Research Methods: Evaluation

First Steps Phase II Initiative: Improving Developmental, Autism, and Lead Screening for Children

Abstract: 

First STEPS (Strengthening Together Early Preventive Services) is a learning initiative supported by Maine's CHIPRA quality demonstration grant to support measure-driven practice improvement in pediatric and family practices across the state on improving developmental, autism, and lead screening for children. This report, authored by research staff at the USM Muskie School, evaluates the impact of Phase II of Maine's First STEPS initiative, which was implemented from May to December 2012 and included 12 practices serving more than 20,000 children on MaineCare (Maine's Medicaid system). The authors assess changes in developmental, autism, and lead screening rates and evidence-based office processes in participating practices before and after the initiative, as well as related systems changes. They also summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.

Suggested Citation: Fox K, Gray C, Elbaum-Williamson M. First STEPS Phase II Initiative: Improving Developmental, Autism, and Lead Screening for Children. Portland, ME: University of Southern Maine, Muskie School of Public Service; August, 2013. Improving Health Outcomes for Children (IHOC) Final Evaluation Report.

Publication Type: 
Report
Publish Date: 
August 30, 2013
URL: 
http://muskie.usm.maine.edu/Publications/PHHP/FirstSTEPS-PhaseII-Developmental-Austism-Lead-Screening.pdf

First Steps Phase I Initiative: Improving Immunizations for Children and Adolescents

Abstract: 

This evalution report, authored by research staff at the USM Muskie School, assesses the change in immunization rates in participating pediatric and family practices that serve a high volume of children insured by MaineCare (Maine's Medicaid system). The authors also summarize lessons learned in implementing changes in practices and challenges in using the immunization measures at the practice-level to inform quality improvement.

Background: Through the Improving Health Outcomes for Children (IHOC) grant, Maine Quality Counts is leading the First STEPS (Strengthening Together Early Prevention Services) Learning Initiative to support Maine’s primary care practices in improving preventive and screening processes for children and building medical homes. The First STEPS Learning Initiative is being implemented in phases, with the first phase (September 2011 - August 2012) focusing on improving immunizations for children and adolescents. As part of the initiative, IHOC identified specific immunization measures to be improved. First STEPS provides wide-ranging and in-depth quality improvement, coaching, andata monitoring of standard quality measures, and educations support to pediatric and family medicine practices as they continue to enhance health outcomes for children. The goal of Phase I was to improve immunization rates in participating practices by at least 4 percentage points within one year of project initiation by implementing changes in office procedures advocated by the American Academy of Pediatrics’ Bright Futures curriculum.

Suggested Citation: Fox K, Gray C. First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents. Portland, ME: University of Southern Maine, Muskie School of Public Service; March, 2013. Improving Health Outcomes for Children (IHOC) Final Evaluation Report.

Publication Type: 
Report
Publish Date: 
March 1, 2013
URL: 
http://muskie.usm.maine.edu/Publications/PHHP/FirstSTEPS-PhaseI-Immunizations.pdf

Child Care and Children With Special Needs: Challenges for Low Income Families.

Abstract: 

Findings from this mixed methods study include:

  • Parents of young children with special needs face significant challenges finding and keeping child care arrangements for their child.
  • Parents report significant problems with the child care arrangements they have used for their child with special needs.
  • There are significant programmatic and financial barriers to supporting parents of children with special needs so they can work, and balance work and family.
  • The combination of all of these problems and the particular demands of caring for a child with special needs often result in employment problems and job instability.
  • Families of children with special needs face more economic difficulties (poverty, food and rent insecurity, lack of health insurance) than do families of children without special needs.
  • Certain types of disabilities have a greater impact on the number of child care and work problems than others.
  • Having a child with multiple special needs or having more than one child with special needs significantly increases the likelihood of employment difficulties and job instability.

Suggested Citation: Ward H, Morris L, Oldham E, et al.  Child Care and Children With Special Needs: Challenges for Low Income Families.  Portland, ME: University of Southern Maine, Muskie School of Public Service, Cutler Institute for Child and Family Policy; December 2006.

Publication Type: 
Report
Publish Date: 
December 1, 2006
URL: 
http://muskie.usm.maine.edu/Publications/CYF/Children-With-Special-Needs-Challenges-for-Low-Income-Families.pdf

Improving Health Outcomes for Children (IHOC) First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents

Abstract: 

This report, co-authored by Kimberley Fox and Carolyn Gray, provides a final evaluation of the initial phase of First STEPS (Strengthening Together Early Preventive Services), a learning collaborative led by Maine Quality Counts to support 24 pediatric and family practices in improving their childhood immunization rates. The evaluation found that all participating practices had higher immunization rates after participating in First STEPS. On average, overall child immunization rates increased by 5.1% at 12 months and 7.1% at 15 months, and average immunization rates across practices increased significantly from 74.2% to 81.3%. Practices also reported significant improvement in the use of recommended office practices, including staff training, recall/reminder procedures, and the use of data/registries.

