States. The criteria establishes requirements regarding definition, identification, tracking, and access to care for children with special health care needs enrolled in capitated managed care arrangements. This study will help CMS and the States move forward with this important effort by providing critical information about current State activity and insights as to how these criteria can be refined, improved, and be put into operation.
PIC ID: 7350; EXPECTED COMPLETION: FY 2002; CONTACT: Jennifer Tolbert, 202-205-8678; PERFORMER: George Washington University Medical Center, Washington, DC

State Implementation of Immunization Recommendations and Guidance

This project in Phase 1 will conduct case studies in up to five States to learn how States (in public health, Medicaid and Medicare) are working on the immunization goals using the guidance and technical assistance provided by the federal government. This phase will highlight the status quo and understand the extent to which States are planning to incorporate CMS’s guidance into their activities. Phase 2 (FY 2000) the project will be in up to three of the States and will work with these States to take this activity to the next level, such as identifying and implementing appropriate outcome measures for immunization (e.g., vaccine-preventable disease rates). Both CDC/National Immunization Program and CMS would be involved in the project.
PIC ID: 7342; EXPECTED COMPLETION: FY 2003; CONTACT: Amy Nevel, 202-690-7795; PERFORMER: Research Triangle Institute, Research Triangle Park, NC

The Changing Structure of Health Insurance Markets

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.
PIC ID: 7160; EXPECTED COMPLETION: FY 2002; CONTACT: Stephen Finan, 202-690-7387; PERFORMER: Alpha Center, Washington, DC

Understanding Health Plan Accreditation and Its Potential to Promote the Consumer Bill of Rights and Responsibilities

The purpose of this project is (1) to provide policy and regulatory staff in the US Department of Health and Human Services (HHS) with an in-depth understanding of the aspects of the health plan accreditation process most closely related to the Consumer Bill of Rights and Responsibilities (CBRR); and (2) to determine the extent to which health plan accreditation fosters implementation of the CBRR. The study’s results will provide useful feedback to the individuals and entities involved in developing the CBRR--by illustrating difficulties that accrediting organizations and health plans may face in operationalizing CBRR provisions.
PIC ID: 7346; EXPECTED COMPLETION: FY 2002; CONTACT: Ellen Bayer, 202-690-7804; PERFORMER: Mathematica Policy Research, Inc., Washington, DC

A Research Synthesis of the Findings from ASPE’s “Leavers” Grants

This study will critically analyze and synthesize the findings of ASPE’s grants that have studied welfare outcomes for individuals and families who have left cash assistance under the Temporary Assistance for Needy Families (TANF) program. The project will result in an Initial Synthesis Report and a Final Report. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) awarded grants to states and counties to study the outcomes of welfare reform on individuals and families who leave TANF, individuals and families entering the caseload, and TANF applicants and potential TANF applicants. All of the grantees are using a combination of linked administrative data and surveys to study the outcomes of the TANF “leavers.” The grantees include: Arizona, Cuyahoga County, District of Columbia, Florida, Georgia, Illinois, Los Angeles, Massachusetts, Missouri, New York, San Mateo County, Washington, and Wisconsin.
PIC ID: 7368; EXPECTED COMPLETION: FY 2002; CONTACT: Matthew Lyon, 202-401-3953; PERFORMER: Urban Institute, Washington, DC

Case Studies on Privatization of TANF Service Delivery and Performance-Based Contracting

The purpose of this project is to conduct case studies on the privatization of delivery of services funded under the Temporary Assistance to Needy Families (TANF) block grant in States and localities, including the implementation of performance-based contracts. The study will focus on those services that are the responsibility of and have historically been performed by the State or local human services agency, such as client intake and assessment, eligibility determination, and case monitoring. A final report, expected in December 2002, will synthesize the information gathered both during the case studies and from a literature review on the topic of privatization of social service delivery. The report will use the information gathered in the site visits to identify some of the challenges involved in privatization. It also will identify emerging positive trends and problem areas, in both the services delivered and the types of contracts that have been enacted. Ideally, this report will be instructive both to federal policymakers and to State and local human services agencies that are considering privatizing significant parts of their TANF programs.
PIC ID: 7755; EXPECTED COMPLETION: FY 2003; CONTACT: Matthew Lyon, 202-401-3953; PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ

