2012 Foster Parent Survey: DSHS Foster Parents Speak
April 2012 and August 2012, DSHS surveyed 1,371 foster parents who had a child in care on February 13, 2012 or May 15, 2012. These foster parents were asked about their satisfaction with support and training provided by Children’s Administration and private agencies contracted by the Administration to provide services to foster parents. They were also asked to offer recommendations for change. The majority of foster parents expressed satisfaction with the support and training they receive, and with the social workers assigned to their cases. In regard to support, they indicated they want more complete and timely information about their foster children’s cases; more efficient and flexible bureaucratic processes; more resources, such as respite and reimbursements; and more social workers hired. In regard to training, they suggested a need for improved access to training; more training on specific topics; more non-traditional training formats; and more choice about which trainings they take.
The Impact of Substance Abuse Treatment Funding Reductions on Health Care Costs for Disabled Medicaid Adults in Washington State
The past decade has seen major changes in the level of funding for substance abuse treatment in Washington State. The five-year period from State Fiscal Year (SFY) 2005 to SFY 2009 saw a major expansion of substance abuse treatment funding for adults enrolled in Medicaid and the program formerly known as General Assistance. This period of expansion has been followed by two biennia of reduced funding for substance abuse treatment. This study examines the impact of these substance abuse treatment funding reductions on medical and nursing facility costs for adults enrolled in disability-related Medicaid coverage in Washington State. We found that increased access to substance abuse treatment in the “expansion era” coincided with a significant reduction in rates of growth in medical and long-term care costs for Disabled Medicaid clients with substance use problems. Conversely, the substance abuse treatment funding contraction that began in late SFY 2009 caused a decline in access to treatment for Disabled Medicaid clients, which coincided with significant relative increases in rates of growth of medical and nursing facility costs for Disabled Medicaid clients with substance abuse problems. These findings demonstrate the importance of access to substance abuse treatment as a strategy for containing medical and long-term care cost growth for persons enrolled in disability-related Medicaid coverage, and point to the need for financing mechanisms that support this strategy.
Educational Disabilities Among At-Risk Students
Children and youth served by the Washington State Department of Social and Health Services who attend public schools are disproportionately likely to qualify for special education relative to their representation in the statewide student population. This study utilizes linked DSHS and educational administrative data sources to analyze the demographic characteristics, patterns of social service use, and educational challenges of children who receive both school-based special education and DSHS services. The findings suggest that within the DSHS population, those who receive services associated with emotional or behavioral needs (DBHR – Mental Health) or an unstable family environment (Children’s Administration services) are more likely to be enrolled in special education than those who do not receive those services.
Outpatient Mental Health Services and Medical Cost Offsets
Mental health services for Medicaid enrollees in Washington are provided through a tiered delivery system. Regional Support Networks (RSNs) manage outpatient and inpatient mental health services for Medicaid enrollees who meet access to care standards defined by diagnosis and level of functioning criteria. Medicaid enrollees who have mental health needs but do not meet the access to care standard may access a limited number of mental health therapy visits through their Medicaid medical benefit. This study compares medical cost and mortality outcomes for Disabled Medicaid adults with mental health needs served in the RSN system with outcomes for clients with similar mental health conditions who are served outside of the RSN system to see whether receipt of RSN outpatient services is associated with medical cost savings.
Washington State’s Housing and Essential Needs Program
The Housing and Essential Needs (HEN) program was implemented in November 2011 and was one of three programs to replace the Disability Lifeline (DL) cash assistance program. To evaluate the impact of HEN over a six-month follow-up period, we compared outcomes for those who received HEN services to two statistically well-matched comparison groups who had similar baseline characteristics but did not receive HEN services. Compared to both comparison groups, we find that HEN recipients: 1. Experienced greater housing stability. 2. Remained connected to Basic Food assistance at significantly higher rates. 3. Were less likely to be incarcerated in a state Department of Corrections facility.
The Impact of Recent Policy Changes on Outcomes for Medical Care Services Clients
This report examines how recent policy changes have impacted caseload trends and measures of well-being among individuals enrolled in the Medical Care Services (MCS) program who were eligible for the Disability Lifeline (DL) program in October 2011, prior to its elimination. We compare the experiences of a cohort of individuals enrolled in MCS/DL in October 2011 with outcomes for cohorts enrolled in October 2009 and October 2010. Over an eight month follow-up period, we find that the October 2011 cohort experienced: 1. Increased migration off MCS coverage, primarily through transitions to Categorically Needy Medicaid coverage associated with ABD cash assistance rather than through exits from medical assistance; 2. Lower mortality rates and emergency department utilization; 3. Higher rates of receipt of housing assistance among those with an identified housing need; and 4. Similar arrest rates and lower rates of incarceration.
