Student Reports
Spring 2011
Professors Douglas J. Besharov and Douglas Call
In Spring 2011, students worked with clients at the DC Office on
Asian and Pacific Islander Affairs, Deloitte-Touche Consulting,
the Folger Shakespeare Library, the Hilltop Institute at the
University of Maryland-Baltimore County, Montgomery County
CountyStat, the Montgomery County Department of Health and Human
Services, the Montgomery County Volunteer Center, the Silver
Spring Regional Service Center, the U.S. Department of Health and
Human Services, and the U.S. Government Accountability Office.
Students performed a wide variety of analyses, including
cost-benefit analysis, cost-effectiveness analysis, performance
measure development, process evaluation, and meta-assessment.
The following are the final projects prepared by the students.
They are listed in order of clients and the names of the authors
have been removed by request.
Note: The associated files are best viewed using Adobe
Reader. To get the software, go to http://get.adobe.com/reader/
County Government
District of Columbia Office on
Asian and Pacific Islander Affairs
1. Language Access Program in OAPIA: Assessing
LAS 2009 and Making Recommendations for LAS 2011. This
report evaluates OAPIA's Language Access Survey (LAS) of 2009 and
makes recommendations for the upcoming 2011 survey. This report
found that the LAS successfully identified evaluation questions,
targeted the information source, conducted the data collection,
and implemented data quality assurance. The LAS, however, did have
some weaknesses: it had a small sample size, did not filter
non-residents of the District of Columbia from the sample, failed
to collect important demographic information including
respondents' educational background and language ability, and
neglected crucial outcome information such as feedback on language
services.
The author proposes the following recommendations to the 2011 LAS
survey: (1) Increase the sample size to at least five hundred with
at least one hundred for each of the five key ethnic groups
including: Chinese Americans, Japanese Americans, Indian
Americans, Korean Americans and Vietnamese Americans; (2) use a
face-to-face format to probe for more information and collect
anecdotes; (3) add survey questions to collect information on
respondents' residency status, educational attainment,
self-reported language ability, quality of language services
provided by the District agencies, motivation to actively seek the
language service, and one open question for any comments; (4)
conduct a pretest; (5) assign a reference number to each survey to
check data entries; and (6) disseminate the results of the survey.
- Paper
Presentation
Montgomery County CountyStat
2. Recommended Performance Metrics for the
Montgomery County Department of Economic Development. This
study examines the existing performance measures of the Montgomery
County Department of Economic Development and proposes new
performance measures due to a restructuring of DED's mission and
goals. It also proposes "comparison counties" to be used in
benchmarking DED's performance. Performance measures were created
for each program area in the new structure: Prospect Development,
Problem Resolution, Technical Assistance, Agricultural Services
and Workforce Services.
Comparison counties were determined through a similarity score
matching system in which the criteria were structurally similar to
Montgomery County's DED and services offered. The counties
evaluated were the thirty-five that CountyStat has identified as
demographically similar and are used to benchmark all other
departments. The best matches scored above fifty percent on a
system with eleven criteria and above fifty percent on a system
where those eleven criteria were narrowed to the most important
seven. They are: Howard County, MD; Anne Arundel County, MD;
Fairfax County, VA; Westchester County, NY; Monmouth County, NJ;
Bucks County, PA; and Oakland County, MN. The good matches scored
above fifty percent on only one scale. They are: Douglas County,
CO; Chester County, PA; Lake County, IL; and Hamilton County, IN.
- Paper
Presentation
Montgomery County Department of
Health and Human Services
3. The Healthy Montgomery Qualitative Data
Collection Process: Successes and Challenges in
Implementation. This report analyzes the qualitative
data collection process of the Healthy Montgomery community health
improvement process. The author conducted an implementation
evaluation, analyzing four community conversations using a series
of criteria developed by the author and approved by the staff of
the Montgomery County Department of Health and Human Services. The
evaluation details developments in the design and methodology of
the qualitative data collection process, successes and challenges
in its implementation and stakeholder evaluations of Healthy
Montgomery's progress.
The author proposes the following recommendations to be
implemented in future iterations of Healthy Montgomery: (1)
Establish more consistency in the methodology, (2) target
underrepresented populations to a greater degree, and (3) explore
additional methods of direct outreach.
- Paper
Presentation
Montgomery County Volunteer
Center
4. Performance Measures for the 2011 Montgomery
County Community Service Week Survey Tool. This report
develops performance measures for the Montgomery County Volunteer
Center to capture the outputs and outcomes of volunteerism in the
County. This survey tool will help quantify the contribution which
the County's volunteers make and the results can be used to
identify areas of improvement, to study volunteerism outcomes, and
to apply for grants.