Devolution and Urban Change

This study presents a unique opportunity to learn about the implementation and impacts of welfare reform in four large urban areas--Cleveland, Philadelphia, Los Angeles, and Miami. From this study, we expect to learn about the challenges of welfare reform in a context of high levels of unemployment and concentrated poverty. The Urban Change project brings together data from a wide array of sources: longitudinal administrative data for all families receiving AFDC/TANF or Food Stamps dating back to 1992, survey data, an implementation study, neighborhood indicators, an institutional study focusing on local service providers, and an ethnographic study of a limited number of families. The contractor hopes to be able to assess the effects of welfare reform on recipient experiences based on the administrative data using a multiple cohort comparison design. The study seeks to answer a broad array of questions, including: How do welfare recipients and other low-income residents fare in the new welfare environment in terms of both economic and non-economic indicators of well-being? What policies do State and local officials formulate, and how are these carried out by line staff in the welfare offices? How do the social and economic conditions of neighborhoods change over the time period before, during, and after implementation of welfare reform?
PIC ID: 7754; EXPECTED COMPLETION: FY 2002; CONTACT: Elizabeth Lower-Basch, 202-690-6808; PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Domestic Violence and Welfare: An Early Assessment

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.
PIC ID: 6724; EXPECTED COMPLETION: FY 2002; CONTACT: Gerald Silverman, 202-690-5654; PERFORMER: Urban Institute, Washington, DC

Economic and Health Status of Immigrants, Their Communities, and the Organizations that Serve Them

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 citizen 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 also be a focus of the study. The project will supplement an examination of existing secondary data with intensive 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 1,650 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.
PIC ID: 6747; EXPECTED COMPLETION: FY 2002; CONTACT: David Nielsen, 202-401-6642; PERFORMER: Urban Institute, Washington, DC

Follow-up Work on the Minnesota Family Investment Program Evaluation

Recently released findings based upon a small sample from the Manpower Demonstration Research Corporation’s evaluation of the Minnesota Family Investment Program suggest that the program had significant positive impacts on the marital stability of two-parent families. This project will support MDRC’s follow-up study of all two-parent recipient families in the sample to determine if the robustness of their findings can be replicated for the larger group. This work is a necessary first step before a decision is made about conducting a longer-term follow-up analysis of well-being outcomes for these families. If the original findings hold up for the larger sample, work will begin on developing instruments for the measurement of longer-term well-being outcomes under MFIP. If the marital stability finding is not replicated, the balance of the project will focus on analyzing data already collected under the original MFIP evaluation to determine links between domestic violence and family formation and work patterns.
PIC ID: 7760; EXPECTED COMPLETION: FY 2003; CONTACT: Alana Landey, 202-401-6636; PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Medical Child Support Cross-Program Coordination Descriptive Study

In the area of medical child support, States have identified coordination with SCHIP and private insurers as the number one issue for which they need federal assistance. Also, the HHS/DoL Medical Child Support Working Group recommended that further research be conducted on State’s efforts to coordinate health care coverage availability between child support, Medicaid, and SCHIP (Recommendation 70). This project will describe and analyze State efforts to coordinate between these three programs in order to secure appropriate health care coverage for eligible children; the effects of federal policy on this cross-program coordination; and barriers to these efforts. The project has two components. The first involves convening a panel of experts to discuss why State agencies collaborate; what the barriers to collaboration are perceived to be, and the effects of federal policy on the decision to coordinate. Second, a series of case studies of several sites where coordination between child support, Medicaid, and SCHIP is underway will document the nature of the coordination, identify innovative practices and barriers; and describe the effects of federal policies.
PIC ID: 7236; EXPECTED COMPLETION: FY 2003; CONTACT: Jennifer Tolbert, 202-205-8678; PERFORMER: Urban Institute, Washington, DC

National Evaluation of Welfare-to-Work Strategies (NEWWS)

