Race and Gender Differences in the Distribution of Home and Community-Based Services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and commnunity characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services– whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black womcn to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homcs are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

Kinship Caregiver Perception of a State-Supervised Kinship Navigator Program

This study evaluated a state-administered Kinship Navigator (KN) program providing information and support to grandparents and other relatives caring for children who are not in child welfare custody. Caregivers’ perceptions of types of services, impact, satisfaction, and areas for improvement were examined. Caregivers (N = 92) reported feeling supported, gaining knowledge about services, and feeling highly satisfied with the program. Caregivers expressed needs for additional financial assistance and more time with their KN. Findings suggest that the KN program may meet key service needs of informal kinship caregivers, but additional staff time and financial resource advocacy would improve the program.     

The theory of change of the evaluation support program: Enhancing the role of community organizations in providing an ecology of care for neurological disorders

This paper discusses the Ontario Brain Institute’s theory of change for the Evaluation Support Program, a program designed to enhance the role of community organizations in providing care and services for people living with a brain disorder. This is done by helping community organizations build evaluation capacity and foster the use of evidence to inform their activities and services. Helping organizations to build capacities to track the ‘key ingredients’ of their successes will help ensure that successes are replicated and services can be improved to maximize the benefit that people receive from them. This paper describes the hypothesized outcomes and early impacts of the Evaluation Support Program, as well as how the program will contribute to the field of evaluation capacity building.     

Race and gender differences in the distribution of home and community-based services in Florida

This article examines the distribution of home and community-based services (HCBS) under Florida's Medicaid waiver program. Controlling for personal and community characteristics, it was found that gender and race significantly affect the access of the disabled adult population to HCBS services, with women and nonwhites significantly more likely to be receiving HCBS services. At the county level, the likelihood of one's being in the waiver program is contingent on the racial composition and level of segregation of the county. People residing in counties with substantial proportions of nonwhites are less likely to receive HCBS services--whatever their race. However, the higher the rate of racial segregation in the county, the higher the probability that the Medicaid disabled adult population will receive HCBS services. The Medicaid waiver program allows older, disabled black women to remain in their home neighborhoods rather than having to move to predominantly white areas where nursing homes are concentrated. Thus, the HCBS program not only provides them with a form of care that is preferred by most older people but also resolves market problems stemming from the lack of nursing homes in segregated areas by taking advantage of support systems in black households.     

Evidence-based practice for youth in supervised out-of-home care: a framework for development, definition, and evaluation

Adolescents comprise more than half of the children in child welfare supervised out-of-home care. This article considers the evidence-base for an array of services to adolescents in out-of-home care and evaluates the existing research base for each program. This review advances a framework for considering the critical need to develop, define, and evaluate the essential elements of out-of-home care services for older foster youth. Policy, program, and evaluation recommendations are forwarded.     

Evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) in Western Australia: barriers to better service provision

This paper details a 2009-2010 evaluation of the Neurodegenerative Conditions Coordinated Care Program (NCCCP) commissioned by the Disability Services Commission (DSC) in Western Australia (WA). The program, run by the Multiple Sclerosis Society of WA (Inc.) provides in-home care and supports and respite for people who are under the age of sixty-five and diagnosed with a rapidly degenerative neurological condition. In 2009, the identified barriers to the better provision of services included: shortage of quality out-of-home respite providers, and convoluted paperwork requirements to qualify for the program. Some service providers were unaware of the program and so were not referring them into the NCCCP, a number of service providers were unwilling to refer their clients into the program, neurologists were unwilling to give a final diagnosis for a client, that would enable them to qualify for the service, there was a general lack of knowledge about what services were available in the general community, and existing equipment pools were under-resourced. In 2010, the study found that most of the issues had been addressed however, out-of-home respite services were still very limited especially in rural areas, and the eligibility criteria for entry to the program is confined to those 65 years and under. This paper discusses the issues that still remain with the program as examples of barriers to better provision of services.     

Effects of family planning and health services on women��s welfare: evidence on dowries and intra-household bargaining in Bangladesh

This paper demonstrates how the availability of family planning and maternal and child health services alters the structure of intra-household bargaining. The overall welfare gains from such programs are likely to be large, but when women obtain access to services only through marriage, some of these gains may be partially offset by changes in their bargaining power and in the dowries that they pay their husbands. I examine these marriage market effects using a family planning and health services program in rural Bangladesh, finding that compared to women without program access, women in the treatment area are 35% less likely to be able to make purchases without permission from their husbands or another household member. Moreover, a difference-in-difference specification confirms that women pay 14% higher dowries in order to obtain husbands with access to the program. The fact that adjustments are made both before and within marriage suggests that marital contracts in rural Bangladesh are negotiated along multiple margins.     

