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.

Through the departmental evaluation planning process, ASPE has the capacity to identify crosscutting program or policy issues of particular concern to the Secretary and specific program and policy areas not covered by the HHS Agency evaluation plans. In these instances, ASPE initiates evaluations or collaborates with the agencies to conduct evaluations or policy assessments. For example, in recent years, ASPE has initiated projects to develop cost estimates for health financing issues in general, and specifically for the Medicare and Medicaid programs; assess the effects of managed care expansion on public health infrastructure; examine welfare-to-work approaches; test alternative methods of long-term care service delivery; and evaluate alternative services for children at risk of harm from drug abuse, crime, child abuse, and other pathologies.

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.

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.

Fiscal Year 2000 Evaluation Reports Office of Disability, Aging, and Long-Term Care Policy A Survey of Employers Offering Group Long-Term Care Insurance to Their Employees Evaluation of the District of Columbia's Demonstration Program - "Managed Care System for Disabled and Special Needs Children" In-Home Supportive Services for the Elderly and Disabled: A Comparison of Client-Directed and Professional Models of Service Delivery National Study of Assisted Living for the Frail Elderly Post-Acute Care Issues for Medicare: Interviews with Provider and Consumer Groups, and Researchers and Policy Analysts State Welfare-to-Work Policies for People with Disabilities: Implementation Challenges and Considerations Synthesis and Analysis of Medicare Hospice Benefits Synthesis and Analysis of Medicare Post-Acute Care Benefits and Alternatives The Use of Nursing Home and Assisted Living Facilities Among Privately Insured and Non-Privately Insured Disabled Elders Understanding Medicaid Home and Community Services: A Primer Office of Health Policy Access and Utilization of New Antidepressant and Antipsychotic Medications An Inventory of Federal HIV-Related Databases Consumer Protection in Private Health Insurance: The Role of Consumer Complaints Consumer Protection in Private Insurance: State Implementation and Enforcement Experience Employer Decision Making Regarding Health Insurance Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices Office of Human Services Policy Assessment of Major Data Sets for Analysis of Hispanic and Asian or Pacific Islander Subgroups and Native Americans Coordination and Integration of Welfare and Workforce Development Systems Dynamics of Children's Movement Among the AFDC, Medicaid, and Foster Care Programs Prior to Welfare Reform: 1995-1996 Evaluating Alternative Welfare-to-Work Approaches: Two-Year Impacts for Eleven Programs Evaluation of the New York City Homerebuilders Demonstration Health Conditions Utilization and Expenditures of Children in Foster Care Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study - Summary Report Implementation, Participation Patterns, costs, and Two-Year Impacts of the Detroit Welfare-to-Work Program Indicators of Welfare Dependence: Annual Report to Congress Oklahoma City's ET&E Program: Two-Year Implementation, Participation, Cost, and Impact Findings Study of Welfare-to-Work Programs Serving Non-Custodial Parents The Low-Wage Labor Market: Challenges and Opportunities for Economic Self-Sufficiency The Role of Intermediaries in Linking TANF Recipients with Jobs: Final Report Trends in the Well-Being of America's Children & Youth: 1999 Welfare Leavers and Medicaid Dynamics: Five States in 1995 What Works Best for Whom: Impacts of 20 Welfare-to-Work Programs by Subgroup Office of Program Systems Community-Level Indicators for Understanding Health and Human Services Issues Food Safety Strategic Elements: Evaluation Synthesis Findings and Research Needs: Final Report

Office of Disability, Aging, and Long-Term Care Policy

A Survey of Employers Offering Group Long-Term Care Insurance to Their Employees

This final report provides information about current and best practices in the employer group LTC insurance market that can inform federal policy makers and employers in deciding how to construct a group LTC insurance offering. Current practices were collected from a random and select sample of employers and best practices were compiled from the select sample. The random sample survey generated a response rate of 58 percent. The total sample included 93 employers. The principle findings indicate the employer market provides greater access to coverage than in the individual market. A majority of employers offered less restrictive underwriting or even guarantee issue policies (i.e., did not require health information) during initial offerings to active, full-time employees. A majority offered coverage to at least one group in addition to full-time active employees (i.e., parents/inlaws, spouses, and retired employees), potentially extending the benefit well beyond the size of the employee population. Most employers usually limited the number of benefit choices. The majority offered two to four benefit amount options and a set package rather than allowing the employee to select every option separately. Nearly all employers used a single LTC insurer. Despite this, however, data from a random sample of employers suggest that the benefit features of employer group plans generally resemble the most common individually purchased policies.

FEDERAL CONTACT: John Cutler, 202-690-6443

PIC ID: 6718.1

PERFORMER: The Lewin Group, Falls Church, VA

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

This evaluation focuses on an assessment of the District of Columbia's 1115 waiver demonstration to integrate acute and long-term care services for SSI (Supplemental Security Income) eligible children with disabilities in a single capitated payment system, called Health Services for Children with Special Needs (HSCSN). The evaluation shows that the capitated model tested in the demonstration is not viable. The main contributing factor is the insufficient size of the population of special needs children in the District to protect a plan against severe financial losses. Despite a proposal by the District's Medicaid Program to add stop-loss protection, HSCSN officials decided to not enter the waiver for re-competition. The impact of the demonstration on participants was mostly positive: better access to services and more satisfaction with services. Caregivers reported heavier use of medical services, particularly preventive services. They also felt less positive about the current or future health of the children being served. The policy implications of the evaluation indicated that coordinated and integrated care models still offer a valuable service despite the lack of success of the demonstration. In addition, policy makers need to consider alternative models of financing care management, such as primary care case management models that involve the child's primary physician in the coordination and integration.

FEDERAL CONTACT: Gavin Kennedy, 202-690-6443

PIC ID: 7361.1

PERFORMER: Abt Associates Inc., Cambridge, MA

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In-Home Supportive Services for the Elderly and Disabled: A Comparison of Client-Directed and Professional Models of Service Delivery

The Office of the Assistant Secretary for Planning and Evaluation conducted a survey of personal assistance services clients, workers, and case managers to compare measures of quality of care, quality of life, client satisfaction, and worker satisfaction between a consumer-directed model (CDM) and a professionally directed model (PDM) of in-home supportive services delivery. The study also compared the outcomes associated with the use of family, friends, and neighbors as independent providers, as compared to services provided by aides previously unknown to the client. The study was conducted in the context of California's In-Home Supportive Services Program with the assistance of state officials. Findings regarding both models were generally positive; however, the study's principal finding is that clients in the CDM had more desirable outcomes than those in the PDM within three broadly defined areas: satisfaction with services, empowerment, and quality of life. Clients who hired family members as paid workers had more desirable outcomes on some measures in the areas of safety, satisfaction with services, and empowerment. Specifically, such clients reported a greater sense of security, having more choice about how their aides performed various tasks, a stronger preference for directing their aides, and a closer rapport with them.

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 6173

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

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National Study of Assisted Living for the Frail Elderly

Research Triangle Institute (RTI) conducted the Discharged Residents Survey for the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services through a subcontract with Myers Research Institute (MRI). The survey was administered during June and July 1999. This report documents the data collection activities undertaken by RTI for the survey. It describes procedures used to identify and local discharged residents, train staff, conduct and monitor data collection, and prepare the data file. It also includes a report on response rates and non-response weight adjustment calculations. See web site http:aspe.hhs.gov/daltcp/reports.htm.

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 4719.7

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Post-Acute Care Issues for Medicare: Interviews with Provider and Consumer Groups, and Researchers and Policy Analysts

The 1997 Balanced Budget Act (BBA) was aimed at curbing the remarkably rapid rate of spending for post-acute care. This research was undertaken to provide an "early indication" qualitative study of the potential effects of the BBA provisions and other related issues. This study collected information through interviews with individuals knowledgeable about Medicare post-acute care issues. They included representatives of post-acute care providers (including discharge planners) and their organizations, quality of care experts, consumer groups, researchers, and health policy analysts. While this study was in progress, Congress enacted the 1999 Balanced Budget refinement Act (BBRA) which increased Medicare payments for post-acute care providers. These Acts have created some changes, however many important post-acute care policy issues remain unresolved, such as the goal of the Medicare home health benefit. Ambivalence about whether individuals requiring extended personal assistance with skilled supervision (who also tend to have high per-person costs) should be covered has resulted in the use of reimbursement policy strategies, such as the per-beneficiary limit in the HHA IPS to contain Medicare costs of those recipients. Also, providers, consumer representatives, and researchers expressed concern about access problems faced by individuals with particularly high service needs, such as Skilled Nursing Facilities (SNF) patients with high non-therapy ancillary costs, rehabilitation patients who exceed the Part B therapy caps, and home health patients whose costs exceed the per beneficiary limits.

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7365.2

PERFORMER: Urban Institute, Washington, DC

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State Welfare-to-Work Policies for People with Disabilities: Implementation Challenges and Considerations

This report focuses on State policy responses to two key aspects of the recent Federal welfare reform law that hold important ramifications for recipients with disabilities and caregivers--work participation and time limit requirements--and State flexibility to exempt recipients from one or both of these requirements. Findings are based on two primary data sources--written policy documents and conversations with State welfare agency staff in each of the 50 States and the District of Columbia--and reflect State policies at a single point in time (April-May 1998). Although this point in time review provides essential baseline information, it is important to note that States are likely to revisit these policies and may use the increased flexibility provided under Federal welfare reform to change policies over time. [Executive Summary and Full Report available at: http://aspe.hhs.gov/daltcp/reports.htm] The full report is in the Portable Document Format (PDF). You will need a copy of the Acrobat Reader in order to view it.]