Performance measures will be collected through two surveys to be
administered during the Community Service Week (October 16, 2011
to October 22, 2011). One of these surveys will be for the
organizations which provide the volunteer activity and the other
will be for the volunteers themselves. The complete surveys are
included in Appendix A and Appendix B of the report.
- Paper
Presentation
Silver Spring Regional Service
Center
5. Performance Measures for the Silver Spring
Civic Building and Veterans Plaza. This report
develops performance measures for the Silver Spring Civic Building
and Veterans Plaza to evaluate the Civic Building and Plaza's
effectiveness in accomplishing their mission.
The program theory of the Civic Building and Plaza can be
described as, if the space can effectively be activated by a
variety of stakeholders including the county and the community,
then the Civic Building and Plaza can improve community cohesion
through community engagement, act as a catalyst for local economic
development, and be a sustainable revenue generator. The
recommended outputs are divided into three categories � operations
and management, financial operations, and community involvement.
Additionally, improvements in four outcome categories are the best
way to evaluate the Civic Building and Plaza: "Access and
Linkages"; "Comfort and Image"; "Uses and Activities", and
"Sociability." All of these recommendations have been proposed
within the context of a tight budget environment in which
resources for data collection are limited. Finally, the report
also recommends creating partnerships to collect additional
outcome data.
- Paper
Presentation
State Government
Hilltop Institute, University of
Maryland-Baltimore County
6. Lessons Learned for the Future: Money Follows
the Person Demonstration. This report develops a
template for states that are looking to implement a Money Follows
the Person (MFP) initiative for their Medicaid programs. It
surveys trends in existing MFP demonstrations to determine which
program characteristics are likely to produce successful MFP
initiatives, and to recommend guiding principles for incoming MFP
states. By understanding the experiences of existing MFP
demonstrations, new states can better optimize how their MFP
inputs and activities can lead to positive program outcomes.
More generally, the research suggests nine guiding principles to
new states implementing MFP:
- Conduct a comprehensive assessment of the state Medicaid
long-term care system
- Invest early in infrastructure that facilitates rebalancing
initiatives
- Build off existing supports and services
- Secure buy-in from key stakeholders
- Utilize contractors to help implement MFP initiatives
- Secure set-aside services within existing programs for MFP
clients
- Manage early expectations
- Build flexibility in MFP initiatives to allow for continuous
improvement
- Establish policies that reallocate resources from institutions
to community-based care
- Paper
Presentation
Federal Government
U.S. Department of Health and
Human Services
7. Assessing the Implementation of Quality
Indicators in the Medicare Physician Group Practice
Demonstration. This report is an assessment of the
implementation of quality indicators in the Medicare Physician
Group Practice demonstration. It focuses on two research
questions: (1) How effectively did demonstration sites implement
interventions to satisfy quality indicators?; and (2) How can the
lessons learned from the PGP Demonstration be useful in
implementing the Medicare Shared Savings Program (MSSP)?
Sites experienced barriers to implementation in a variety of
forms--financial, geographical, administrative, and in data
collection and reporting. As demonstrated in the quality
performance results, sites are achieving their quality thresholds
for the majority of measures. However, all sites are not earning
shared saving payments. The report recommends that future quality
measures need to be easily captured by electronic reporting
systems and create meaning for providers and patients.
Streamlining quality measures across Medicare and private payers
will yield an effective national benchmark that can improve and
coordinate future quality reporting. Physician buy-in is critical
to the success of implementing outcomes-based quality measures and
improving the coordination of care.
- Paper
Presentation
8. Creating Greater Accountability and
Organization in Applications and Reports for CSBG Grants. This
report is a process evaluation of the funding opportunity
announcements, applications, and semi-annual reports for nine
grantees that received two Community Services Block Grant (CSBG)
Training and Technical Assistance (T/TA) Grants to determine if
there were inappropriate overlaps in funding or deviations from
original plans without clear explanations. In examining the
reporting documents, it became clear that the lack of organization
and detail within the documents made it time-consuming and
sometimes impossible to tell what activities were funded, how many
community actions agencies benefitted, and the amount of overlap
between the grants and between periods.
