Office of the Assistant Secretary for Planning and Evaluation
	Policy Information Center

OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION

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.

Another continuing evaluation objective of ASPE is to support and promote the development and improvement of data bases that HHS agencies and ASPE use to evaluate health care programs and health trends. For example, ASPE has been the major initiator in collaboration with the National Center for Health Statistics at the Centers for Disease Control and Prevention of the first comprehensive survey of people with disabilities in the United States. The first component of these new data was completed in FY 1996, and national prevalence data on disability are now available. The ASPE co-chairs and provides support to the HHS Data Council, which is charged with integrating key national surveys, such as linking health status indicators with indicators of well-being. The Department needs more comprehensive data sources to assess anticipated transformations in health and human services.

Finally, ASPE uses evaluation funds to promote effective use of evaluation-generated information in program management and policymaking. The latter is accomplished through the dissemination of evaluation findings and other activities, such as providing technical assistance to agencies in the development of performance measures.

Summary of Fiscal Year 1998 Evaluations

Disability, Aging, and Long-Term Care Policy

TITLE: Children with Severe Chronic Conditions on Medicaid

ABSTRACT: Many children with special health care needs depend on the health and supportive services provided by Medicaid. It is important that policymakers have a sound understanding of these children's patterns of health care use, especially given the shift to managed care. Previous studies of children on Medicaid with severe disability and/or chronic illness have focused on "SSI-related" children, or children with extremely high health care costs. This study provides further analysis of Medicaid expenditures for SSI children, and adds to the literature by applying diagnostic and utilization-based criteria to claims data to identify children with severe chronic illness. This methodology enables analysis of the service use patterns and expenditures for children with severe chronic conditions who are receiving Medicaid, but are not enrolled in SSI. Three data sources were used in the analysis: (1) Medicaid administrative records extracted from the Health Care Financing Administration's (HCFA's) database provided data on Medicaid service utilization and expenditures. (2) The 1992 MarketScan database, a proprietary database of integrated claims and population data of individuals enrolled in private insurance plans, was used to compare the prevalence of children with chronic conditions and private health insurance coverage, to the prevalence of children with chronic conditions enrolled in Medicaid. (3) For SSI children, data on the principal disabling condition (as identified by the disability determination process) were obtained from Social Security Administration records. Results of the study indicate that there are many more children with severe chronic conditions receiving Medicaid coverage than simply those who become eligible for Medicaid through the SSI program.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 5758

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA
 

TITLE: Consumer-Directed Personal Assistance Services: Key Operational Issues for State CD-PAS Programs Using Intermediary Service Organizations

ABSTRACT: This study was initiated by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to identify best practices for implementing consumer-directed personal assistance (CD-PAS) programs through the use of various intermediary service organization (ISO) models. Twenty-three State and Medicaid-funded CD-PAS programs that used ISOs in eleven States were examined. The term personal assistance services (PAS) refers to a range of human and mechanical assistance provided to persons with disabilities of any age who require help with routine activities of daily living. Consumer-directed modes of financing and delivering PAS permit the consumer (as opposed to medical or social work professionals) comparatively greater choice and control over all aspects of service provision including: (1) recruiting, hiring, and training attendants; (2) defining attendants' duties and work schedules; (3) supervising attendants regarding how specific tasks are to be performed; (4) managing the payroll functions, including paying attendants; and (5) disciplining and discharging attendants. When a third party payor is involved in financing PAS (e.g., private insurance or publicly-funded programs such as Medicaid), certain limitations may be placed on the consumer's ability to exercise choice and control over his or her PAS. Because of these issues, States have begun to develop a variety of intermediary service organization (ISO) models to facilitate the use of CD-PAS programs by persons with disabilities and chronic conditions, and to assist government policymakers in achieving an appropriate balance among competing goals. ISO models seek to provide appropriate PAS that affords consumers choice and control, while assuring program and fiscal accountability, regulatory, compliance, protection from liability, service quality and consumer health and safety. This report examines several ISO models.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6164

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

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

ABSTRACT: This project evaluates the District of Columbia's managed care demonstration program for disabled and special needs children. The demonstration program relies on a Medicaid-financed managed care system for children in the District's Supplemental Security Income (SSI) program, and is offered to eligible children as an alternative to the traditional Medicaid fee-for-service system. Enhanced Medicaid benefits through the demonstration program include individual treatment plans, respite care, van transportation and taxi vouchers, care management services and limited-use phones. The Medicaid payment system includes risk sharing based on 85 percent risk corridors (as defined by medical loss ratios) between the District's Medicaid office and the non-profit health plan operating the demonstration, a capitated payment system for the health plan, and negotiated fee schedules for providers. This evaluation considers access and cost issues, placing considerable emphasis on issues related to quality of care and satisfaction. The research design centers on three main activities: (1) analyses of the implementation of the demonstration; (2) analyses of enrollment which will describe which children enroll and disenroll in this type of system; and (3) outcomes analyses that document the experiences of the District, plan, providers, children and families. The study of the implementation of the demonstration is based on interviews, a series of site visits to the District's Medicaid office and HSCSN, and review of the documentary record. This project was co-funded by the Health Care Financing Administration (HCFA).

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7015

PERFORMER ORGANIZATION: Abt Associates, Inc., Cambridge, MA and Urban Institute Washington D.C.
 

TITLE: Exploratory Study of Health Care Coverage and Employment of People with Disabilities

ABSTRACT: Most policymakers agree that the current structure of the Social Security Administration's disability programs creates substantial work disincentives for people with disabilities. One set of policy options concerns changing the links both between Medicare and the Social Security Disability Insurance (DI) program, and between Medicaid and the Supplemental Security Income (SSI) program. More generally, reforms that expand access to health insurance for people with disabilities who are not DI or SSI recipients could have an impact on both employment and program participation. The purpose of this study is to examine empirical evidence on the relationships among health insurance, employment and program participation of people with disabilities. Specifically, it presents the findings of an analysis of expansions in the income threshold for the SSI work incentive program established by Section 1619 of the Social Security Act. These expansions have allowed many working SSI recipients to maintain Medicaid eligibility even after their incomes rise above the level that makes them ineligible for SSI payments. This report also presents findings from an analysis of the employment, insurance and program participation status of people with disabilities using the 1993 Survey of Income and Program Participation (SIPP) and the 1994 National Health Interview Survey (NHIS). This analysis focuses on groups of people with disabilities who would most likely be affected by expansions in public health insurance.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Kathleen Bond

PHONE NUMBER: 202-690-6443

PIC ID: 6240

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
 

TITLE: International Evidence on Disability Trends Among the Elderly

ABSTRACT: Recent studies indicate that disability rates among the elderly may be declining. The data for these findings come from the National Long-Term Care Survey. Currently, over forty programs assist persons with disabilities. Information on trends in elderly disability rates could help in estimating the size of the population eligible for these programs, as well as their projected costs. This project attempts to: (1) assemble the evidence regarding trends in disability rates among the elderly; (2) critique the evidence from a scientific perspective; (3) carry out additional analyses and expand the evidence on trends, especially on differences of age, gender, and other subgroup status; and (4) assess the implications for disability policy and expenditure trends.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: William Marton

PHONE NUMBER: 202-690-6443

PIC ID: 6719

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.
 

TITLE: Meeting The Challenge of Serving People With Disabilities: A Resource Guide for Assessing the Performance of Managed Care Organizations

ABSTRACT: This Resource Guide is designed to support efforts to measure and improve Medicaid Managed Care Organization (MCO) performance for people with disabilities. The purpose of the guide is threefold: (1) To provide an overview of the issues to be considered in measuring the performance of MCOs; (2) To bring together in one volume, key information about measures that now exist, or are about to be made available, that can be counted on to support efforts to measure and improve the care provided by MCOs to people with disabilities; and (3) To make clearer the areas where technically strong measures do not exist, in order to encourage further measurement development in these areas. Additionally, the guide presents the results of an extensive search for existing performance measures that can be used for quality measurement and improvement by: (1) State Medicaid agencies; (2) managed care organizations; (3) providers within MCOs; and (4) people who advocate for the health care needs of the disabled.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7060

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

TITLE: Report on In-Depth Interviews with Developers

ABSTRACT: This report is intended to supplement ongoing research being conducted as part of The National Study of Assisted Living. In this supplementary study, detailed interviews were conducted with 29 individuals from 21 States who are involved in various aspects of the development of assisted living facilities (e.g., architects, builders, developers and consultants to the development industry). The report provides preliminary information concerning barriers to the development of assisted living and future trends in the industry, as well as the potential for assisted living to serve a larger lower income and Medicaid-eligible population. The study focuses on the following issues: (1) trends in the supply and demand for assisted living; (2) barriers to the development of assisted living; (3) scope and status of the regulatory and quality assurance systems for assisted living; (4) ways in which the current assisted living industry embodies the principles of consumer choice and autonomy, and the extent to which the industry matches the conceptual model of assisted living; and (5) the effects of different models of assisted living on consumer and worker satisfaction, resident length of stay, affordability, and its potential substitutability for nursing home care. The findings of the report are designed to provide a context for the larger study and provide information about emerging trends.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 4719.5

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC
 

TITLE: State Assisted Living Policy: 1998

ABSTRACT: This study reviewed the assisted living and board-and-care policies in each of the 50 States. States reported a total of 28,131 licensed facilities with 612,063 units or beds. Over 25 percent of the beds are located in three States: California (123,238); Florida (66,293); and Pennsylvania (62,241). Twenty-two States have existing licensing regulations using the term assisted living, up from 15 in the previous study. Wisconsin has re-named their assisted living regulations as residential-care apartment complexes. Draft regulations using the term assisted living have been developed by an additional nine States, including Maryland, which is significantly expanding the scope of an earlier program, previously termed, "assisted living". Four States are revising existing assisted living regulations. West Virginia is developing rules for a new category and New Hampshire revised rules which took effect in 1998. Thirty-five States reimburse, or plan to reimburse, services in assisted living or board-and-care facilities as a Medicaid service. Eleven States had created a task force or a process within a State agency to make recommendations for developing assisted living rules. While a common or standard definition of assisted living is still unlikely, State approaches share some common components. This new model for long-term care is developing as a residential, rather than institutional, model. The major issues addressed by State policies concern requirements for the living unit, for tenant admission/retention, level of services allowed, and for administrator and staff training. This report describes the primary approaches States are taking to license assisted living, discusses Medicaid reimbursement and other selected areas, and summarizes each State's licensing rules.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 4719.6

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC
 

TITLE: The Role of Home and Community-Based Services in Meeting the Health Care Needs of People with AIDS: Final Report

ABSTRACT: Home- and community-based services, such as assistance with daily living activities and the provision of home-delivered meals, have long been an integral part of AIDS care. However, improved health and functioning have broadened the scope of these services. Changes in AIDS treatment and in the characteristics of the AIDS population have had profound and interrelated effects on the use of home- and community-based services by people with AIDS and increased life expectancy has increased the duration of needed services. Improved treatment has also improved health and decreased levels of functional impairment for many people, which in turn appears to have led to a decrease in the use of traditional home- and community-based services (such as home-delivered meals and personal care). At the same time, this treatment has led to a greater need for other types of support, such as assistance with treatment adherence and return to work. Meanwhile, the increased incidence of AIDS among people with low incomes, people with substance abuse problems, and women with families has led to an increased need for home- and community-based service providers to interact more often with substance abuse treatment, mental health, family services and public assistance systems. The goal of this project was to assist in the development of a research agenda for studying home- and community-based service use among people with AIDS. The project had three components: (1) a review of the literature describing the delivery and financing of home- and community-based services for people with AIDS, (2) case studies of service provision in New York City and Los Angeles, and (3) an analysis of use and reimbursement patterns for New Jersey Medicaid beneficiaries with AIDS.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 6418

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

Health Policy

TITLE: A Framework for Research and Evaluation Into the Effects of Managed Care on the Pharmaceutical Marketplace

ABSTRACT: The growing influence of managed care has had a profound effect on the pharmaceutical marketplace, and has highlighted a number of long-standing concerns among those involved in providing pharmaceutical services, including the industry, purchasers, providers, third-party payers and the government. The goal of this project, therefore, was to improve the quality and accessibility of information used to make decisions in the public and private sectors about how to deal with the revolutionary changes in the pharmaceutical marketplace and the impact of managed care on pharmaceutical services. The project also developed information on how managed care has affected consumer access to pharmaceutical services. The principal product of the project describes a framework for research and evaluation that serves the information needs of all the stakeholders, public and private, providing a common basis for discussion and decision making. The principal report is supported by a series of study papers that synthesize the best current research on the evolution of key elements of the health care delivery system. These study papers do not focus on solutions to problems or recommendations for change. Instead, their purpose is to analyze and synthesize the existing research into a comprehensive, balanced portrait of the system.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 6049

PERFORMER ORGANIZATION: The George Washington University and Urban Institute, Washington, D.C.
 

