Jim Mayfield, Marna Miller - February 2012

A family caregiver voluntarily cares for a parent, spouse, partner, or another adult relative or friend. The assistance that family caregivers provide may allow care recipients to remain at home rather than in long-term care. The Family Caregiver Support Program (FCSP) at the Department of Social and Health Services (DSHS) provides resources and services to unpaid family caregivers in Washington State. In concert with the state’s 13 Area Agencies on Aging, the FCSP provides information and outreach; screening, assessment, consultation, coordination of services, and caregiver support services and resources. The program directly served 5,800 caregivers in fiscal year (FY) 2011. For fiscal year 2012, the legislature increased funding for FCSP to expand in-depth services to more caregivers. The legislature also directed the Washington State Institute for Public Policy to work with DSHS to establish and review outcome measures associated with the FCSP expansion. The goal of the study is to assess whether the expansion of this program delays entry of care recipients into Medicaid-paid long-term care. This report gives a brief description of the program and outlines the approach to evaluation. A final report will be published by August 30, 2012

Marna Miller, Stephanie Lee - January 2012

The 2009 Washington State Legislature passed Second Substitute House Bill 2106, requiring the Children’s Administration of the Department of Social and Health Services to:

• Convert existing contracts with service providers to performance-based contracts and reduce the overall number of contracts; and

• Set up two demonstration sites to compare child welfare case management by private agencies with child welfare case management by DSHS employees.

The legislation also established the Child Welfare Transformation Design Committee to advise DSHS in this effort. The Washington State Institute for Public Policy (Institute) was directed to report on the transition to performance-based contracts and, in 2015, evaluate the outcomes of case management performed by private agencies compared with that of DSHS employees.

This initial report to the legislature and governor provides a brief description of the legislation and an overview of the progress to date in converting and consolidating CA contracts. The Institute will provide a final report on performance-based contracts in June 2012, and an evaluation report of the demonstration project in April 2015.

Elizabeth Drake - December 2011

The Department of Corrections contracted with the Washington State Institute for Public Policy to examine effective community supervision practices of offenders. In this interim report, we provide background information on community supervision as it is delivered in Washington. We also summarize our findings to date on our systematic review of the literature regarding “what works” for community supervision.

Annie Pennucci, Laurie Anderson - December 2011

Washington’s Learning Assistance Program (LAP) provides funding to school districts for supplemental services for K–12 students at-risk of not meeting state standards in reading and math. The state Quality Education Council (QEC), which makes recommendations to the legislature regarding basic education, requested that the Washington State Institute for Public Policy (Institute) collaborate with the Office of Superintendent of Public Instruction (OSPI) on a study that measures the impact of LAP on student achievement.

This study is being conducted in two phases: (1) statistical analysis of the association between LAP funding and student outcomes; and (2) site visits at schools that provide LAP-funded services. This report describes preliminary results from the statistical analysis, focusing on elementary school student test scores. The final report, due September 1, 2012, will examine other grade levels and outcome measures.

This report was revised January, 2012, to include an executive summary.

Mason Burley - December 2011

In 2007, the Washington State Legislature passed Substitute Senate Bill 5320, establishing an Office of Public Guardianship (OPG) within the Administrative Office of the Courts. This new pilot program provides state-paid guardians for legally incapacitated individuals in cases where a volunteer guardian was unavailable and the individual lacks financial resources.

The pilot program started in five counties throughout Washington State, and now provides services in ten counties. While a limited number of incapacitated individuals were served during this pilot period, initial estimates (completed in 2005) found that 4,500 individuals may be eligible for a public guardian in Washington. This estimate, however, was based on research conducted over 20 years ago in different states.

This report uses two different sources – 2009 census data, and a 2011 survey of care providers – to estimate the need for public guardianships services in Washington State. Based on this analysis, we found that between 4,000 and 5,000 individuals may be potentially qualify for a public guardian. The need for these services is also classified according to region and type of care setting.

Mason Burley - December 2011

Guardians are court-appointed legal representatives who have the authority to make personal, medical, and financial decisions on behalf of incapacitated individuals. Washington State implemented a pilot program in 2007 to provide public (state-paid) guardianship services for individuals whose family members were unable to serve as a guardian, or the individual did not have financial resources to pay for a guardian.

