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Image of report cover 13.04Improving Women’s Access to Long-Acting Reversible Contraception: Role of Medicaid Reimbursement Policy Change

Long-acting reversible contraception (LARC) is highly effective at preventing unintended pregnancy, yet is underutilized in the United States. In an effort to improve women’s access to LARC, the Washington State Medicaid program increased provider payments for provision of LARC as of September 2015 and started to provide separate payment for immediate postpartum LARC insertion. This policy brief examines the changes in LARC utilization among women of reproductive age 15-44 years old receiving public health insurance in Washington State before and after the Medicaid reimbursement policy change. We found a statistically significant increase in LARC use within three and 60 days of delivery after the increase in reimbursement rates in 2015. Our findings suggest that Medicaid payment policy change can be an effective policy option to increase postpartum LARC initiation and highlight the need to improve access to LARC methods outside the postpartum period.

Image of report cover 6.64The Maternal Well-Being of Washington State’s TANF Population

This descriptive report provides information on the well-being of new mothers who receive Temporary Assistance for Needy Families (TANF) and their newborns in order to identify potential service gaps and needs for this vulnerable population. Findings indicate that women who give birth and receive TANF have complex needs and face significant barriers to well-being including housing instability, behavioral health conditions, low education levels, and significant health problems. Given these needs, services to ensure well-being for new mothers on TANF are multifaceted and require coordination across service systems and agencies.

Image of report cover 6.63Washington State Youth Treatment Implementation (WSYT-I) Program: Final Evaluation Report

This report describes the outcomes of the Washington State Youth Treatment Implementation (WSYT-I) Program. Funded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) from 2016 through 2019, the program provided evidence-based standardized assessment (GAIN) and substance use disorder (SUD) treatment (A-CRA), in conjunction with care coordination and recovery support services to youth (age 12-18) with SUD diagnosis, including those with co-occurring mental health needs. Self-reported results from post-enrollment interviews indicated that WSYT-I participants had increased rates of abstinence, reduced criminal justice involvement, and experienced fewer health, behavioral health, or social consequences from alcohol and drug use six months after enrollment. Youth who received WSTY-I and similar services were more likely to complete treatment than a statistically matched group of comparison youth who shared similar baseline characteristics to WSYT-I participants. Participation in WSYT-I or similar services also led to increased utilization of SUD outpatient and case management services. We did not find statistically significant differences between the WSYT-I and comparison youth in medical utilization, criminal justice involvement, and employment outcomes.

Image of report cover 6.63Basic Food Client Characteristics

This report presents a descriptive portrait of Basic Food households and the working-age clients within them. Working-age Basic Food clients face multiple barriers to economic well-being, including low education, low wages, and significant behavioral health needs. Understanding recipients’ barriers to economic well-being can help DSHS develop additional strategies to support low-income households as they work toward increased earnings and improved well-being.

Image of report cover 6.65What Follows Basic Food Exit?

This report assesses the frequency of “successful exits” from the Basic Food program and examines how the characteristics of successfully exiting households differ from other households exiting from, and remaining on, Basic Food. Success is based on consistent household earnings significantly above the poverty level in the two years following exit without a return to Basic Food. Results show that “successful exits” are more likely for households with higher educational attainment and a track record of employment and earnings.

Image of report cover 6.60TANF Supported Employment Pilot Participant Characteristics

This report describes 219 participants who enrolled in the Temporary Assistance for Needy Families Supported Employment Pilot (TANF SEP) between April 2015 and June 2017. The TANF SEP program used the Individual Placement and Support (IPS) model of supported employment services to help TANF clients with mental health and co-occurring substance abuse disorders obtain and maintain competitive employment. Individuals were eligible for participation in the pilot if they were unemployed and receiving TANF, met access to care standards for mental health treatment, expressed an interest in being employed, and lived in Skagit or Snohomish counties. TANF SEP participants faced a variety of barriers to employment, including housing instability, poor employment history, behavioral health treatment needs, other chronic health conditions, criminal justice system involvement, and childcare needs. Despite these challenges, employment rates almost doubled for program participants who enrolled in the program by June 2016 between the pre- and post-periods, and housing instability rates decreased by 22 percent. The report has two key limitations: (1) it is based on a small subset of TANF recipients in a restricted geographic area, so it may not be generalizable to Washington’s broader TANF population; and (2) the analysis did not use a comparison group necessary to assess the net effects of the program. It is unclear if the changes in observed outcomes in employment are due to participation in the program or other factors, such as participant motivation..

