Research and Data Analysis

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Image of report cover 11.253Veterans Health Administration Program Participation and State Health and Social Service Use

The Veterans Health Administration (VHA) provides a variety of health and social services to enrolled Veterans in Washington State, including a Primary Care Management Module (PCMM) designed to support coordination between providers. Despite having access to Veteran specific services, some Veterans are also seeking state-funded social and health services. In 2016, about 17 percent of those enrolled with the VHA also received at least one of the following services: Basic Food, Child Support Services, Child Welfare Services, Aging and Long Term Support Services, or Medicaid. Prior research has shown that the frequency of state service use is not consistent across the Veteran population. This study uses a logistic regression approach to identify factors associated with the use of state services.

Image of report cover 9.119Washington State Behavioral Health Treatment and Recovery Support Services Utilization

In September 2019, the Centers for Medicare and Medicaid Services (CMS) awarded Washington state $3.8 million under the §1003 SUPPORT ACT to develop a policy framework. This framework will guide future activities to advance statewide whole-person, integrated substance use disorder (SUD) treatment and recovery service improvements. An understanding of the current utilization of behavioral health treatment and recovery support services is crucial to identifying both strengths and gaps in the existing behavioral health system in Washington.

Image of report cover 7.1182019 Caregiver Survey

Between October 2018 and August 2019, DSHS surveyed 1,342 caregivers (529 licensed and 813 kinship) who had a child in care within six months of the sampling date (August and November, 2018; February and May, 2019). These caregivers were asked about their satisfaction with support, licensing, training, and information provided by the Department of Children, Youth, and Families (DCYF) and private agencies contracted by the Department to provide services to caregivers. They were also asked to offer recommendations for change.

Image of report cover 7.117Home Visiting Services for TANF Families with Young Children: Second Year Outcomes

This report examines second year outcomes for families who enrolled in the TANF Home Visiting program between May 2015, when the program began, and October 2016. Outcomes for participating families during the 24 months following enrollment were compared to outcomes for similar families receiving TANF who did not enroll in home visiting. Parents enrolled in TANF Home Visiting were more likely than comparison parents to engage in WorkFirst activities that prepared them for work, including education and training activities, and to use child care subsidies. Infants born to parents in TANF Home Visiting also experienced better health and safety including fewer emergency department visits and visits for injury treatment in the second year after enrolling, and reduced likelihood of being placed out-of-home in the first year after enrolling. The results from the second year of follow-up for the TANF Home Visiting program are promising and suggest that home visiting services may impact the behavior of parents and improve outcomes for kids. The DSHS Economic Services Division should consider whether to make this type of service available to more TANF families, especially those families who are expectant or have a new baby.

Image of report cover 7.116In-Home Service Use and Family Risk for Child Welfare Involved Families: Findings from Washington State

This report describes in-home service utilization and family risk factors for families involved in the Washington State child welfare system from 2013 to 2016. In-home services are available to child welfare-involved families for the purposes of strengthening parenting capacity and supporting child safety. Family risk was measured from a variety of administrative data sources and included measures of domestic violence, parent criminality, parent substance abuse, parent mental illness, economic stress, homelessness, and prior child welfare involvement. Results show that more than half of child welfare-involved families experienced five or more family risk factors, yet only one out of ten families received an in-home service. The rate of in-home service use was especially low (6 percent) for families with children who remained at home, while half of the families with a child in a long-term out-of-home placement received an in-home service.

Image of report cover 11.2522019 Employee Engagement Survey

The 2019 survey shows overall declines in employee engagement since the last major survey. Compared to 2017, there were statistically significant declines in positive responses to nine of the 24 items included in both surveys and only one statistically significant increase. Although down compared to the record-high positivity seen in 2017, the current survey compares favorably to years prior to 2017. The response rate in 2019 was 81%, the highest level of participation since the survey began in 2002. Survey results show opportunities for positive change, and in some cases, important challenges. Many of the opportunities and challenges are specific to administrations and major units, and are the subject of action planning at every level of the organization. The Employee Engagement Survey is an important component of Governor Inslee’s Results Washington initiative for performance management and continuous improvement. Survey results are used as the primary outcome measure for the goal to “Increase Washington as an employer of choice” under Goal 5: Effective, efficient and accountable government.

Image of report cover 3.51Mental Health Clubhouse Services in Washington State: An Evaluation

Under Washington State's 1915(b) Medicaid waiver authority, mental health clubhouse (MHC) services were offered from 2005 until 2012 to individuals with mental illness and/or co-occurring mental health and substance use disorders. Legislative interest in expanding MHC services prompted this evaluation, which compares Medicaid MHC clients—served between January 2009 and June 2012—to a matched comparison group who received some other form of mental health treatment (“treatment as usual”) during the same time period. Clubhouse services were expected to reduce outpatient emergency department utilization, inpatient hospitalizations, arrests, homelessness, and use of crisis/stabilization services while increasing employment rates and engagement in ongoing behavioral health treatment services. This study found that, relative to treatment as usual, MHC service receipt was associated with improvements in arrest rates and increased SUD treatment utilization but worsening rates of crisis mental health service utilization and homelessness. MHC services, as provided in Washington State during the study period, did not systematically outperform treatment as usual on other key behavioral health and quality of life measures for Medicaid-only clients.