This report proposes a model set-up for applications and
semi-annual reports that includes a categorization system that
could help CSBG Program Specialists identify the types of
activities their grants fund and enable them to identify problems
more quickly. In addition, it provides some recommendations for
the State Associations on the details they should include in their
applications and reports.
- Paper
Presentation
9. Electronic Health Record Incentive Program:
Assessing Potential Cost Savings. This report
attempts to quantify the potential cost savings as a result of the
Electronic Health Records Incentive Program (EHR) between
2011-2019. The analysis looks only at practice-based physicians
treating Medicare patients, even though incentive payments are
available also for Medicaid providers and hospitals. In particular
this paper attempts to answer the following questions: (1) What is
the first year in which potential cost savings as a result of EHRs
equal costs?; (2) Looking at the whole 2011-2019 timeframe, when
will the cumulative savings equal the cumulative costs for the
program?; and (3) For every dollar spent in incentive payments,
how much savings will CMS see in return by 2019?
The report finds, using a 4.5 percent reduction in costs
assumption, the first year in which savings equal the costs will
be in 2014. Using a more conservative 3.0 percent savings
assumption, savings will equal costs approximately three months
later into 2014. Looking at cumulative costs and savings for the
program, the break-even point between costs and savings occurs in
2016, assuming a 4.5 percent savings from EHRs. The more
conservative 3.0 percent savings assumption gives us a break-even
point closer to 2017. A cursory analysis of the savings
assumptions indicated that a savings rate of 1.03 percent would be
necessary in order to have savings equal costs at all by 2019.
- Paper
Presentation
10. The Financing of Care for Dual Eligible
Beneficiaries: An Overview of Care for Dual Eligibles and a
Cost-Comparison Analysis of Two Service Delivery Models for
the Centers for Medicare and Medicaid Services. This
report examines the Medicaid costs for dual eligible beneficiaries
enrolled in two of the service delivery models involving
community-based care: HCBS waivers and the PACE program. The
specific HCBS waiver examined is the HCBS-Disabled/Elderly
(HCBS-DE) waiver commonly used by dual eligibles. The
cost-comparison analysis sought to identify which service delivery
model, HCBS-DE waivers or PACE, provided lower cost care for dual
eligible beneficiaries 65 and older.
Using data from the Medicaid Statistical Information System
(MSIS), this analysis compared the reported Medicaid data by state
for (1) the number of beneficiaries, (2) total payment amount, and
(3) payment per beneficiary. This study found that Medicaid costs
were higher for dual eligibles 65 and above who were enrolled in a
PACE program when compared to those using HCBS-DE waivers.
- Paper
Presentation
11. Managing for Performance: Child Welfare
Waiver Program and Cost-Effectiveness Analysis. This
report seeks to evaluate demonstrations of waivers of certain
provisions of Title IV-E of the Social Security Act related to
foster care by focusing on the cost studies, typically the weakest
portion of these evaluations. The three research questions are: (1)
How can cost-effectiveness analysis improve child welfare waiver
evaluations? (2) How can cost-effectiveness analysis be conducted
in child welfare waiver evaluations? and (3) How can the
performance management of the waiver program otherwise be
improved?
Recommendations include that HHS require the use of
cost-effectiveness analysis and experimental design. HHS should
also encourage the use of similar program designs across States.
- Paper
Presentation
12. Runaway and Homeless Youth Cost Study:
Estimating the Impact of a Unified Definition of Homelessness
Among U.S. Departments. This report addresses the
question: "How much would it cost the Runaway and Homeless Youth
(RHY) Program to alter its definition of "homeless" to the
definition used by HUD or the definition used by Education?"
Current program per youth expenditures and new eligibility
estimates outlined by the alternate definitions are used to assess
the program costs given the use of different homeless
classifications.
The author analyzes these calculated costs under various program
take-up rates, as well as diverse regional conditions. By
illustrating the additional costs caused by accommodating a common
vocabulary of homelessness and outlining the vast differences
between departmental definitions, the report demonstrates the need
for diverse program guidelines and illustrates their influence in
shaping program goals and intentions.
- Paper
Presentation
U.S. Government Accountability
Office
13. Statewide Longitudinal Data Systems in
Education: Enabling Data-Based Decision Making in Florida,
North Carolina, and Washington. This report is a
process evaluation of the development of statewide longitudinal
data systems in three states: Florida, North Carolina, and
Washington. It finds that certain factors facilitate data system
development and implementation. State-level political support
encourages and aids the development of the states' data systems.