The supportive community: a new concept for enhancing the quality of life of elderly living in the community

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a "neighborhood facilitator," and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

Uniform assessments and standards of social and health care services.

This paper describes the procedures and methodology used in the development of a model In-Home Care services program for aged and disabled adults in Washington State. This program was designed to replace the existing Title XX chore services program in two geographic regions in which dissimilar chore service usage patterns have been exhibited by similar types of recipients. An analysis of the resultant cost, service utilization, and recipient health status data suggests that in the model program home-based services for the aged and disabled were provided in a more equitable and cost-effective manner than is the case with the existing chore service program in this state.     

Program Evaluation Practice in the Nonprofit Sector

Nonprofit organizations are increasingly being asked to demonstrate the effectiveness of their programs and services. Faced with this challenge, agencies that decide to engage in program evaluation must choose among various approaches and methods. This article provides a window into why and how nonprofit organizations are conducting program evaluations, and it reveals the factors nonprofit agencies identify as contributing to a useful and credible evaluation. In addition, the article addresses the role of stakeholder participation in program evaluation.     

The Supportive Community

Abstract

This study examines supportive community programs in Israel, which aim to improve the quality of life of the elderly. These innovative programs pool existing resources to provide a benefits package that includes medical services, an emergency call switchboard, a “neighborhood facilitator,” and social activities. Data were collected in 2000-2001 using qualitative and quantitative methods. The program provides specific services to meet needs that otherwise are not adequately addressed. The major contributions of the program reported by the members was increasing their personal security (two-thirds), easing the burden on their children (one-third), and enabling them to remain at home (one-quarter). The supportive community program enriches the variety of services available, thus providing the elderly with the choice of staying within their familiar surroundings of their homes and neighborhoods. This model appears to be both a cost-effective way to facilitate aging in place and a way to meet many of the elderly's essential needs, thereby maintaining their quality of life.     

New Zealand Vietnam Veterans’ Family Programme,Nga Whanau a Tu (Families of War): Development and Outcome

This article reviews recent research concerned with the association between combat-related posttraumatic stress disorder (PTSD) and interpersonal functioning, before describing the development of a pilot program established to provide mental health services for Vietnam veteran family members. The results of a brief program evaluation are also presented. Sixty clients provided posttreatment and six-month follow-up data on a variety of outcome measures which were compared with independent ratings returned by 33 therapists. On average, clients reported that counselling had been beneficial and indicated satisfaction with services received. However, at posttest, therapists indicated that approximately 50% of clients were in need of continued treatment. There was a decrease in satisfaction with services over the posttest-follow-up period, but no change on most measures of psychotherapy outcome.     

A preventive services program model for preserving and supporting families over time

Selected findings from a three-year study are reported regarding a prospective sample of 189 families served by the Center for Family Life's preventive services program and the nature and results of the services the families received. The program combines elements of both family preservation and family support services to provide a comprehensive, individualized response to families in need and prevent the unnecessary placement of children in care. Four program elements correspond with those typically identified as characterizing family preservation programs, and three key program elements differentiate the Center's approach from other family preservation programs. These latter characteristics are more typically found in family support programs and address limitations of current family preservation programs as identified in the literature.     

“They give you back that dignity”: understanding the intangible resources that make a transitional house a home for homeless families

Approximately 33% of the homeless population in 2017 were families with children. Researchers have argued for interventions and services to employ an ecological perspective to mitigate some of the unintentional harm inherent in existing programs designed to serve homeless families. This paper utilized a case study of a transitional housing program to (1) determine how well the program met recommendations informed by the ecological perspective and (2) explore underlying themes across recommendations. Past and current residents of a transitional housing program participated in semi-structured interviews as part of a program evaluation. Interviews were deductively and inductively coded to meet aims 1 and 2, respectively. Residents identified several aspects of the program that met the ecological perspective recommendations including culturally-responsive services, trauma-based services, and social and community connections. Major underlying themes spanning across recommendations included interpersonal resources (caring, sense of belonging), empowerment resources (advocacy, family preservation), impact on family (family life, positive youth development), and communication. This case study, through the analysis of residents’ perspectives, highlights the important role of transitional housing programs in providing a supportive, empathetic, empowering, and home-like environment that gives residents “back that dignity” so they are emotionally and physically prepared to successfully transition to permanent housing.     

