Washington State Department of Social and Health Services

Patterns of Hospital Readmissions and Nursing Facility Utilization among Washington State Dual Eligibles: Opportunities for Improved Outcomes and Cost Savings

Dual eligibiles—persons enrolled in both Medicare and Medicaid—are among the highest cost beneficiaries of publicly funded medical care. They are currently served through a fragmented delivery system in which health care providers have conflicting incentives and incomplete information, which may result in cost-shifting between payers and increased costs. This policy brief focuses on implications of care transitions between hospital and nursing facility settings, in the context of a nursing facility benefit currently fragmented between Medicare and Medicaid.

Permanent Options for Recovery-Centered Housing: Year 1 Annual Report

This report describes baseline characteristics for individuals who enrolled in the Permanent Options for Recovery-Centered Housing (PORCH) program during the first 12 months of program services (May 2011 through April 2012). PORCH is a permanent supportive housing (PSH) program offered in Pierce, Chelan and Douglas counties. PSH is typically defined as affordable housing combined with services that are provided to chronically homeless individuals with substantial mental, physical or behavioral health barriers to maintaining housing. The combination of affordable housing and services is expected to encourage progress towards mental health and substance abuse recovery goals, and minimize spells of homelessness.

Washington State Institutional Review Board, January – December 2011

This report provides an overview, organization, and membership of the Washington State Institutional Review Board. It documents the legal authority for the Review Board, and describes major activities during 2011. It also includes a log of all research projects reviewed during this period.

DSHS Integrated Client Database

DSHS’ INTEGRATED CLIENT DATABASE (ICDB) is a longitudinal client database containing over a decade of detailed service risks, history, costs, and outcomes. ICDB is used to support cost-benefit and cost offset analyses, program evaluations, operational program decisions, geographical analyses and in-depth research. DSHS serves almost 2.4 million clients a year. The ICDB is the only place where all the client information comes together. From this central DSHS client database, we get a current and historical look into the life experiences of residents and families who encounter the state’s social service system.

The Housing Status of Individuals Discharged from Behavioral Health Treatment Facilities

This report examines the housing status of individuals following their last discharge from a behavioral health treatment facility in State Fiscal Year 2010. Over a 12-month follow-up period, we find that nearly half of the 9,909 clients discharged from residential chemical dependency treatment facilities had an indication of housing need, yet only 18 percent of those in need received housing assistance recorded in the Homeless Management Information System (HMIS). Similarly, while approximately 30 percent of the 1,792 clients discharged from state mental health hospitals had an indication of housing need, only 17 percent of those in need received housing assistance recorded in HMIS.

Identifying Homeless and Unstably Housed DSHS Clients in Multiple Service Systems

This report combines administrative data from multiple service systems to identify homeless and unstably housed DSHS clients. By leveraging data from the Automated Client Eligibility System (ACES) and four other data systems, we identify an additional 39,267 (or 27 percent more) homeless DSHS clients in State Fiscal Year 2010 than when ACES is used alone. Homeless clients are more likely than those in the overall DSHS client population to be African American and Native American, live in high density urban areas, have mental illness and substance abuse problems, receive medical treatment for injuries, and receive cash and/or food assistance.

2011 DSHS Employee Survey

10,289 employees completed the 2011 Employee Survey. They addressed communication, supervisor/manager support, fairness and diversity, job satisfaction, and business practices. The 2011 survey shows the effects of the greatest economic downturn since the Great Depression. The overall survey trend was downward – reflecting uncertainty, pay cuts, reduced resources, and greater client need. This is consistent with an overall drop in scores for all state employees. In the eleven years that the Department of Social and Health Services has conducted agency-wide surveys, there has never been such a dramatic drop in morale and employee engagement. The survey results reflect a workforce increasingly anxious and unsure about the future, worn down by changes and increased workload, feeling left out of important communication, and feeling like they have less “say” in the workplace. However, workers continue to be proud of their contribution to society, and to know what is expected of them. Most employees continue to report fair and respectful treatment, especially from supervisors and co-workers.

Characteristics and Criminal Histories of Adult Offenders Admitted to Treatment under Washington State’s Criminal Justice Treatment Account

This report compares key demographic, criminal history, and geographic differences between offenders 1) involved with formally established drug courts, and 2) those charged through non‐drug court programs (Superior Courts or Courts of Limited Jurisdiction). We found 39 percent of offenders entering treatment were from a drug court program. One in three offenders was a young adult (age 18 to 25). Felonies were the most serious charge for 94 percent of drug court offenders and 19 percent of non-drug court offenders. Felony drug offenses were the most serious charge for 65 percent of those from drug courts. The most serious charge for half of non-drug court offenders was a traffic-related offense with 36 percent charged with driving under the influence or driving while intoxicated.