Legislative mandates ensure the data systems moved from the
development to the implementation stage. The availability of
funding is a critical component; longitudinal data systems
including data that encompasses all aspects of public education
require funding for the system development, implementation, and
ongoing staff, monitoring, and enhancements. Further, the data
systems cannot be constructed in a day or even over the course of
a year. The three states collect data from pre-existing data
systems and used their past experiences to inform current
decisions.
At the same time, some factors worked to hinder data system's
usability. Inadequate staffing results in long wait times in
receiving data requests. The analytical tools that could help
relieve staff and allow stakeholders to access data themselves are
not developed to their fullest extent. The data system
stakeholders expect the systems to be developed as planned,
including these enhanced capabilities. Managing multiple
expectations and needs has proven difficult. Collaborating with
the source data systems is a challenge, as well.
The author recommends the following to improve state's transition
towards a data-based environment that is used to improve
educational instruction: (1) Set priorities using the Statewide
Longitudinal Data System Grant's Request for Application (RFA);
(2) Mandate, rather than encourage, the Common Education Data
Standards; (3) Encourage and support data system training at the
state, district and school-levels; and (4) Provide guidance on the
potential uses of longitudinal data.
- Paper
Presentation
14. Identifying Potential Areas of Overlap in
Federal Education Research. This report examines
potential duplication within federal education research, looking
at two major questions: 1) What types of education-related
research do federal agencies and academies sponsor and conduct?;
and 2) Do their research areas overlap?
A thorough study of these publications reveals no duplication in
federal education research within the temporal and topical scope
of the evaluation. Although agencies and academies support
research on similar topics, studies within the same category make
use of different types of methodology and include different
subject matter. Despite this lack of duplication, agencies should
endeavor to leverage resources between agencies interested in
studying similar issues in education in order to maximize their
efficiency and produce data that are relevant to multiple agencies
and academies. Future research in this area might also include
cost effectiveness research to increase government efficiency and
identify which types of research are ultimately the most useful to
policymakers and the public.
- Paper
Presentation
15. Process Evaluation of Supplemental
Educational Services. This paper documents a process
evaluation of Supplemental Educational Services (SES) under No
Child Left Behind. Using a case study method, 12 SES coordinators
at the state and local level were interviewed. States and
districts identified four primary challenges to SES
implementation, including difficulty evaluating the effectiveness
of SES providers, trouble removing providers from state approved
lists, variation in provider rates, and the lack of alignment
between tutoring services and school day curriculum.
Based on the findings of this evaluation, SES would benefit from a
shift in focus from provider effectiveness to assessing provider
quality. This would help improve the quality of tutoring services
and make the provider removal process more objective and
consistent. Districts would benefit from having greater control
over the program's design; as the day-to-day operators of this
program, LEAs should have a greater say in establishing provider
rates, approving curriculum and removing providers from state
approved lists.
- Paper
Presentation
Nongovernmental
Deloitte-Touche
16. Health Reform: Implementing Health Insurance
Exchanges. This report provides a timeline for
state implementation of health insurance exchanges under the
Patient Protection and Affordable Care Act (PPACA), detailing
necessary state action to meet the 2014 deadline. This report
serves only as a guideline for implementation, and states will
need to consider their specific needs in determining how to
approach mplementation. Considering the complexity of establishing
exchanges, states should move forward with implementation
immediately, remain flexible and ensure continued coordination
with key stakeholders.
- Paper
Presentation
Folger Shakespeare Library
17. Assessing the Impact of the Folger
Shakespeare Library's Shakespeare Set Free Teaching Training
Programs. This report uses a process evaluation to
examine the Folger Shakespeare Library's Shakespeare Set Free
program, a series of educational workshops offered by the Folger
Shakespeare Library that teaches an alternative way of teaching
and learning Shakespeare known as performance-based teaching. It
aims to answer the following questions: (1) Is the program
accomplishing what it expects to accomplish? and (2) Does the
Shakespeare Set Free teacher training program change the way
teachers teach and students learn Shakespeare?
A process evaluation was conducted in Providence, RI which
included interviews with key stakeholders, observations of
workshops in action, a review of the supplemental materials
available to participants, and participant responses to a survey
about experiences using the techniques in the classroom. The
evaluation found that the Shakespeare Set Free program is working
effectively towards achieving its desired objective.
To ameliorate the problem of lack of data, this report suggests
conducting an impact evaluation, which would compare student test
scores between a treatment group, whose teachers took the
Shakespeare Set Free workshops, and a control group, whose
teachers continued using the traditional methods.
- Paper
Presentation
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