This work was conducted under a Cooperative Agreement between the Maine Department of Health and Human Services and the Muskie School of Public Service at the University of Southern Maine and is funded under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) authorized by Section 401(d) of the Child Health Insurance Program Reauthorization Act (CHIPRA). These contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.

Suggested citation: Fox K, Gray C. Improving Health Outcomes for Children (IHOC) First STEPS Phase I Initiative: Improving Immunizations for Children and Adolescents. (Final Evaluation Report).  Portland, ME: University fof Southern Maine, Muskie School of Public Service; March 2013.

Publication Type: 
Report
Publish Date: 
March 29, 2013
URL: 
http://www.maine.gov/dhhs/oms/pdfs_doc/ihoc/first-steps-phase1-eval-report.pdf

Maine Rural Health Research Center 2012

Duration: 
9/1/2012 - 8/31/2013
Director: 
David Hartley, Ph.D., M.H.A.
Principal Investigator: 
David Hartley, Ph.D., M.H.A.
Erika Ziller
Research Staff: 
Andrew Coburn
Anush Hansen
David Hartley, Ph.D., M.H.A.
David Lambert
Donna Reed
Erika Ziller
Jennifer Dunbar Lenardson, M.H.S.
John Gale
Karen Pearson M.L.I.S., M.A.
Zachariah Croll
Abstract: 

Established in 1992, the mission of the Maine Rural Health Research Center is to inform health care policy making and the delivery of rural health services through high quality, policy-relevant research, policy analysis and technical assistance on rural health issues of regional and national significance. The Center's core funding is provided by the federal Office of Rural Health Policy.

Project URL: 
http://muskie.usm.maine.edu/ihp/ruralhealth/
Start Date: 
Sat, 2012-09-01
End Date: 
Sat, 2013-08-31
Legacy Muskie ID: 
8 071

Maine Patient Centered Medical Home (PCMH) Pilot: Implementation Evaluation

Abstract: 

The purpose of this Maine Patient Centered Medical Home (PCMH) Pilot is to improve quality of care, efficiency, and patient/family satisfaction provided by primary care practices. Its premise is that the resources provided to practices through the Pilot (including enhanced payments, training, consultation, and learning collaborative) will help them transform themselves and reach a higher level of functionality as medical homes, which in turn will lead to improvements in quality of care, efficiency, and patient/family satisfaction. The three-year Pilot was convened by MaineCare, the Maine Quality Forum, and Quality Counts. The participating payers are MaineCare (Maine Medicaid), Aetna, Anthem, and Harvard Pilgrim Health Care. Three aspects of the Pilot are being evaluated by the Muskie School of Public Service: 1) patient’s experiences; 2) the implementation process and interim results during Year 1; and 3) changes in the quality and efficiency of primary care. This report focuses on findings from the implementation evaluation. The objectives of the implementation evaluation are to
• Profile the characteristics of the Pilot practices
• Describe the practices’ objectives and strategies for implementing the Pilot
• Describe the implementation process during Year 1
• Provide practical guidance to the practices, the Pilot conveners, and MaineCare
• Develop profiles of the Pilot practices for use in the quality and efficiency evaluation
• Make recommendations for use by evaluators of other PCMH pilots

Publication Type: 
Report
Publish Date: 
May 4, 2011
Author: 
URL: 
http://muskie.usm.maine.edu/Publications/Maine-PCMH-Implementation-Evaluation.pdf

2012 Maine Child Support Guidelines: Review and Recommendations

Abstract: 

Ward, S., Daley, J., Fraumeni, B., Shaler, G., Griffin, E., Knox, M., Hallett, L., & Mandeville, L. (2012, July). 2012 Maine child support guidelines: Review and recommendations. Portland, ME: University of Southern Maine, Muskie School of Public Service, Cutler Institute for Health and Social Policy. <br></br>
Prepared for the Maine Department of Health and Human Services, Office for Family Independence, Division of Child Support Enforcement. This report summarizes the quadrennial review of Maine's child support guidelines conducted by the USM Muskie School , which complies with federal law requiring each state's child support guidelines be reviewed at least once every four years. Principle findings of the extensive review by the Muskie School show that many aspects of Maine's child support system work well. Maine's low deviation rate reflects a reasonably high level of consistency in apply the guidelines, and in large part, protect the needs and interests of the children. The report provides background and overview of child support modes and the Maine guidelines, and describes the elements of the review: Literature Review, Policy Analysis, Economic Analysis, Deviation Study, Stakeholder Input, Interviews with other State Child Support Officials, and concludes with several findings and recommendations. For additional information about the report or the study, contact Janice Daley at the Muskie School (jdaley@usm.maine.edu).

Publication Type: 
Report
Publish Date: 
July 31, 2012

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