Research and Data Analysis

The Well-Being of Washington State’s Children During the COVID-19 Pandemic: Behavioral Health Trends

This report uses Medicaid claims data to examine trends in children’s behavioral health diagnoses and services before and during the COVID-19 pandemic in Washington State. We examine trends in outpatient mental health services, claims with specific mental health diagnoses, claims with a suicide or self-harm diagnosis, and mental health and substance use-related emergency department claims. Trends across gender and race/ethnicity are also examined.

First Episode Psychosis: Estimating Annual Incidence Using Administrative Data

This report presents estimated incidence rates of first episode psychosis (FEP) among the Washington Medicaid population in state fiscal year (SFY) 2021. Using administrative data from 1997 forward, we identified 4,388 Medicaid enrollees in Washington State who received their first psychotic disorder diagnoses in SFY 2021. The overall incidence rate of FEP was estimated at 235 per 100,000 Medicaid enrollees. The demographic characteristics and geographic distribution of Medicaid enrollees experiencing FEP are presented in the report.

Synthetic Estimates of Substance Use Treatment Need in Washington State

This report provides synthetic estimates of substance use disorder (SUD) treatment need among the low-income population in Washington State. By calibrating need estimates derived from Medicaid data to SUD prevalence rates reported by the National Survey on Drug Use and Health, we produced estimates of SUD treatment need for the Medicaid population as well as the low-income population not enrolled in Medicaid. We found that 4.4 percent of low-income youth and 15.8 percent of low-income adults had SUD treatment need in 2019. Results are presented by county and age group.

Predictive Models of Adult Protective Services Involvement Among Medicare Beneficiaries in Washington State

The Adult Protective Services (APS) program administered by the DSHS Aging and Long-Term Support Administration investigates reports of self-neglect, financial exploitation, neglect, or abuse of vulnerable adults in Washington. In 2018, APS received 60,038 reports of abuse and neglect. This report is part of a series of analysis examining factors associated with the risk of being identified as an alleged or substantiated victim in an APS investigation. This report extends earlier descriptive analysis through the use of predictive modeling to better understand the association between potential risk and protective factors and APS outcomes. This report examines APS experiences among persons enrolled in Medicare, including persons under 65 qualifying for Medicare through disability. Informed by findings from our previous analysis, separate risk models are estimated by age group, allegation type (self-neglect and non-self-neglect), and substantiation status.

Predicting Receipt of Substance Use Disorder Treatment Among Medicaid Clients

This study uses statistical modeling to identify factors generally associated with receipt of substance use disorder (SUD) treatment in calendar year 2019 across three SUD treatment modalities (outpatient, inpatient, and medication for opioid use disorders). We found that we could adequately predict treatment receipt for two populations of Medicaid clients: those with a recent treatment history (received any treatment in 2017 or 2018), and those who had not. However, a limited number of factors were consistently associated with uptake of the three SUD treatment modalities, and the types of factors that predicted treatment differed between clients with and without a recent treatment history. This report discusses the findings in more depth, their implications, and how they can inform future efforts to connect Medicaid clients to SUD treatment services.

2021 DSHS Employee Engagement Survey

The 2021 survey shows overall declines in employee engagement since the last major survey, much of which may be attributable to the extensive impact of COVID-19. Compared to 2019, there were statistically significant declines in positive responses to eight of the 17 comparable items in both surveys, and five statistically significant increases. The response rate in 2021 was 67% (10,170 responses). Areas of improvement include satisfaction with flexibility and mobility (among those with opportunities to telework), fair treatment in work groups, recognition for a job well done, and teamwork. Challenges include indications of burnout (issues with workload, staffing, feeling valued, and morale), substantial drops in job satisfaction and net promotion, dissatisfaction with change management, and unmet individual needs for autonomy and growth. Opportunities and challenges vary across administrations and work groups. The Employee Engagement Survey is an important component of Governor Inslee’s Results Washington initiative for performance management and continuous improvement. Results are used by DSHS to inform strategic planning and initiatives to improve employee engagement at every level of the organization.