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 4917.3

PERFORMER: The Lewin Group, Falls Church, VA

Synthesis and Analysis of Medicare Hospice Benefits

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 hospice services. However, a larger study is needed to examine key hospice trends nationally and in selected States. This report synthesizes the literature related to the Medicare hospice benefit and summarizes discussions with key informants about nursing home residents who elect this benefit. In addition, this report analyzes Medicare utilization and expenditures for beneficiaries electing the hospice benefit, analyzes and compares outcomes derived from the nursing home MDS data for decedents electing the hospice benefit with decedents not electing this benefit, and analyzes hospice coverage policy and utilization data from private insurers. This and other Medicare hospice benefit reports can be found at: http://aspe.hhs.gov/daltcp/projects.htm.

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7154

PERFORMER: Urban Institute, Washington, DC

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Synthesis and Analysis of Medicare Post-Acute Care Benefits and Alternatives

This project synthesized what is known about : (a) current coverage and payment policies for post-acute care (PAC); (b) predictors of PAC use and nonuse and of the type, amount, and duration of PAC use; (c) PAC utilization including characteristics of PAC patients, patterns of PAC utilization, and geographic distribution of providers; (d) Medicare expenditures during the course of PAC episodes; (e) outcomes of patients in and across PAC settings; and (f) State policies designed to maximize Medicare PAC coverage. Two reports have been reproduced. The first report, Medicare's Post-Acute Care Benefits: Background, Trends, and Issues to be Faced" provides background on post-acute care expenditures and utilization, and Medicare policy changes that have contributed to these trends; the supply and changes in distribution of post-acute care providers; beneficiary, provider, and market characteristics associated with differential post-acute care provider use; and issues that need to be addressed regarding Medicare post-acute care services. [see PIC ID#7365.1] The second report, "Interviews with Provider and Consumer Groups, and Researchers and Policy Analysts" summarizes discussions with key stakeholders regarding issues with Medicare's skilled nursing facility, home health, rehabilitation and long-term care hospital benefits. Many comments were raised regarding the impact of the changes enacted in the Balanced Budget Act on these benefits. [see PIC ID# 7365.2]

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7365

PERFORMER: Urban Institute, Washington, DC

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The Use of Nursing Home and Assisted Living Facilities Among Privately Insured and Non-Privately Insured Disabled Elders

The purpose of this study was to collect detailed information on the experiences of long-term care policy holders who have filed insurance claims to receive home care benefits and how their formal and informal service use compares to a comparable population of elderly persons without private insurance. Primary data collection involved face-to-face interviews with approximately 1,000 persons (500 disabled insurance claimants and 500 next-of-kin of those claimants) to collect information on functional and medical characteristics of claimants as well as formal and informal services use. The sample of claimants was drawn from the files of insurance companies that account for the majority of private long-term care policies now in force. Four reports were prepared that contributed to this study: (1) The Use of Nursing Home and Assisted Living Facilities Among Privately Insured and Non-Privately Insured Disabled Elders; (2) Informal Caregivers of Disabled Elders with Long-Term Care Insurance; (3) Multivariate Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community; (4) A Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community.

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 6399

PERFORMER: Lifeplans, Waltham MA

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Understanding Medicaid Home and Community Services: A Primer

Medicaid now offers so many options for providing home and community services that they can be confusing for policymakers, state officials, advocates, and consumers alike. To add to the confusion, the extensive flexibility states have to combine these options has resulted in 50 different state Medicaid programs. This Primer is designed to encourage use of the Medicaid program in a manner that minimizes reliance on institutions and maximizes community integration in a cost-effective manner. It is intended for policymakers and others who wish to understand how Medicaid can be used--and is being used--to expand access to a broad range of home and community services and supports, and to promote consumer choice and control. In addition to comprehensive explanations of program features, states can implement to achieve these goals, the Primer presents examples of state programs that have taken advantage of Medicaid's flexibility to expand home and community services for people of all ages with disabilities. Each chapter of the Primer provides an annotated bibliography, with full information on how to obtain each publication. The next four chapters lay out and discuss the basic elements involved in Medicaid's financial and functional eligibility criteria and service coverage alternatives. The last four chapters focus on key policy goals in the provision of home and community services and supports. It concludes with a series of Appendices that provide additional information about the Medicaid program.

FEDERAL CONTACT: Gavin Kennedy, 202-690-6443

PIC ID: 7162

PERFORMER: George Washington University Medical Center, Center for

Health

Outcomes Improvement Research, Washington, DC

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Office of Health Policy

Access and Utilization of New Antidepressant and Antipsychotic Medications

This study was commissioned to identify, document, and assess the factors that affect access to and utilization of new generation antidepressant and antipsychotic medications. It is designed to assist the U.S. Department of Health and Human Services evaluate existing and proposed policies in this area by developing important insights and knowledge concerning the complex processes related to access, utilization, and coverage of newer psychotropic mediations from a variety of perspectives. This study is also designed to identify clinical and health policy issues where further research is needed. The analysis was developed based on published literature, pharmaceutical claims, and primary research with stakeholders. It focuses on antidepressants and antipsychotics as general classes of pharmacotherapy, with emphasis on agents introduced to the US market after 1988. The report's findings are organized into categories, guided by the original principal questions. For example, in terms of access to newer antidepressant and antipsychotic medications, the pharmaceutical benefits are commonly available for psychotherapeutic agents; Limits on prescription coverage and cost sharing requirements apply equally to all classes of medications. In terms of the cost-effectiveness of newer antidepressant and antipsychotic medications, the findings indicate the published cost-effectiveness literature shows no clear differences in total treatment costs associated with the use of different antidepressant agents, although individual studies have claimed that one particular agent is superior to another.

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7193

PERFORMER: The Lewin Group, Fairfax, VA

An Inventory of Federal HIV-Related Databases

Many federal agencies maintain major HIV-related databases. They contain a range of potentially useful information, including epidemiologic and patient-level data as well as health resource utilization, disability benefits, and insurance claims information. However, there is no single inventory that fully describes their study design, data collection methodology, and common and unique data elements. This report is designed to help address this information gap. The resulting resource can be used to catalyze collaborations among government agencies, philanthropies, industry, and academia to increase the understanding of HIV disease and its impact on the health care delivery system. The inventory summarizes the types of HIV-related research supported by DHHS, SSA, and the VA. It describes the major issues addressed by the various studies reviewed in the inventory, their study designs, and their research applications. The inventory includes primarily major studies and databases. The report also identifies selected policy, clinical, evaluation, or other questions that might be the focus of new studies or database development.

FEDERAL CONTACT: Leslie Hardy, 202-690-7858

PIC ID: 7146

PERFORMER: George Washington University Medical Center, Washington, DC

Consumer Protection in Private Health Insurance: The Role of Consumer Complaints

This study provides background lessons for federal regulators who may be required to implement federal patient protection legislation by focusing on consumer complaints about private health insurance in a sample of selected states and major employers. Specifically, the study identified the agencies responsible for health insurance complaints and the availability of complaints data, to review the status of complaints "report cards" and to analyze complaints data as a tool in understanding the implementation of patient protections. A sample of six states (California, Maryland, New York, Oregon, Texas and Vermont) was selected to represent a range of jurisdictional responsibility for health insurance complaints and the existence of ombudsman programs, together with states representing best practice in publication of health insurance complaints report cards. The principal findings include: 1) Jurisdiction over private health insurance complaints varies across states, with responsibility for indemnity health insurance, managed care and quality complaints often split within or between state agencies. 2) There is a wide spectrum in the type of consumer assistance or ombudsman programs available to people with health insurance complaints. 3) There is a hierarchy of complaints handling, with state regulators seeing only the tip of the iceberg in consumer complaints. Across three states for which data were available, the volume of grievances received directly by plans about about seven to eight times greater than the volume of complaints receiped by state regulators.

FEDERAL CONTACT: Bernadette Fernandez, 202-401-8398

PIC ID: 7339

PERFORMER: Health Systems Research, Inc., Washington, DC

Consumer Protection in Private Insurance: State Implementation and Enforcement Experience

The Office of the Secretary for Planning and Evaluation (OASPE) requested this study of state implementation of consumer protections (access to emergency services, network adequacy, continuity of care, standing referral, and access to out-of-network specialists) specifically for the most seriously and chronically ill patients. These protections are sought by people with AIDS, cancer, diabetes, heart disease, and other serious or chronic conditions. This report discusses the experience of four states (Colorado, Maryland, Minnesota, and New York) that have enacted these forms of consumer protection. These states were selected because they had several years of experience implementing most, if not all, of these protections. The report provides a summary of 10 findings, with recommendations for policy direction. The findings from the states indicate those experiences provide a range of approaches that federal regulators can consider when deciding how to implement consumer protection laws. The states also provide potential solutions to implementation challenges that have worked and insights into practices federal regulators may want to avoid because they have not worked well at the state level.