Treatment services received in the CASAWORKS for Families program

This article presents information on treatment services received by women participating in an initial multistate evaluation of CASAWORKS families. Results indicated most women received services to address medical, employment, basic needs, alcohol and drug, family, and psychiatric problems during the first six months of the program. The clients also had frequent contact with their case managers and were retained in the program for an average of 222 days. Considerable variation was observed across sites in the percentage of clients who received various services and the number of sessions they received. In Cox regressions, shorter retention in the program was predicted by referral to program from Child Protective Services or parole/probation, social conflicts, employment, and marijuana use at baseline, whereas a history of suicide attempts was associated with longer retention. Longer retention was associated with better alcohol use outcomes but was unrelated to employment or drug use outcomes.     

Peer mentoring services,opportunities, and outcomes for child welfare families with substance use disorders

Peer recovery support services (PRSS) in child welfare are being provided by peer mentors in sustained recovery from substance use disorders (SUD) to parents with acute SUD. Previous retrospective interviews demonstrate that peer mentors engage parents in family-centered systems of care through relationships and empowerment. However, the specific profile of services provided is unknown. Personnel challenges and opportunities for persons in recovery serving as peer mentors are described in the literature without understanding the frequency of both. As enthusiasm for hiring peer mentors grows, it is important to understand the specific services provided, the risks and opportunities associated with hiring individuals in recovery, and the impact of mentor services on outcomes. This knowledge can assist in developing training, implementation guides, policies, job expectations, and program evaluation strategies. This is a prospective study of 28 family mentors providing PRSS services to 783 families with child maltreatment and parental SUD over 8 years in a family-centered integrated program with SUD treatment providers. We describe mentor services overall, during the early engagement period, in rural and urban settings, and test the association between services and child/parent unification status at case closure; we identify the proportion of peer mentors that experienced employment challenges and career advancement opportunities. Results demonstrate the complexity of service provision overall and in differing contexts. Face to face visits with children were associated with greater likelihood of parent/child unification at case closure and 64.3% of peer mentors experienced career advancement opportunities. The implications of these findings are discussed.     

The development and evaluation of a natural helpers' training program to increase the engagement of urban,Latina/o families in parent-child interaction therapy

Latina/o immigrant children are at increased risk for developing conduct disorders, and are simultaneously less likely to access services. Natural helpers are uniquely positioned to promote effective parent training programs to address service disparities in these communities. This study describes one effort to train natural helpers to increase engagement in parent-child interaction therapy (PCIT), an evidence-based parent training program. An academic-community partnership prompted the development and evaluation of this natural helpers training program. Five natural helpers were trained to recruit Latina/o families into PCIT, address barriers to treatment, and support parents' skill development. Over the course of training, natural helpers increased their knowledge of PCIT and their ability to use and model treatment targeted parenting skills. Additional consultation was necessary to improve the natural helpers' abilities to conduct behavioral observations of parent skill use and provide feedback on these skills. Natural helpers expressed overall satisfaction with PCIT and the training program. Suggestions for incorporating natural helpers into PCIT services are discussed based on the strengths and challenges identified from the evaluation of this training program.     

Taking it to scale: evaluating the scope and reach of a community-wide initiative on early childhood

In implementing broad community initiatives, the ability to assess the delivery of services is a distinct challenge. Yet, understanding both the magnitude and cross-usage of services by target populations is often a precursor to effective program evaluation, program improvement and additional program planning. This research examines the extent to which a comprehensive early childhood initiative successfully reached young children and their families in a large urban county. By linking birth records and administrative datasets at the level of the individual child, the study tracks the experiences of children in respect to engagement in program services and their receipt of public benefits. The study shows both the rapid growth in programs and the reach of the program elements to the majority of newborns in the target county after 5.5 years. The research highlights the challenges of effectively using individual-level data from a variety of sources for the purposes of documenting program receipt by participants.     

Exploring the link between service quality and outcomes. Parents' assessments of family support programs

Relationships among consumer-generated quality factors, satisfaction, and outcome measures were examined for family support services provided by Michigan's public mental health system. Parents focused on structural and procedural aspects of program accessibility and attended less to program administration issues. Parents who gave the services the highest quality ratings also were the most satisfied with services, saw the services as more effective, had fewer family problems, and rated their time and child-related resources as more adequate. Implications for evaluation practice are discussed.