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

ABSTRACT: This study examines issues surrounding tribal experiences with private liability insurance and the Federal Tort Claims Act (FTCA). The primary purposes of the study are to: (1) examine access to private liability insurance by tribes and tribal organizations operating programs under the Indian Self-Determination and Education Assistance Act (ISDEAA), and the coordination of that insurance with the immunity from tort liability for self-determination contractors and compactors and their employees provided under the FTCA; (2) identify barriers to the appropriate pricing of private liability insurance; and (3) recommend strategies that will assist tribes, tribal organizations, and other contractors and self-governance compactors to reduce the need for private liability insurance, as well as its cost. The grant of immunity from tort claims provided under the FTCA for P.L. 93-638 activities should have resulted in tribes and tribal organizations paying less for private insurance. However, a lack of awareness of the applicability of the FTCA and/or full understanding of its scope appear to have prevented some tribes from doing so. One of the most important steps that tribes can take to lower their private liability costs is to become better informed about the fundamentals of the FTCA and the types of commercial insurance they need to supplement the immunity from tort claims that the FTCA provides. The Federal government can assist tribes and tribal organizations by providing more accessible information about the FTCA in a form that is simple and useful to laypersons. Tribes and tribal organizations can help each other by sharing information about their experiences in obtaining appropriate and reasonably priced insurance.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Tom Hertz

PHONE NUMBER: 202-690-7779

PIC ID: 6345

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

TITLE: Children's Health Insurance Expansions: State Experience in Developing Benefit Packages and Cost-Sharing Arrangements

ABSTRACT: This project reviews the experiences of nine States that either utilized Medicaid expansions or developed stand alone programs to expand health insurance for children prior to the enactment of Title XXI. The enactment of the State Children's Health Insurance Program (CHIP), under Title XXI of the Social Security Act, is providing $24 billion in funding to States over a five-year period to expand health insurance coverage to uninsured children. Under CHIP, States have the option of expanding their existing Medicaid programs, developing stand alone programs or some combination of the two. As States select their approaches, design of the benefit package, including cost-sharing features, is one of the critical considerations States are facing. While the legislation defines standards for benefit packages and limits the extent to which States can impose premiums or cost-sharing (i.e., deductibles and copayments), the States maintain a fair amount of flexibility in program design. The nine States interviewed for this study are divided into two broad categories: Medicaid expansion programs and stand alone insurance programs. Generally, the survey revealed that States debated over whether to provide a more limited insurance product for more children, or include inpatient benefits and therefore serve fewer children. In terms of cost sharing, results of the survey indicated that program directors believed that by instituting moderately priced premiums and copayments, families were more willing to enroll, and did not view the program as a form of welfare. Several States identified the affordability of employer-sponsored insurance as an important consideration in the implementation of mechanisms to limit crowd out. Related to issues of price sensitivity is the decision of whether to implement a flat fee premium for all participants, or one that is based on a sliding scale.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: 202-690-7794

PIC ID: 6729.1

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
 

TITLE: Children's Health Insurance Patterns: A Review of the Literature

ABSTRACT: Policymakers are currently considering a number of proposals aimed at reducing the number of children without health insurance. This report attempts to address the lack of information about the uninsured child population. This literature review focuses on (1) uninsured children: how many there are, their characteristics, how long are they uninsured, and why are they uninsured; and (2) Medicaid eligibility, enrollment, participation rates, program dynamic, and measurement issues. The review found that: (1) the uninsured are found in every age group of children, even among the very young supposedly covered by past expansion efforts under Medicaid; (2) over two-thirds of uninsured children live in families with a family income of less than 200 percent of poverty; (3) about 70 percent live in two-parent families and 64 percent have one parent working full-time; (4) the vast majority (80 percent) of uninsured children have one parent who is also uninsured; (5) even though a majority of uninsured children are white, minorities (especially Hispanics) are disproportionately represented; (6) uninsured children include a disproportionate number of noncitizens (10 percent versus 4 percent in the general population of children); and (7) there are inconsistencies in the research concerning how long children are insured. Also identified are topics for further investigation. (Final report 72 pages.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6721

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

TITLE: Deriving State Level Estimates from Three National Surveys: A Statistical Assessment and State Tabulations

ABSTRACT: This report assesses the statistical issues involved in the production of State-level estimates related to health and welfare issues from three national surveys: the Current Population Survey (CPS), the Survey of Income and Program Participation (SIPP), and the National Health Interview Survey (NHIS). With the devolution of many welfare programs from the Federal Government to the States, there is a strong interest in being able to track the health and welfare of the population in each State. This would allow for examination of the effects of various State welfare initiatives that are to be implemented in the next few years. Ideally, the CPS, SIPP and NHIS would be able to provide "direct" estimates of adequate precision for every State, as opposed to the "indirect" estimates derived from statistical models. The surveys, however, are not large enough to produce accurate direct estimates for every State, and there are great disparities in sample size. The relevant statistical issues involved in making State-level estimates from the three surveys include State stratification, non-sampling errors and precision of the estimates. For this report, the most current databases for two of the three surveys were examined: March 1996 for the CPS and the 1993 panel for the SIPP. In 1995, the NHIS sample was completely redesigned, so examining the 1994 data would yield little information on the ability of future years to provide State-level estimates. For all three surveys, the allocation of sample size to the States is made with the aim of balancing the precision requirements of both State and national estimates. As a result, disparities exist. Approaches to overcome the sample size limitations of these surveys include the following: (1) increase State samples, (2) combine data from multiple years of the same survey, and (3) combine data from two or more surveys. These methods can both increase the size, and improve the accuracy of, State samples.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: 202-690-7794

PIC ID: 6380

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
 

TITLE: Examining Substitution: State Strategies to Limit Crowd Out in the Era of Children's Health Insurance Expansions

ABSTRACT: In recent years, State initiatives to provide health insurance for low-income children have raised a new set of concerns regarding the actual and potential impact of employer and individual-based substitution. As a number of States elected to expand Medicaid in the late 1980s, researchers began to explore the possibility that Medicaid was substituting private coverage. As Federal and State governments seek to increase the proportion of people with health coverage, it is critical to understand the nature and extent of substitution. Concerns focus on the potential that, if Medicaid and other public expansions are responsible for shifting individuals from employer-sponsored insurance to public programs, the effectiveness of public funds to expand insurance coverage might be limited. As programs minimize the effects of substitution, States will then have the ability to target funding specifically to children who do not have access to affordable health coverage. Several States have suggested that the coverage issue, in most cases, is not employers dropping coverage, rather individuals choosing to opt out of private insurance coverage for State subsidized programs. Research has attempted to assess the amount of substitution, suggested ways to limit its effects, and weighed the benefits and costs of expanding Medicaid with the potential of crowding out private insurance. State strategies to address substitution include nine mechanisms that either purposefully or inadvertently limit two types of substitution: individual-based and employer-based. The extent to which States deliberately institute mechanisms limiting substitution varies by program and State.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Cheryl Austein-Casnoff

PHONE NUMBER: 202-690-6102

PIC ID: 6729

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
 

TITLE: Public Health Laboratories and Health System Change

ABSTRACT: All fifty States and the District of Columbia operate their own Public Health Laboratories (PHLs). Changes in the private health care delivery system, especially the growth of managed care organizations (MCOs), hospital consolidations, and large commercial laboratories, are causing public health professionals to examine the viability of publicly funded laboratories. The study identifies aspects of the public health infrastructure critical for developing assessment and evaluation tools. The report includes a literature review, interviews with stakeholders, an informal poll of state PHL directors and detailed case studies of three States that have PHLs and relationships with MCOs and/or private laboratories. The report concludes that: (1) PHLs are part of the broader public health infrastructure and must respond to changes in the health care marketplace; (2) services that are not commercially viable within the private sector, and those that are critical to identifying emerging diseases, should remain in the domain of PHLs; (3) assurance of quality and consistency of laboratory testing are critical functions of PHLs; and (4) policy development in laboratories needs to address the growth of managed care and changes in the health care delivery system. The study recommends increased Federal guidance in: (1) assessing the regionalization of laboratory services, (2) supporting information infrastructure development, and (3) facilitating communication between private and public sectors. (Final report variously paginated.)

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Cheryl Austein-Casnoff

PHONE NUMBER: 202-690-6102

PIC ID: 6458

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA
 

TITLE: Resource Evaluation of the FDA Food Additive Petition Review Process Executive Summary

ABSTRACT: This project analyzes the food additive petition process in the Food and Drug Administration (FDA) to determine the resources needed to achieve a petition processing time frame of 180 days. The Food Additives Amendment to the Food, Drug and Cosmetics Act requires the Food and Drug Administration to provide premarket approval for food additives prior to inclusion in food. Premarket approval is sought via the petition process and the statute requires the FDA to complete its petition review within 90 days of filing, with a possible extension of another 90 days and an extended processing period of 180 days. The FDA had been unable to consistently meet these statutory time frames. This project quantifies the resources required for each of the Office of Premarket Approval's (OPA's) various responsibilities, and details the impact of competing requirements on the petition review system. Conclusions state that the statutory time frames are unrealistic for most petitions. The ability to meet the time frames is not a question of staffing or personnel availability. The only way to address the statutory time frames is to either change the time frames, or completely rethink the entire functioning of OPA and the types of review it should be performing.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Laina Bush

PHONE NUMBER: 202-205-5271

PIC ID: 6342

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

Human Services Policy

TITLE: Building and Sustaining Community Partnerships for Teen Pregnancy Prevention: A Working Paper

ABSTRACT: This report stresses lasting community partnerships as a strategy for teen pregnancy prevention. Factors influencing teens' sexual and contraceptive behavior include characteristics of the teens themselves, their peers and sexual partners, their families and communities. Since no single factor is highly related to behavior, the establishment of comprehensive community partnerships will, it is believed, reduce teen pregnancy rates. The advantages of community partnerships include: (1) pooled resources, shared risks and increased efficiency; (2) integrated and coordinated services; (3) strengthened communities through partnerships. The report covers the process, as well as the importance of, partnership development.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Sonia Chessen

PHONE NUMBER: 202-690-8471

PIC ID: 7016

PERFORMER ORGANIZATION: Cornerstone Consulting Group, Inc. Washington, DC
 

TITLE: Aid to Families with Dependent Children: The Baseline

ABSTRACT: On August 22, 1996, President Clinton signed into law the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). PRWORA replaced the Aid to Families with Dependent Children (AFDC) program. The purpose of this report is to provide an overview of the AFDC program prior to the enactment of PRWORA. The report: (1) traces the historical origins and evolution of the program over the past sixty years and provides detailed national and state data since the mid 1960s; (2) traces the trends in the caseload for the basic AFDC program and the unemployed parent component; (3) provides some descriptive statistics regarding the family and household characteristics; (4) examines the level of Federal and State spending on the program; (5) discusses the eligibility thresholds and the AFDC benefit levels; (6) reviews the research and the length of stays on AFDC, and the factors associated with entering and leaving the program; and (7) describes the Food Stamp Program and provides data from the Food Stamp Quality Control system that are relevant to describing the characteristics of the AFDC caseload up to the end of 1996. (Final report 123 pages plus appendix.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Gilbert Crouse

PHONE NUMBER: 202-401-6616

PIC ID: 6944

PERFORMER ORGANIZATION: Office of Human Services Policy, Washington D.C. 20201
 

TITLE: Ancillary Services to Support Welfare to Work

ABSTRACT: This project provides information on ancillary services, such as addiction treatment, housing needs, legal services, medical needs (including services such as eye and dental care) and mental health services, for both policymakers and State and local program operators. The project synthesizes and interprets existing research in a non-technical format, identifies gaps in knowledge, identifies service needs that are not being met and their potential impact, and highlights promising program practices that incorporate ancillary services into a long-term strategy to improve employment outcomes of welfare recipients.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Richard Silva

PHONE NUMBER: 202-401-6638

PIC ID: 6740

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

TITLE: Approaches to Evaluating Welfare Reform: Lessons from Five State Demonstrations (Two Volumes)

ABSTRACT: Most States obtained waivers from Aid to Families with Dependent Children (AFDC) and Food Stamp Program rules in order to implement welfare reform. Between 1993 and 1996, the Clinton administration approved waivers for 43 States. This project examined waiver demonstration projects in five States (California, Colorado, Michigan, Minnesota and Wisconsin). Four of the five used an experimental evaluation design, while the fifth was quasi-experimental. The report addresses issues in five areas: (1) the choice between an experimental and quasi-experimental evaluation design, (2) sample design, (3) implementation of experimental evaluations, (4) data collection, and (5) analysis methods. The report found that: (1) most evaluations of State welfare reform demonstrations used an experimental design which involved random assignment of cases to an experimental group subject to welfare reform, or to a control group subject to pre-reform policies; (2) only one waiver (Wisconsin's) was approved with a quasi-experimental design, but this may become more common in a block grant environment; and (3) when designing a study sample, evaluation planners should ensure that the sample size is adequate and should design the sample so that applicant and recipient subgroups can support separate impact estimates. The sample should also be representative of the State as a whole. The report also found that four aspects of the implementation of an experimental evaluation require special care, including: (1) the timing of the random assignment, (2) the method of the random assignment, (3) ensuring that control group policies remain unchanged, and (4) preventing experimental and control group cases from changing status. The report also discusses data collection and analysis. (Final report Volume I 128 pages plus appendices, Volume II 8 pages.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6050

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.
 