FEDERAL CONTACT: Sarah Shoenecker, 202-401-0882

PIC ID: 7344

PERFORMER: The Lewin Group, Falls Church, VA

Employer Decision Making Regarding Health Insurance

This study provides background lessons for federal regulators who may be required to implement federal patient protection legislation by focusing on consumer complaints about private health insurance in a sample of six states (California, Maryland, New York, Oregon, Texas and Vermont) and major employers. The study sought to identify the agencies responsible for health insurance complaints and the availability of complaints data, to review the status of complaints "report cards" and to analyze complaints data as a tool in understanding the implementation of patient protections. The principal findings are: 1) Jurisdiction over private health insurance complaints varies across states, with responsibility often split within or between state agencies. The lead role is usually taken by state insurance regulatory agencies. 2) There is also a wide spectrum in the type of consumer assistance available to people with health insurance complaints. 3) There is no consistency in grievance data collection requirements across the states. 4) There is a hierarchy of complaints handling, with state regulators seeing only the tip of the iceberg in consumer complaints. Across three states for which data were available, the volume of grievances received directly by plans was about seven to eight times greater than the volume of complaints received by state insurance regulatory agencies. The report does not recommend pursing uniform models of health insurance complaints management, but does recommend that strategies be developed which clarify responsibility, facilitate communication and enhance the knowledge and experience of regulators in complaints management.

FEDERAL CONTACT: Stephen Finan, 202-690-7387

PIC ID: 7338

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

Report to the President: Prescription Drug Coverage, Spending, Utilization, and Prices

In 1999 the President directed the Secretary of Health and Human Services to study prescription drug costs and trends for Medicare beneficiaries. Specifically, he asked that they investigate: (1) price differences for the most commonly used drugs for people with and without coverage; (2) drug spending by people of various ages, as a percentage of income and of total health spending; and (3) trends in drug expenditures by people of different ages, as a percentage of income and of total health spending. This study represents the work of individuals and agencies throughout HHS. Key findings are: (1) Individuals without drug coverage pay a higher price at the retail pharmacy than the total price paid on behalf of those with drug coverage. The differences held up when examining the Medicare and non-Medicare populations. (2) Cash customers pay more for a given drug than those with third party payments at the point of sale. In fact, the typical cash customer paid nearly 15 percent more than the customer with third party coverage. This study presents a detailed examination of multiple factors relating to coverage, utilization, and spending for prescription drugs, particularly by the Medicare population.

FEDERAL CONTACT: Jack Hoadley, 202-401-8401

PIC ID: 7506

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation,

Office of Income Security Policy, Washington, DC

Office of Human Services Policy

Assessment of Major Data Sets for Analysis of Hispanic and Asian or Pacific Islander Subgroups and Native Americans

This is the first of two reports to assess the capability of a number of federal surveys: (1) to provide data on the major subgroups of Hispanic, Asian or Pacific Islanders (API) and on American Indian or Alaska Natives, to analyze the health, education status, and social and economic well being of these groups; (to identify barriers to developing such data; and (3) to identify options for improving the capacity to obtain statistically reliable data about these populations. The report contains information on the applicable sample sizes, and an inventory of existing Federal databases for most of the major demographic, social, economic and health related surveys carried out by or for U.S. Government agencies. Most of the databases consist of surveys that are carried out annually, or at other regular intervals, so that they provide reasonably current statistical information. Two important sources of information were also included: the decennial census and the National Vital Statistics System. the report notes that it is a general reference for a potential audience of analysts and policy makers seeking information on the possible uses of these databases as a source of data on race/ethnic groups of interest, rather than as technical handbooks.

FEDERAL CONTACT: Canta Pian, 202-690-7149

PIC ID: 7199

PERFORMER: Westat, Inc., Rockville MD

Coordination and Integration of Welfare and Workforce Development Systems

This study provides a snapshot of welfare and workforce system coordination in a limited number of sites at a point in time where welfare programs are work-focused and workforce development systems are reorganizing to provide one-stop services to a broad population. As a result, there is an increased interest in coordination between welfare and workforce development agencies and a greater awareness in each other's programs and services. States and local sites selected for this study represented a range of organizational structures, historical experiences, and economic and demographic variables. Cities in these six states were visited- Missouri, Ohio, Oregon, Pennsylvania, Rhode Island and South Carolina. No information collected from clients. The description of client flow and service receipt are developed from discussions with service providers and administrators. There were several key findings: (1) past relationships in implementing previous welfare-to-work programs were important factors in current coordination models and activities. (2) Coordination can occur under a variety of organizational approaches. Different levels of coordination may be appropriate in different communities; (3) Service systems need to fit local conditions. Planners should consider issues of scale--a one-stop with all services in one location works in Dayton, but may not work in a larger city. In some localities, a decentralized, neighborhood-based structure may be more effective.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7144

PERFORMER: Urban Institute, Washington, DC

Dynamics of Children's Movement Among the AFDC, Medicaid, and Foster Care Programs Prior to Welfare Reform: 1995-1996

This report describes pre-welfare reform behavior in order to understand the caseload dynamics around major social programs and provides a baseline for future follow-up. The report traces patterns of children's service use in three programs affected by welfare reform: TANF, Medicaid, and foster care. The data span 1995-1996, the years immediately prior to welfare reform, which was implemented first in 1997. The key findings are: (1) In each of the states less than 3% of children who entered during the study period moved to foster care. However, while this is a small percentage, the majority (60%) of entries to foster care in each of the states were from AFDC and therefore, the small flow from AFDC accounts for a large flow into foster care. (2) Infants are nearly three times as likely to enter foster care from an AFDC spell. This suggests that for young children, there may be a link between the stress or crisis that propels families onto the AFDC rolls and a child's entry to foster care. (3) The numbers participating in AFDC and Medicaid prior to foster care entry suggests that poverty, or perhaps participation in the welfare program, plays an important role in the entry of children into foster care. (4) There was considerable variation in the three states as to patterns of transition of children from AFDC to Medicaid, which suggests that it is unlikely that there will be many similarities in program utilization across the states given the differences. Each state will differ based on its program practices and policies, economy, demographic characteristics and other factors. Each state will have to tailor its plans accordingly.

FEDERAL CONTACT: Laura Radel, 202-690-5938

PIC ID: 7511

PERFORMER: American Institutes for Research, Washington, DC

Evaluating Alternative Welfare-to-Work Approaches: Two-Year Impacts for Eleven Programs

This report analyzes the effectiveness of 11 mandatory welfare-to-work (WtW) programs operated in seven locales: Atlanta, GA, Columbus, OH, Detroit and Grand Rapids, MI, Oklahoma City, OK, Portland, OR, and Riverside, CA. Individuals in these programs did not face a time limit on eligibility for assistance since all the programs studies were pre-TANF. The 11 programs differed in the messages that they sent to welfare recipients about how best to obtain and retain employment. Some stressed getting a job quickly, and others stressed initial investments in basic education or training. Most of the programs imposed a mandatory participation requirement, with several using financial sanctions (i.e., welfare grant reductions) extensively to enforce this mandate. Sample members are being followed for five years from the time they entered the study. This report focuses on adult outcomes, although some information on children's outcomes is provided. The report cites a number of findings, including 1) All programs reduced welfare dependency to some degree; (2) Most programs increased sample members' reliance on earnings, as opposed to welfare, but their families' net incomes were largely unchanged; and, (3) All programs, regardless of their approach, increased participation in activities designed to promote employment during the two-year follow-up period.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.3

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Evaluation of the New York City Homerebuilders Demonstration

In 1993, the New York State Department of Social Services (DSS) and the New York City Child Welfare Administration began testing a new approach to the financing of services to foster children and their birth families based on concepts from managed care. Based on the premise that paying for each day a child is in foster care (per diem payment) is a disincentive to return children home, the demonstration tested an alternativve method of agency reimbursement. Instead of paying for each day in care, agencies were paid a flat amount of money or capitation payments for an identified group of children in foster care. The funds were to be used to serve the children for three years. A projection of care day utilization was calculated based on each agency's historic care day usage. A strategy was agreed upon to pay agencies a percentage of the three-year capitation each year. Funding was front loaded in the first year to encourage early discharge. It was hypothesized that the change in the payment system would achieve earlier permanency for children through intensified discharge planning and aftercare services. Funds could be used for foster care costs and any services the agencies believed would achieve earlier permanency. The initiative included six agencies, using an experimental design involving comparison groups in five of the agencies, with random assignment in three. The new financing mechanism was to be used in the experimental groups while services to the control group were financed under the old system. The purpose of the evaluation was to document the implementation of the program, the services provided, and the outcomes of those services. (See PIC ID 5337 and 5337.1.)

FEDERAL CONTACT: Matthew Stagner, 202-690-5653

PIC ID: 5337.2

PERFORMER: Westat, Inc., Rockville MD

Health Conditions Utilization and Expenditures of Children in Foster Care

This study was funded by the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services to inform policymakers of the health care experience of children in foster care who are enrolled in Medicaid, including their demographic characteristics, diagnosed health conditions, and patterns of health care utilization and expenditures. The data source for the study is the State Medicaid Research Files (SMRF) from three states (California, Florida and Pennsylvania) of children under age 19 who received adoption assistance, AFDC, or SSI benefits. The results indicate: (1) Children in foster care accounted for a disproportionate share of Medicaid expenditures (1.1 and 3.3 percent enrolled; 3.6 to 7.8 percent of Medicaid expenditures); (2) Children in foster care had less continuous Medicaid coverage than children receiving SSI benefits and those in families receiving adoption assistance; (3) Children in foster care were more likely than other groups of Medicaid children to have a mental health or substance abuse condition. They had a higher likelihood of comorbidities than AFDC and adoption assistance children, but were less likely than SSI children to have multiple diagnoses; (4) In general, foster care children in California were less likely to receive health care services than those in the other two states. (5) In general, expenditures were highest for the SSI population and second-highest for foster care children.

