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Human Services Research Institute

Shaping Human Services Policy and Practice – December 2015

Valerie Bradley

A Message From Our President

Thank you very much for the outpouring of support and appreciation that followed my last announcement—that David Hughes would be taking the reins as the next HSRI president in January 2017. It’s gratifying to know how many others feel invested in HSRI and the continuation of its mission. This transition will free me from the day-to-day leadership tasks, and will allow me to invest time in a range of HSRI projects and advocacy. I will not be retiring but will shift my energies to areas of our work where I can make a contribution. I also look forward to ushering in HSRI’s 40th year in 2016!!

Val Bradley

Advancing Individualized, Self-Directed Supports

In October, members of our Intellectual and Developmental Disabilities Research Teams attended the international Claiming Full Citizenship Conference in Vancouver, Canada, which focused on self-determination, personalization, and individualized funding initiatives. All told, HSRI staff gave nine separate presentations, covering such topics as supported decision-making, community inclusion, personal supports budgets, accessible data, natural support networks, and service trends. A video series from the conference is available online, including several that feature HSRI Vice President John Agosta and HSRI President Val Bradley speaking on strategies related to individual and family support.

In September, members of our Behavioral Health Research Team participated in an International Institute for Mental Health Leadership (IIMHL) Learning Exchange on Self-Direction and Recovery. Self-direction is a model for financing services and supports in which people manage or direct a flexible budget with support from a specially trained broker, often a peer with lived experience of the mental health system. Learning Exchange participants identified and discussed five critical themes needing additional attention and research: (1) achieving culture change in support of self-direction; (2) involving and supporting people with lived experience at every level, including brokerage, leadership, and oversight; (3) obtaining sustainable funding; (4) addressing barriers for the implementation; and (5) exploring self-direction as a promising solution to some of the wider challenges facing the mental health system.

Compare Maine

HSRI Develops New Healthcare Comparison Tool

The launch of in October was an exciting event for HSRI. Our Health Data team developed the new website for the state of Maine, aided by partners NORC at the University of Chicago and website design firm Wowza.

Patients and consumers can use the site to compare the average cost of a medical procedure at more than 170 healthcare facilities in the state. They can also compare quality ratings for those facilities.

"Many of us are paying higher out-of-pocket costs for our healthcare services. I hope that by making this information available, consumers and employers will be positioned to make better informed decisions," said Maine Governor Paul LePage.

HSRI developed under contract with the Maine Health Data Organization. Grant funds from the Centers for Medicare & Medicaid Services made the site possible.

Learn More

Assessments at the County Level: Integrated Care Delivery and Outpatient Behavioral Health

HSRI and its partner Desert Vista Consulting completed an evaluation of an integrated care delivery program for people with serious mental illness in Minnesota’s Dakota County. The Preferred Integrated Network (PIN) program is a public-private partnership between Medica, a managed care organization, and Dakota County. In addition to an expanded benefit set that includes mental health services, program enrollees also receive a Wellness Navigator—a designated case manager and single point of access and coordination for all medical, behavioral, and social services. Given that the PIN program preceded and anticipated many developments in health care reform—notably, the provision for health care homes in the Affordable Care Act—the evaluation provides a number of important lessons and recommendations for future system improvement and reform in Minnesota and throughout the nation.

Read the final report here

HSRI recently completed an analysis of Milwaukee County’s outpatient behavioral health capacity. The Milwaukee County Outpatient Capacity Analysis is the third report issued jointly by HSRI, the Technical Assistance Collaborative, and the Public Policy Forum on redesigning the behavioral health care delivery system in Milwaukee County. As described in the report, we found that Milwaukee County is challenged by issues of fragmentation among outpatient providers, a lack of communication between providers and hospital discharge specialists, a shortage of psychiatrists, and insufficient Medicaid reimbursement rates that are negatively impacting provider supply. We developed a number of recommendations for the County, including centralizing coordination via the County’s Behavioral Health Division, enhancing the role of Federally Qualified Health Centers in integrating behavioral health care with comprehensive patient-centered medical homes for low-income individuals, expanding the use of telepsychiatry, and more.

Read more of our recommendations and the full report here

Val and Jack

Thanks, Jack, for Your Service on the Board of Directors!

After 30 years of service, John (Jack) Noble stepped down from the HSRI Board of Directors. He was honored for his contributions to HSRI during a celebration held on Oct. 6.

"Jack has made immeasurable contributions to the well-being of HSRI," said President Valerie Bradley. "He has always been prepared and ready to ask the penetrating and insightful questions. His research skills as well as his strong sense of social justice have provided grist for many provocative, productive and important conversations."

Jack’s career spans federal and state government and university teaching. He has worked passionately to promote human rights, spur reforms in peer reviewed literature, and protect the integrity of scientific evidence by exposing fraud and bias. (Notably, he has also been a board member of the Alliance for Human Research Protection.) We count ourselves very lucky to have had him as part of our story for three decades.

HSRI Researchers Share Their Findings

HSRI Research Associates Bevin Croft and Ben Cichocki, along with colleague Clifton Chow, had an article published in the Journal of Vocational Rehabilitation. As presented in the article, they found that job accommodations for people with psychiatric disabilities were associated with a monthly Supplemental Security Income savings, suggesting that efforts to expand job accommodations could lead to cost-savings to federal entitlement programs.

Ben Cichocki also authored an article published online ahead of print in the journal Work. To explore the possibility of common predictors of the strength of the therapeutic alliance for rehabilitation programs serving people with serious mental illnesses, he examined data from a supported employment program. Ben found that individuals who were most strongly allied with their employment specialists were more likely to be older and have a smaller social network size, suggesting that program staff may want to make early efforts to engage younger clients and those with more social supports, though further study is needed.

HSRI Senior Policy Specialist Alixe Bonardi co-authored a chapter in the newest volume, Health Disparities and Intellectual Disabilities, in the International Review of Research in Developmental Disabilities book series. The chapter, which focuses on Health Surveillance, mentions NCI as an available health assessment tool. Alixe also co-authored the article Pregnancy Outcomes Among U.S. Women With Intellectual and Developmental Disabilities in the American Journal on Intellectual and Developmental Disabilities. According to the study, women with intellectual and developmental disabilities (IDD) had longer hospital stays and were more likely to have Caesarean deliveries than other women. Rates of adverse pregnancy outcomes were elevated for women with IDD across a range of measures.

Direct Support Professionals

A New Survey Report on Direct Support Professionals

Recognizing that the quality of life for individuals with intellectual and developmental disabilities in the service system is inextricably linked to the work quality and stability of those who are paid to support them, the National Core Indicators (NCI) assists states in collecting accurate and comprehensive data on the direct support professional (DSP) workforce. In November, NCI released its 2014 Staff Stability Survey Report, which compiles survey data taken from provider agencies in nine participating states and the District of Columbia. Some findings include:

  • Across the responding agencies, the turnover rate for DSPs was 45%.
  • Across participating states, DSPs received an average hourly wage of $11.11. DSPs providing in-home and residential supports earned less on average than those providing non-residential supports.

Read the full set of findings in the report

NCI is a collaboration between the National Association of State Directors of Developmental Disabilities Services and the Human Services Research Institute.

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