TITLE: Building an Employment Focused Welfare System: Work First and Other Work-Oriented Strategies in Five States

ABSTRACT: The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 made dramatic changes to the Nation's welfare system. States are now translating PRWORA's goal of a work-oriented , transitional assistance program into an operational reality. This report reviews the policy choices and experiences of six sites in five States that are engaged in making the transition from the more traditional welfare focus on cash assistance, to the new Work First focus on employment. Work First programs in Indiana, Massachusetts, Oregon, Virginia and Wisconsin exemplify a range of strategies being used to achieve increased employment among welfare recipients. Among these States there are two distinct Work First models in place: (1) The Work First, Work Mandate model (Massachusetts and Virginia) mandates employment participation as a requirement for continued cash assistance only a few months after initial receipt of benefits. (2) The Work First, Participation Mandate model (Oregon, Indiana, and Wisconsin) includes job search, education and training as allowable forms of participation throughout the period of cash receipt. Data were collected from site visits to State and local welfare offices between January and March of 1997. Since the passage of the PRWORA, Indiana and Wisconsin have implemented new work-based reforms, while the remaining States have made few changes. Thus, although the report measures State experiences at one point in time, it reflects States at different stages in their own evolution towards an employment-focused welfare system. (Executive summary 45 pages; final report 97 pages bound separately.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Elizabeth Lower-Basch

PHONE NUMBER: 202-690-6808

PIC ID: 6227

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.
 

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

ABSTRACT: This report is one of several in a series from an evaluation of mandatory welfare-to-work programs in seven sites, and presents findings from the Portland, Oregon welfare-to-work program run between 1993 and 1996. Through the program, Portland provided employment and support services to a broad cross-section of the Aid to Families with Dependent Children (AFDC) caseload, who were required to participate in program activities, or face reductions in their welfare grants. Although designed and implemented prior to the 1996 welfare reform law, the program's goals were very similar: to foster the self-sufficiency of adult recipients through increased employment and decreased welfare receipt. 5,547 single-parent AFDC applicants over the age of 21were randomly assigned to either a program group or a control group. This report describes the implementation, participation patterns and cost of the Portland program, and examines the effects of the program on employment, earnings and welfare receipt during the two years following enrollment in the program. The report finds that, over the two-year period: (1) employment levels increased 11 percent and earnings increased by $1,800 per sample member, a 35 percent increase over the control group's earnings; (2) the proportion of people with full-time jobs increased by 13 percent, and the number with employer-provided health benefits increased by 10 percent; (3) welfare expenditures were reduced by 17 percent; (4) the impact of the program was consistent for recipients with few barriers to employment and those typically considered hard-to-place; and (5) though program group members' average combined income from earnings, AFDC and Food Stamps was not substantially higher than that of control group members, more positive results at the end of the program period suggest that the control group may be better off in the future. See also PIC ID 6576, 6576.1, 6576.2, 6576.4.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576.3

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

TITLE: Moving Into Adulthood: Were the Impacts of Mandatory Programs for Welfare-Dependent Teenage Parents Sustained After the Programs Ended?

ABSTRACT: Teenage parents have a high probability of engaging in behaviors and lifestyles that place them and their children at risk of poor health and long-term dependency on welfare. Therefore, from 1987 through 1991, the Department of Health and Human Services (HHS) and the States of New Jersey and Illinois operated a demonstration to test innovative approaches for this population. The programs provided intensive case management support, allowances for child care costs and transportation and other training-related expenses, as well as a variety of workshops designed to develop the teenagers' life skills, motivations and abilities to pursue continued education, training, or employment. Failure to participate could result in sanctions, until the teenage parent complies with the program. This evaluation assesses the impact of the program on welfare use, education, literacy, employment, income, family formation, child care use, repeat pregnancies, and many other outcomes of current policy interest. The results of the program have informed State JOBS and other programs with teen cohorts. A five year follow-up has been completed, and includes information about impacts on the children. The child outcomes portion of the study analyzes the impact of the demonstration on the cognitive, emotional, social, and health well-being of the children of these young mothers. The data are comparable to the child impacts component of the JOBS evaluation.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Reuben Snipper

PHONE NUMBER: 202-690-5880

PIC ID: 2771.9

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

TITLE: National Evaluation of Welfare-to-Work Strategies: Evaluating Two Welfare-to-Work Program Approaches: Two Year Findings on the Labor Force Attachment and Human Capital Development in Three Sites

ABSTRACT: This report is part of a larger study called the National Evaluation of Welfare-to-Work Strategies, formerly known as the JOBS Evaluation, which has randomly assigned more than 55,000 individuals in seven sites to groups eligible for specific welfare-to-work programs, and to control groups that do not participate in these programs. This study compares two distinct welfare-to-work strategies, labor force attachment (LFA) and human capital development (HCD), at each of three of sites: Atlanta, GA; Grand Rapids, MI; and Riverside, CA. At each site, Aid to Families with Dependent Children (AFDC) applicants were randomly assigned to one of three groups: (1) a group subject to the LFA program, (2) a group subject to the HCD program, or (3) a control group not subject to any welfare-to-work program. This report presents findings on the implementation, participation patterns and costs of the two types of programs operated at each site. Additionally, the report assesses the two program approaches in promoting employment and reducing welfare expenditures after two years. The study finds that: (1) The LFA programs increased participation in the job search and the HCD programs increased participation in adult basic education. (2) Welfare sanction rates for nonparticipation were higher in the LFA and HCD programs than in previously studied programs, although higher sanction rates were not associated with higher rates of eventual participation in program activities. (3) The HCD programs cost approximately twice as much as the LFA programs. (4) Both programs increased individuals' two-year cumulative employment and earnings. (5) Both programs reduced welfare expenditures within the two-year follow-up period. The report concludes that a period of two years is insufficient to make a credible comparison between the two approaches. See also PIC ID series 5776. See PIC ID 6576 and 6576.2. (Executive summary 36 pages; Final report 276 pages plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576.1

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

TITLE: The Health and Well-Being of Children in Immigrant Families

ABSTRACT: The well-being and development of children are a priority for all America, because they are our future and because the rapid growth in the number of children who live in immigrant families gives them special prominence. The Board on Children, Youth, and Families of the Commission on Behavioral and Social Sciences and Education (CBASSE) of the National Research Council (NRC) and the Institute of Medicine (IOM) established the Committee on the Health and Adjustment of Immigrant Children and Families in March, 1996. The committee was composed of 19 members with expertise in public health, pediatrics, child psychiatry, developmental psychology, population studies, anthropology, sociology, economics, public policy, law and history. The committee reviewed relevant research and literature and provided demographic descriptions of immigrant children and families. They characterized the development of immigrant children, providing information on the risks and protective factors associated with differential health and well-being of different immigrant groups, and about the delivery of health and social services to these groups. Although no conclusions were drawn concerning recent policy changes, the research offered a critical "baseline" portrait of immigrant children prior to welfare reform against which their status could be compared in the coming years. Specific recommendations were made concerning research, data collection and information dissemination that are intended to expand scientific knowledge about children in immigrant families, and help inform future public policy deliberations.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: David Nielsen

PHONE NUMBER: 202-401-6636

PIC ID: 6752

PERFORMER ORGANIZATION: National Academy of Sciences, Board on Children and Families Washington, D.C.
 

TITLE: The Number and Cost of Immigrants on Medicaid: National and State Estimates

ABSTRACT: The Personal Responsibility and Work Opportunity Act (PRWORA) of 1996 established new rules for the Medicaid eligibility of non-citizen immigrants. Under the Act, most immigrants entering the U.S. after August 1996 are not eligible for federally-funded health insurance, with the exception of emergency benefits, under the Medicaid and CHIP programs. Prior to this welfare reform legislation, immigrants were eligible for the same Medicaid benefits as U.S. citizens. This report provides national and State estimates of the number of pre-welfare reform, non-citizen Medicaid beneficiaries, and their cost to the program. Information for analyses came from the Medicaid Quality Control (QC) database from the first half of 1994, and was supplemented with data from the Social Security Administration (SSA) on Supplemental Security Income (SSI) participants. The report found that prior to welfare reform: (1) One in 13 Medicaid beneficiaries were non-citizen immigrants; and (2) PRWORA did not affect the majority of immigrants receiving Medicaid benefits in 1996, but will have a greater impact as the number of new immigrants increases. The report concludes that the new eligibility restrictions are likely to increase the number of immigrants who are uninsured, although many factors will determine how these numbers will change in the future. States may replace, either wholly or partially, the lost federally-funded health insurance with state-funded assistance. New immigration policies will affect the rate of immigration and the composition of new immigrants. Additionally, an increase in the number of immigrants seeking naturalization may, in part, be attributed to apprehension surrounding welfare reform. Once the immigrants are citizens, they will again be eligible for Medicaid benefits. The impact of this potential increase in Medicaid caseloads is unclear. The future costs of increasing the number of low-income immigrants without Medicaid also remains to be seen. (Final report 47 pages plus appendices.)

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: David Nielson

PHONE NUMBER: 202-690-6636

PIC ID: 6791

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.
 

TITLE: Trends in the Well-Being of America's Children and Youth: 1998

ABSTRACT: This is the third edition of an annual report from the Department of Health and Human Services (HHS) on trends in the well-being of America's children and youth. The report presents the most recent and reliable estimates on more than 90 indicators of well-being. It is intended to provide the policy community, the media, and all interested citizens with an accessible overview of data describing the condition of children in the U.S. The indicators have been organized into five broad areas: (1) population, family and neighborhood; (2) economic security; (3) health conditions and health care; (4) social development, behavioral health, and teen fertility; and (5) education and achievement. For each indicator, the report provides graphics to highlight key trends and important population subgroup differences, and tables to provide more detailed information for the interested user. These are accompanied by text that briefly describes the importance of each indicator, and highlights the most salient features of the data.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Matthew Stagner

PHONE NUMBER: 202-690-5653

PIC ID: 6170.2

PERFORMER ORGANIZATION: Child Trends, Inc. Washington, D.C.