FEDERAL CONTACT: Laura Radel, 202-690-5938

PIC ID: 7149

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

Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study

This component of the evaluation focuses in depth on children's development and well-being for a sample of families with young (preschool age) children at the start of the evaluation drawn from three of the NEWWS sites: Atlanta, Grand Rapids, and Riverside. The report asks whether young children's development and well-being were affected when their mothers were assigned to participate in Welfare-to- Work (WtW) programs implemented as part of the Job Opportunities and Basic Skills Training (JOBS) Program. This program required mothers of young children as young as age three (or age one, at state option) to participate in WtW activities. The findings indicate that the WtW programs did have significant impacts on children's developmental outcomes, but these impacts were not widespread and were generally small. When impacts did occur, they were favorable in the area of the children's cognitive development and academic achievement, unfavorable in the area of the children's health and safety, and mixed in the area of behavioral and emotional adjustment. Looking at subgroups of families, there was a pattern of favorable impacts for children from higher-risk families assigned to human capital development programs or to the Atlanta labor force attachment program. Yet, at the same time, there was a concentration of unfavorable, and policy relevant, impacts for children from lower-risk families in three of the programs studied.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.5

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Impacts on Young Children and Their Families Two Years After Enrollment: Findings from the Child Outcomes Study – Summary Report

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. This study focuses in depth on children's development and well-being for a sample of families with young (preschool age) children at the start of the evaluation, drawn from three of the evaluation's seven research sites. The results indicate that the welfare-to-work programs implemented as part of the JOBS Program did have significant impacts on children's developmental outcomes, but these impacts were not widespread and were generally small. When impacts did occurs, they were favorable in the area of the children's cognitive development and academic achievement, unfavorable in the area of the children's health and safety, and mixed in the area of behavioral and emotional adjustment.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 6576.4

PERFORMER: Child Trends, Inc., Washington, DC

Implementation, Participation Patterns, costs, and Two-Year Impacts of the Detroit Welfare-to-Work Program

This report examines the welfare-to-work programs operated in two of Detroit's welfare districts: and Hamtramck. It describes Michigan Opportunity and Skills Training (MOST), an education-focused program that was in place in these two offices in 1992 at the start of the evaluation, and the transition to Work First, an employment-focused program emphasizing job search services that was implemented in October 1994 and is one component of Michigan's current welfare reform program. This report analyzes data on participation, AFDC and Food Stamp receipt, employment, and earnings. The results are based on a random assignment research design, in which welfare recipients were randomly assigned to one of two groups: the program group, whose members were assigned initially to MOST and were subject to MOST participation requirements; and the control group, whose members were not subject to any participation requirements for three years, but who could seek out, on their own, educational and training programs available in the community, and who were eligible for child care and transportation assistance provided by the MOST office. The report sample consisted of 4,459 single-parent sample members (2,226 program group and 2,233 control group members). The report provides a summary of the results and data depictions of the impact of the MOST and Work First programs.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.2

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Indicators of Welfare Dependence: Annual Report to Congress

The Welfare Indicators Act of 1994 requires HHS to prepare annual reports to Congress on indicators and predictors of welfare dependence. This is the third of these annual reports. The report focuses on benefits under the Aid to Families with Dependent Children (AFDC) program, now Temporary Assistance to Needy Families (TANF); the Food Stamp Program; and the Supplemental Security Income (SSI) program. Selected highlights from the many findings in the report include the following: In 1995, 5.1 percent of the total population was dependent in the sense of receiving more than half of total income from AFDC, food stamps, and/or SSI. The percentage of the population that received AFDC/TANF in 1998 was lower than in any year since 1970. Long term dependency is relatively rare. Only 4 percent of those who were recipients in 1982 received more than 50 percent of their income from these programs in nine or more years over a ten-year period. This represents less than 0.5 percent of the total population. Recipients of AFDC, food stamps, and SSI are less apt to have a family member participating in the labor force than are individuals in the general population. Full-time participation in the labor force has increased among AFDC families between 1993 and 1995, according to Census Bureau data. Other data sources indicate that this trend of increased labor force participation has continued through 1998.

FEDERAL CONTACT: Julia Isaacs, 202-690-6805

PIC ID: 7281.3

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation, Office of Income Security Policy, Washington, DC

Oklahoma City's ET&E Program: Two-Year Implementation, Participation, Cost, and Impact Findings

This report presents evaluation results for Oklahoma City's Education, Training, and Employment (ET&E) program, which was designed to promote self-sufficiency among applicants for and recipients of AFDC. The program advocated participation in education, training, and job search classes to enhance the individual's employability and granted child care assistance to support participation in the program and employment. This report's data measure ET&E's operation before it was overhauled in late 1995. At that time, Oklahoma City's program shifted from one that encouraged individuals to build skills through formal education and that put great emphasis on participants' choice to a program that is mandatory and employment-focused, requiring individuals to look for a job first, both before and after their application for welfare is approved. Future NEWWS documents will follow Oklahoma City sample members for up to five years; it is possible that longer follow-up will reflect Oklahoma City's shift to a program type that has produced large effects in other locales. Major two-year findings are: (1) ET&E administrators and staff did not strongly enforce the stated mandate to participate. (2) There was only a slight increase in participation among welfare applicants in training and education activities above what they would have accessed on their own within a two-year period. (3) Less than $1,000 was spent on each program group member, the lowest found for a NEWWS program. (4) ET&E produced no impacts on employment or earnings within two years, but did generate moderate AFDC savings.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.1

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Study of Welfare-to-Work Programs Serving Noncustodial Parents

The Welfare-to-Work (WtW) Grants Program presents an important opportunity for states and localities to provide employment services to noncustodial fathers. In order to assist organizations developing programs for noncustodial fathers, this paper provides information on employment barriers facing these fathers, current and past programs serving this group, and strategies for providing effective services. It finds that the noncustodial fathers targeted by the WtW Grants Program include disproportionately high numbers of poorly educated minorities with limited work experience. The paper provides guidance for assisting these fathers in preparing for and locating stable employment and facilitating their efforts to pay child support and become involved with their families.

FEDERAL CONTACT: Alana Landey, 202-401-6636

PIC ID: 7086

PERFORMER: Mathematica Policy Research & Urban Institute, Washington, DC

The Low-Wage Labor Market: Challenges and Opportunities for Economic Self-Sufficiency

In this report, experts in labor market analysis synthesize the current literature on the low-wage labor market and highlight important policy implications flowing from their review. The nine expert reviews of the literature on the low-wage labor market discuss several challenges to obtaining self-sufficiency in the low- wage labor market and highlight several policy options for improving the wage, employment, and economic self-sufficiency outcomes of low-wage workers such as: (1) Policies to improve labor market access and job retention through continued funding and support for programs that provide labor market information. Services such as child care and transportation are also important. (2) Policies to encourage or support occupational mobility/job advancement. These include developing information networks and policies to encourage businesses to delineate skill requirements and career ladders for entry-level jobs, as well as on-the-job training for such career ladders. (3) Policies to raise the incomes of low-wage workers and enhance employment security. These include the Earned Income Tax Credit, targeted public and community service jobs strategies, and minimum wage policies.

FEDERAL CONTACT: Kelleen Kaye, 202-401-6634

PIC ID: 7425

PERFORMER: Urban Institute, Washington, DC

The Role of Intermediaries in Linking TANF Recipients with Jobs: Final Report

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 is presented for a large number of intermediaries, in general terms, focusing on the basic characteristics of the intermediaries and the types of services provided. The second part of the project presents in-depth information on implementation issues based on site visits to the communities of an urban and rural site in ten states.

FEDERAL CONTACT: Kelleen Kaye, 202-401-6634

PIC ID: 7151

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

Trends in the Well-Being of America's Children & Youth: 1999

This report presents the fourth edition of a collection of national estimates of child and youth well-being. Trends are presented from the 1970s through the 1990s. The report presents the most recent and reliable estimates on more than 90 indicators which have been organized into these five broad areas: (1) population, family, and neighborhood; (2) economic security; (3) health conditions and health care; (4) social development, behavioral health, and teen fertility; and (5) education and achievement. Now indicators for this edition of the report include: arts proficiency for children in grade 8; student computer use. In terms of how children are faring overall, the report highlights indicate: youth violence has been decreasing; the birth rate for teen females ages 15 to 19 continues its downward trend; median incomes of families with children receiving welfare payments decreased steadily since 1993; and the percent of single mothers in the labor force increased from 66 percent in 1996 to 74 percent in 1998. The report also speaks to major gaps in the federal statistical system which contributes to an incomplete picture of the quality of our children's lives. For example, there are few measures of social development and health- related behaviors for very young and pre-teenage children that are measured on a regular basis. There are few indicators available that reflect important social processes affecting child well-being that go on inside the family and within the neighborhood. Other areas in need of measurement development or improvements in the quality, consistency, and frequency of available data include child abuse and neglect, youth violent crime, day care quality, learning disabilities, and measures of children in institutionalized care.