Image of report cover 5.40Respite Needs Among Developmental Disabilities Administration No-Paid Caseload

The Washington State Department of Social and Health Services, Aging and Long Term Services Administration (ALTSA) Lifespan Respite grant staff collaborated with the Developmental Disabilities Council administered a survey to caregivers and clients to explore respite needs among the Developmental Disabilities Administration (DDA) no-paid client population. Nearly all survey respondents reported needing respite and currently relying on an informal network of friends and family members for assistance. Almost none of the caregivers were currently using assistive technology to take a break from caregiving.

Image of report cover 11.251The Foundational Community Supports Program: Preliminary Evaluation Findings

The Foundational Community Supports (FCS) program launched in January 2018 under Washington State's 1115 Medicaid Transformation Project. FCS provides supportive housing and supported employment services to clients with complex physical or behavioral health care needs. This brief reports preliminary outcomes for 1,736 persons enrolled during the first nine months of program operations. We found that Aging and Long-Term Support (ALTSA) and Health Care Authority (HCA) clients enrolled in supported employment services experienced statistically significant improvements in employment rates, earnings, and hours worked. Similarly, clients enrolled in supportive housing services realized increased transition out of homelessness. Supportive housing services were also associated with reductions in outpatient emergency department and inpatient utilization for Medicaid beneficiaries served through HCA. Longer-term evaluation findings will be provided by the Oregon Health Sciences University Center for Health Systems Effectiveness, in their role as the independent external evaluator for the 1115 Waiver.

Image of report cover 11.2482019 Social and Health Services Client Survey

Between September 2018 and April 2019, the Research and Data Analysis Division of the Washington State Department of Social and Health Services (DSHS) conducted 1,222 telephone interviews with randomly selected clients who received services between May 2017 and April 2018. Most services covered in the survey were provided by DSHS; medical assistance, mental health services and substance use treatment services were provided by the Washington State Health Care Authority; and children and family services were provided by the Department of Children, Youth, and Families. Clients were asked about their satisfaction with social and health services and for recommendations for change. The 2019 survey is the most positive on record. Over half (12 of 20) of the standard questions are at new highs. Compared to the 2017 survey, there were statistically significant improvements in ease of getting services, reaching a live person, timely responses to calls, knowledge of available services, ease of getting information, and client involvement in receiving services. There were no statistically significant decreases. Comments show that there are still some areas where many clients desire improvement, including more information about what services are available, easier ways to connect with staff, and streamlined application processes.

Image of report cover 11.249The Snohomish Diversion Pilot: Treatment Services for Homeless Individuals with Substance Use Disorders as an Alternative to Jail

The Snohomish Diversion Pilot (SDP) is a jail diversion program established by the 2018 Legislature (ESSB 6032) with an allocation of $800,000 for state fiscal year 2019 and additional funding provided by local sales tax dollars. Homeless individuals at risk of arrest for minor infractions who have substance use or co-occurring mental health and substance use disorders (SUD) were referred to the SDP by embedded social workers and law enforcement officers throughout Snohomish County. Eligible individuals amenable to treatment received on-site medical and behavioral health screenings by staff at the 44-bed Snohomish Diversion Center and were connected to treatment, social services, and housing resources. This report describes short-term, pre-post outcomes for 192 SDP participants who enrolled from July through October 2018. Compared to the three months prior to enrollment, engagement in SUD treatment services more than doubled, jail bookings and the average number of days jailed decreased, and almost half of participants were re-housed. Due to the short follow-up and lack of comparison group, findings should be considered preliminary. Further analyses is required to confidently assess the effectiveness of the program.

Image of report cover 11.250Prosecutorial Diversion of Individuals with Serious Mental Illness Involved in the Criminal Justice System

Program Descriptions and Participant Characteristics of DSHS-Contracted Diversion Programs Using different approaches, three DSHS-contracted prosecutorial diversion programs aim to divert individuals with behavioral health conditions from the criminal justice system and competency services, into outpatient behavioral health services. This report describes participant characteristics at program entry for the 354 individuals who entered the three prosecutorial diversion programs from January 2017 to March 2019 and the behavioral health, criminal justice, and employment history for a subset of participants. Key findings include: 1. The Lourdes (Tri Cities) and LINC (King County) programs had higher percentages of participants with court orders for competency services in the five years prior to program entry, and more extensive criminal histories, compared to the Spokane County program; 2. A larger proportion of the LINC program participants were hospitalized for inpatient mental health services and were diagnosed with a psychotic disorder compared to the other programs; 3. The Lourdes program enrolled more participants with felony charges into their program compared to the LINC and Spokane County programs.

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