Program Systems

TITLE: Evaluation of the Minority Male Consortium for Violence Prevention

ABSTRACT: This project evaluated the Office of Minority Health (OMH) Minority Male Consortium for Family and Community Violence Prevention Programs. At the time of this study, 19 historically black colleges and universities (HBCUs) were participating in this program. Features of violence prevention program models at 13 historically black colleges and universities/family life centers' (HBCUs/FLCs) were synthesized to determine approaches that could prevent or minimize violence committed on or by minority males. The contractor: (1) performed an extensive literature review; (2) collected and analyzed relevant program documentation and materials; (3) conducted focus groups; (4) examined target populations; (5) developed a site visit discussion guide; (6) selected 10 HBCUs for site visits; (6) developed and executed an analysis plan; (7) interpreted analyses findings, defined program models and analyzed HBCUs' organizational capacity; (8) held briefings with Consortium leaders, members, and government personnel; (9) reviewed the overall organization, design, and implementation of the programs; and (10) evaluated prevention strategies adopted by the HBCU/FLCs. Violence prevention programs suffer from an inability to produce valid performance data demonstrating that prevention investments pay off in the long run. The report recommends that: (1) without completely centralizing the design process, the Federal government and the Consortium should move towards a consensus-seeking information model in which individual schools are no longer free to pursue independent designs; and (2) constraints should be introduced as to which program models are implemented by which schools. See also PIC ID Nos. 5789 and 5789.1. (Final report 68 pages plus appendices.)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Margaret Price

PHONE NUMBER: 202-260-0382

PIC ID: 5789.2

PERFORMER ORGANIZATION: Macro International, Inc. Calverton, MD
 

TITLE: Health Performance Measurement in the Public Sector: Principles and Policies for Implementing an Information Network

ABSTRACT: The Panel on Performance Measures and Data for Public Health Performance Partnership Grants was assembled in fall 1995 at the request of the Department of Health and Human Services (DHHS) to assess performance measurement for the specific block grant programs included in the original Performance Partnership Grant (PPG) proposal, recommend measures that could be used to monitor the proposed PPG agreements to be negotiated between each State and the Federal government, and recommend steps to improve performance measures and performance measurement for health-related programs. In this report, the panel addresses broader data and information system issues that require attention at the Federal, State and local levels to advance the practice of performance measurement for publicly funded health programs. This report broadens the discussion begun in the first report by looking beyond the Federal-State PPG framework and beyond the specific program areas covered by the PPG proposal. Although the discussion focuses on the public sector perspective, closely related private sector interests and developments in clinical health care are also considered. (See PIC ID 6176)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: James Scanlon

PHONE NUMBER: 202-690-7100

PIC ID: 6176.1

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

Evaluations in Progress

Disability, Aging, and Long-Term Care Policy

TITLE: Institute on Consumer Directed Services (Long-Term Care Infrastructure)

ABSTRACT: This research, technical assistance and dissemination project, jointly funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Administration on Aging (AOA), is designed to: (1) facilitate the ability of people with disabilities to exercise choice and control over the provision of the home and community based care (HCBC) they receive; (2) educate consumers or their representatives who want to use independent providers of personal assistance services, (PAS) about effective strategies for recruiting, training and managing independent providers; (3) educate consumers, their representatives and program personnel about consumer participation in care planning, on-site supervision of agency-employed workers and ways to work with case managers and agency personnel to modify care plans; and (4) provide information to States and communities to help them evaluate the outcomes and costs of strategies involving consumer choice and consumer directed services, and to develop and implement cost-effective policies and programs.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6162

PERFORMER ORGANIZATION: National Council on Aging, Inc. Washington D.C.

PROJECTED DATE OF COMPLETION: 10/20/98
 

TITLE: Client-Directed In-Home Care/Personal Assistance Services

ABSTRACT: This project will conduct a survey of personal assistance services clients, workers and case managers in order to compare measures of quality of care, quality of life, client satisfaction and worker satisfaction across modes of service provision. The modes of service provision to be compared include: (1) independent and supported-independent providers (client-directed modes), and (2) agency-employed providers (professionally-managed modes). The study will also compare the outcomes associated with use of family, friends and neighbors as independent providers, as compared to services provided by aides previously unknown to the client. The study is being carried out in the context of California's In-home Supportive Services program with the assistance of State officials.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6173

PERFORMER ORGANIZATION: University of California at Los Angeles, Los Angeles CA

PROJECTED DATE OF COMPLETION: 3/1/99
 

TITLE: National Study of Assisted Living for the Frail Elderly

ABSTRACT: The aging of America has significant implications for the nation's long-term care system. Assisted living is seen by many as one logical response, at least conceptually, to this population growth, which is likely to be accompanied by an increasing need for assistance with chronic diseases and disabilities. This study will focus on how assisted living fits in the long-term care system and its potential for addressing the needs of the elderly and persons with disabilities. It will examine the role of assisted living from the perspective of consumers, owners, workers, regulators, developers and investors, and others who have a stake in the nation's long-term care system. Issues to be addressed are: (a) the supply of assisted living facilities, (b) barriers to development, (c) existing regulatory structures, (d) principles of consumer autonomy and choice in supportive residential settings, and (e) impact on persons who live and work in assisted living facilities.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 4719.7

PERFORMER ORGANIZATION: Research Triangle Institute Washington, DC

PROJECTED DATE OF COMPLETION: 12/31/99
 

TITLE: Study of Private Long-Term Care Insurance Claims

ABSTRACT: This study will examine formal and informal home and community-based long-term care (LTC) services use among private insurance policy holders "in claim" (i.e., those who are receiving insurance benefits). It will compare patterns of formal and informal services use among these insurance claimants with those of a nationally representative sample (from the 1994 National Long-Term Care Survey) of disabled elders living in the community. Statistical processes will be employed to match claimants with particular characteristics (e.g., age, marital status, disability level) to elders in the national sample. The purpose of the comparison will be to measure the effects of private long-term care insurance on access to formal home care services and to determine whether or to what extent insurance-financed formal services supplement or substitute for informal family care. The study will also examine the interaction between insurance financed home care and the use of Medicare home health services.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6399

PERFORMER ORGANIZATION: Lifeplans, Waltham MA

PROJECTED DATE OF COMPLETION: 3/1/99
 

TITLE: Study of Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

ABSTRACT: This project will study the experiences of elderly Medicare beneficiaries with disabilities and chronic illnesses in a managed delivery system (MDS) at four separate sites. An MDS is broadly defined as a health care system that integrates the financing and/or delivery of primary, acute and long-term care of persons for the purpose of controlling costs and improving access to, and coordination of, services across a continuum of providers. The specific goals of the study are to: (1) foster a better understanding of the unique characteristics and health/long-term care needs of elderly persons with disabilities and chronic illnesses among health plan administrators, providers and policymakers; (2) assess how managed care delivery systems meet the needs of this population and the factors that promote or impede success; and (3) describe the health care experiences of disabled elderly Medicare beneficiaries in MDS.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 6391

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

PROJECTED DATE OF COMPLETION: 6/30/99
 

TITLE: Analysis of Employer-Group Long-Term Care Insurance

ABSTRACT: This project will first survey employers offering their employees long-term care insurance benefits, identifying the existing group market and how if functions. Because most of the long-term care insurance market is composed of individual products--and because much of the employer information on long-term care insurance is fairly recent and not well explored--not much is known about the benefit packages, price, or design of these group products. The goal here is to identify quantitatively the "best practices" in the industry. Secondly, the project will examine designs for possible long-term care insurance benefits for Federal employees (and presumably their spouses, parents and retirees as well). Reviewing market survey data to identify important elements of existing employer groups, several long-term care insurance coverage options for Federal employees will be developed. The project will inform the primary Federal policy makers (such as the Office of Personnel Management) as to progress on this research and the accompanying design options.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Cutler

PHONE NUMBER: 202-690-6443

PIC ID: 6718

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 6/30/99
 

TITLE: A Primer for States and Consumers on Medicaid Home and Community-Based Services

ABSTRACT: Medicaid, the principal source of financing for long-term care services, has frequently been said to have an "institutional bias," because State spending on nursing homes and institutions outweighs spending on home and community-based supports by a ratio of approximately 80 to 20. Many States have, however, demonstrated that it is possible to work within a Medicaid framework to expand home and community-based services, (HCBS) providing consumers with greater choice and control. Decreased dependence on unnecessary institutional long-term care and the expansion of consumer responsive home and community-based long-term care options are important policies of both the White House and the Secretary for the Department of Health and Human Services. To address this priority, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) proposes to develop a "primer" on existing long-term care options in Medicaid that promote consumer choices in long-term care. The primer will be an important and useful development tool for State Medicaid and aging policy and program staff, consumers and their representatives, and providers interested in the expansion of choices in long-term care, including the promotion of home and community-based options.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Gavin Kennedy

PHONE NUMBER: 202-690-6443

PIC ID: 7162

PERFORMER ORGANIZATION: The George Washington University Medical Center, Center for Health Outcomes Improvement Research, Washington, D.C.

PROJECTED DATE OF COMPLETION: 7/20/99
 

TITLE: Synthesis and Analysis of Medicare Hospice Benefit

ABSTRACT: The rapid rise in Medicare hospice expenditures, particularly on behalf of nursing home residents, has drawn the attention of a wide variety of health policymakers and the Office of the Inspector General (OIG). The OIG has advanced recommendations to modify how Medicare and Medicaid will pay for these services. However, a larger study is needed to examine key hospice trends nationally and in selected States. Additional information on the Medicare hospice benefit, including trends in utilization and expenditures, who is covered, and where, will help inform health policymakers as they consider alternative hospice benefit and payment designs. This project will describe trends and issues with the Medicare hospice benefit, particularly with respect to nursing home residents who elect this benefit. Information will be gathered through a review of the literature, discussion with key informants, and an analysis of claims, assessment and provider data. This project will: (1) examine trends in Medicare and Medicaid hospice and non-hospice utilization and expenditures for hospice and other similar beneficiaries; and (2) compare the quality of care for hospice beneficiaries.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 7154

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/20/99
 

TITLE: Evaluation of Five State Health Reform Demonstrations

ABSTRACT: The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of Medicaid 1115 waiver demonstrations in five States attempts to add a disability focus to the State of Tennessee. This supplement will focus on the experiences of disabled adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) and disabled children enrolled in the TennCare and TennPartners programs. The project will conduct: (1) in-depth qualitative analyses of the State's experience in enrolling individuals with disabilities into managed care systems, and (2) quantitative analyses to examine costs and utilization data for these populations. In addition, the supplement will conduct a survey of disabled consumers to examine issues of satisfaction, quality, health status and functioning. See PIC ID 6289, 6289.1, 6166, and 6166.1.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Hunter McKay

PHONE NUMBER: 202-690-6613

PIC ID: 6289.2

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

PROJECTED DATE OF COMPLETION: 8/31/99
 

TITLE: Data Analytic Support for the Review of Long-Term Care Policy Options

ABSTRACT: This project will analyze data from the 1994 National Long-Term Care Survey to assist Health Care Financing Administration (HCFA) actuaries in estimating costs of the potential effects of eliminating or redefining the requirement that Medicare beneficiaries be "homebound" in order to access the Medicare home health benefit. It will also analyze data from the Community Caregiver Supplement to the 1996 Medical Expenditures Panel Survey Nursing Home Component. The purpose of this analysis is to understand the factors influencing decisions by severely disabled persons and their family members as to whether or not the disabled person should enter a nursing home. This analysis will guide the work of the HCFA/ASPE Task Force on Promoting Home and Community-Based Alternatives to Nursing Home Care. In particular, the analysis will help design a major demonstration project and technical assistance program for the States.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6677

PERFORMER ORGANIZATION: MEDSTAT Group Washington, DC

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Analysis of Patterns of Post-Acute and Chronic Care Services Use Among Disabled and Non-Disabled Medicare Beneficiaries: 1989-1994

ABSTRACT: This study uses the 1989 and 1994 National Long-Term Care Surveys to analyze factors that predicted growth in Medicare post-acute (i.e., home health and skilled nursing facility) benefits from the late 1980s through the mid-1990s.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6768

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

ABSTRACT: The FY 1997 contract modification allows a more focused review of how Medicare managed delivery systems address the needs of elderly persons with disabilities. This is accomplished in part through this contract modification which: (1) adds a longitudinal survey of elderly enrollees with targeted conditions, (2) limits the cross-sectional to elderly persons with disabilities, (3) adds a focus group of physicians, and (4) requires interviews with long-term care providers serving this population.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Jennie Harvell

PHONE NUMBER: 202-690-6613

PIC ID: 7155

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

PROJECTED DATE OF COMPLETION: 12/20/99
 

TITLE: Analysis of the Disability Supplement to the National Health Interview Survey

ABSTRACT: The disability supplement to the National Health Interview Survey (NHIS-D) is the first comprehensive survey on disability in the United States. The survey is unique in that it focuses on several populations of persons with disabilities who are generally omitted or under-represented in national survey efforts: children, persons with mental retardation and other developmental disabilities and the working-age population. The goal of this project is to conduct a series of analyses and produce both short-term products and final reports that will inform ongoing Assistant Secretary for Planning and Evaluation (ASPE) departmental and administrative research and policy initiatives. The analyses will address a specific set of questions in four topical areas using the NHIS-D: (1) welfare receipt and disability (including chronic illness); (2) disability and chronic illness among low income populations; (3) childhood disability and chronic illness; and (4) employment and disability.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: William Marton