2021 Caregiver Survey Report

Between August 2020 and August 2021, DSHS surveyed 1,345 caregivers (601 foster and 744 kinship) who had a child in care within six months of the sampling date (August and November, 2020; February and May, 2021). 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. They were also asked to offer recommendations for change. Satisfaction with support, training, and licensing services remained high in 2021. Among kinship caregivers, there was a statistically significant increase in positive responses for being treated like part of the team and no decreases for any question. Among foster caregivers, positive responses increased in some areas and decreased in others, though none of the changes were significant. Notably, the previously reported decline in satisfaction with social worker listening did not continue. Differences between groups were small, but kinship caregivers were generally more satisfied than foster caregivers, a different pattern of responses from 2020, when foster caregivers were more positive than kinship caregivers in several areas. Written comments identified areas for improvement, including timelier information‐sharing, more inclusion, additional resources, and more effective processes. Caregivers appreciated training that was trauma-informed and continued to highlight the need for a variety of trainings and multiple ways to access them.

Suicide Prevention: Peer Navigators

The Emergency Response for Suicide Prevention (ERSP) Peer Navigator program provided evidence-based suicide prevention services to 232 participants from December 2020 to January 2022. The program was funded as part of an $800,000 SAMHSA grant and referred individuals who screened positive for suicidality at participating Emergency Departments, psychiatric inpatient facilities, and a domestic violence services site to Peer Navigators with lived experience of suicidality. Peers provided evidence-based, individualized support services and care coordination for participants discharged from five sites in King and Stevens counties. Participants were also offered a digital health application (Jaspr HealthTM) with on-demand evidence-based suicide supports. This report describes the clients enrolled in the program and a pre-post analyses examining suicide attempts, psychiatric emergency department and inpatient events, substance misuse, and social connectedness.

Medicare Post-Acute Care Savings from Medicaid-Paid Long-Term Services and Supports - Findings from Washington State

Medicare pays for post-acute care, including Medicare skilled nursing facility, inpatient rehabilitation, other inpatient, and home health services after a hospital stay. These post-acute care expenditures are the fastest-growing component of Medicare spending. Medicaid pays for Long-Term Services and Supports (LTSS), including in-home, residential, nursing home services. These services may reduce Medicare post-acute costs through two channels. First, long-term services and supports may substitute for Medicare post-acute care. Second, the need for post-acute care may be reduced due to beneficial health effects of long-term services and supports. We find that, after controlling for other factors, for each $1,000 dollars spent on Medicaid-paid LTSS in the year after an acute hospital stay, Medicare expenditures are reduced by: $208 for elders and $254 for adults receiving in-home personal care services, and $246 for elders and $126 for adults receiving community residential services (e.g., services in an adult family home or assisted living facility). Our findings suggest that LTSS services funded through WA Care Fund benefits are likely to generate substantial savings for Medicare.

The Impact of Prosecutorial Diversion Programs on Behavioral Health Service Use and Criminal Justice System Involvement

This study evaluates the impact of the three DSHS-contracted prosecutorial diversion programs on competency order, criminal justice, and behavioral health measures for Medicaid-enrolled participants relative to statistically matched comparators. Overall, we found that the diversion programs reduce re-arrest rates, days of incarceration, and state psychiatric hospital stays, and increase receipt of community-based mental health treatment for study participants. There was no measurable impact on competency orders. The report presents program participant characteristics and findings from the outcome evaluation for all Medicaid-enrolled program participants and a subset of those participants with a history of competency services.

Informing the Placement Continuum: Classifying Children in Out-of-Home Placement Using Integrated Administrative Data

This report presents results from a proof of concept study that examined whether administrative data contained in the DSHS Integrated Client Database (ICDB) could group children in out-of-home care according to their characteristics, needs, and experiences. We found that measures built using cross-agency administrative data contained in the ICDB assigned children to ten mutually exclusive groups that were associated with placement outcomes and child welfare costs. The report summarizes the characteristics and outcomes for children in each of the ten groups and discusses how this analysis may inform DCYF’s efforts to expand its out-of-home placement continuum.