FEDERAL CONTACT: Matthew Stagner, 202-690-5653

PIC ID: 6170.3

PERFORMER: Child Trends, Inc., Washington, DC

Welfare Leavers and Medicaid Dynamics: Five States in 1995

In addition to the unprecedented decline in state welfare caseloads, since 1994, is the decline in Medicaid enrollment for children and their parents. These declines in Medicaid enrollment were not expected, given the many ways family members, especially children, can remain eligible for Medicaid after welfare. There has also been a decline in the number of uninsured. This study analyzed the 1995 Medicaid enrollment patterns of children and their parents in five states to increase our understanding of the enrollment interactions between welfare and Medicaid. One part of the analysis focused on persons who left welfare during the year to see how many stayed on Medicaid. A second part of the analysis looked at the dynamics of overall Medicaid enrollment during 1995, with a focus on the extent of turnover. State Medicaid Research Files (SMRF) from the Health Care Financing Administration (HCFA) are the primary data source. The findings indicate: 1) Declines in state welfare caseloads are associated with declines in Medicaid enrollment, particularly for parents; (2) Many welfare leavers are not staying on Medicaid and are at risk of becoming uninsured; (3) Medicaid programs appear to disproportionately lose low-cost welfare leavers while continuing to cover those with higher costs; (4) States are experiencing considerable turnover in their Medicaid caseloads.

FEDERAL CONTACT: Julia Paradise, 202-690-6476

PIC ID: 7510

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

What Works Best for Whom: Impacts of 20 Welfare-to-Work Programs by Subgroup

During the ten years prior to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, large-scale rigorous studies of welfare-to-work (WtW) programs were launched in many states and counties. This report investigates results from 20 of these programs to determine who has benefited from welfare-to-work programs (and who has not) and whether some practices appear more effective than others at increasing the employment and earnings of single-parent welfare recipients. All the programs required some portion of the welfare caseload to participate in a WtW program or risk losing some or all of their welfare benefits through sanctions. The researchers used an experimental research design in which individuals were assigned at random either to a program group, which was required to participate in an employment or training program, or to a control group, which did not have access to the program. The findings are described in brief, including 1) People in the program groups had higher earnings and lower welfare payments than people in the control groups, but generally had the same combined income from earnings, AFDC, and Food Stamps. 2) Employment-focused programs tended to be more effective than education-focused programs for the more disadvantaged groups. Programs that provided a mix of first activities tended to help the broadest range of people.

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089.4

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

Office of Program Systems

Community-Level Indicators for Understanding Health and Human Services Issues

Local governments, private civic improvement organizations, community foundations and private community-based services organizations are beginning to build and use data sets to create local indicator systems that, in turn, have become fundamental tools for tracking and understanding community viability, health and social functioning. The HHS, Office of the Secretary for Planning and Evaluation (ASPE) has a keen interest in partnering with states and localities to further the availability and appropriate use of local- level data. This compendium is a useful tool for achieving that goal. This compendium is a resource for people in local, state and federal government agencies, private sector organizations and others who are interested in learning more about the growing use of community-level social indicators. It is designed as a user-friendly tool that showcases an interesting and diverse selection of indicator systems and resource organizations. It is intended to facilitate information sharing among those who are doing local indicator work and to provide background information for those who are new to this rapidly evolving area of interest. By focusing attention specifically on community-based indicator systems, this publication may also increase awareness of current data resources and inform discussions of strategies for improving the availability, quality and applicability of local indicator data.

FEDERAL CONTACT: Mary Ellen O'Connell, 202-260-0391

PIC ID: 7359

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Food Safety Strategic Elements: Evaluation Synthesis Findings and Research Needs: Final Report

The purpose of this evaluation synthesis is to identify research needs and directions for enhancing our knowledge base in food safety. Using the President's Council on Food Safety's Draft Preliminary Food Safety Strategic Plan, the first step in the process consisted of identifying key elements critical to achieving the draft food safety goals and objectives. While the Council's plan is comprehensive and includes microbial, chemical and physical hazards, this report is limited to microbial hazards. Once the key elements were selected and the research review questions clearly defined, a review was conducted of the scientific research literature related to the policy-relevant question for each of the eight food safety elements. The report is divided into three sections: Section 1 - provides an overview of the report; Section 2 - summarizes the scientific research literature on the eight strategic elements. For each element, a specific research question is stated followed by a summary of key findings from the literature; and Section 3 - provides information on future research needs which constitute the starting point of a two- fold process in developing a food safety research agenda. The first step is the idea-generating and feedback phase. The second step is the development of a process for and the prioritization of the generated list of research needs in line with a strategic plan for food safety.

FEDERAL CONTACT: Paul Johnson, 202-401-8277

PIC ID: 7360

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

In-Progress Evaluations Office of Disability, Aging, and Long-Term Care Policy A Comparative Study of the Outcomes and Costs Associated with Medicare Post-Acute Services in Skilled Nursing Faciities, Rehabilitation Hospitals/Units Analyses of Changes in Elderly Disability Rates: Implications for Health Care Utilization and Costs Analyses of Residential Transition of Older Americans Analysis of the Disability Supplement to the National Health Interview Survey Case Studies and Technical Assistance for Medicaid Buy-Ins for People with Disabilities Characteristics of Nursing Home Residents Clarifying the Definition of Homebound and Medical Necessity Using OASIS Data Developing Concise Measures of Child Disability Disability Suplements to HCFA Evaluation of Medicaid Managed Care in Tennessee Evaluation of Practice in Care (EPIC) Long Term Care Microsimulation Model Longitudinal Study of Welfare Reform and Its Implications for Persons with Disabilities Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses Medicare Post-Acute Care: Quality Measurement Monitoring the Health Outcomes for Disabled Medicare Beneficiaries Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation Research on Employment Supports for People with Disabilities Study of Fair Hearing Adaptations Synthesis of Research on Disability and Managed Care Office of Health Policy Assessing Core Capacity for Infectious Disease Surveillance Assessment of Approaches to Evaluating Telemedicine Programs and Projects Comparative Analysis of Decliners of Employer-Based Health Insurance Construction of an Integrated Measure of the Burden of Disease Developing a Framework for Domestic Infectious Diseases Surveillance Development and Validation of a Performance Measure Set for the Evaluation of Medicaid Services Rendered to People with Developmental Disabilities Evaluating the Effects of Direct-to-Consumer Advertising on Consumers Evaluation of Seafood Hazard Analysis Critical Control Point (HACCP) Program Evaluation of the Projects for Assistance in Transition from Homelessness (PATH) Program Factors Influencing Effective Dissemination of Prevention Research Findings by DHHS Follow-Up to Clustering Co-Occurrence Youth Risky Behaviors Impact of Medicare HMO Enrollment on Health Care Costs in California Innovative Coverage of Health Promotion, Clinical Preventive Services, and Other Coverage Issues in the Private Sector Medicare Supplement Insurance: Structure, Change & Implications Preventing Abusive Intimate Relationships Among Adolescents Safety Net Framework Project Safety Net Project: Exploring State Use of Medicaid Disproportionate Share Funds to Enhance Provision of Care to Uninsured State Activity Monitoring Medicaid Managed Care for Children with Special Health Care Needs State Implementation of Immunization Recommendations and Guidance The Changing Structure of Health Insurance Markets Understanding Health Plan Accreditation and Its Potential to Promote the Consumer Bill of Rights and Responsibilities Office of Human Services Policy A Research Synthesis of the Findings from ASPE's "Leavers" Grants Abstinence-based Teen Pregnancy Prevention Efforts Targeting Boys Disaggregating the TANF Child-Only Caseload in Three States Domestic Violence and Welfare: An Early Assessment Economic and Health Status of Immigrants, Their Communities, and the Organizations that Serve Them Indicators of Welfare Dependence Low-Income and Low-Skilled Worker's Involvement in Non-Standard Employment National Evaluation of Welfare-to-Work Strategies (NEWWS) Pregnancy Prevention Programs Targeting Boys and Young Men: Policy Information Dissemination Strategy The National Evaluation of the Welfare to Work Grants Program Welfare Outcomes Panel Study Welfare Reform and Changing Program Participation Patterns in Four States Office of Program Systems State Telephone Survey Estimates for Evaluation and Monitoring The Importance of Place Trends in Demand for Emergency Assistance Services

Office of Disability, Aging, and Long-Term Care Policy

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

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

EXPECTED DATE OF COMPLETION: 01/20/2004

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 6836

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

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

The purpose of this project is to conduct analyses using the 1984 to 1999 National Long-Term Care Survey (NLTCS) and the Medicare Current Beneficiary Survey (MCBS) to understand the nature of recent declines in elderly disability rates and their implications for health care utilization and costs. Specifically, researchers are (1) decomposing changes in elderly disability rates using the 1984 to 1999 NLTCS and exploring possible reasons for the decline, and (2) linking changes in elderly disability rates to the use of specific medical procedures (e.g., cataract surgery, coronary and joint replacement surgeries) and/or assistive technology. The MCBS is the primary data set for the latter analyses.