PHONE NUMBER: 202-690-6613

PIC ID: 7153

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/27/00
 

TITLE: Medicare Home Health Practice Variations

ABSTRACT: The main goal of this study is to examine how patient, provider, agency and market/regulatory forces relate to variations in Medicare home health care practices and outcomes. Three key questions form the basis of the study: (1) What is the actual practice of home health care in terms of amount, type and decision-making? (2) How are decisions about care made in light of the Health Care Financing Administration's (HCFA) Medicare home health care coverage rules? and (3) What elements of practice are associated with long lengths of stay in the home health benefit? The study will use a range of quantitative and qualitative methods to address these questions, including longitudinal data collection on samples of home health agencies and home health patients at those agencies, focus groups, case studies and analyses of secondary data.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6443

PIC ID: 6720

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 3/31/00
 

TITLE: Research on Employment Supports for People with Disabilities

ABSTRACT: The objective of this study is to collect detailed information on the experiences of people with disabilities, their knowledge of work incentive policies and provisions, the events and factors affecting their employment decisions, the relative importance of specific factors, and the reasons for successful and unsuccessful employment attempts. The purpose to gain a better understanding of the supports people with significant disabilities currently use to successfully participate in employment, supports that would improve their employment outcomes, and supports that would improve the employment outcomes of those who are not employed. The collection of this information is intended to advance the understanding of the effect of supports and programs on the employment of people with disabilities. The project is designed to provide information that may be used by Federal agencies, states, social service agencies, advocates for people with disabilities, and consumers with disabilities to develop and inform policies that will promote the employment of people with significant disabilities.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Floyd Brown

PHONE NUMBER: 202-690-6613

PIC ID: 4917.2

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 4/20/00
 

TITLE: Evaluation of Practice in Care (EPIC)

ABSTRACT: From 1989 to 1992, there was a 210 percent increase in Medicare expenditures for home health services. This increase in utilization has generated policy interest in measures to control expenditures without compromising quality. Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. This study will: (1) analyze "episodes" of care under the Medicare home health benefit, (2) assess the actual practice of care, (3) determine the extent to which there is variation in practice between acute and long-term care patients, and (4) uncover the factors accounting for that variation. The study will also examine decision-making processes between patients, providers and physicians. The events that take place during a visit and between visits as "actual practice" have never been measured. Furthermore, the function of decision-making by various parties has not been observed in "actual practice". This effort to understand issues surrounding regional and practice variations of home health care delivery will aid the Department of Health and Human Services and the industry in combating fraud and abuse, as well as contribute valuable data to a future prospective payment system.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Ruth Katz

PHONE NUMBER: 202-690-6613

PIC ID: 5888

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 6/30/00
 

TITLE: Private Payers Serving Individuals with Disabilities and Severe Chronic Conditions

ABSTRACT: This project examines the experiences of persons with disabilities or severe chronic conditions in health insurance plans sponsored by selected large employers. A methodology was developed to identify such individuals using diagnoses from health care claims and encounter databases. This methodology was applied to data from the health plans of two large employers. The prevalence of disabilities and severe chronic conditions was estimated among employees, their dependents, and retirees. The choice of indemnity versus managed care plans, and associated service utilization and expenditures were analyzed. The performance of various risk adjustment models was tested for physical and mental conditions. This project will provide information on the factors influencing the choice of insurance plans, and the effect of managed care on service utilization and expenditures. It also estimates the extent of adverse selection across plans, and indicates how various risk sharing strategies can mitigate its effects.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 6398

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 9/28/00
 

TITLE: The Long Term Care Financing Model

ABSTRACT: The Long-Term Care Financing Model is a resource which has been extensively used by ASPE to project future long- term care utilization and expenditures and simulate various long term care policy options. These include expansions of public financing, such as those proposed during health care reform, as well as changes to Medicaid and Medicare. The model has also been used extensively to study private sector policy options, such as the impact of further growth on private long-term care insurance and the impacts of changing trends in disability rates on long-term care use and expenditures. Recent data on disability rates, nursing home use, and home care use will be used to update existing portions of the model. In addition, the model will be expanded to include acute care use, thereby increasing the Assistant Secretary for Planning and Evaluation's (ASPE's) ability to simulate a wide range of policy options. ASPE will use this computer model for projections and policy simulation and a series of policy simulations from the revised model will be presented in reports. In addition to its previous long-term care policy uses, the revised model will enable ASPE to address acute care issues, such as the combined burden of acute and long-term care spending on the elderly. Since the model simulates the income and assets of the population, including pension and Social Security payments, the model will also be used to study other aging-related issues, such as the impact of changes in employer-sponsored health insurance for retirees.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: John Drabek, Ph.D.

PHONE NUMBER: 202-690-6613

PIC ID: 7143

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/30/00
 

TITLE: A Study of Home Health Practice Variations Study

ABSTRACT: Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. What takes place during a visit and between visits as "actual practice" has never been measured. Furthermore, the extent to which various parties participate in the decision making process, is also unknown. Such information is needed to improve understanding about actual practice and explain its variations. This study will analyze variations in home health care services, focusing on patient characteristics, provider characteristics, agency characteristics and market characteristics. Primary data will be collected at the patient and agency levels. Data from this study and the Health Care Financing Administration's (HCFA) Outcomes of Home Care Study will be used to assess the relationships between the process of home health care and its outcomes and resource use.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Ruth Katz

PHONE NUMBER: 202-690-6613

PIC ID: 6168

PERFORMER ORGANIZATION: Center for Health Policy Research Denver, CO

PROJECTED DATE OF COMPLETION: 12/20/00
 

TITLE: Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation

ABSTRACT: This study will employ a classical experimental research design (i.e. random assignment of participants to treatment and control groups) in order to test the effects of "cashing out" Medicaid-funded personal assistance services for the disabled. Arkansas and New York are expected to participate in the demonstration, with an option to expand to include New Jersey and Florida. Control group members will receive "traditional" benefits in the form of case-managed home and community-based services where payments for services are made to vendors. Treatment group members will receive a monthly cash payment in an amount roughly equal to the cash value of the services that they would have received under the traditional program. It is hypothesized that cash payments will foster greater client autonomy and that, as a result, consumer satisfaction (particularly among disabled persons under age 65) will be greater. It is also hypothesized that States will save Medicaid monies (mostly in administrative expenses) from cashing out benefits.

AGENCY SPONSOR: Office of Disability, Aging and Long-Term Care Policy

FEDERAL CONTACT: Pamela Doty

PHONE NUMBER: 202-690-6613

PIC ID: 6161

PERFORMER ORGANIZATION: University of Maryland, Center on Aging, College Park MD

PROJECTED DATE OF COMPLETION: 1/20/01

Health Policy

TITLE: Enabling Services Methodology Workshop

ABSTRACT: This project seeks to address enabling services issues by: (1) exchanging information regarding what is known and unknown about enabling services in primary care settings, particularly in managed care environments, costs, efficacy, cost-effectiveness and new research efforts; (2) identifying key policy questions related to enabling services, particularly as used in managed care settings; (3) identifying major methodological questions that studies of these services present, both generally and in managed care settings, and strategies for overcoming them; and (4) developing a broad-based research agenda for consideration by the many public and private sector organizations which pay for, or otherwise have interests in, these services.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6750

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 10/1/98
 

TITLE: State Linked Data Meeting and Monograph

ABSTRACT: Data from a single source is frequently inadequate to examine effectively the relationships between and among costs, services and health outcomes. As a result of research and other efforts by the Federal government, foundations and States, a pool of experienced researchers and program administrators have created the linked data sets needed to examine the complicated relationships between and among programs. Sharing lessons learned in a meeting with the Federal research and data community will improve the Department of Health and Human Services (HHS) studies and help focus data initiatives. Sharing this information with the broader research and data community through a monograph will help encourage additional efforts, and may make such projects less daunting for those who follow.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6346

PERFORMER ORGANIZATION: MEDSTAT Group Cambridge, MA

PROJECTED DATE OF COMPLETION: 11/1/98
 

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

ABSTRACT: The goal of this project is to improve our understanding of direct-to-consumer (DTC) advertising. The relation of this kind of advertising to aspects of public health will be examined through a survey of selected consumers and the Food and Drug Administration (FDA) Center for Drug Evaluation and Research's (CDER) analysis of that survey. This analysis will yield an initial broad description of some possible associations between DTC advertising and consumer knowledge, attitudes and behaviors. The survey and CDER's descriptive analysis will lay the foundation for the long- term task of determining what effects DTC advertising may have on overall consumer knowledge, attitudes and behaviors concerning prescription drugs and the overall effects of this practice on the public health.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Susannah Bruns

PHONE NUMBER: 202-690-7996

PIC ID: 6343

PERFORMER ORGANIZATION: Market Facts, Inc. McLean VA

PROJECTED DATE OF COMPLETION: 1/1/99
 

TITLE: Preventing Abusive Intimate Relationships Among Adolescents

ABSTRACT: The role of abusive relationships in the lives of adolescents is not as well researched or understood as either adult domestic violence or child abuse. A recent study found that 60 percent of young women who had sex before age 15 were involved in coercive sexual relationships. Apart from this study there is little research on coercive, controlling, or abusive relationships among teenagers. A new source of data in this area, the National Longitudinal Study of Adolescent Health (Add Health) has just been made available to the public. This project will examine the issue of abusive relationships among teenagers through a literature review, analysis of available data, identification of data needs, focused discussion groups, a summary of promising approaches to prevention and intervention and recommendations for further research and discussion.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Sandra Howard

PHONE NUMBER: 202-690-7778

PIC ID: 6751

PERFORMER ORGANIZATION: Research Triangle Institute Research Triangle Park, NC

PROJECTED DATE OF COMPLETION: 1/1/99
 

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

ABSTRACT: Despite the important private sector employers play in shaping the current health care market, the views of this group concerning the provision of a variety of clinical preventive services and what their health plans currently provide have not been adequately described. In addition, the factors which influence their decisions to include or exclude such services have not been characterized. In collaboration with the Office of Disease Prevention and Health Promotion (ODPHP), and the Office of the Assistant Secretary for Planning and Evaluation (ASPE), researchers are forming a partnership with Partnership for Prevention to support the commissioning of a set of expert papers on the clinical preventive service benefits offered by employer-sponsored health plans. These papers are intended to meet two objectives: (1) to characterize the trends and decision processes occurring within the private sector; and (2) to evaluate the impact of government information on this issue in the private sector. As the government is investing its resources in producing and disseminating information designed to encourage the appropriate use of clinical preventive services, it is important to know how its customers in the private sector perceive and use such information.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 6347

PERFORMER ORGANIZATION: Partnership For Prevention, Washington D.C.