Image of report cover 4.102Washington State’s Medication Assisted Treatment – Prescription Drug and Opioid Addiction Project – Preliminary Outcomes through Year Two

This report examines years one and two of program implementation for the Washington State Medication Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) program. MAT-PDOA was a three year, federally funded initiative to increase access to MAT with buprenorphine in Grays Harbor, King, and Thurston counties and was awarded to Washington State’s Department of Social and Health Services in August 2015. Building upon the success of year one, MAT-PDOA provided MAT with buprenorphine to 532 patients through year two and 51 percent of all enrolled patients were in the program for a year or longer. At six months after enrollment in treatment, MAT-PDOA patients reported significant reductions in alcohol and drug use rates, including any opioids, cannabis and methamphetamine. Similar to year one findings, self-reported reductions in adverse outcomes related to opioid use disorder, including improvements in employment and school enrollment, reductions in inpatient and emergency department utilization, and increases in outpatient service utilization were seen six months after enrollment.

Image of report cover 11.2462018 Foster Parent Survey: DCYF Foster Parents Speak

This report describes the results of the 2018 DCYF Foster Parent Survey, which was previously conducted annually by the DSHS Children’s Administration. From September 2017 through August 2018, DSHS surveyed 1,349 foster parents about their satisfaction with the support and training provided by DCYF (Children’s Administration through June 2018) and private agencies. Relative to 2017, more foster parents said they get adequate support, can get help when they ask for it, find that social workers listen to their input, are treated as part of the team, and get adequate information about the needs of children placed with them. Responses about the quality of training continue to be very positive – 87% agreed that their training was somewhat adequate or more than adequate. Written comments show that there are still some areas where many desire improvement, including information sharing, inclusiveness, reimbursements, and efficient processes. Foster parents continue to emphasize that participation of experienced foster parents and the ability to interact with one another add value to training.

Image of report cover 9.118Evaluation of Integrated Managed Care for Medicaid Beneficiaries in Southwest Washington: First Year Outcomes

On April 1, 2016, two counties in Southwest Washington (Clark and Skamania) became the first region in Washington to adopt an integrated managed care (IMC) model. This evaluation examines the impact of the transition to IMC on the health and social outcomes of Medicaid beneficiaries in the IMC region. Difference-in-difference approaches were used to examine changes in a broad set of health care performance metrics in the first year after implementation of the IMC model (April 1, 2016 to March 31, 2017), relative to beneficiary experience in the prior year. We report findings derived from both simple t-tests and generalized estimating equation (GEE) models that control for the potential confounding effect of regional differences in beneficiary characteristics. Of the health and social outcome metrics examined, two-thirds showed no significant relative change in Southwest Washington, compared to the balance of state. The outcome measures that had significant differences were mostly positive for the Southwest region, with few statistically significant negative results.

Image of report cover 3.50First Episode Psychosis: Predicting the Risks of Psychosis Using Administrative Data

This report describes key risk indicators associated with first episode psychosis (FEP) among youth and young adults between the ages of 12 and 25. The report also presents a model to identify individuals with the highest risks for experiencing FEP using administrative data. We found that mental health history and mental health service utilization are the strongest predictors of FEP. High-risk individuals often have encounters with mental health and substance use disorder treatment facilities, child welfare agencies, and hospital emergency rooms within six months before being first diagnosed with psychotic disorders. They are also likely to be receiving other social services such as Basic Food and to be involved with the criminal justice system.

 

Image of report cover 7.115Identifying Infants at Risk of Adverse Outcomes Using Administrative Data: Findings from Washington State

This report summarizes a set of predictive models which used administrative data available at birth to predict adverse outcomes for children on Medicaid. The three outcomes of interest were: 1) infant mortality, 2) Child Protective Services involvement before age four, and 3) developmental disorder diagnosis before age four. The findings demonstrate the utility of combining birth certificate information and other state administrative data about maternal and child factors such as low birth weight, maternal child welfare involvement, and number of previous births to identify infants that are most at risk of adverse outcomes.

