Research and Data Analysis

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Overdose Deaths among Medicaid Enrollees in Washington StateOverdose Deaths among Medicaid Enrollees in Washington State

Overdose deaths have risen over the past two decades, primarily driven by increased use of opioid analgesic prescription drugs. This policy brief reviews the incidence and scope of drug overdose deaths in Washington State from 2006 to 2012, and identifies the Medicaid populations at greatest risk of overdose. Findings from this study provide useful context for assessing recent overdose prevention efforts and provide a framework for behavioral health system quality measures focused on reducing overdoses.


2015 Social and Health Services Client Survey2015 Social and Health Services Client Survey

Between October 2014 and April 2015, DSHS surveyed 1,187 clients who received services between April 2013 and March 2014. These clients were asked about their satisfaction with social and health services and recommendations for change. As in previous years, the great majority of clients expressed satisfaction with services and their interactions with staff. Substantial improvements in satisfaction and access were noted for Community Service Offices, and there are indications that coordination of services may be improving. Fewer clients reported that information is easy to access in 2015. Clients of Apple Health (Medicaid) services were less satisfied with the ease of getting information and services and information, ease of getting to a provider’s office, and overall helpfulness. These changes were probably due to a substantial influx of newly eligible adult Apple Health (Medicaid) clients in 2015. This major change in the social and health services client population may also make comparisons to previous survey years difficult to interpret in other program areas, such as Division of Child Support.


Characteristics of Public Housing Assistance Recipients in Washington StateCharacteristics of Public Housing Assistance Recipients in Washington State

Statewide data on clients served by Washington State Public Housing Authorities (PHA) were linked with the social service and other data in the Department of Social and Health Services Integrated Client Database. This report examines three questions about housing assistance recipients served by PHAs across the state: 1) To what extent do DSHS and PHAs serve the same individuals? 2) What are the characteristics and service use profiles of jointly served PHA-DSHS clients? And 3) to what extent do PHA clients differ from other DSHS clients? We find that almost all (97 percent) of PHA clients in Calendar Year 2013 were DSHS clients at some point, and 91 percent received a DSHS service that same year. Medical coverage and Basic Food were the most common DSHS services received by PHA recipients. PHA recipients were more likely to be older, female and African American, receive Temporary Assistance for Needy Families and Basic Food, and have physical or behavioral health challenges, particularly among working age adults. The report was funded by the United States Department of Housing and Urban Development and also supported by the Bill & Melinda Gates Foundation.


Predicting Homelessness among Low-Income Families on TANFPredicting Homelessness among Low-Income Families on TANF

This report identifies key risk and protective factors associated with the start of a new homeless spell among parents receiving Temporary Assistance for Needy Families (TANF). Three key findings emerged: 1) recent homelessness puts families at increased risk while receipt of public housing serves as a strong protective factor, 2) criminal justice, behavioral health, and family violence issues increase the risk of future homelessness, and 3) income from work earnings or public assistance can buffer parents from homelessness, while being sanctioned for non-compliance with TANF requirements can place them at increased risk.


Impact of Housing Assistance on Outcomes for Homeless FamiliesImpact of Housing Assistance on Outcomes for Homeless Families

The Ending Family Homelessness (EFH) pilot program, which began in April 2013, provides rapid re-housing and other services to homeless families receiving Temporary Assistance for Needy Families (TANF). We examined outcomes over a 12-month follow-up period for EFH participants relative to three separate statistically matched comparison groups: those in non-EFH rapid re-housing, those in transitional housing, and those who remained homeless. Compared to TANF parents who remain homeless, EFH participants are significantly more likely to remain on TANF, progress along the WorkFirst program continuum from barrier removal to employment, be employed, and have higher average annual earnings. They are significantly less likely to be sanctioned while on TANF, experience a return to homelessness, or be arrested.


DSHS Opportunity Youth Data Project FindingsDSHS Opportunity Youth Data Project Findings

This study examines the characteristics and experiences of “Opportunity Youth,” defined as young people ages 16-24 who are not engaged in work or school. We summarize the experiences of Opportunity Youth with DSHS service histories who attended school in the Road Map region of south King County. We find that many face immediate barriers that may prevent them from engaging in work or school, including parenting responsibilities, incarceration, disabilities, and homelessness. Opportunity Youth have interacted with multiple systems, including criminal justice, behavioral health, child welfare, and public assistance. There are opportunities to better connect these systems to education and the workforce so that at-risk students are supported and those who do become Opportunity Youth are provided pathways to reengagement.