PROJECTED DATE OF COMPLETION: 1/30/99
 

TITLE: Analysis of Prescription-To-Over-The-Counter Switch Movement

ABSTRACT: There are now more than 600 over-the-counter (OTC) drugs which would have required a prescription only twenty years ago. These products are now available without a prescription because the Food and Drug Administration (FDA), determined that they could be used safely and effectively without a doctor's supervision. In the last few years alone, several important and widely used drugs have been switched to OTC status: Children's Motrin (ibuprofin), (2) Orudis KT (ketoprofen) for pain relief and fever reduction, (3) Femstat 3 (butoconazole nitrate) for vaginal yeast infection, and (4) several heartburn medications like Pepcid AC (famotidine). Consumers have responded enthusiastically, turning OTCs into a $19 billion a year industry, with the total retail market value of four billion dollars. Despite the far-reaching effects on the switch movement, there is a relatively sparse study of this trend. If it can be assumed that consumers will continue to self-medicate and that this trend will continue, factors determining the impact on public health need to be examined. This project will provide a comprehensive review and analysis of the prescription-to-over-the-counter switch movement, through several analytical methods, and with an overall emphasis on the impacts of the switches on public health, consumer information, choice and decision making, the doctor-patient relationship, pharmaceutical pricing, profits, health care costs and managed care policy.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Laina Bush

PHONE NUMBER: 202-205-5271

PIC ID: 6723

PERFORMER ORGANIZATION: Northwestern University, Center for Health Services and Policy Research, Evanston IL

PROJECTED DATE OF COMPLETION: 4/1/99
 

TITLE: An Inventory of Federal HIV-Related Databases

ABSTRACT: This project will develop an inventory of major Federally sponsored HIV-related databases. The inventory will describe the relevant databases and review their potential applications for administrative, clinical research, epidemiologic, financing, policymaking, or program administration purposes. It will also identify key research questions that could be addressed by these databases and identify opportunities for cross-agency collaboration in data collection or analysis. The project will produce a final report including an annotated inventory, as well as the relevant database assessments that point to key research issues and opportunities for interagency collaboration and cross-cutting analyses.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Leslie Hardy

PHONE NUMBER: 202-690-7858

PIC ID: 7146

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

PROJECTED DATE OF COMPLETION: 6/20/99
 

TITLE: Statistical Linkage of Data Files for Evaluation: National Health Interview Survey and Survey of Income and Program Participation

ABSTRACT: This project, jointly sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the National Center for Health Statistics (NCHS), will establish analytical and modeling databases derived from statistical matches of the National Health Interview Survey (NHIS) and the Survey of Income and Program Participation (SIPP). The resulting analytical database will also be useful for analysis of inter-relationships between health status and health care use, socioeconomic factors and a range of income and program participation data from SIPP. The linked database will support sophisticated analyses to aid in understanding the interrelationships between health and human services variables. It will also support policy analyses through microsimulation modeling and other analytical techniques.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Joan Turek

PHONE NUMBER: 202-690-6141

PIC ID: 6419

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 6/30/99
 

TITLE: Consequences and Cost of Intimate Partner Violence

ABSTRACT: This project will apply the methodology developed in "The Cost of Domestic Violence to the Health Care System" (PIC ID No. 4528) to prevalence and other data related to violence committed by adult intimate partners. The study will document the incidence of violence against women by intimate partners, estimate economic costs of related injuries and develop preliminary recommendations for reducing incidence and related injuries. It will form the basis for a report to Congress, authorized under the Crime Act. This project will be jointly funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Centers for Disease Control and Prevention (CDC). See also PIC 4528.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Sandra Howard

PHONE NUMBER: 202-690-7778

PIC ID: 4528.1

PERFORMER ORGANIZATION: University of California, San Francisco, Institute for Health and Aging, San Francisco CA

PROJECTED DATE OF COMPLETION: 7/1/99
 

TITLE: Evaluation of the Oregon Medicaid Reform Demonstration

ABSTRACT: The disability supplement to the existing Health Care Financing Administration (HCFA) evaluation of the Oregon Medicaid Reform Demonstration attempts to add a disability focus to the Statewide evaluation. This supplement will focus on the experiences of disabled children and adults (physically disabled, mentally retarded, or developmentally disabled) who are enrolled in the Oregon Health Demonstration. The disability supplement will examine cost and utilization data, and will link this data to functional data collected by State agencies and managed care plans. In addition, the supplement will conduct a survey of consumers and providers to examine issues of satisfaction, access, quality, health status and functioning. See PIC ID 6166 and the 6289 series.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 6166.1

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

PROJECTED DATE OF COMPLETION: 8/31/99
 

TITLE: The Changing Structure of Health Insurance Markets

ABSTRACT: This project will result in two research papers evaluating the following: (1) insurance market changes relating specifically to State laws complying with the Health Insurance Portability and Accountability Act of 1996, and (2) the relationship between health insurance market structure and health insurance coverage of the population. This study builds on an ongoing effort funded by the Robert Wood Johnson Foundation to compile an expanded and updated insurer database and to conduct several basic analyses of health insurance market structure, change and performance. State insurance markets are not well understood and have seldom been systematically studied in a manner that can inform public policy discussions and development. These products will contribute significantly to the public's understanding of how insurance markets are changing.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Stephen Finan

PHONE NUMBER: 202-690-7387

PIC ID: 7160

PERFORMER ORGANIZATION: Alpha Center Washington, DC

PROJECTED DATE OF COMPLETION: 9/20/99
 

TITLE: Developing a Framework for Domestic Infectious Diseases Surveillance

ABSTRACT: The purpose of this study is to develop an analytic framework that can be used to help create consensus on core capacities needed at each level of government for effective national infectious diseases surveillance. Emphasis will be placed on several areas including: (1) defining the relative roles of each level of government, and of the public and private sectors; (2) analyzing resource issues with particular attention to sources of funding, and to categorical versus integrated funding streams; (3) translating surveillance activities into meaningful public health responses; (4) evaluating surveillance activities; and (5) identifying training needs. The study will take into account the rapidly changing environment, especially the role of local health departments, and the changing nature of infectious diseases. The work will consist of: (1) collecting and analyzing data and information from the literature and from experts; (2) using this information to develop an initial framework describing what is needed for effective surveillance; and (3) establishing an expert panel which will use the framework as a tool to reach consensus on the minimum core capabilities needed at each level of government, and the relative roles of the public and private sector for more effective national infectious diseases surveillance.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 7161

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/20/99
 

TITLE: Access and Utilization of New Antidepressant and Antipsychotic Medications

ABSTRACT: The proposed project involves a collaboration with the National Institute of Mental Health (NIMH). Very little is known about how and why decisions are made regarding insurance coverage for many of the newer antidepressant and antipsychotic medications. The proposed study will provide important insight and knowledge from multiple perspectives (and with regard to multiple programs) concerning the often complex processes related to access, utilization and coverage of newer psychotropic medications. This new knowledge will serve to inform the department in efforts to evaluate existing and proposed policies.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 7193

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/20/99
 

TITLE: Construction of an Integrated Measure of the Burden of Disease

ABSTRACT: The burden of disease in a population consists of the morbidity and disability experienced by its members, their psychological perception of the adequacy and effectiveness of the care they receive, and resources expended for health maintenance. The essence of medical care is to determine the balance among these components that will most enhance overall health. The objective of the proposed project is to develop and evaluate analytic techniques that will permit: (1) the construction of an integrated measure of the burden of disease based on the explicit assessment of what trade-offs are currently accepted; and (2) identify changes in strategies to optimize the mix.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 7142

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 9/27/99
 

TITLE: Safety Net Framework Project

ABSTRACT: The Nation's health care provider safety net consists of: (1) hospitals, (2) primary care facilities, (3) specialized service providers such as family planning clinics, HIV service providers, community mental health centers, drug and alcohol treatment clinics, and (4) individual practitioners. These providers operate under both public and private auspices. As a group they are diverse, with varied funding sources including: (1) Medicaid and Medicare patient revenues and other payments, (2) Federal grant support from multiple sources, (3) other grants, (4) State and local public funding, (5) limited private third party insurance, (6) patient fees (often sliding scale), and (7) private philanthropy. Federal policy affects these providers in several ways. Products from this project will include a series of working papers, a workshop summary and a final "framework" document. The project is intended to result in new ways of shaping the Department's views concerning safety net providers. In particular, the Department plans to have a structure which considers how Federal grant programs, payment policies and other Federal policies affect these providers as they interact among each other at the community level.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Caroline Taplin

PHONE NUMBER: 202-690-7906

PIC ID: 7156

PERFORMER ORGANIZATION: Northwestern University, Evanston IL

PROJECTED DATE OF COMPLETION: 9/28/99
 

TITLE: Impact of Medicare HMO Enrollment on Health Care Costs in California

ABSTRACT: The Office of the Assistant Secretary for Planning and Evaluation (OASPE) is supporting a time series study of the relationships between competition in hospital markets and the prices of hospital care, hospital revenues and hospital costs. The project began in the late 1980s and was extended in 1994 to investigate how health maintenance organization (HMO) enrollment affects changes in Medicare payments on behalf of beneficiaries. The project will collect time series data on California Hospitals (cost reports supplemented by a small survey on selective contracting by the hospital) to investigate whether competition continues to depress hospital prices, revenues and costs. In addition, several smaller projects are underway to investigate whether hospital mergers result in increased prices and a series of investigations (individual and county level) to determine if HMO enrollment leads to a decline in Medicare costs when other appropriate variables are held constant. California is particularly important in this study, because it tends to be a trend-setting State.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: George Greenberg

PHONE NUMBER: 202-690-7794

PIC ID: 6889

PERFORMER ORGANIZATION: RAND, Santa Monica, CA

PROJECTED DATE OF COMPLETION: 9/30/99
 

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

ABSTRACT: The proposed project involves a collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA) to conduct an evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program. The objectives of the proposed evaluation are to: (1) assess whether PATH-funded expenditures are consistent with the authorizing legislation; and the adequacy of program controls; (2) develop a typology for better understanding the delivery of local PATH-funded services and assess whether the typology adequately characterizes meaningful differences in process-level variables, such as outreach and engagement activities with clients; (3) provide background information useful in interpreting data collected to meet the Government Performance and Results Act (GPRA) requirements; and to suggest measures that may be used in conjunction with the GPRA mandate; and (4) examine, where possible in site visit programs, existing administrative or client-level data to describe relevant outcomes for a sample (albeit non-representative) of PATH program participants.

AGENCY SPONSOR: Office of Health Policy

FEDERAL CONTACT: Kevin Hennessy

PHONE NUMBER: 202-690-7272

PIC ID: 7210

PERFORMER ORGANIZATION: Westat, Inc. Rockville, MD

PROJECTED DATE OF COMPLETION: 8/20/00

Human Services Policy

TITLE: Mandatory Review and Modification in TANF Cases

ABSTRACT: The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 made the review and modification of child support awards for those receiving welfare assistance optional, a change from prior law which required such reviews every three years. Given that States now have a policy choice, this project seeks to inform that choice by developing national estimates of the financial impacts of not reviewing child support awards for welfare recipient families on State child support collections. This project seeks to provide estimates of the financial impacts to the Federal and State governments (how such a discontinuance would impact child support offsets to cash assistance payments.) The financial impacts on families are to be estimated, paying particular attention to those who have left the welfare rolls.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Don Oellerich

PHONE NUMBER: 202-690-5877

PIC ID: 6749

PERFORMER ORGANIZATION: Institute for Research on Poverty, Madison WI

PROJECTED DATE OF COMPLETION: 11/10/98
 

TITLE: Child Health and Development Programs in the Context of Welfare Reform

ABSTRACT: This project will identify and present profiles of promising Federal, State and/or community-based health and human services programs believed to be enhancing the health and development of children in the context of welfare reform. Targeted activities include case management strategies, child assessment programs, links between pre-kindergarten and child care programs, school-readiness programs and the use of formal child care versus informal child care arrangements.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Martha Moorehouse

PHONE NUMBER: 202-690-6939

PIC ID: 6754

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

PROJECTED DATE OF COMPLETION: 06/30/99
 

TITLE: Diagnosed Health Conditions and Health Care Service Utilization of Children in Foster Care

ABSTRACT: This project will conduct a study of health care issues regarding children in foster care. The study will use State Medicaid Research Files (SMRF) for three States to examine the extent of diagnosed illness and disability among children in foster care and the receipt of health care by these children. SMRF data includes information on health care claims made through the Medicaid program as well as information regarding the diagnoses associated with those claims. The study will examine questions regarding: (1) the extent of diagnosed illness and disability among children in foster care as compared to other children on Medicaid; (2) receipt of health care services including acute care, care for chronic health conditions and preventive services; (3) receipt of health care services following transitions into and out of foster care; and (4) subgroups of children in foster care, such as adolescents' use of substance abuse treatment and/or pregnancy-related services.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: 202-690-5938

PIC ID: 7149

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

PROJECTED DATE OF COMPLETION: 2/20/99
 

TITLE: Domestic Violence and Welfare: An Early Assessment

ABSTRACT: This project will study early implementation of the Temporary Assistance for Needy Families (TANF) Family Violence Option and child support enforcement program responses, including the use of good cause waivers for battered women. Evidence suggests that some battered women seek employment and child support while others need specialized assistance in addressing partner abuse. To address domestic violence, States may have policies regarding screening and other forms of identification, assessment of a battered woman's needs, service provision, confidentiality, corroboration required, staffing arrangements, agreements with community resources and other considerations. The study will provide information about these policy issues, the status of program implementation and descriptions of useful models.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Gerald Silverman

