Topics on this page: Goal 2. Objective D | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary
Goal 2. Objective D: Increase our understanding of what works in public health and human services practice
Working together with its public and private partners, HHS is committed to improving the quality of public health and human service practice by conducting applied, translational, and operations research and evaluations. HHS uses these studies to inform policy and program implementation efforts. HHS has identified approaches that help people make healthy choices, assist communities as they work to improve the health and well-being of their residents, support safety and stability of individuals and families, and help children reach their full potential. HHS also monitors and evaluates programs to assess efficiency and responsiveness and to inform the effective use of information in strategic planning, program or policy decisions, and program improvement.
HHS investments in public health and human service research have yielded many important findings about what works. The Department will work to identify promising, effective approaches that are culturally competent and effective for populations with varying circumstances and needs.
A number of HHS agencies promote the adoption of evidence-based programs and practices including ACF, ACL, AHRQ, CDC, HRSA, NIH, OASH, and SAMHSA. CDC conducts systematic reviews of scientific literature that form the basis for evidence-based Community Preventive Services Task Force recommendations about effective programs, services, and policies for improving health and preventing many chronic and infectious diseases and injuries. ACF and SAMHSA both maintain “What Works” clearinghouses of research in the areas of family and youth support and mental health and substance abuse services to facilitate evidence based decision making. Below are representative measures which HHS and its components will use to guide performance. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.
Objective 2.D Table of Related Performance Measures
Increase the percentage of Community-Based Child Abuse Prevention (CBCAP) total funding that supports evidence-based and evidence-informed child abuse prevention programs and practices. (Lead Agency - ACF; Measure ID - 7D)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 60 % | 65.3 % | 76.7 % | 71.4 % | Prior Result +3PP | Prior Result +3PP |
| Result | 62.3 % | 73.7 % | 68.4 % | Oct 30, 2015 | Oct 31, 2016 | Oct 31, 2017 |
| Status | Target Exceeded | Target Exceeded | Target Not Met | Pending | Pending | Pending |
Increase access to and awareness of the Guide to Community Preventive Services, and Task Force Findings and Recommendations, using page views as proxy for use (Lead Agency - CDC; Measure ID - 8.B.2.5)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | Set Baseline | 973,724 | 1,032,147 | 1,400,000 | 1,400,000 | 1,420,000 |
| Result | 927,357 | 1,220,956 | 1,359,772 | 1,339,561 | Oct 31, 2015 | Oct 31, 2016 |
| Status | Baseline | Target Exceeded | Target Exceeded | Target Not Met | Pending | Pending |
By 2018, identify three effective system interventions generating the implementation, sustainability and ongoing improvement of research-tested interventions across health care systems. (Lead Agency - NIH; Measure ID - SRO-8.7)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | Identify at least 3 mechanisms for tracking successful implementation within studies to improve the uptake of research-tested interventions in health care settings. | Complete target by identifying three effective implementation strategies that enhance the uptake of research-tested interventions in service systems such as primary care, specialty care and community practice. | Identify three key factors influencing the sustainability of research-tested interventions in service systems such as primary care, specialty care, and community practice. |
Identify three effective implementation strategies that enhance the sustainability of research-tested interventions in service systems such as primary care, specialty care and community practice. | Identify three key factors influencing the scaling up of research-tested interventions across large networks of services systems such as primary care, specialty care and community practice. | Initiate testing of hypothesized mechanism of treatment effect of one novel intervention, and determine whether the intervention should progress further to clinical testing. |
| Result | Three mechanisms for tracking successful implementation within studies were identified to improve the uptake of research-tested interventions in health care settings. | NIH identified three approaches that enhance the uptake of research-tested interventions in service delivery systems addressing child mental health, attention deficit hyperactivity disorder, and depression. | NIH researchers identified three influences on sustainability of research-tested interventions in service systems such as primary care, specialty care, and community practice: Community Development Teams in child mental health service systems; barriers and facilitators to evidence-based interventions to control blood pressure in community practice; and a set of factors to enhance sustainability of health care interventions across multiple settings. | NIH researchers identified three effective implementation strategies that enhance the sustainability of research-tested interventions in service systems such as primary care, specialty care, and community practice including: strategies to overcome these barriers and to enhance the sustainability of research-tested interventions; development of specific scales on sustainability as a strategy to identify factors affecting ongoing use as diagnostics for system action; and, strategies to scale-up and sustain HIV prevention interventions within low and middle income countries. | Dec 31, 2015 | Dec 31, 2016 |
| Status | Target Met | Target Met | Target Met | Target Met | Pending | Pending |
Analysis of Results
The most efficient and effective programs often use evidence-based and evidence-informed practices. Currently, ACF’s Children’s Bureau and its National Resource Center for the Community-Based Child Abuse Prevention (CBCAP) program are working closely with states to promote more rigorous evaluations of their funded programs. The CBCAP program developed an efficiency measure to gauge progress towards programs’ use of these types of practices. For the purposes of this efficiency measure, the Children’s Bureau defines evidence-based and evidence-informed programs and practices along a four level continuum (from least to most): Emerging and Evidence Informed; Promising; Supported; and Well-Supported. The funding directed towards these types of programs (weighted by “evidence-informed” or “evidence-based” practices level) will be calculated over the total amount of funding used for direct service programs to determine the percentage of total funding that supports evidence-based and evidence-informed programs and practices. HHS selected the target of a three percentage point annual increase in the amount of funds devoted to evidence-based practice as a meaningful increment of improvement through FY 2016. This performance expectation takes into account the fact that this is the first time that the program has required grantees to target their funding towards evidence-based and evidence-informed programs, and it will take time for states to adjust their funding priorities to meet these new requirements. ACF has made steady progress on this measure, with the percent of Community-Based Child Abuse Prevention funding directed toward evidence-based or evidence-informed practices exceeding targeted increases from FY 2010 to FY 2012. In FY 2013, the percent of funding dropped to 68.4 percent, missing the target. Although there was a drop in the reported percent of funds supporting evidence-based and evidence-informed practices, ACF has been providing more technical assistance to states to ensure that the data are accurate, which may have contributed to the change.
