Bright Futures Guidelines and Washington State Medical Assistance Programs, Revised

The 2012 Legislature directed the Institute to assess the costs and benefits of implementing the American Academy of Pediatrics’ Bright Futures Guidelines for well-child visits and developmental screening in medical assistance programs. Currently, federal regulations require non-grandfathered private health plans to comply with Bright Futures, but state Medicaid programs can choose whether to implement the guidelines or not.

We analyzed Washington Medicaid eligibility, claims and encounter data to assess the likely cost of providing additional well-child visits and developmental screening. We reviewed the literature to examine potential effects on health and other outcomes. We elicited advice from clinical experts and reviewed coverage in other state Medicaid programs and private health insurers.

The Center for Evidence-based Policy (CEbP) at the Oregon Health & Sciences University assisted the Institute by searching for studies that examined (a) the effects of additional well-child visits and developmental screening on outcomes for children and (b) the effectiveness of speech and language interventions. Links to the CEbP reports are provided.

Revised on 1/28/2013 to modify the discussion of developmental screens on p. 17.

Wildfire Suppression Cost Study

The 2012 Washington State Legislature appropriated funding to conduct a detailed analysis of potential mechanisms for reducing the amount of and variation in the state’s fire suppression costs. The desired analysis consists of two parts:

1. An examination of Oregon’s excess forest fire suppression cost insurance program and an analysis of the potential application of this model for Washington, and
2. An examination of Washington’s total and marginal costs related to staffing and overtime to determine whether these total or marginal costs are in excess of market rates.

Based on this direction, the Washington State Institute for Public Policy (Institute) developed a scope of work that incorporated the legislature’s objectives to address two issues: the variability in wildfire suppression budget requirements and fire suppression labor costs. After a competitive selection process, WSIPP contracted with FCS GROUP to conduct the analysis, and the FCS GROUP team worked primarily with the Department of Natural Resources (DNR) to gather data and information. In addition, FCS GROUP held discussions with key external DNR stakeholders such as the Washington Forest Protection Association, Farm Forestry Association and Weyerhaeuser, and conducted a comparative analysis of how similar programs in Oregon, Idaho, Montana, South Dakota, British Columbia, and the United States Forest Service funded and managed their fire suppression expenditures. This report details this analysis and presents findings from FCS.

For more information, please contact John Bauer at (360) 586-2783, or bauerj@wsipp.wa.gov.

Updated Inventory of Evidence-Based, Research-Based, and Promising Practices

Inventory of Evidence-Based, Research-Based, and Promising Practices
For Prevention and Intervention Services for Children and Juveniles
in the Child Welfare, Juvenile Justice, and Mental Health Systems

The 2012 Legislature passed E2SHB 2536 with the intention that “prevention and intervention services delivered to children and juveniles in the areas of mental health, child welfare, and juvenile justice be primarily evidence-based and research-based, and it is anticipated that such services will be provided in a manner that is culturally competent.”

The bill directs the Washington State Institute for Public Policy (WSIPP) and the University of Washington Evidence-Based Practice Institute (UW) to publish descriptive definitions and prepare an inventory of evidence-based, research-based, and promising practices and services, and to periodically update the inventory as more practices are identified. This is the first update to the September 30, 2012 publication. The accompanying report describes the inventory update process, as well as the ongoing technical assistance process by UW.

Chemical Dependency Treatment for Offenders: A Review of the Evidence and Benefit-Cost Findings

The Washington State Institute for Public Policy was directed by the 2012 Legislature to review whether chemical dependency treatment in the adult and juvenile justice systems reduces crime and substance abuse. The Institute was also asked to estimate the monetary benefits and costs of these programs.

We conducted a systematic review of research studies to determine if, on average, these programs have been shown to reduce crime. To narrow our review of this vast literature, we focused on the type of chemical dependency programs funded by Washington taxpayers.

We located 55 unique studies with sufficient research rigor to include in our review. Programs for adult offenders have been evaluated more frequently than for juveniles. Of the 55 studies, 45 evaluated treatments delivered to adults while only 10 were for juveniles.

Our findings indicate a variety of chemical dependency treatments are effective at reducing crime. Recidivism is reduced by 4-9%. Some programs also have benefits that substantially exceed costs.

We found that community case management for adult substance abusers has a larger effect when coupled with “swift and certain.” This finding is consistent with an emerging trend in the criminal justice literature—that swiftness and certainty of punishment has a larger deterrent effect than the severity of punishment.

State Need Grant: Student Profiles and Outcomes

Students who are state residents and have family incomes at or below 70% of the state’s median family income may receive a State Need Grant to pay for the costs of undergraduate tuition. During the 2011–12 academic year, nearly 75,000 students received this grant. In the last 10 years, state spending on this grant program has increased 120% (from $121 million in 2002–03 to $267 million in 2011–12). A sharp increase in the cost of tuition at undergraduate institutions coupled with a growing student population has led to this rise in program expenditures. While the program has historically been able to serve all students who qualify, in recent years, about 30,000 eligible students have been unable to receive a grant.

