EVALUATIONS COMPLETED IN FY 2007

Universal Newborn Hearing Screening and Intervention Program

In 2004, a contract was executed with Mathematica Policy Research to conduct an evaluation of the Universal Newborn Hearing Screening and Intervention (UNHSI) program administered by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB).  The work was carried out in 2005 through an OMB approved  survey mailed to 57 States and Territories and selected site visits.  There was a 100% response to the survey.  Although screening rates in the program, which began in 2000 have climbed steadily from a beginning rate of 35% to the current rate of 95%, the delivery of appropriate and timely follow-up services has continued to be a problem.  Mathematica identified the following barriers in the service delivery system:  1. lack of service system capacity, 2. lack of provider knowledge, 3. family challenges in obtaining services, and 4. information gaps remain, particularly in the public domain.  Recommendations included: 1.improving data systems to support surveillance and follow-up activities, 2. building capacity beyond identified key providers, 3. improving data systems to support surveillance and follow-up activities, 4. building capacity beyond identified key providers, 5. developing family-to-family support services, and 6. promoting understanding of the importance of early detection in both the provider community and among families.  Many UNHSI programs appear poised to take these action steps.  Most programs have implemented universal screening in their States, and many are working actively to address key barriers and reduce loss to follow-up.  HRSA’s MCHB has an important role to play in monitoring these activities and helping to identify and disseminate effective program strategies.  The report was completed in 2006 and released to the public in December 2007.

Ryan White HIV/AIDS Program

“Review of the Management of Unobligated Funds Provided by Title I of the Ryan White Comprehensive AIDS Resources Emergency Act” (A-02-03-02006) (Final Report - February 2007).  The findings of this Office of Inspector General audit indicated that HRSA did not always comply with Departmental policy that limit the carryover of unobligated grant balances to the next budget year only.  These funds were originally awarded to provide services during a specific budget year were instead carried over for use in subsequent budget periods.  Departmental policy guidance issued after the audit period now permits the carryover of unobligated grant funds into either of the next two budget periods.  HAB has taken appropriate steps and follows current Departmental policy regarding the approval of carryover requests from Part A (Title I) grantees. 

“Review of the Management of Unobligated Funds Provided by Title II of the Ryan White Comprehensive AIDS Resources Emergency Act” (A-06-04-00060) (Final Report - May 2007).  The findings of this Office of Inspector General audit indicated that HRSA did not always comply with Departmental policy that limit the carryover of unobligated grant balances to the next budget year only.  These funds were originally awarded to provide services during a specific budget year were instead carried over for use in subsequent budget periods.  Departmental policy guidance issued after the audit period now permits the carryover of unobligated grant funds into either of the next two budget periods.  HAB has taken appropriate steps and follows current Departmental policy regarding the approval of carryover requests from Part B (Title II) grantees.  Additionally, the Part B program will examine the reasons for some States’ large unobligated balances, and monitor compliance to obligate 75 percent of grant award with in 120 days.   

Family Planning

Project:  Assessment of Parent Involvement Strategies in Programs Serving Adolescents

The study assessed the effectiveness of Parental Involvement Strategies to influence adolescent behavior in Title XX Prevention (of pregnancy) and Care (to parenting adolescents) programs and Title X (family planning) programs. There were two major assessment approaches: (1) a literature assessment; and (2) Site visits to 5 Title X family planning projects, 5 Title XX Prevention projects for adolescent pregnancy, and 5 Title XX Care projects for pregnant and parenting adolescents. The site visits collected qualitative data on parental involvement strategies used, barriers encountered and lessons learned. The literature assessment examined a wider range of reproductive health programs with parental involvement components, and focused on those with the best available systematic evidence on the impact of program components on adolescents' reproductive health attitudes and behaviors. For the literature assessment, 26 studies of parent involvement programs were examined, including 14 randomized controlled trials. Overall, there was mixed evidence for effectiveness of parent involvement programs. A number of limitations to the best available studies were noted, suggesting the need for more evaluation effort in this area. From the site visit studies, it became very clear that inducing parents to participate in such programs in significant numbers is quite difficult. Barriers to parental participation are quite pronounced, with logistics, psychosocial factors, relationship dynamics and cultural issues among the obstacles.