Using Claims-Based Risk Indicators to Predict Health Outcomes for Children with Mental Illness
This paper demonstrates the feasibility of building behavioral health risk indicators for children from integrated medical and behavioral health service data. We analyze data for children and young adults enrolled in Medicaid in Washington State, to assess the degree to which risk indicators experienced in the past were predictive of higher future inpatient and emergency department (ED) service utilization. Several risk indicators are found to be strongly predictive of future utilization. These findings point to the potential for these risk indicators to help treating providers, health plans and behavioral health plans proactively target services towards children and young adults with behavioral health needs.
Independent Living Services for Foster Care Youth
This report describes demographic characteristics of youth who received Independent Living Services (ILS) from DSHS Children’s Administration between April 1 and September 30, 2011. As documented by ILS providers, 1,707 youth aged 16 to 21 years participated in ILS services ranging from educational support and employment preparation to mentoring, life skills training and financial assistance. One half of ILS participants were still in foster care. Nearly 6 in 10 participants were 18 years old or less, the same share were female, and one half were minority race or ethnicity. Older participants were more likely to be female and non-Hispanic White. Career preparation and academic support services were most common ILS (46 and 43 percent of participants, respectively).
Adverse Childhood Experiences Associated with Behavioral Health Problems in Adolescents
This report demonstrates the use of state administrative data to measure adverse childhood experiences (ACEs), and to quantify associations between these experiences and behavioral health problems identified during adolescence. The adverse experiences reported include the occurrence of the following in the child’s birth family: child abuse and/or neglect; parental substance abuse, criminal justice involvement, mental illness, or death; domestic violence; and homelessness. Although odds of having a substance abuse or mental health problem documented in state administrative data during adolescence increased substantially with each added adverse experience, risk levels varied greatly by type of experience. Specifically, child abuse and/or neglect increased behavioral health risk at a much higher rate than other factors.
High School Outcomes for DSHS-Served Youth - Graduation and Drop-out Rates for Students Who Were 9th Graders in 2005-2006
High school progress indicators and outcomes are described for a statewide cohort of youth served by the Washington State Department of Social and Health Services (DSHS). This report is the first product of a federally funded cross-agency effort (ARRA, 2009) that provided DSHS with the capacity to track educational progress and outcomes for children and youth served by the agency. Within 6 years of entering the 9th grade, 55 percent of the DSHS cohort had graduated from high school, 43 percent had dropped out or disappeared, and 2 percent were still enrolled in public school. Youth served by the Juvenile Rehabilitation Administration, the Division of Behavioral Health and Recovery, and the Children’s Administration had extremely low graduation rates and high drop-out rates, compared to those receiving Medical Assistance or Child Support Enforcement only, and had early indications of risk in the form of low grade point averages and high numbers of unexcused absences.
Employment Outcomes Associated with Rapid Re-housing Assistance for Homeless DSHS Clients in Washington State
Programs providing Homelessness Prevention and Rapid Re-Housing (HPRR) assistance served 15,057 individuals in 2010, according to the Washington State Department of Commerce’s Homeless Management Information System (HMIS). Assistance may include rent assistance, relocation and stabilization assistance, security deposits, utility payments and other financial help to help stabilize someone at risk of losing their current housing or rapidly re-house a homeless person into a permanent location they do not have to leave once the assistance ends. Using a quasi-experimental, matched comparison group design, this report examines employment outcomes of working-age adults who were eligible for publicly funded medical assistance in the prior year who also received assistance to be rapidly re-housed in 2010 (we call these HMIS-DSHS Rapid Re-housing clients). We found that—compared to similar homeless clients who did not receive rapid re-housing assistance—HMIS-DSHS Rapid Re-housing clients experienced improved employment outcomes in the year after intervention: 1. HMIS-DSHS Rapid Re-housing clients were almost 50 percent more likely than the comparison group to be employed during the quarter they received assistance. 2. HMIS-DSHS Rapid Re-housing clients were 25 percent more likely than the comparison group to be employed sometime over the entire follow-up year. 3. On average, HMIS-DSHS Rapid Re-housing clients earned about $422 more than the comparison group over the follow-up year.
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.
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