The 2012 Legislature directed the Washington State Institute for Public Policy to “determine whether the funding for the State Need Grant has been utilized in the most efficient way possible to maximize the enrollment and degree attainment of low-income students.” This report is the first of two detailed analyses on the characteristics and outcomes of State Need Grant students. Descriptive information in this report includes profiles of State Need Grant students, data related to college affordability, enrollment outcomes for State Need Grant students, and a comparison of need-based aid policies in selected states.

Our final report (due December 2013) will evaluate the impact of the State Need Grant program on enrollment and degree completion outcomes, after considering other factors related to student performance.

Passport to College Promise: College Assistance and Support for Former Foster Youth

Washington State’s Passport to College Promise program (Passport) was created in 2007 to increase post-secondary educational outcomes for former foster youth. Passport consists of three components: 1) pre-college preparation provided to high school-age foster youth; 2) a scholarship for former foster youth attending eligible in-state schools; and 3) academic and support services from Designated Support Staff at participating colleges.

Washington is one of only two states that provide these kinds of “wraparound” services in addition to financial aid for former foster youth attending college. In this evaluation of the program, we compared outcomes for Passport students relative to common college performance benchmarks: retention, persistence, and completion. About two-thirds of Passport students remained enrolled for more than six months during their first year. These students had retention and completion outcomes similar to other (non-foster) students. Several recommendations for program improvement are also provided based on interviews with program staff and a review of available data.

Educational Outcomes of Foster Youth--Benchmarks

The Department of Social and Health Services (DSHS) Children’s Administration (CA) asked the Institute to develop outcome measures to establish how the educational prospects of foster students have changed over time. This report includes detailed definitions and results on four long-term measures related to the educational status of youth in foster care. These measures include:

• School retention: Nine out of ten foster youth re-enroll in the following school year.
• Behind grade level: 8% of foster youth are behind their expected grade level.
• Adjusted cohort graduation rate: Over a four-year period, the longitudinal graduation rate for youth in long-term foster care was between 45 and 55%.
• Annual graduation rate: Measured on an annual basis, the graduation rate for foster youth was 47%.

For each measure, results for foster youth were compared to other students in Washington State. These measures will also be updated in the future to assess improvements.

Retiree Benefits in Public Pension Systems

The 2012 Legislature directed the Institute to evaluate three topics related to public pension policies: benefit levels, portability, and excess compensation. The Institute consulted with the Office of the State Actuary, Department of Retirement Systems, and local government plan sponsors in conducting this study. We surveyed public pension plans in the 50 states to compare benefit levels. We also analyzed state data on recent retirees in Washington State to examine overtime and excess compensation. Finally, we contracted with a professional actuary who has expertise in public employee retirement systems to review our methods and findings. This report summarizes our findings.

DSHS Special Commitment Center: Population Forecast, Revised

In 2010, the Washington State Institute for Public Policy was directed to study the commitment of sexually violent predators to the Special Commitment Center. The study assignment concentrated on two topics: a population forecast, as well as issues related to treatment participation and less restrictive alternatives.

This first report of two examines the projected future demand for the Special Commitment Center. The second report, which will be published by the end of December 2012, examines residents’ participation in treatment, the annual review process, and the capacity and future demand for less restrictive alternatives.

Did Expanding Eligibility for the Family Caregiver Support Program Pay for Itself by Reducing the Use of Medicaid-Paid Long-Term Care?

Washington’s Family Caregiver Support Program (FCSP) provides a comprehensive array of information, resources and services to unpaid family caregivers caring for adults with functional disabilities. One objective of this program is to delay or avoid placement of the care recipient in long-term care. To expand the program to serve more caregivers, the 2011 Legislature increased funding for the FCSP by $3.45 million for fiscal year 2012. The additional funding was based on assumed savings associated with delayed or avoided placements into more costly Medicaid-paid long-term care (LTC). The legislature also directed the Institute to assess whether the expansion of this program delayed or reduced entry of care recipients into LTC and thereby reduced LTC costs.

The short legislative timeline for this study precluded a comprehensive evaluation. Nonetheless, based on the limited data available, we report two preliminary results. First, we observed a significant delay in the use of LTC by those served during the expansion. Second, we estimate that the maximum savings possible from the expansion would have been $1.67 million in the first year. Since $3.45 million was budgeted for the FCSP expansion, it appears unlikely that the expansion would have been cost neutral, at least in the first year, as assumed in the budget.

We recommend that a longer term evaluation of the expansion be conducted to determine if benefits match cost over an extended period.