EXPECTED DATE OF COMPLETION: 12/30/2001

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 7554

PERFORMER: Urban Institute, Washington, DC

Analyses of Residential Transition of Older Americans

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

EXPECTED DATE OF COMPLETION: 03/31/2002

FEDERAL CONTACT: Kamal Hijjazi, 202-690-6443

PIC ID: 7555

PERFORMER: Urban Institute, Washington, DC

Analysis of the Disability Supplement to the National Health Interview Survey

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 7153

PERFORMER: Urban Institute, Washington, DC

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

In an effort to encourage more states to provide Medicaid to working individuals with disabilities, and to give states addition options for providing Medicaid to those individuals, Congress permitted states to expand their Medicaid programs (through a Medicaid "buy-in") and allow people with disabilities to continue to receive Medicaid services even if they return to work and have earnings greater than 100% of the Federal Poverty Level. The goal of this project is to: (1) examine the early implementation experiences of states that have opted for a Medicaid buy-in for people with disabilities, and (2) offer technical assistance to states on developing cost models, design features of a buy-in, as well as implementation and administration considerations for a buy-in. The project represents a unique opportunity to compare the design and implementation experiences of different states, and use the information gathered to inform both state and federal policy makers about strategies for improving systems that support the employment of people with disabilities.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andreas Frank, 202-690-6443

PIC ID: 7556

PERFORMER: George Washington University, Washington, DC

Characteristics of Nursing Home Residents

Caring for persons with disabilities in the least restrictive setting is a major long-term policy objective. It is important to identify nursing home residents who could be discharged to the community if appropriate home and community-based services were available. This project will analyze data from the Minimum Data Set (MDS). The MDS consists of assessments which have been conducted on all nursing home residents in selected States as part of a HCFA demonstration (and starting the summer of 1998, the data will be collected in all 50 States). Using this new data set will provide more information about the medical conditions, functional needs, and specific services used by nursing home residents than was possible with previous data sets. It will also be possible to study important subpopulations, especially the nonelderly.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: John Drabek, 202-690-6443

PIC ID: 6275

PERFORMER: Hebrew Rehabilitation Center for the Aged, Boston, MA

Clarifying the Definition of Homebound and Medical Necessity Using OASIS Data

Home health care services are covered in full for Medicare beneficiaries who meet a set of coverage criteria. Though most coverage criteria are straightforward, there is no operational definition to either the homebound or the medical necessity criteria that can be used uniformly by providers and intermediaries. The vagueness of these two criteria led to wide interpretations by and subsequent problems for the Fiscal Intermediaries and providers as well. The purpose of this project is to develop and test a set of uniform and reliable indicators that can be systematically used to document and monitor two Medicare home health care coverage criteria: the "Homebound" and the "Medical Necessity" criteria. The indicators will be linked to items from the Outcome and Assessment Information Set (OASIS) in a decision tree algorithm (or a logic model). Two decision algorithms will be developed for the two criteria. The algorithms will represent a major step toward helping providers, HCFA, and the intermediaries in administering the home health benefit.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kamal Hijjazi, 202-690-6443

PIC ID: 7557

PERFORMER: Visiting Nurse Service, New York, NY

Developing Concise Measures of Child Disability

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: John Drabek, 202-690-6443

PIC ID: 7558

PERFORMER: National Institute of Child Health and Human Development, Bethesda, MD

Disability Supplements to HCFA Evaluation of Medicaid Managed Care in Tennessee

This project adds a disability component to an existing HCFA evaluation of Medicaid 1115 waiver demonstrations in five States, with a focus on the Tennessee evaluation. The study will follow the experiences of SSI disabled children and adults (physically disabled, mentally ill, mentally retarded, or developmentally disabled) enrolled in the TennCare and TennPartners Programs. The project will conduct in-depth qualitative analyses of the State's experience in enrolling individuals with disabilities into managed care systems, and will conduct quantitative analysis to examine cost and utilization data for these populations. The supplement will also include a survey of disabled consumers to examine issues of satisfaction, quality, health status, and functioning.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Hunter McKay, 202-690-6443

PIC ID: 6166.2

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

Evaluation of Practice in Care (EPIC)

From 1989 to 1992, there was a 210 percent increase in Medicare expenditures for home health services. This increase in utilization has generated policy interest in measures to control expenditures without compromising quality. Medicare home health has been the subject of considerable research, but the actual practice of home health care has not been extensively examined. This study will: (1) analyze "episodes" of care under the Medicare home health benefit, (2) assess the actual practice of care, (3) determine the extent to which there is variation in practice between acute and long-term care patients, and (4) uncover the factors accounting for that variation. The study will also examine decision-making processes between patients, providers and physicians. The events that take place during a visit and between visits as "actual practice" has 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 combatting fraud and abuse, as well as contribute valuable data to a future prospective payment system.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kamal Hijjazi, 202-690-6443

PIC ID: 5888

PERFORMER: University of Colorado, Denver, CO

Long Term Care Microsimulation Model

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: John Drabek, 202-690-6443

PIC ID: 7143

PERFORMER: The Lewin Group, Fairfax, VA

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

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

EXPECTED DATE OF COMPLETION: 09/30/2003

FEDERAL CONTACT: William Marton, 202-690-6443

PIC ID: 7362

PERFORMER: Johns Hopkins University, Baltimore, MD

Managed Delivery Systems for Medicare Beneficiaries with Disabilities and Chronic Illnesses

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

EXPECTED DATE OF COMPLETION: 08/31/2001

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 6391

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

Medicare Post-Acute Care: Quality Measurement

This project will specify performance measures that can be used to determine the cost-effectiveness of post-acute care (PAC) services. The specific measures and data elements will apply to patient conditions that are prevalent within and across PAC settings. In addition, this project will identify the data collection methods that could be used with respect to these elements. Finally, this project will identify issues that need to be considered in applying these measures, including whether there is the need to engage in validity and reliability testing, and, if so, how.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Jennie Harvell, 202-690-6443

PIC ID: 7363

PERFORMER: Urban Institute, Washington, DC

Monitoring the Health Outcomes for Disabled Medicare Beneficiaries

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 7364

PERFORMER: Laguna Research Associates, San Francisco CA

Personal Assistance Services "Cash and Counseling" Demonstration/Evaluation

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

EXPECTED DATE OF COMPLETION: 09/30/2004

FEDERAL CONTACT: Pamela Doty, 202-690-6443

PIC ID: 6161

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

Research on Employment Supports for People with Disabilities

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andreas Frank, 202-690-6443

PIC ID: 4917.2

PERFORMER: The Lewin Group, Fairfax, VA

Study of Fair Hearing Adaptations

The purpose of this task order is to conduct a qualitative study that describes in detail selected aspects of four adaptations to the Medicaid Fair Hearing process for beneficiaries enrolled in managed care. The adaptions include evidentiary hearings, ombudsman programs, external review organizations and expedited review of appeals. Descriptive information will be gathered through case studies on the mechanics of each adaptation and the perceptions of state Medicaid staff, managed care organization administrators and advocacy organizations regarding issues related to their use by Medicaid beneficiaries. A policy meeting will be held to discuss the project's findings and the potential for using the findings to improve the Medicaid Fair Hearing process.

EXPECTED DATE OF COMPLETION: 11/30/2001

FEDERAL CONTACT: Hunter McKay, 202-690-6443

PIC ID: 7559

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

Synthesis of Research on Disability and Managed Care

Since the mid-1990s, a number of research institutions initiated projects to assess how well disabled persons are cared for in managed care settings. The research focused on many different aspects of managed care and disability, and used a wide variety of research designs. The purpose of this delivery order contract is to: (1) synthesize recent research on the performance of managed care plans in caring for persons with disabilities, (2) summarize research on current trends in enrollment of disabled persons into Medicaid managed care programs, (3) recommend areas for future research, and (4) convene a small research conference to explore the perspectives of other organizations sponsoring research in this area.

EXPECTED DATE OF COMPLETION: 08/30/2001

FEDERAL CONTACT: Hunter McKay, 202-690-6443

PIC ID: 7560

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

Office of Health Policy

Assessing Core Capacity for Infectious Disease Surveillance

This project will assess the capacity of the infectious disease surveillance system in the United States. The purpose is to identify major gaps in infectious disease surveillance preparedness and to develop an investment framework to address the gaps identified. This multi-part study included a comprehensive literature review, interviews with infectious disease experts, two expert panel meetings, and site visits to three public health jurisdictions. The final investment plan will include detailed information on specific investment strategies that will ensure adequate capacity to identify and understand infectious disease threats.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andrea Pernack, 202-690-6860

PIC ID: 7351

PERFORMER: The Lewin Group, Falls Church, VA

Assessment of Approaches to Evaluating Telemedicine Programs and Projects

This project will collect information on current and planned evaluations of telemedicine activities; assess the purpose and methods of such evaluations and the relevance of the resulting or potential findings to federal policy and programs; and develop a conceptual framework for designing such evaluations. Information will be collected through literature searchers, interviews and document review at Federal agencies, and site visits to ongoing telemedicine projects. The purpose of the study is to develop a better understanding of how telemedicine evaluations can be designed to better inform and facilitate Federal program and policy decisions.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Tom Hertz, 202-690-7779

PIC ID: 7340

PERFORMER: The Lewin Group, Falls Church, VA

Comparative Analysis of Decliners of Employer-Based Health Insurance

This study will compare health care use of uninsured decliners to uninsured and insured workers. One theory for why certain people decline offered health insurance is that it is not a good deal for them-- especially young, single, relatively low wage workers. To test this theory, we will compare health care use for workers who decline employer offered insurance to other uninsured workers and to insured workers using the NHIS and controlling fro age, health status, income and other factors that are related to health care use.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Bernadette Fernandez, 202-401-8398