Transition to Adulthood - An Analysis of the National Youth in Transition Database Survey Data for Washington State

This report examines results of the first National Youth in Transition Database survey of 17-year-old youth in foster care in Washington. A total of 419 youth, or 92 percent of those eligible, participated in the survey. A majority of the surveyed youth report going to school, having no barriers to completing their education, living in a stable setting, having emotional and financial support, and receiving medical treatment as needed. However, the youth also report serious risk factors such as history of involvement with the criminal justice system (35 to 48 percent of the respondents, depending on the questions asked), history of behavioral health problems (34 to 44 percent) or housing instability (19 to 37 percent).

State/County: Trends in Social Service Use, For State Fiscal Year 2008

These Chartbooks provide local human service information for government planning, monitoring and funding purposes. For each county and for the state as an aggregate, we identify service use levels, DSHS client-based risk factors, demographics, and geographic detail for:

• Infants and their birth parents
• Youth with high levels of adverse childhood experiences in their birth families
• Youth and adults with behavioral health needs (mental health and alcohol/drug treatment)
• Youth and adults with criminal justice involvement
• Working-age adults and children with disabling health conditions

This one-time project was funded by the federal Substance Abuse and Mental Health Service Administration, through the Washington State Mental Health Transformation Project. Data provided is for State Fiscal Year 2008.

Disability Caseload Trends and Mental Illness: Incentives under Health Care Reform to Invest in Mental Health Treatment for Non-Disabled Adults

Mental illness impacts health outcomes and program costs across the social and health services spectrum. This paper documents the role of mental illness in driving disability caseload growth and health care costs. With the expansion of Medicaid under federal health care reform to more non-disabled low-income adults, and with an enhanced federal share of costs for the Medicaid Expansion population, this paper shows that states have an incentive to invest in mental health treatment for non-disabled adults prior to persons becoming functionally impaired to the point of disability.

The Health Impact of Substance Abuse: Accelerating Disease Progression and Death

Substance abuse is a key driver of adverse outcomes across the spectrum of health and human services. In the areas of medical service utilization and potentially avoidable medical costs, research has shown that substance abuse increases the risk of hospitalization, increases the risk of acquiring infectious diseases, and is associated with drug-seeking behavior that results in extreme Emergency Department (ED) utilization. This study documents another pathway through which untreated substance abuse increases medical costs: by increasing the risk of onset and accelerating the progression of cardiovascular disease. This study leverages multi-year longitudinal data available in the DSHS Integrated Client Database to analyze long-term patterns of onset of hypertension, risk of progression from hypertension to more serious cardiovascular disease, medical costs, and mortality.

The Washington State Problem Solving Court Strategic Planning Survey

In Spring 2011, the Department of Social and Health Services’ Division of Behavioral Health and Recovery conducted a survey of 59 problem solving courts that address problems of substance abuse and dependency in communities across the state of Washington. This presentation highlights the results based on responses from 35 of the courts. The survey gathered information on drug court policies and procedures and the perceptions of drug court administrators, judges and their staff concerning the potential benefits of uniform policies and practices, the degree of local and state collaboration with drug courts, and desirable components of a statewide strategic plan to help promote the sustainability of problem solving courts. The survey documented that most of the drug courts work with adult felony drug offenders who are chemically dependent at the time of admission. Nearly all of the courts reported that they conduct random drug tests, followed by court sanctions for infractions. Support for drug courts was perceived to be more common at the local level than at the state as evidenced by strong collaboration and coordination between the courts and local agencies and organizations. Two themes surfaced frequently: the need for a statewide training strategy for court professionals and the need to communicate problem-solving court effectiveness to the general public.

A Profile of Housing Assistance Recipients in Washington State by Household Type

This report examines differences in rates of DSHS social and health service use, employment and arrests by household composition for 35,908 people who received assistance from four housing and homelessness prevention programs in state fiscal year 2010. The four household types are included in the analysis are households made up of one adult plus children, households with two or more adults plus children, unaccompanied adults, and “other” households (i.e., unaccompanied minors, and multiple adults without children). Findings show that differences in service use across the housing programs (Transitional Housing, Emergency Shelter, Permanent Supportive Housing, and Homelessness Prevention and Rapid Re-housing) reflect differences in the types of households that each program serves, combined with DSHS program eligibility requirements.