PHONE NUMBER: 202-690-5654

PIC ID: 6724

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/1/00
 

TITLE: Wisconsin Data Project on Former AFDC Recipients

ABSTRACT: This project will provide early results on the economic and employment outcomes of women who leave the Aid to Families with Dependent Children (AFDC) rolls in Wisconsin, a State that has experienced a rapid decline in caseloads over the past ten years. While no data are available on women who leave the rolls under Temporary Assistance for Needy Families (TANF), this project will examine women as they make the transition from welfare to work in a State that began many TANF-like welfare reforms before the passage of Personal Responsibility and Work Opportunities Restoration Act (PRWORA). The analysis will be conducted using linked administrative data from the State of Wisconsin including: (1) AFDC data, Food Stamps data and Medicaid data from the Client Assistance for Re-Employment and Economic Support administrative database (CARES); (2) earnings data from the Unemployment Insurance records database (UI); and (3) income and family status data from the State tax record database. This project will not explain caseload decline; rather, it will describe the characteristics and outcomes of two groups of women who have left the AFDC program in Wisconsin. The first group will be composed of recipients who left AFDC during 1995, and the second group will be composed of recipients who left AFDC in 1990. The project will include: (1) a descriptive analysis of those who left the rolls, (2) a descriptive comparison of the economic status of women before and after leaving welfare, and (3) a detailed comparison of both the characteristics and outcomes of those who left AFDC in 1995 and 1990.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Susan Hauan

PHONE NUMBER: 202-690-8698

PIC ID: 6727

PERFORMER ORGANIZATION: Institute for Research on Poverty, Madison WI

PROJECTED DATE OF COMPLETION: 1/1/99
 

TITLE: Welfare Reform and Changing Program Participation Patterns in Four States

ABSTRACT: The purpose of this study is to understand how families' use of a variety of safety net programs changes over time as welfare reform is implemented. This will be an early look at how welfare waivers and the welfare reform law influenced families' program participation. Using administrative data in four States from 1994-1997, the study will examine a series of questions regarding whether families' program participation patterns change in response to program eligibility changes and policy shifts. It will examine the child and family outcomes in such areas as family self sufficiency, child living arrangements and child abuse and neglect reports. The study's unique contribution will be its effort to look at families' pathways across a series of safety net programs.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: 202-690-5938

PIC ID: 7148

PERFORMER ORGANIZATION: Chapin Hall Center for Children, University of Chicago, IL

PROJECTED DATE OF COMPLETION: 3/20/99
 

TITLE: Fixing to Change: The Role of One-Stop Job Centers Working with Welfare Recipients

ABSTRACT: One-stop job centers have become an important part of the welfare-to-work effort. These one-stop centers can take on many forms and provide a variety of services. This project looks at implementation issues for one-stop job centers serving welfare recipients. The study focuses on five cities, describing the range of program models used in the cities, and identifying those approaches that seem to be working well, as well as those issues posing challenges to one-stop centers. The study incorporates background information supplied by the one-stop centers, summary data on employer and welfare recipient characteristics, staffing information and responses from focus groups conducted among one-stop officials, one-stop staff, current recipients, previous recipients and employers.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 7152

PERFORMER ORGANIZATION: University of Washington, Fiscal Policy Center Seattle, WA

PROJECTED DATE OF COMPLETION: 3/20/99
 

TITLE: Paper Series on the Low Wage Labor Market

ABSTRACT: While research exists regarding the low-wage labor market, it is often not in a format that is useful to policymakers at the State and local levels. It is difficult and time-consuming to review the extensive volume of research papers that have been published in numerous sources. Furthermore, much of the research on the low-wage labor market is written from an academic perspective, focusing on statistical findings but not interpreting these findings in terms of policy implications. This project will synthesize important findings on major topics related to the low-wage labor market.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 6717

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/31/99
 

TITLE: Adolescent Decision Making Workshop

ABSTRACT: Efforts to reduce teen marijuana use, smoking and pregnancy are not new, but they are now being debated in a policy climate characterized by frustration at past attempts to address teen behavior and renewed efforts to take strong actions to reduce these behaviors. The role of decision making processes in these interventions is a topic that has generated a substantial core of new research. This project will convene a January workshop and prepare a summary report to: 1)identify the major lessons learned from the last decade of research on adolescent decision making, particularly as they bear on efforts to reduce behavior among adolescents; 2)discuss the results of research on efforts to intervene in adolescent behaviors; and 3)discuss the implications of this research for alternative approaches to reducing behavior among the Nation's youth, particularly in the areas of substance abuse and sexuality.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Elisa Koff

PHONE NUMBER: 202-690-5932

PIC ID: 6877

PERFORMER ORGANIZATION: National Academy of Sciences, Board on Children and Families Washington, D.C.

PROJECTED DATE OF COMPLETION: 3/31/99
 

TITLE: Labor Market Conditions, Job Search Strategies, and Welfare-to-Work Transitions

ABSTRACT: This study examines the effects of local low wage market conditions on the duration of welfare enrollment periods. While various studies have looked at the impact of employment conditions on welfare duration, employment conditions have often been measured using State-level indicators and/or indicators for the labor market as a whole. This study collects detailed information on the local labor market conditions for low-skilled workers and estimate the impact of such conditions, thus providing a more accurate picture of how labor market opportunities affect a recipient's ability to leave the welfare roles.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 6892

PERFORMER ORGANIZATION: University of North Carolina at Chapel Hill, School of Public Health, Chapel Hill, NC

PROJECTED DATE OF COMPLETION: 3/31/99
 

TITLE: Pregnancy Prevention Programs Targeting Boys and Young Men: Policy Information Dissemination Strategy

ABSTRACT: This project will develop a research and policy information strategy to inform regional, State, and local policy officials and community-based organizations serving children and youth of the program models, primarily directed at boys and young men, that can be implemented to help teenagers avoid premature sexual activity and unintended pregnancies. Project staff will: (1) review activities within the Department of Health and Human Services (HHS) and outside the Federal government to collect information about pregnancy prevention activities targeted at boys and young men; (2) meet with national, State, and community leaders to determine information needs; (3) develop information packets; and (4) test strategies to get information to State and community decision makers in a timely and usable format. This project is an integral part of the National Strategy to Prevent Teen Pregnancy and the Clinton Administration's Fatherhood Initiative, which promotes delaying fatherhood until a man is emotionally and financially ready, and encourages fathers to take a more active role in providing support and guidance to their children. It is also being undertaken in collaboration with the activities of the non-profit, non-partisan National Campaign to Prevent Teen Pregnancy.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Linda Mellgren

PHONE NUMBER: 202-690-6806

PIC ID: 6766

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 4/1/99
 

TITLE: Home Visitor Services Demonstration: Home Visiting for Teen Parents Required to Participate in JOBS

ABSTRACT: This demonstration tests the effectiveness of combining the Job Opportunities and Basic Skills Training (JOBS) program with weekly home visiting services provided by paraprofessionals to teen parents. The teens participating will be welfare recipients who are required to participate in education, training and employment-related activities through the JOBS program, including participation with the home visiting component. They will be first-time teen parents on public assistance and, based on past research, about one-half will be living on their own. The controlled experimental design evaluates whether the home visitors help participants increase participation in JOBS activities, improve parenting, experience fewer repeat pregnancies and births and increase use of preventive health care. A main focus of this project is obtaining appropriate health care, including preventive care, for teen parents and their children. Health outcomes such as immunizations for children will be measured.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6160

PERFORMER ORGANIZATION: University of Pennsylvania Philadelphia, PA

PROJECTED DATE OF COMPLETION: 4/30/99
 

TITLE: Making Ends Meet: How Mothers Manage When Their Welfare Grants Are Cut

ABSTRACT: This study will describe how family life adjusts to sanctions, through collection of in-depth qualitative data from mothers who are currently experiencing a cut in their welfare budget due to an imposed sanction. The data will include details on: (1) changes in financial resources, (2) how family members are affected, (3) where families turn for additional support, (4) additional reported and unreported employment activity, (5) mothers' perceptions about conflicts between work and family responsibilities, and (6) perceptions about the availability of affordable child care.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 6893

PERFORMER ORGANIZATION: Teachers College Columbia University, New York, NY

PROJECTED DATE OF COMPLETION: 8/1/99
 

TITLE: National Evaluation of Welfare-to-work Strategies

ABSTRACT: The Department of Health and Human Services is undertaking a study of the effectiveness of welfare-to-work programs. As part of the National Evaluation of Welfare-to-Work Strategies, the effects of two approaches to preparing welfare recipients for employment will be compared in three sites (Atlanta, Grand Rapids, and Riverside). In one approach, the human capital development approach, individuals are directed to avail themselves of education services and, to a lesser extent, occupational training before they seek work, under the theory that they will then be able to get better jobs and keep them longer. In the other approach, the labor force attachment approach, individuals are encouraged to gain quick entry into the labor market, even at low wages, under the theory that their work habits and skills will improve on the job and they will thereby be able to advance themselves. Note that the study does not focus on the effects of postsecondary education.

The evaluation uses a random assignment design in order to get reliable results. Sample members are being followed for five years from the time they entered the study. Comprehensive data on economic outcomes, including information on quarterly Unemployment Insurance-reported earnings and monthly TANF and Food Stamp payments is being collected. A broad range of data is being collected through surveys including data on educational attainment, family composition, housing status, wage progression, employment, child care, depression, and total family income. In addition, effects on the well-being of the children of the mothers in the study is being evaluated. Four types of child outcomes are being measured: cognitive development and academic achievement; safety and health; problem behavior and emotional well-being; and social development. Assessments in each of these area will be compared across research groups two and five years after the mothers entered the study sample.

The study is being conducted by the Manpower Demonstration Research Corporation. The project period is 1989-2000.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576

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

PROJECTED DATE OF COMPLETION: 6/30/00
 

TITLE: Child Outcome Study of the National Evaluation of Welfare-to-work Strategies: Two-Year Impacts

ABSTRACT: The Child Outcomes Study is a substudy of the National Evaluation of Welfare-to-Work Strategies (NEWWS), a longitudinal evaluation of a set of welfare-to-work strategies implemented under the Job Opportunities and Basic Skills Training (JOBS) Program as a part of the 1988 Family Support Act. In the three sites selected for the Child Outcomes Study--Atlanta, GA; Grand Rapids, MI; and Riverside, CA--the evaluation is examining the impacts of two types of welfare-to-work approaches. The "labor force attachment (LFA) approach" encourages a rapid transition into the labor force, whereas the "human capital development (HCD) approach" follows a long-term strategy of investing in recipients' basic education, with the aim of increasing qualifications for higher wage jobs. The Child Outcomes Study seeks to evaluate the impacts of each strategy on children's development and behavior in three domains: (1) cognitive development and academic achievement, (2) behavioral and emotional adjustment, and (3) physical health and safety. It will examine which maternal, family, and contextual characteristics help to explain these impacts on children. Background information is included on such topics as: (1) mothers' educational attainment, (2) current and previous employment, (3) welfare history, (4) household composition, (5) psychological well-being, and (6) welfare-related attitudes. This and other information (e.g., parenting, child care, father involvement) was collected at two and five years after random assignment from administrative records and in-home surveys. In addition, the five-year follow-up will survey teachers about children's school progress and behavior.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 6576.4
 

TITLE: The Role of Intermediaries in Welfare to Work

ABSTRACT: Moving millions of welfare recipients into the workforce is the cornerstone of the recently enacted welfare reform legislation, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. Efforts to employ welfare recipients under PRWORA will not be successful without the involvement and support of private sector employers. Across the country, businesses are getting involved to varying degrees in welfare-to-work, including more than 2,500 member companies of the Welfare to Work Partnership who have pledged their commitment to hire welfare recipients. Many of these businesses are in turn relying on intermediaries to help them hire welfare recipients. The role of intermediaries varies significantly, from providing referrals or assistance with filing for tax credits, to providing extensive pre and post-employment services. While the importance of intermediaries is growing rapidly, little is known about them. This study provides two types of information on intermediaries. The first is a broad description of the types of intermediaries currently participating in welfare-to-work efforts in several sites across the country. This information will be presented for a large number of intermediaries, but will be fairly general, focusing on the basic characteristics of the intermediaries and the types of services provided. The second part of the project will present in-depth information on implementation issues based on site visits to the communities of approximately ten of these intermediaries.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Kelleen Kaye