 

Image of report cover 3.49The Impact of Mental Health Court on Recidivism and Other Key Outcomes

This report presents results from a study examining outcomes for participants of the King County District Court Regional Mental Health court. The therapeutic court aims to reduce recidivism and improve community safety by facilitating behavioral health treatment for individuals with a mental disorder who are involved in the criminal justice system. Over a one year period, the mental health court significantly improved outcomes for participants across multiple domains. Mental health court participants had significantly lower rates of re-offending and psychiatric hospitalization, and fewer incarceration days and emergency department visits, relative to a matched comparison group.

 

Image of report cover 7.114Service Use, Risk Factors, and Assessments among ECLIPSE, ECEAP, and ESIT Clients

This report examines the children enrolled in three Department of Children, Youth, and Families (DCYF) Family Support and Early Learning Program Division programs: Early Childhood Intervention and Prevention Services (ECLIPSE), Early Childhood Education and Assistance Program (ECEAP), and Early Support for Infants and Toddlers (ESIT). The aims of the report were to examine overlaps between ECLIPSE and the other two programs, consider the feasibility of using assessments from ESIT and/or ECEAP to evaluate outcomes for the ECLIPSE population, and assess service use and risk factors of the population(s).

 

Image of report cover 11.247Use of State Health and Social Services Among United States Veterans Living in Washington State

This report describes the characteristics, service needs, and service receipt of Veterans in Washington State. We found that 17 percent of Veterans enrolled in Medicaid and/or received a social service from a state agency in 2016. Among this group of Veterans, 52 percent accessed Basic Food, 56 percent had an identified mental health treatment need, and 8 percent received a housing service during the year.

 

Image of report cover 6.62WorkFirst Parents in Vocational Education at State Community and Technical Colleges: The Role of Basic Food Education & Training

This study describes the experiences of parents pursuing education through WorkFirst with a special focus on parents who do and do not continue their education through the Basic Food Education & Training program (BFET). WorkFirst students who used BFET were more likely to complete a degree or credential, but this may be because these students tended to be more educationally prepared and had stronger work histories. WorkFirst students were also more likely to complete a credential if they did not require basic skills coursework, attended full-time, or enrolled in the Integrated Basic Education and Skills Training Program (I-BEST).

 

Image of report cover 7.113The Effect of Dispensing One-Year Supply of Oral Contraceptive Pills- Findings from Washington State

THE HEALTH CARE AUTHORITY (HCA) of Washington State changed the policy for oral contraceptive pills (OCPs) supply in 2014 by requiring the dispensing of one-year packages for Medicaid recipients (under Section 213, Chapter 4, Laws of 2013, 2nd Special Session). The program goals are to achieve savings by reducing unintended pregnancies that result in Apple Health (Medicaid) funded births. This report presents findings on dispensing patterns for OCPs to Medicaid women, estimates the averted births associated with the policy change and cost savings due to averted births as a result of dispensing one-year supply of OCPs. Dispensing at least a one-year supply was associated with a significant reduction (12%) in Medicaid funded births. The state saved $1.5 million, an average of $226 per client, on maternity and infant care services due to averted births compared with those who were dispensed an initial one-month supply during 2014.

Image of report cover 4.99Drug Court Participants: Recidivism and Key Outcome Measures

These reports present recidivism measures and other key outcomes and characteristics of offenders participating in adult drug courts across Washington State. The reports contain yearly trends for individual courts and for courts statewide. Measures include drug court enrollment, demographics, recidivism, substance use disorder treatment participation, employment and Medicaid enrollment. The reports were written in collaboration with the Criminal Justice Treatment Account Panel and the HCA Division of Behavioral Health and Recovery, and will be updated annually. To protect client confidentiality, reports for courts with a small number of participants are not included.

 

Image of report cover 9.113Childhood Adversity and Medical Costs for Adolescents in Washington State

This research brief highlights results from a study examining the relationship between adverse experiences and healthcare costs of adolescents enrolled in Medicaid in Washington State. The brief focuses on findings about the association between adverse childhood experiences and medical service costs. A companion research brief highlights findings about the association between child adversity and behavioral health costs. Taken together, these two reports highlight the relationship between childhood adversity and increased healthcare costs.

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