The Community Preventive Services Task Force (Task Force) is an independent, nonpartisan, nonfederal, unpaid panel of public health and prevention experts. The Task Force's mandate is to identify population-based programs, services, and policies that are effective in saving American lives and dollars, increasing longevity, and improving quality of life. Task Force recommendations provide information about evidence-based options that decision makers and stakeholders can consider when determining what best meets the specific needs, preferences, available resources, and constraints of their jurisdictions and constituents. Task Force recommendations are compiled in The Guide to Community Preventive Services (The Community Guide). The Community Guide website (http://www.thecommunityguide.org 
) is the primary dissemination tool used to 1) provide information about Task Force-recommended options to individuals, organizations, agencies, and communities who are making their own decisions about what is best for their circumstances, and 2) assist those who request help in implementing Task Force recommendations that best meet their needs. In FY 2014, CDC received 1,339,561 page views on the Community Guide website, an increase of 44 percent over the 2011 baseline, nearly achieving the FY 2014 target. CDC maintained the majority of expected page views by utilizing processes, strategies, and web-based products developed and tested during 2011-2013.
NIH has broadened its portfolio of implementation research by encouraging teams of scientists and practice stakeholders to work together to overcome barriers to implementing research-tested interventions. In FY 2014 NIH researchers met the target of identifying three effective implementation strategies that enhance the sustainability of research-tested interventions in service systems such as primary care, specialty care, and community practice including: strategies to overcome these barriers and to enhance the sustainability of research-tested interventions; development of specific scales on sustainability as a strategy to identify factors affecting ongoing use as diagnostics for system action; and, strategies to scale-up and sustain HIV prevention interventions within low and middle income countries.
Plans for the Future
Over time, the ACF CBCAP program expects to increase the number of effective programs and practices that are implemented, maximizing the impact and efficiency of CBCAP funds. ACF is committed to continuing to work with CBCAP grantees to invest in known evidence-based practices, while continuing to promote evaluation and innovation, so as to expand the availability of evidence-informed and evidence-based practice over time. ACF aims to increase each year the percentage of CBCAP funds directed to evidence-based and evidence-informed practices by at least 3 percentage points greater than the previous year’s result through FY 2016.
CDC expects modest growth in page views of the Community Guide website in FY 2015 through FY 2016 due to the release and promotion of enhancements to the Community Guide website (developed in 2012-2014) that provide customized decision and implementation support for a range of user audiences.
NIH has developed and will implement a series of process steps to identify three effective system interventions generating the implementation, sustainability, and ongoing improvement of research-tested interventions across health care systems by 2018.
Objective Progress Update Summary
HHS demonstrated progress toward this objective as shown by the representative performance measures described in the HHS Annual Performance Plan and Report. Further evidence of progress is described below.
- ACL's Alzheimer's Supportive Services Program (ADSSP) grants are translating evidence-based interventions into community-based aging and disability networks. The September 2013 program report for completed grants reported a number of participant measures with statistical significance. Several ADSSP grantees reported that, as a result of program engagement, caregivers reported decreased depression and stress, improved coping, as well as increased knowledge and/or use of available services. The state of Georgia reported significant improvements in caregiver health. Grantees implementing the New York University Caregiver Intervention reported improved caregiver reaction to problem behaviors, reduced caregiver burden, and increase in social network, all with statistical significance. In addition to implementation of evidence-based interventions, the ADSSP has recently directed attention to the development of dementia capable networks/systems. In relation to dementia capability, the state of North Carolina's program has reported improvement in the ability of physicians to work with persons with dementia and their caregivers, as well as improvements in the area agencies on aging's understanding and response to the needs of individuals with early stage dementia and their caregivers.
- HRSA Special Projects of National Significance (SPNS) support the development and testing of innovative HIV service delivery models and promote the replication of successful models. A new SPNS project in FY 2013 supported 10 demonstration sites to design, implement, and evaluate innovative methods to identify Latinos/as at high risk or living with HIV, and improve their access, timely entry, and retention in quality HIV primary medical care. Continuing in FY 2013 were demonstration projects to test ways of addressing HIV-related care needs and retention in care of multiply diagnosed homeless populations, women of color, transgender women of color, individuals co-infected with HIV and Hepatitis, and hard-to reach populations.
- Despite strides in developing effective disease prevention and control programs, NIH recognizes there has been slow adoption of these programs into community, public health, and clinical practice settings. Current NIH-funded dissemination and implementation (D&I) projects support important public health issues such as reducing rates of smoking, increasing cancer screening, optimizing diabetes treatment and prevention of obesity. Training clinicians and scientists to implement, disseminate and evaluate effective programs of health care delivery in community settings shortens the time from scientific discovery to better population health by providing evidence of improved health outcomes. In 2013 NIH supported forty-five doctoral level trainees to participate in D&I research training. Thirty-four grant applications were directly attributable to the training. D&I working groups have produced 3 webinars for clinicians and researchers interested in D&I science, to make training more widely available.