Predicting Maternal Well-Being Outcomes for Washington State’s TANF Population

This study uses a predictive modeling approach to identify factors related to well-being outcomes for women who give birth while receiving TANF, and outcomes for their babies. We found that models using linked administrative data could adequately predict two outcomes of interest: infant out-of-home placement within the first year of life and the mother’s use of the emergency department in the 12 months following the birth. This report discusses the findings from the predictive models and makes recommendations on how they can inform prevention and case management services.

Our Clients Speak: Results from the 2021 Social and Health Services Client Survey

Between October 2020 and March 2021, the Research and Data Analysis Division of the Washington State Department of Social and Health Services (DSHS) conducted 1,251 telephone interviews with randomly selected clients who received services between May 2019 and April 2020. Most services covered in the survey were provided by DSHS; medical assistance, community-based mental health services, and substance use disorder 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 2021 Client Survey started seven months into the COVID-19 pandemic, giving us a window into the client experience during a momentous shift in service provision. Overall, satisfaction with social and health services remained high. As in previous years, the great majority of clients expressed satisfaction with services and their interactions with staff. Compared to 2019, responses to three questions increased in positivity, 10 decreased, and two stayed the same. None of the changes were statistically significant. Access to a live person continues to be a challenge for many clients – an existing issue that worsened during the pandemic. Comments show that clients appreciate remote options for service delivery, but would like more user-friendly online services and easier ways to connect with staff.

Prior Gestational Age and Subsequent Risk for Preterm Birth among Washington State Women

Preterm birth (before 37 completed weeks of gestation) is a leading cause of infant mortality and morbidity. In this report, we explored rates of preterm birth as they relate to gestational age of prior deliveries and interpregnancy intervals (IPI) among Washington State women. We found that both prior preterm birth and early term birth were associated with subsequent preterm birth. The association between a short IPI (less than six months) and very preterm birth varied by gestational age of prior delivery. Specifically, women with a prior preterm or early term birth and a short IPI had the highest risk of subsequent very preterm birth.

Assessment of Phase 1 Co-responder Program Staffing Needs

Following the Trueblood et al. v. Washington State DSHS et al. lawsuit, the Trueblood Contempt Settlement Agreement established a multi-phase plan for providing services and treatment to persons in the criminal court system aiming to reduce their likelihood of recidivism. This report fulfills the Settlement Agreement’s requirement for Washington state to “perform an assessment of law enforcement agency co-responder mental health staffing needs to guide future funding requests” in the Phase 1 regions, which include 10 Washington counties. RDA conducted and analyzed data collected from two surveys to assess mental health field response and co-responder program staffing needs in Phase 1 regions. The primary survey represented law enforcement agencies (LEAs) identified by the Washington Association of Sheriffs and Police Chiefs (WASPC) within these regions. A secondary survey represented Behavioral Health Agencies (BHAs) participating in existing co-responder programs that were identified by referral from LEAs. This report presents a detailed analysis of co-responder program staffing and needs, a general description of other issues addressed in the survey, and interpretation of results.

Spokane Better Health through Housing: A Pilot Program Connecting Homeless High Emergency Department Utilizers to Housing

Funded by the 2019 Legislature (ESHB 1109), the Better Health Through Housing pilot program sought to reduce health care costs by providing housing and other services to homeless, frequent emergency department visitors with complex healthcare needs. The program was administered by the Department of Commerce and implemented by Better Health Together, an Accountable Community of Health located in northeastern Washington. This report describes program implementation and the experiences and characteristics of individuals referred to the pilot, including their: 1) progression through key program milestones; 2) health histories; and 3) medical utilization patterns before and after referral to the program.