The National Evaluation of Welfare-to-Work Strategies (NEWWS) evaluation is a study of the effectiveness of eleven mandatory welfare-to-work programs in seven locales: Atlanta, Georgia; Columbus, Ohio; Detroit and Grand Rapids, Michigan; Oklahoma City, Oklahoma; Portland, Oregon; and Riverside, California. Program impacts were evaluated by comparing outcomes for a randomly assigned experimental group subject to program requirements with outcomes for control groups. As part of the NEWWS, the effects of two approaches to preparing welfare recipients for employment were compared in three sites (Atlanta, Grand Rapids, and Riverside). In one approach, the human capital development approach, individuals were directed to avail themselves of education services and, to a lesser extent, occupational training before they sought work, under the theory that they would then be able to get better jobs and keep them longer. In the other approach, the labor force attachment approach, individuals were encouraged to gain quick entry into the labor market, even at low wages, under the theory that their work habits and skills would improve on the job and they would thereby be able to advance themselves. Sample members are being followed for five years from the time they entered the study.
PIC ID: 7089; EXPECTED COMPLETION: FY 2002; CONTACT: Audrey Mirsky-Ashby, 202-401-6640; PERFORMER: Manpower Demonstration Research Corporation, New York, NY

State Experience and Perspectives on Reducing Out-of-Wedlock Births

This project examines State efforts to reduce out-of-wedlock childbearing since the passage of PWRORA in 1996, and the issues States have encountered. The study will pay particular attention to the role that the Bonus to Reward Decrease in Illegitimacy ratio played in motivating or funding those efforts. The project will first gather and synthesize the results from several existing surveys of specific state efforts related to reducing nonmarital childbearing. Then the project will convene three panels representing a diverse sample of States. The panels will include both States that have and have not received the bonus, as well as those with greater and lesser publicized efforts to receive the bonus. The discussion will focus first on State experiences regarding their efforts to reduce nonmarital childbearing--what efforts they have undertaken and what issues have they faced. The discussion will then focus specifically on the extent to which the bonus played a role in their efforts (either their attempts to qualify for the bonus, or their actual receipt of the bonus).
PIC ID: 7757; EXPECTED COMPLETION: FY 2002; CONTACT: Kelleen Kaye, 202-401-6634; PERFORMER: Lewin Group Fairfax, VA and The Johns Hopkins University, Baltimore, MD

The National Evaluation of the Welfare to Work Grants Program

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 long-range project is evaluating the effectiveness of the DOL-sponsored Welfare-to-Work initiatives, including those undertaken by the Welfare-to-Work grantees and by Native American tribal organizations. HHS has worked with the Departments of Labor and Housing and Urban Development to design 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 outcomes of the various program approaches on employment and other measures of family well-being? and (3) What challenges are confronted as grantees implement and operate the programs?
PIC ID: 7147; EXPECTED COMPLETION: FY 2004; CONTACT: Alana Landey, 202-401-6636; PERFORMER: Mathematica Policy Research, Inc., Washington, DC

Welfare Outcomes Panel Study

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) examining the appropriate data sources, research designs and statistical methods for analyzing welfare reform outcomes; and (3) identifying 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 (see PIC # 7145.1) included early recommendations of the panel and the final report will document the comprehensive list of final recommendations to the department. The panel is also releasing an accompanying compilation of papers written for the panel study, entitled: “Studies of Welfare Populations: Data Collection and Research Issues.”
PIC ID: 7145; EXPECTED COMPLETION: FY 2002; CONTACT: Susan Hauan, 202-690-8698; PERFORMER: National Academy of Sciences, Washington, DC

State Telephone Survey Estimates for Evaluation and Monitoring

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.
PIC ID: 6420; EXPECTED COMPLETION: FY 2002; CONTACT: James Scanlon, 202-690-7100; PERFORMER: National Center for Health Statistics, Hyattsville MD

The Importance of Place

There is a growing body of research documenting the synergistic effect that the configuration of community resources, community values, population demographic, geography, and other factors have on health and human service outcomes. The Office of the Assistant Secretary for Planning and Evaluation is funding the National Academy of Sciences (NAS) to commission a series of papers to synthesize the available research on the relationship between these place-based factors and outcomes in the areas of health, child and youth development, and welfare reform. The papers will identify available data to assess these interactions and make recommendations for a future research agenda. NAS also will convene a workshop of researchers and policy makers from federal, state and local government, academic institutions and private organizations to reflect on the papers and develop and refine an integrated research agenda. The commissioned papers as well as a workshop summary which will include the research agenda will be available for dissemination.
PIC ID: 7552; EXPECTED COMPLETION: FY 2002; CONTACT: Barbara Greenberg, 202-401-8279; PERFORMER: National Academy of Sciences, Washington, DC