Use of Long-Acting Reversible Contraception by Washington Women on MedicaidUse of Long-Acting Reversible Contraception by Washington Women on Medicaid

Overall, more than one-third of Washington State births result from unintended pregnancies. The rate is significantly higher for women with Medicaid coverage (51%) than for women not receiving Medicaid (23%). This report summarizes use of Long-Acting Reversible Contraception (LARC) among Washington women and teens on Medicaid, including yearly numbers of LARC insertions from 2010-2014, and describes the medical specialty and licensure of practitioners who performed LARC insertions for Medicaid clients and the clinical settings in which LARCs were inserted. Key findings include: more than 100,000 women and teens on Medicaid received LARCs in the past five years, 2010-2014; more than 2,000 medical providers performed LARC insertions for Medicaid clients in 2014; and women on Medicaid receive LARCs in a wide range of clinical practice settings. With the 2014 expansion of Medicaid eligibility through the ACA, the TAKE CHARGE family planning waiver of fifteen years’ duration, and a state-funded program for postpartum family planning coverage for undocumented women, a variety of Medicaid programs provide coverage for contraceptive products and counseling; however, some groups including undocumented women and women who decline to apply for Medicaid have limited access to Medicaid coverage for family planning services.


Transition to Adulthood: Foster Youth at 19Transition to Adulthood: Foster Youth at 19

An Analysis of the 2013 National Youth in Transition Database Survey for Washington State This report follows-up on an earlier National Youth in Transition Database survey of 19-year-old youth transitioning from foster care in Washington. Authors examine outcomes related to education, employment, and measures of stability among 370 youth who participated in the survey (88 percent of those eligible). We found 78 percent of respondents are no longer in foster care. Many youth report participating in education (53 percent), employment (30 percent), and job training (18 percent). Nine in ten youth have established close, supportive relationships with adults. The biggest reported challenge is housing instability, which was identified for 30 to 52 percent of respondents (depending on the question asked). Reported utilization of the behavioral health support system has dropped precipitously since two years ago, when the youth were 17 years of age and in foster care.


Take Charge - Health Insurance SurveyTake Charge - Health Insurance Survey

This report describes the reasons that women remained on the TAKE CHARGE family planning waiver program instead of obtaining health insurance through another source, such as Washington’s Health Benefit Exchange. The main data source was a brief mailed survey of women enrolled in TAKE CHARGE between February and July 2014. The majority of women who remained on the TAKE CHARGE program were working but did not have employer-sponsored health insurance, for a variety of reasons. Nearly half the respondents indicated they were unable to pay for health insurance because of bills they had to pay. A small number of women in Washington continue to have clear needs for family planning coverage that are not being met, except through the TAKE CHARGE family planning program.


Access to RecoveryAccess to Recovery

This report examines the benefits of Washington State’s Access to Recovery (ATR) program, which provides recovery support services to adults in recovery from substance use disorders. Changes in outcomes between a one-year baseline and one-year outcome period were examined for ATR recipients relative to a statistically matched comparison group. The analysis examines differences in substance use disorder treatment rates, employment outcomes, arrests and hospital utilization. We found that, relative to the matched comparison group, ATR clients experienced greater increases in outpatient SUD treatment and employment, and greater decreases in incidence of arrests. These outcomes were found both for clients who had received SUD treatment in the baseline year and those who had not. Statistically significant declines were also found in rates of hospitalization from Emergency Department admissions and for other hospitalizations, relative to changes experienced by the matched comparison group. No significant effects on outpatient Emergency Department visits were found.


Permanent Options for Recovery-Centered Housing (PORCH)Permanent Options for Recovery-Centered Housing (PORCH)

The Permanent Options for Recovery-Centered Housing (PORCH) program aims to increase housing stability and encourage independent living among adults with a history of mental illness and housing instability or homelessness. Regional support networks, mental health and housing providers located in two counties (Pierce and Chelan/Douglas) participated in the SAMHSA funded project. In this third report about the PORCH program, we provide an update on the population served and examine preliminary outcomes on housing stability, psychiatric hospitalizations, emergency department use, arrests and employment. We found that most participants (89 percent) were stably housed after one year of PORCH services. Preliminary data indicate PORCH may reduce emergency department visits and community psychiatric hospitalizations. A final evaluation at the end of the five-year grant period will assess the extent to which outcomes for PORCH participants may differ from those of other DSHS clients with similar housing needs and behavioral health problems.


TANF Caseload DeclineTANF Caseload Decline

This report describes key outcomes for parents and children who left TANF before and after recent program changes, including changes to the criteria for time limit extensions. WorkFirst cases make up a decreasing share of the TANF caseload relative to child-only cases, as a greater proportion of WorkFirst families leave and do not return. Relative to other groups of WorkFirst leavers, those who left due to time limits had high rates of baseline health risk but were less likely to transition to disability-related medical coverage. Time limited leavers and those who took longer to leave the caseload also faced greater barriers to work but remained connected to supports and services.


2014 Foster Parent Survey: DSHS Foster Parents Speak2014 Foster Parent Survey: DSHS Foster Parents Speak

This report describes the results of the third annual DSHS Foster Parent Survey. Between September 2013 and August 2014, 1,351 foster parents were surveyed about their satisfaction with the support and training provided by Children’s Administration and private agencies. Most foster parents expressed satisfaction with the support and training they receive, and with their social workers. Some would like better access to resources, faster and more flexible processes, and more inclusion and information concerning the cases of their foster children. Some would like more convenient training locations and schedules, interaction with experienced foster parents, online training, and choices for their training.

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