PIC ID: 7345

PERFORMER: Urban Institute, Washington, DC

Construction of an Integrated Measure of the Burden of Disease

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7142

PERFORMER: The Lewin Group, Fairfax, VA

Developing a Framework for Domestic Infectious Diseases Surveillance

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Caroline Taplin, 202-690-7906

PIC ID: 7161

PERFORMER: The Lewin Group, Fairfax, VA

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

Many public policies seek to influence the decisions employers make about whether and how to offer health benefits to their employees. The process of how employers make such decisions, however, is largely unknown. The Office of the Assistant Secretary for Planning and Evaluation convened two panels of senior corporate managers to discuss how firms make decisions about health benefits. The purpose was to help the office formulate a more comprehensive view of employer decision-making by posing common questions to a cross-section of knowledgeable people, and to identify issues that may be empirically measured. The long-term goal is to be able to better determine how public policies affect or influence the decisions made by employers and unions regarding health coverage. The first meeting focused on the "strategic" trends and issues affecting employer health coverage, addressing such questions as, "What is the role of the employer in shaping health care markets?" The second meeting focused on the internal and operational issues of how employers make health benefit decisions, addressing such questions as: "At what level of the corporate structure are health benefit decisions made?" More information can be found in the summary report at this web address: http://aspe.dhhs.gov/health/reports

EXPECTED DATE OF COMPLETION: 09/29/2002

FEDERAL CONTACT: Elizabeth Couchoud, , 410-786-6722

PIC ID: 7391

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Susannah Bruns, 202-690-7996

PIC ID: 6343

PERFORMER: Market Facts, Inc., McLean VA

Evaluation of Seafood Hazard Analysis Critical Control Point (HACCP) Program

The Seafood Hazard Analysis Critical Control Point (NACCP) Program mandates the application of HACCP principles to the processing of seafood. HACCP is a preventive system of hazard control that can be used by processors to evaluate the kinds of hazards that could affect products, institute appropriate controls to keep the hazards from occurring or minimize their occurrence, and monitor performance of those controls. this program supplants the old FDA seafood inspection system. The effective date of the program is December 1997. In approving FDA's Seafood HACCP final rule, the Department committed to evaluating the program. The proposed project would develop an evaluation program to be implemented sometime after the rule's effective date.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Laina Bush, 202-260-7329

PIC ID: 7343

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

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

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7210

PERFORMER: Westat, Inc., Rockville MD

Factors Influencing Effective Dissemination of Prevention Research Findings by DHHS

This project is designed to further our understanding of the mechanisms that affect the movement of health promotion and disease prevention research findings from one stage to the next and the role the Department of Health and Human Services (HHS) plays in each of these stages. By identifying the relevant mechanisms that affect the dissemination process, HHS will be better able to successfully disseminate the research findings which have public health and clinical importance. In addition, HHS has a direct stake in effective dissemination of research findings for purposes of producing improvements in Departmental programs such as Medicare and Medicaid and to improve the quality of life for the people served by programs such as Head Start.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Andrea Pernack, 202-690-6860

PIC ID: 7347

PERFORMER: The Lewin Group, Falls Church, VA

Follow-Up to Clustering Co-Occurrence Youth Risky Behaviors

A current project has analyzed data from several major Departmental surveys (the National Longitudinal Study on Adolescent Health, the Youth Risk Behavior Survey, and the National Survey of Adolescent Males), and produced a series of data tables and three Research briefs regarding incidence and prevalence estimates for various clusterings/co-occurrences of risky behaviors among youth, as well as the clustering of risk and "positive" behaviors. This study would seek to conduct further and more detailed analyses on some of the findings emerging from the existing project. These additional analyses would then be presented in a series of working papers that would be disseminated to researchers, policy makers, Federal and State program staff in child and youth areas, and other relevant stakeholders.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Kevin Hennessy, 202-690-7272

PIC ID: 7349

PERFORMER: Urban Institute, Washington, DC

Impact of Medicare HMO Enrollment on Health Care Costs in California

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: George Greenberg, 202-690-7794

PIC ID: 6889

PERFORMER: Rand Corporation, Santa Monica, CA

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

Despite the important 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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Caroline Taplin, 202-690-7906

PIC ID: 6347

PERFORMER: Partnership For Prevention, Washington, DC

Medicare Supplement Insurance: Structure, Change & Implications

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Stephen Finan, 202-690-7387

PIC ID: 7348

PERFORMER: Alpha Center, Bethesda, MD

Preventing Abusive Intimate Relationships Among Adolescents

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Sandra Howard, 202-690-7778

PIC ID: 6751

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

Safety Net Framework Project

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Caroline Taplin, 202-690-7906

PIC ID: 7156

PERFORMER: Northwestern University, Evanston IL

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

This project will study the cases in which States redirected or changed their use of Medicaid Disproportionate Share Funds (DSF) funding streams to strengthen safety net infrastructure in communities within their States; used DSF to increase the services available to uninsured populations; or provided insurance to previously uninsured individuals through DSF.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: George Greenberg, 202-690-7794

PIC ID: 7352

PERFORMER: Urban Institute, Washington, DC

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

The purpose of this project is to investigate how States are monitoring and evaluating the experience of children with special health care needs enrolled in Medicaid Managed care. Research findings will be used to refine the standards HCFA requires States to meet in order to enroll children with special health care needs into capitated Medicaid managed care plans, and to assess States' ability to meet these standards. Policy makers are interested in addressing the issue of whether Medicaid plans and providers are meeting the complex needs of Supplemental Security Income (SSI) children, for example, but the lack of concrete data or information related to the experience of this population in Medicaid managed care hamper their efforts. In response, HCFA has developed interim review criteria that will be applied to all upcoming 1915(b) waiver applications and renewals from States. The criteria establishes requirements regarding definition, identification, tracking, and access to care for children with special health care needs enrolled in capitated managed care arrangements. This study will help HCFA and the States move forward with this important effort by providing critical information about current State activity and insights as to how these criteria can be refined, improved, and operationalized.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Jennifer Tolbert, 202-205-8678

PIC ID: 7350

PERFORMER: George Washington University Medical Center, Washington, DC

State Implementation of Immunization Recommendations and Guidance

This project in Phase 1 will conduct case studies in up to five states to learn how states (in public health, Medicaid and Medicare) are working on the immunization goals using the guidance and technical assistance provided by the federal government. This phase will highlight the status quo and understand the extent to which states are planning to incorporate HCFA's guidance into their activities. Phase 2 (FY 2000) the project will be in up to three of the states and will work with these states to take this activity to the next level, such as identifying and implementing appropriate outcome measures for immunization (e.g., vaccine-preventable disease rates). The goal of the project is to evaluate how states use federal guidance toward improving immunization status and further to assist the federal government on continuing to implement this work with states. Both CDC/National Immunization Program and HCFA would be involved in the project.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Amy Nevel, 202-690-7795

PIC ID: 7342

PERFORMER: Research Triangle Institute, Research Triangle Park, NC

The Changing Structure of Health Insurance Markets

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Stephen Finan, 202-690-7387

PIC ID: 7160

PERFORMER: Alpha Center, Washington, DC

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

The purpose of this project is (1) to provide policy and regulatory staff in the US Department of Health and Human Services (HHS) with an in-depth understanding of the aspects of the health plan accreditation process most closely related to the Consumer Bill of Rights and Responsibilities (CBRR); and (2) to determine the extent to which health plan accreditation fosters implementation of the CBRR. The study's results will provide useful feedback to the individuals and entities involved in developing the CBRR--by illustrating difficulties that accrediting organizations and health plans may face in operationalizing CBRR provisions.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Ellen Bayer, 202-690-7804

PIC ID: 7346

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

Office of Human Services Policy

A Research Synthesis of the Findings from ASPE's "Leavers" Grants

This study will critically analyze and synthesize the findings of ASPE's grants that have studied welfare outcomes for individuals and families who have left cash assistance under the Temporary Assistance for Needy Families (TANF) program. The project will result in an Initial Synthesis Report and a Final Report. The Office of the Assistant Secretary for Planning and Evaluation (ASPE) awarded grants to states and counties to study the outcomes of welfare reform on individuals and families who leave TANF, individuals and families entering the caseload, and TANF applicants and potential TANF applicants. All of the grantees are using a combination of linked administrative data and surveys to study the outcomes of the TANF "leavers." The grantees include: Arizona, Cuyahoga County, District of Columbia, Florida, Georgia, Illinois, Los Angeles, Massachusetts, Missouri, New York, San Mateo County, Washington, and Wisconsin.