This evaluation examines program outcomes and cost effectiveness for clients served by public guardians between 2008 and mid-2011. Our analysis over this period found the following:

• Average residential costs per client decreased by $8,131 over the 30-month study period. The average cost for providing a public guardian was $7,907 per client during that time.

• Personal care decreased by an average of 29 hours per month for public guardianship clients, compared with an increase in care hours for similar clients.

• One in five public guardianship clients showed improvements in self-sufficiency during the study.

This report discusses the characteristics and outcomes of public guardianship clients and presents related research on outcomes for public guardianship programs outside Washington State. While we found positive results for public guardianship clients in this evaluation, without a randomly assigned control group (that did not receive services), it is difficult to determine the extent to which public guardians may have contributed to these outcomes.

Mason Burley - December 2011

Since 2006, over 3,500 students in foster care have received assistance from an Educational Advocacy Coordinator. The Educational Advocacy program was started in order to help foster youth maintain enrollment, connect to school services, and progress academically. The program was first implemented in King County in 2001. Treehouse, the non-profit agency that developed the program model, now manages the statewide program under contract with the Department of Social and Health Services (DSHS). This includes training advocates, screening referrals, tracking outcomes, and developing instructional material for social workers, caregivers, and educators.

The 2011 Legislature directed the Institute to “examine the child welfare and educational characteristics for foster youth who are served by educational advocates.” During the 2009–10 school year, advocates spent nearly 8,200 hours assisting youth in foster care. This report describes the background and characteristics of those students served by advocates. We also examine placement mobility and school changes as well other educational outcomes (i.e. grade point average and graduation rate). Our final evaluation report in October 2012 will address the overall effectiveness of the program

Mason Burley - October 2011

In 2012, recent amendments to Washington State’s Involuntary Treatment Act (ITA) will take effect. New legal guidelines will allow a designated investigator to more fully consider information from both credible witnesses and historical records when making commitment decisions. The 2010 Legislature directed the Washington State Institute for Public Policy (Institute) to estimate the number of additional psychiatric admissions that may occur as a result of this law and examine how many inpatient psychiatric beds may be necessary to accommodate this increase. These estimates were presented in a companion to this report (completed in July 2011).

This report outlines various approaches for addressing the projected increase in psychiatric admissions. First, we discuss options for developing additional capacity within the state’s inpatient psychiatric system. Next, we highlight both programmatic and statutory alternatives that may help prevent (or divert) future psychiatric admissions. This section also summarizes laws from four different states that provide for alternatives to involuntary inpatient admissions. Finally, this report examines the relationship between ITA-related psychiatric admissions and utilization of both county jails and hospital emergency departments.

Steve Aos, Stephanie Lee, Elizabeth Drake, Annie Pennucci, Tali Klima, Marna Miller, Laurie Anderson, Jim Mayfield, Mason Burley - July 2011

The 2009 Washington Legislature directed the Institute to “calculate the return on investment to taxpayers from evidence-based prevention and intervention programs and policies.” The Legislature instructed the Institute to produce “a comprehensive list of programs and policies that improve . . . outcomes for children and adults in Washington and result in more cost-efficient use of public resources.” The Legislature authorized the Institute to receive outside funding for this project; the MacArthur Foundation supported 80 percent of the work and the Legislature funded the other 20 percent. This main report summarizes our findings. Readers can download the two detailed technical appendices for in depth results and statistical methods.

Mason Burley - July 2011

In 2010, the Washington State Legislature amended the legal guidelines for Involuntary Treatment Act (ITA) commitments to allow a Designated Mental Health Professional (DMHP) to more fully consider reasonably available information about individuals from credible witnesses and historical records (RCW 71.05.212). These statutory changes will take effect in 2012. The Legislature directed the Institute to assess the potential impact of these changes.

This paper discusses trends in both the utilization of inpatient psychiatric treatment beds and changes in the capacity of these facilities to admit patients. To assess potential increases in psychiatric admissions as a result of this law, we conducted a survey that asked DMHPs to review ITA cases during a one-week period in 2010. Based on this survey, we estimate that the commitment rate could increase from 40 percent to between 45 and 55 percent of all investigations as a result of the statutory changes. Between 42 and 168 additional psychiatric beds (above current capacity) would be necessary to accommodate this growth in admissions.