March 2008
DHHS, Administration for Children and Families
This study follows up on a study conducted by the Lewin Group and its subcontractor, the Nelson A. Rockefeller Institute of Government, which assessed and reported on recent adaptations made by local offices in managing Temporary Assistance for Needy Families (TANF) programs. The assessment sought to clarify recent changes implemented by local program managers in five study sites to improve performance, several years after the initial wave of change brought about by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). This study revisited the original five study sites to determine the nature of changes brought about by the Deficit Reduction Act (DRA) of 2005, which reauthorized the TANF program.
Client Area: Federal Government
Expertise Area: Income Security
March 2008
DHHS, Administration for Children and Families, Office of Refugee Resettlement
One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Sacramento, California. The study focused on refugees who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Sacramento, including primarily refugees from countries in the former Soviet Union and Hmong arriving in 2004. Themes emerging from this case study include Sacramento’s strong emphasis on English language training as a component of employability services; the use of on-the-job training by several service providers as a tool for moving refugees into permanent employment; and the importance of the welfare system in understanding the context in which the refugee employability programs operate. The report also presents employment, income, and public assistance outcomes of service recipients.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security
March 2008
DHHS, Administration for Children and Families, Office of Refugee Resettlement
One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Miami, Florida. The study focused on refugees, asylees, and related populations who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Miami, including primarily Cubans, Colombians, and Haitians. Themes emerging from this case study include the role of Miami’s extensive network of experienced service providers and community support for arrivals; the strong focus on employment in refugee services; the relatively high education level of refugees served in Miami; the importance of bi-lingual Spanish and English skills; and special challenges facing the Haitian population The report also presents employment, income, and public assistance outcomes of service recipients.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security
March 2008
DHHS, Administration for Children and Families, Office of Refugee Resettlement
An extension of The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report outlines ways that the Office of Refugee Resettlement (ORR) can better plan for and institutionalize evaluation and accountability throughout the range of refugee resettlement programs. It presents a variety of options ORR might consider to enhance its existing performance management activities and proposes experimental and non-experimental evaluations of selected service strategies.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
March 2008
DHHS, Administration for Children and Families, Office of Refugee Resettlement
One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Houston, Texas. The study focused on refugees who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Houston, which settled a large, diverse, and frequently changing refugee population. Themes emerging from this case study include Houston’s emphasis on rapid employment, driven in part by the relatively low TANF benefits offered in the state, the necessity of understanding newly arriving refugees’ cultural experiences when providing services to a changing population, and the special challenges facing refugees from Somalia and Liberia, who arrived with very low educational attainment. The report also presents employment, income, and public assistance outcomes of service recipients.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security
March 2008
DHHS, Administration for Children and Families, Office of Refugee Resettlement
This report summarizes findings from The Lewin Group’s evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) programs. The Office of Refugee Resettlement (ORR) administers these programs and sponsored an evaluation to assess how program services are delivered and how refugees who receive them fare over time. RSS and TAG services aim at helping refugees overcome barriers to employment and integration into the United States. The study focuses on refugees in three sites—Houston, Miami, and Sacramento—who entered the country between 2000 and 2004. It relies on administrative and programmatic data, a survey of refugees, and information collected through interviews with service providers and focus groups with program participants. The study documents differences across the sites with regard to which refugee groups they served, the approaches taken for delivering services, and the emphasis placed on ESL instruction versus rapid employment. The report also presents employment, income, and public assistance outcomes of service recipients.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security
September 2007
DHHS, Health Resources and Services Administration (HRSA)
Lewin contact: Clifford Goodman
The U.S. Department of Health and Human Services (HHS) has devoted considerable effort to achieving increased organ donation and transplantation rates by developing public awareness campaigns and identifying and replicating organ procurement organization donor hospital, and transplant center best practices. Despite a trend toward increased numbers of organ donors and transplants, a disparity remains between the demand for and supply of donor organs. In order to address tihs unmet need, HHS’s Health Resources and Services Administration has implemented several initiatives which have assisted in increasing the supply of donor organs and the number of organs transplanted per donor. HRSA now seeks to identify and spread the best practices of transplant centers that are quickly adapting to the increased supply of donor organs in order to help transplant programs across the country effectively grow. This report, prepared by The Lewin Group, presents observations of the best practices of selected high-performing transplant centers that have achieved high organ transplantation rates and efficiency in recovered organ use, while maintaining expected or higher than expected patient and graft survival outcomes.
Client Area: Federal Government
September 2007
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Clifford Goodman
The concept of personalized health care (PHC) has attracted considerable scientific, medical, commercial and policy interest for its potential to sharpen the focus of health care and improve its effectiveness and efficiency. As part of a broader vision of advancing and leveraging medical research to improve and transform health care in the US, the Secretary of the US Department of Health and Human Services (DHHS) has identified personalized health care as one of the Department’s top 10 priorities. The Office of the Assistant Secretary for Planning and Evaluation commissioned The Lewin Group to convene a PHC Expert Panel to provide input to the Office of the Secretary, DHHS, toward realizing the integration of PHC into clinical and public health practice. During the meeting the panel considered and discussed five main issues pertaining to the integration of PHC into clinical and public health practice: Demonstrating clinical validity and utility of PHC; Demonstrating value/cost-effectiveness of PHC Identifying the role of PHC in reducing health disparities Educating and engaging providers and patients about PHC; and Using databases to build evidence and inform decisions in PHC. The report summarizes key observations that emerged from the Expert Panel’s discussion of these five main issues.
Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA
January 2007
DHHS, Administration for Children and Families
The devolution of responsibility for the nation’s primary welfare program from the federal government to state and local agencies was one of the most important institutional changes in federal welfare policy during the 1990s. The Personal Responsibility and Work Reconciliation Act (PRWORA) of 1996 created the Temporary Assistance for Needy Families (TANF) block grant, which gave states considerable latitude to allocate funds across program functions and move functions outside of traditional welfare agencies to other public agencies and private organizations. This study, conducted by the Lewin Group and the Nelson A. Rockefeller Institute of Government, determined how local management of TANF programs has evolved to address changing needs and improve program results. Rather than viewing TANF implementation as a single event followed by a stable administrative structure and a static array of services and requirements, the project viewed implementation in dynamic terms. It sought to understand how local welfare offices in five areas modify their programs and adopt more effective approaches in response to changing circumstances.
Client Area: Federal Government
Expertise Area: Income Security
January 2007
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Clifford Goodman
The Office of the Assistant Secretary for Planning and Evaluation commissioned The Lewin Group to determine how and to what extent cost-effectiveness (CE) considerations are incorporated in the approval and adoption of new health technologies and the implications of not incorporating such considerations. This report examines the use of CE and other cost-health tradeoff evidence by federal and nonfederal health stakeholders, paying particular attention to the scope of authority, range and/or circumstances of use, and responsibilities for regulating CE and other economic information by the Food and Drug Administration. The role of economic evidence in decision-making also is explored in case studies of four contemporary health technologies: nucleic acid testing, Relenza (zanamivir), drug-eluting stents, and implantable cardioverter-defibrillators.
Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA
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