Brian Bruen, Richard Jensen, Patricia Riley, Anthony Lara, Xiaoxiao Lu - April 2011

The 2010 Washington State Legislature funded a study to examine options to contain costs in the state Medicaid program. Following a competitive bid, George Washington University was selected as the contractor. They found that small numbers of users account for most fee-for-service spending for inpatient and outpatient services. Options to reduce short-term costs include reducing reimbursement, placing restrictions on benefits, and instituting cost-sharing for beneficiaries. Long-term solutions require concentrated, coordinated care management for high-use, high-cost Medicaid beneficiaries and strategic approaches to reform the service delivery system, with accompanying payment reform to incentivize change.

Jim Mayfield - April 2011

In 2007, the Washington State Department of Social and Health Services established the Thurston-Mason Children’s Mental Health Evidence-Based Practice Pilot Project (Pilot) to provide mental health services to children. The first evidence-based practice selected by the Pilot was Multisystemic Therapy (MST), an intensive family- and community-based treatment program for youth. Over a one-year follow-up period, the Institute examined criminal convictions of youth enrolled in the Pilot’s MST program. Compared to youth with similar criminal histories and demographic characteristics, MST youth were convicted of fewer crimes on average. Due to sample size, statistical significance was not attained in this evaluation of MST outcomes. The effect sizes observed, however, are within the expected range for MST according to other rigorous studies of that intervention and would likely return a net economic benefit to tax payers and crime victims.

Marna Miller - March 2011

Washington’s Children’s Administration uses Family Team Decision Making (FTDM) meetings to involve parents and other family members, the child (when appropriate), friends, foster parents, caseworkers, and other professionals. Ideally, FTDM meetings are held for all decisions involving child removal, change of placement, and reunification or other permanency plan. In 2008, DSHS convened 6,600 FTDM meetings regarding nearly 8,000 children.

An earlier Institute study demonstrated over-representation of Indian, Black and Latino children in Washington’s child welfare system. Following referrals to Child Protective Services (CPS), Indian and Black children (but not Asian or Latino children) were more likely to be placed in foster care, and to remain in care significantly longer than White children. In 2009, the Legislature directed the Institute to study the effects of the implementation of FTDM on racial disproportionality.

When we studied outcomes for the child welfare caseload statewide, we found that FTDM had no effect on out-of-home placement, time to permanency, or new referrals to CPS.

When we examined outcomes by racial groups, however, we found three positive results for FTDM. 1) Latino children experienced decreased rates of placement. 2) Asian children achieved permanency more quickly than those in non-FTDM offices. 3) Black children exiting to permanency were less likely to be the alleged victims of new accepted CPS referrals.

With the exception of these three favorable results, FTDM as implemented in Washington did not affect disproportionality for Indian or Black children with respect to placement in foster care or time to permanency.

Marna Miller - February 2011

Temporary Assistance for Needy Families (TANF) is a federal/state program providing cash assistance to families with children. In Washington, the TANF program is administered by the Department of Social and Health Services (DSHS). The 2007 Legislature directed the Institute to study the prevalence of depression among women receiving TANF and to evaluate the effectiveness of current screening methods used by the DSHS.

A random sample of 707 women receiving TANF in February 2008 was interviewed by telephone using a well-validated survey instrument to diagnose major depressive disorder (MDD). Compared with a national sample of depressed women with children, we found that women receiving TANF were more likely to be depressed and their depression was twice as likely to be categorized as severe. Depressed TANF clients were also significantly more likely to receive professional treatment for their condition.

Compared with non-depressed TANF clients, those with MDD were employed less and received TANF longer in the nine-month follow-up period. Depression was not associated with TANF sanction, either at the time of sampling or during the follow-up period.

DSHS has implemented screening procedures that identify a substantial portion of depressed TANF clients. To the extent the state wishes to increase treatment rates, DSHS could modify its Comprehensive Evaluation to include one of several brief, freely available mental health screening instruments.

Elizabeth Drake - January 2011

In this report, we examine recidivism rates for close to 70,000 adult offenders who released from prison in Washington State over a 17-year-period. Our analysis reveals quite notable and favorable recidivism trends.

Mason Burley - January 2011

In Washington State, specialized investigators, called Designated Mental Health Professionals (DMHPs), are responsible for determining if individuals can be committed for 72 hours under the state’s Involuntary Treatment Act (ITA). The criteria established under the ITA statute (RCW 71.05) allow individuals to be involuntary detained to a psychiatric facility if, as a result of a mental disorder, the individual is gravely disabled or presents a substantial risk of serious harm to him or herself or others.

A DMHP relies on both professional judgment and historical case records to determine the extent to which an individual may pose a risk. While protocols have been adopted for ITA investigations, at present, DMHPs do not use a standardized risk assessment instrument to determine the level of danger an individual may pose.

This report reviews both mental health and risk assessment instruments that potentially could be utilized in an ITA investigation. None of the risk instruments discussed here, however, have been validated for use within the general population. While we could not identify suitable instruments for ITA investigations within the research literature, other measures are discussed which may assist a DMHP in the investigation process. These options include expanded access to criminal records and centralized access to previous mental health investigation and commitment data.

Elizabeth Drake - December 2010

During the last 15 years, the Washington State Legislature has taken a number of steps to develop an “evidence-based” juvenile justice system. The central concept has been to identify and implement strategies shown—through rigorous research—to reduce crime cost-effectively. In 2009, the Legislature turned its attention to the mechanism through which Washington’s 33 juvenile courts receive state dollars. The Institute was directed to report on the administration of the new funding mechanism. We also summarize key policy reforms over the past 15 years that have established an emphasis on providing evidence-based programs in Washington’s juvenile justice system.

Jim Mayfield - November 2010

In 2009, the Legislature directed the Institute to study and make recommendations regarding disability benefits available to members of Washington State’s Public Employees’, Teachers’, and School Employees’ Retirement Systems (Plans 2/3).

This follow-up report summarizes the findings and recommendations of the 2009 Institute report and describes implementation efforts of the Health Care Authority regarding enhanced education, changes to Public Employees Benefits Board (PEBB) long-term disability (LTD) products, and their investigation of new LTD products; describes statutory changes and fiscal impacts associated with providing enhanced disability benefits to Plans 2/3 members; and discusses policy advantages and disadvantages for insurance and pension options.

Steve Aos - October 2010

The 2009 Legislature directed the Washington State Institute for Public Policy “to calculate the return on investment to taxpayers from evidence-based prevention and intervention programs and policies.” This report summarizes the Institute’s four-step research approach for this project and lists the topics being reviewed as well as Institute staff contacts for each area. Initial findings will be presented prior to the 2011 Legislative Session, with a full report due June 2011.

Mason Burley - October 2010

This report includes updated statistics on high school graduation and dropout rates for foster youth in Washington State. Since 2005, the graduation rate for all students in Washington State has ranged between 70 and 75 percent. For students in foster care, graduation rates vary between 32 and 44%. While these rates are significantly below other students, graduation numbers for foster youth have improved in each of the last three years. However, graduation levels for foster youth lag behind other disadvantaged groups, such as low-income, special education, and migrant students. In the 2008–09 school year, 12% of foster youth dropped out of high school, a rate more than twice as high as the statewide dropout rate (5%).