EXPECTED DATE OF COMPLETION: 11/01/2001

FEDERAL CONTACT: Matthew Lyon, 202-401-3953

PIC ID: 7368

PERFORMER: Urban Institute, Washington, DC

Abstinence-based Teen Pregnancy Prevention Efforts Targeting Boys

The purpose of this project is to: (1) identify abstinence-based pregnancy prevention programs that target boys or both boys and girls; (2) utilize a framework to assess and summarize the state of the field; and (3) provide the information in a format useful to state, local, and community policy-makers. Adolescent pregnancy is a complex issue, and understanding its causes, as well as effective prevention strategies, is still not well-developed. Traditionally, adolescent pregnancy prevention research and programs have focused on adolescent girls. It is becoming increasingly clear, however, that adolescent boys and young men must share that focus. At the same time, there has been a recent influx of funding for programs that use an abstinence-based approach. States and communities have shown an interest in providing services and programs for boys and young men, but have also expressed frustration that they do not have access to information about what strategies have been tried, if these have been successful, and how they can access funding for the development and operation of these programs. The project will result in a final report identifying existing abstinence-based teen pregnancy prevention efforts undertaken by youth organizations serving boys, target populations, and results of any evaluation activities. It will include information on issues of approach, cost, target group, impact, community support, geography, race/ethnicity, and special needs. This project is an integral part of the Department of Health and Human Services' (HHS) National Strategy to Prevent Teen Pregnancy and the Clinton Administration's Fatherhood Initiative.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Sonia Chessen, 202-690-8471

PIC ID: 6726

PERFORMER: South Bronx Overall Economic Development Corporation, Bronx NY

Disaggregating the TANF Child-Only Caseload in Three States

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Laura Radel, 202-690-5938

PIC ID: 7188

PERFORMER: The Lewin Group, Fairfax, VA

Domestic Violence and Welfare: An Early Assessment

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Gerald Silverman, 202-690-5654

PIC ID: 6724

PERFORMER: Urban Institute, Washington, DC

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

This project will conduct research on the economic and health status of immigrants, their communities and the organizations serving them. The research will profile the status of immigrants with regard to health, employment and participation in programs administered by public and private agencies, with special attention to distinguishing categories of immigrants and drawing comparisons with the citizen population. The project will also explore the impacts of welfare reform on immigrants and organizations, with special attention to both individual and institutional adaptations. Since the loss of food stamps appears to be the most far-reaching and permanent change affecting current legal immigrants, its impact on immigrants and their families will also be a focus of the study. The project will supplement an examination of existing secondary data with intensive data collection in Los Angeles and New York, the two cities that together account for one-fourth of the immigrant population. Primary data collection in the two cities has been designed to develop profiles of immigrants in these cities and the agencies serving them. This effort has several components, including: (1) interviews with 1,650 immigrant households in each city; (2) telephone interviews with most of the non-profit agencies providing services to immigrants; (3) in-depth interviews with 100 immigrants who lose Food Stamps and with additional immigrants who retain food stamps in each city; and (4) in-depth interviews with administrators and staff in public and private agencies.

EXPECTED DATE OF COMPLETION: 12/31/2001

FEDERAL CONTACT: David Nielsen, 202-401-6642

PIC ID: 6747

PERFORMER: Urban Institute, Washington, DC

Indicators of Welfare Dependence

The Welfare Indicators Act of 1994 requires the Department of Health and Human Services to prepare annual reports to Congress on indicators and predictors of welfare dependence. Each annual Report on Welfare Indicators is developed with the advice and recommendations of the bipartisan Advisory Board on Welfare indicators, the assistance of the U.S. Department of Agriculture, the Social Security Administration and the U.S. Bureau of the Census. The purpose of this report, as stated in the law, is "to provide the public with generally accepted measures of welfare receipt so that it can track such receipt over time and determine whether progress is being made in reducing the rate at which and, to the extent feasible, the degree to which, families depend on income from welfare programs and the duration of welfare receipt."

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Julia Isaacs, 202-690-6805

PIC ID: 7281

PERFORMER: Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Washington, DC

Low-Income and Low-Skilled Worker's Involvement in Non-Standard Employment

A growing proportion of the work force is involved in forms of nonstandard employment such as temporary work, and there is apparently considerable overlap between the nonstandard workforce and at-risk populations such as the low-income and low-skilled and public assistance recipients or ex-recipients. These circumstances have combined to spur a strong policy interest in the implications of nonstandard employment for the well-being of those who enter it. This project was developed to achieve a greater understanding of the circumstances, characteristics and trends of those involved in the alternative workforce who are most at risk of welfare dependency--i.e., current assistance recipients and the low- income and low-skilled in general. It is hoped that insight will be gained into the conditions of the nonstandard work sectors, the experiences of employers hiring welfare clients to fill nonstandard slots, to better understand the employment context for these at-risk populations. The overall aim in doing these descriptive analyses is to answer the question: Are those at risk of welfare dependency who enter nonstandard employment better or worse off than their counterparts in more traditional jobs?

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Alana Landey, 202-401-6636

PIC ID: 7367

PERFORMER: Urban Institute, Washington, DC

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

The Department of Health and Human Services (HHS) is undertaking a study of the effectiveness of welfare-to-work programs. as part of the National Evaluation of Welfare-to-Work Strategies (NEWWS), 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. 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 Temporary Assistance for Needy Families (TANF) and Food Stamp payments is being collected.

EXPECTED DATE OF COMPLETION: 03/30/2002

FEDERAL CONTACT: Audrey Mirsky-Ashby, 202-401-6640

PIC ID: 7089

PERFORMER: Manpower Demonstration Research Corporation, New York, NY

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

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Linda Mellgren, 202-690-6806

PIC ID: 6766

PERFORMER: Urban Institute, Washington, DC

The National Evaluation of the Welfare to Work Grants Program

The Balanced Budget Act of 1997 authorized the Department of Labor to award $3 billion in Welfare-to- Work grants to States and local communities to promote job opportunities and employment preparation for the hardest-to-employ recipients of Temporary Assistance for Needy Families (TANF), and for non- custodial parents of children on TANF. This project is evaluating the effectiveness of Welfare-to-Work initiatives, including those undertaken by the Welfare-to-Work grantees and by American Indian and Alaska Native tribal organizations.The Deparment of Health and Human Services (DHHS), in conjunction with the Departments of Labor and Housing and Urban Development, has designed an evaluation to address four key questions: (1) What are the types and packages of services provided by Welfare-to- Work grantees? (2) What are Welfare-to-Work program participants’ outcomes regarding employment and family well-being? (3) What challenges are confronted as grantees implement and operate the programs? (4) 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 three main components: (1) a descriptive assessment of all Welfare-to-Work grantees based on mail surveys and site visits; (2) in-depth process and implementation study; and (3) a special process and implementation study focusing on tribal welfare and employment systems.

EXPECTED DATE OF COMPLETION: 10/20/2003

FEDERAL CONTACT: Alana Landey, 202-401-6636

PIC ID: 7147

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

Welfare Outcomes Panel Study

The Office of the Assistant Secretary for Planning and Evaluation (OASPE) is conducting a panel study with the National Academy of Sciences (NAS) to evaluate the design of current, proposed and future studies of the effects of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. This panel study will assist the department in: (1) reviewing existing research efforts on the effects of welfare reform; (2) examining the appropriate data sources, research designs and statistical methods for analyzing welfare reform outcomes; and (3) identifying research gaps and data needs for the continued study of welfare reform. Specific topics to be covered by the panel of experts include: (1) the appropriate outcome measures needed to effectively evaluate the outcomes of welfare reform; (2) the appropriate population of study; (3) the design and usefulness of existing national-level surveys (e.g., the Survey of Program Dynamics and the Survey of Income and Program Participation); (4) data needs for monitoring State and sub-State variation in outcomes; (5) potential uses and limitations of administrative data; and (6) integration of survey and administrative data. Over the course of the study, the NAS expert panel will address the above mentioned tasks through workshops, quarterly panel meetings and the publication of both an interim report and a final report. The interim report (see PIC # 7145.1) included early recommendations of the panel and the final report will document the comprehensive list of final recommendations to the department.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Susan Hauan, 202-690-8698

PIC ID: 7145

PERFORMER: National Academy of Sciences, Washington, DC

Welfare Reform and Changing Program Participation Patterns in Four States

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.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Laura Feig, 202-690-5938

PIC ID: 7148

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

Office of Program Systems

State Telephone Survey Estimates for Evaluation and Monitoring

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

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: James Scanlon, 202-690-7100

PIC ID: 6420

PERFORMER: National Center for Health Statistics, Hyattsville MD

The Importance of Place

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

EXPECTED DATE OF COMPLETION: 03/31/2002

FEDERAL CONTACT: Mary Ellen O'Connell, 202-260-0391

PIC ID: 7552

PERFORMER: National Academy of Sciences, Washington, DC

Trends in Demand for Emergency Assistance Services

Since 1993, the number of families receiving federally-funded assistance under Title IV-A of the Social Security Act (welfare) has declined by 50%. While many studies have addressed the circumstances of those who have left welfare, little research has examined: 1) the impact that declining caseloads and welfare reform may have on the demand for and utilization of services from the perspective of community- level emergency assistance providers, and 2) reasons for changes in the composition of clients using such services (e.g., increasing over-representation of of single mothers). The Office of the Assistant Secretary for Planning and Evaluation (ASPE) is committed to research in this latter area in order to determine the outcomes of welfare reform. Since 1999, ASPE has carried out an ongoing project to support the efforts of state and local research organizations in examining the question of whether declining welfare caseloads and TANF implementation have led to a shift in the demand and/or utilization of emergency assistance programs, especially those that provide food and shelter, and to explore some of the reasons this may be occurring. Using grant and contract approaches, the analyses rely upon provider data in conjunction with socioeconomic and caseload information over time to describe and understand trends in demand for and use of emergency assistance providers at the state and local levels.

EXPECTED DATE OF COMPLETION: 09/30/2001

FEDERAL CONTACT: Walt Leginski, 301-443-3706

PIC ID: 7551

PERFORMER: University of Massachusetts, Boston MA