July 2002
DHHS, Administration for Children and Families
While the federal government has mandated the use of a number of enforcement techniques, states and localities still have considerable flexibility in designing the processes by which they establish child support. States have discretion in terms of shaping and running their child support programs. In many states, courts play a key role in child support order establishment, as well as other aspects of the program. In others, executive-branch agencies establish orders administratively. Despite the widespread use of the terms "judicial" and administrative," no study has tried to define each process -- or a range of quasi-judicial processes. The 50 states and the District of Columbia each has its own order establishment process and its own set of "players." This study addressed the following questions: What key characteristics define administrative and judicial processes? Is it possible to classify state processes into four or five key categories or types? Are there similarities, as well as differences, between the processes? How do cases progress through each of the process types? Are there differences in the number of people or agenies involved? Do clients perceive the processes as fair and accessible? Do cases appear to move quickly through one process or another? In order to answer the study questions, the project team developed a taxonomy of judicial and administrative processes; reviewed processes in nine states; and conducted site visits in five states.
Client Area: Federal Government
Expertise Area: Income Security
July 2002
US Department of Health and Human Services
Few features of the 1990s welfare reforms have generated as much attention and controversy as time limits on benefit receipt. Time limits first emerged at the state level and subsequently became a central feature of federal welfare policy in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which imposed a 60-month time limit on federally funded assistance for most families.
To inform discussions about the reauthorization of PRWORA, the U.S. Department of Health and Human Services contracted with the Manpower Demonstration Research Corporation (MDRC) to conduct a comprehensive review of what is known about time limits. As part of this project, The Lewin Group conducted a survey of all 50 state welfare agencies.
Client Area: Federal Government
Expertise Area: Income Security
June 2002
DHHS, Center for Substance Abuse Treatment
This bibliography lists books, published articles and research/evaluation studies, and government documents (including "Web" publications) published since 1980 that focus on the costs of substance abuse treatment, methods for estimating the costs of treatment, and studies of the cost effectiveness and cost benefits of substance abuse treatment. This document also identifies trends and areas where there are gaps in the literature. A companion document, Cost Effectiveness and Cost Benefit Analysis of Substance Abuse Treatment: A Literature Review, synthesizes the major findings from the reports and studies focusing on the cost effectiveness and cost benefits of substance abuse treatment identified in this bibliography.
Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness, Mental Health and Substance Abuse
June 2002
DHHS, Center for Substance Abuse Treatment
This literature review summarizes the major findings from books, published articles, research and evaluation studies, and government documents (including "Web" publications) published since 1980, which focus on the cost effectiveness and cost benefits of substance abuse treatment. Cost effectiveness and cost benefit studies play an important role in evaluating existing and alternative substance abuse approaches and in assessing new treatment methods. Evaluating the outcomes and costs of treatment is necessary in order to determine how to more efficiently allocate scarce resources. This document is intended to assist policymakers, researchers/evaluators, and treatment providers interested in this field to identify and acquire evidence-based information specific to their interests. This review also explores trends and areas where there are gaps in the literature.
Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness, Mental Health and Substance Abuse
April 2002
DHHS, Health Resources and Services Administration
"How do we know cultural competence when we see it?" is the central question that prompted the Health Resources and Services Administration (HRSA) to sponsor a project to develop indicators of cultural competence in health care delivery organizations. The Assessment Profile builds upon previous work in the field, such as the National Standards for Culturally and Linguistically Appropriate Services (CLAS) , and serves as a future building block that advances the conceptualization and practical understanding of how to assess cultural competence at the organizational level. The Assessment Profile is an analytic or organizing framework and set of specific indicators to be used as a tool for examining, demonstrating, and documenting cultural competence in organizations involved in the direct delivery of health care and services. At a general level, the Profile can help organizations frame and organize their perspectives and activities related to the assessment of cultural competence. More specifically, it can be used in routine performance monitoring, regular quality review and improvement activities, assessment of voluntary compliance with cultural competence standards or guidelines, and periodic evaluative studies.
Client Area: Federal Government
April 2002
DHHS, Centers for Medicare and Medicaid Services
Lewin contact: Lisa Alecxih
As part of a CMS-funded study, case studies were conducted in Alabama, Indiana, Washington, Wisconsin, Maryland, Michigan, and Kentucky to assess the major features of the home and community-based services system for older people and younger adults with physical disabilities in each State. The case studies analyzed the financing of services; administrative systems; eligibility, assessment, and case management structures; the services provided, including consumer-directed home care and group residential care; cost-containment efforts; and quality assurance. The role that Medicaid plays in home and community-based services is a major focus of the study.
Client Area: Federal Government
Expertise Area: Aging and Disability, Medicaid and CHIP
December 2001
DHHS, Office of the Assistance Secretary for Planning and Evaluation (ASPE)
This paper provides a summary of the health insurance issues affecting employment of people with disabilities, including a discussion of the current programs and policies that are available. It presents findings from focus groups conducted with individuals with disabilities who have achieved a reasonable measure of employment success. The focus groups provided information about the extent to which access to health care influenced employment decisions of participants, and about various strategies participants employed for securing access both to employment and needed health care.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
November 2001
DHHS, Health Resources and Services Administration
Lewin contact: Clifford Goodman
This report provides an analysis of national and state level activity related to organ and tissue donor registries. It describes national- and state-level initiatives related to organ donor registries, examines the relative roles of federal and state governments in such registries, and assesses the effect of these activities and policies on efforts to strengthen donor registries. The report was sponsored by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation to better inform attendees of its conference, Guidelines for Donor Registry Development on November 29-30, 2001. The conference is part of the HHS Gift of Life Donation Initiative. The report updates an earlier Lewin report Analysis of State Actions Regarding Donor Registries.
Client Area: Federal Government
October 2001
Social Security Administration
Lewin contact: Lisa Alecxih
Over the past two years, the Social Security Administration conducted a demonstration to increase enrollment in the Medicare Part-B Buy-in program, using a variety of outreach methods. This is the final report that evaluates these efforts to increase participation. This report presents key findings that indicate that outreach letters significantly increased enrollment. In addition, it examines whether the outreach made a difference if interested beneficiaries were referred to Medicaid agencies or SSA became actively involved in the application process. Finally, it examines the effect of other means of outreach, such as public service announcements and grass roots information dissemination.
Client Area: Federal Government
Expertise Area: Medicare
October 2001
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Clifford Goodman
On behalf of the Office of the Assistant Secretary for Planning and Evaluation, The Lewin Group analyzed factors influencing effective dissemination of prevention research findings. The objectives of the study included identifying the mechanisms by which DHHS translates research findings into clinical and public health practices and how these processes can be improved.
Client Area: Federal Government
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