PHONE NUMBER: 202-401-6634

PIC ID: 7151

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

PROJECTED DATE OF COMPLETION: 10/20/99
 

TITLE: Integration of Welfare and Workforce Development Systems

ABSTRACT: This study will: (1) build on research which examined State-level coordination and integration, and (2) provide an examination, using a case study approach, of the ways in which welfare agencies are working with other organizations involved in workforce development at the local level. It will provide additional insights into possible implications of various approaches to integration for individuals who are receiving public cash assistance through the Temporary Assistance to Needy Families (TANF) program, and who must seek employment and move toward economic self-sufficiency in a time-limited welfare environment. In addition to providing current information for policymakers and program administrators regarding the challenges to coordination and integration and lessons learned by local officials, the study will help to identify issue areas requiring in-depth study.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Audrey Mirsky-Ashby

PHONE NUMBER: 202-401-6640

PIC ID: 7144

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 8/31/99
 

TITLE: Disaggregating the TANF Child-Only Caseload in Three States

ABSTRACT: The purpose of this study is to give the Department of Health and Human Services more detailed information about the make-up and trends of the Temporary Assistance for Needy Families (TANF) child-only population three States. Child-only cases are those in which benefits are paid only on behalf of minor children, and there are no adults in the household receiving assistance. In some cases the children are living with adults other than their parents. In such a case, the caretaker receives assistance on behalf of the child, but not for himself/herself. In other cases, a parent is in the household but is ineligible for benefits for one of several reasons, including: (1) receipt of SSI, (2) unqualified alien status, or (3) imposed sanctions. Such cases currently make up 21 percent of the TANF caseload, a proportion which has grown significantly in recent years. This study will use administrative data, case file reviews, and interviews with program and policy staff in three States to provide a better understanding of the issues regarding child-only TANF cases.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Laura Feig

PHONE NUMBER: 202-690-5938

PIC ID: 7188

PERFORMER ORGANIZATION: The Lewin Group Fairfax, VA

PROJECTED DATE OF COMPLETION: 12/20/99
 

TITLE: Review of Family Preservation and Family Reunification Programs

ABSTRACT: This mandated evaluation attempts to document the impacts of a variety of family preservation programs on children and families. For the purposes of this evaluation, family preservation programs include: (1) placement prevention services aimed at preventing children from entering substitute care; (2) broader family preservation services that may be less intensive and of longer duration than placement prevention services; and (3) reunification services to speed the return of children to their homes after entering substitute care. Measures of program success include: (1) prevention of placement into substitute care (for pre-placement services), (2) successful reunification (for reunification services), (3) reduction of the recurrence of child abuse and neglect, (4) improved child psychological well-being, (5) improved child behavior, and (6) improved family functioning. A rigorous random assignment design is being used to assess differences between families who receive family preservation services and those who do not. The study examines five sites with existing family preservation and reunification programs: Louisville and Lexington, Kentucky; Memphis, Tennessee; Philadelphia, Pennsylvania; New York City, New York; and eight counties in New Jersey. Field work is underway in all five sites. See PIC ID 5337 and 5337.1.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Matthew Stagner

PHONE NUMBER: 202-690-5653

PIC ID: 5337.2

PERFORMER ORGANIZATION: Westat, Inc. Rockville, MD

PROJECTED DATE OF COMPLETION: 12/31/99
 

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

ABSTRACT: This project will conduct research on the economic and health status of immigrants, their communities and the organizations serving them. The research will profile the status of immigrants with regard to health, employment and participation in programs administered by public and private agencies, with special attention to distinguishing categories of immigrants and drawing comparisons with the Native population. The project will also explore the impacts of welfare reform on immigrants and organizations, with special attention to both individual and institutional adaptations. Since the loss of food stamps appears to be the most far-reaching and permanent change affecting current legal immigrants, its impact on immigrants and their families will be a particular focus of the study. The project will supplement an examination of existing secondary data with intensive secondary data collection in Los Angeles and New York, the two cities that together account for one-fourth of the immigrant population. Primary data collection in the two cities has been designed to develop profiles of immigrants in these cities and the agencies serving them. This effort has several components, including: (1) interviews with 1,200 immigrant households in each city; (2) telephone interviews with most of the non-profit agencies providing services to immigrants; (3) in-depth interviews with 100 immigrants who lose Food Stamps and with additional immigrants who retain food stamps in each city; and (4) in-depth interviews with administrators and staff in public and private agencies.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: David Nielson

PHONE NUMBER: 202-401-6642

PIC ID: 6747

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 10/1/00
 

TITLE: Welfare Outcomes Panel Study

ABSTRACT: The Office of the Assistant Secretary for Planning and Evaluation (OASPE) is conducting a panel study with the National Academy of Sciences (NAS) to evaluate the design of current, proposed and future studies of the effects of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. This panel study will assist the department in: (1) reviewing existing research efforts on the effects of welfare reform; (2) examine the appropriate data sources, research designs and statistical methods for analyzing welfare reform outcomes; and (3) identify research gaps and data needs for the continued study of welfare reform. Specific topics to be covered by the panel of experts include: (1) the appropriate outcome measures needed to effectively evaluate the outcomes of welfare reform; (2) the appropriate population of study; (3) the design and usefulness of existing national-level surveys (e.g., the Survey of Program Dynamics and the Survey of Income and Program Participation); (4) data needs for monitoring State and sub-State variation in outcomes; (5) potential uses and limitations of administrative data; and (6) integration of survey and administrative data. Over the course of the study, the NAS expert panel will address the above mentioned tasks through workshops, quarterly panel meetings and the publication of both an interim report and a final report. The interim report will include early recommendations of the panel and the final report will document the comprehensive list of final recommendations to the department.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Susan Hauan

PHONE NUMBER: 202-690-8698

PIC ID: 7145

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

PROJECTED DATE OF COMPLETION: 3/2/01
 

TITLE: The National Evaluation of the Welfare to Work Grants Program

ABSTRACT: The Balanced Budget Act of 1997 authorized the Department of Labor to award $3 billion in welfare-to-work grants to States and local communities to promote job opportunities and employment preparation for the hardest-to-employ recipients of Temporary Assistance for Needy Families (TANF), and for non-custodial parents of children on TANF. This project will evaluate the effectiveness of welfare-to-work initiatives, including those undertaken by the welfare-to-work grantees and by American Indian and Alaska Native (AI/AN) tribal organizations. The Department of Health and Human Services (DHHS), in conjunction with the Departments of Labor and Housing and Urban Development, has designed an evaluation to address five key questions: (1) What are the types and packages of services provided by welfare-to-work grantees? (2) What are the net impacts of various welfare-to-work program approaches on employment and on family well-being? (3) What challenges are confronted as grantees implement and operate the programs? (4) Do the benefits of the programs outweigh the costs? and (5) How well do private industry councils and other non-TANF organizations meet the challenges of implementing the programs for the hard to employ? The evaluation study includes four main components: (1) a descriptive assessment of all welfare-to-work grantees based on mail surveys and site visits; (2) in-depth impact and cost-effectiveness study; (3) in-depth process and implementation study; and (4) a special process and implementation study focusing on tribal welfare and employment systems.

AGENCY SPONSOR: Office of Human Services Policy

FEDERAL CONTACT: Alana Landey

PHONE NUMBER: 202-401-6636

PIC ID: 7147

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

PROJECTED DATE OF COMPLETION: 10/03/02

Program Systems

TITLE: Community Programs: Performance Measurement and Program Innovation Series

ABSTRACT: The purpose of this project is to conduct two performance measurement and program innovation seminars to: (1) improve the understanding of performance measurement among DHHS and State and local staff members; (2) stay abreast of current performance developments at the State and local levels; and (3) increase knowledge of potentially promising State and local innovations. The seminars will also allow the DHHS staff to interact with State and local officials on a variety of performance measurement and program innovation questions. Two themes for the seminars are Local Innovative Programs and Performance Measurement for Community Programs. (See PIC ID 7209)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Margaret Price

PHONE NUMBER: 202-260-0382

PIC ID: 7209.1

PERFORMER ORGANIZATION: Howard University, School of Social Work, Washington D.C.

PROJECTED DATE OF COMPLETION: 5/20/99
 

TITLE: Research Consultation on Review of HHS Services Research, Demonstrations, and Evaluations Targeted to Hispanic/Latino Americans

ABSTRACT: The purpose of this project is to obtain consultation for a review of the various health services and social services research programs, demonstration grant programs, policy studies and evaluation projects targeted toward Hispanic/Latino Americans. Consultants with research expertise in Hispanic/Latino health and human service needs and delivery system issues will conduct a review to determine gaps in knowledge and make recommendations for future research priorities.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Paul Johnson, Ph.D.

PHONE NUMBER: 202-401-8277

PIC ID: 6698

PERFORMER ORGANIZATION: Interuniversity Program for Latino Research, Austin TX

PROJECTED DATE OF COMPLETION: 5/31/99
 

TITLE: State Telephone Survey Estimates for Evaluation and Monitoring

ABSTRACT: This project, funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and carried out by the National Center for Health Statistics (NCHS), develops and evaluates an integrated survey mechanism to collect broad State-based health and human services data. It also evaluates the quality and utility of State-level estimates developed from telephone surveys alone and in conjunction with, estimates obtained from the National Health Interview Survey (NHIS). A variety of health and human services data estimates for a selected number of States will be obtained through a telephone interview survey based on the NHIS questionnaire and selected supplemental data.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: James Scanlon

PHONE NUMBER: 202-690-7100

PIC ID: 6420

PERFORMER ORGANIZATION: National Center for Health Statistics, Hyattsville MD

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Estimating an Analytical Framework for Assessing Insurer Response to the Health Care Market

ABSTRACT: This project will result in a conceptual paper that establishes a framework for analyzing insurer behavior, responses to insurance market reforms and the likely effect of insurer behavior on the availability and cost of insurance. The objectives are to: (1) identify potential data sources and data needs to facilitate empirical work based on identified important characteristics; and (2) provide the Department of Health and Human Services (HHS) staff with a better understanding of the operation of insurance markets, including how insurers make business decisions based on the demand for insurance from employers and individuals. The paper will survey existing literature on insurer behavior and decision making, develop an analytical framework which can be applied to a variety of questions, and discuss potential data sources that could be used in conjunction with the analytical framework to assess insurer response to change. The focus of the paper will be on insurer product line decisions.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Dale Hitchcock

PHONE NUMBER: 202-690-5882

PIC ID: 6429

PERFORMER ORGANIZATION: Urban Institute Washington, D.C.

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: State and Regional Programs: Performance Measurement and Program Innovation Series

ABSTRACT: The purpose of this project is to plan and conduct, in collaboration with the Department of Health and Human Services (DHHS), four performance measurement and program innovation seminars, which will help the department to: (1) improve understanding of performance measurement among the DHHS and State and local staff members; (2) stay abreast of current performance developments at the State and local levels; and (3) increase knowledge of potentially promising State and local innovations. The seminars will also allow the DHHS staff to interact with State and local officials on a variety of performance measurement and program innovation questions. Themes for the seminars are as follows: (1) Welfare Reform and the Homeless; (2) Regionalism; (3) Performance Measurement and Evaluation; and (4) State Innovative Programs. (See PIC ID 7209.1)

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: Margaret Price

PHONE NUMBER: 202-260-0382

PIC ID: 7209

PERFORMER ORGANIZATION: South Carolina State University, Orangeburg SC

PROJECTED DATE OF COMPLETION: 9/30/99
 

TITLE: Mississippi Community Works HELP DESK - (MS-CWHD)

ABSTRACT: The DELTA project will establish an interactive, multi-sectoral Help Desk in Jackson, Mississippi, to assist and support the EZ/EC/Champion Communities in furthering their strategic plans. The Help Desk will provide access to, and technical assistance with, tested strategies and model programs, best practices and lessons learned related to a variety of economic and social development issues. It will also provide information about, and access to, external resources, both funding and programmatic, to serve as partners in the implementation of development initiatives planned by these communities. An evaluation will be conducted during the course of the Help Desk project to include site visits, client surveys and telephone interviews, in order to determine impact and track progress on established outcomes for these communities. An interim evaluation report is due to be completed in October 1999.

AGENCY SPONSOR: Office of Program Systems

FEDERAL CONTACT: James K. Gatz

PHONE NUMBER: 202-260-0397

PIC ID: 7213

PERFORMER ORGANIZATION: Delta/Tides Center, Bethesda, MD

PROJECTED DATE OF COMPLETION: 9/30/99