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A JOURNEY BEGINS On a dreary Pacific Northwest afternoon in spring 2015, a group of advocates expressed disappointment with the recently passed state budget. Five years after the Great Recession [...]

Purpose: Washington State's initiatives to increase the availability and quality of community residential care presented an opportunity to describe clients entering adult family homes, adult residential care, and assisted living and to identify outcomes of care. Design and Methods: We enrolled 349 residents, 243 informal caregivers, and 299 providers in 219 settings. We conducted interviews at enrollment and 12 months later, and we collected data from state databases. Results: The average resident was a 78-year-old woman reporting dependence in two of six activities of daily living. Residents in adult family homes demonstrated significantly more disability. Seventy-eight percent of residents survived at the 12-month follow-up. In analyses that controlled for differences at enrollment, residents in the three types of settings were very similar in health outcomes at follow-up. Implications: State policies should reflect the wide range of needs of residents seeking care in these settings. Choices among type of setting can be based on the match of needs to individual preferences. Key Words: Long-term care, Assisted living, Health status

An evaluation of Washington's Basic Health program was completed to determine if other incentives, besides financial ones, would increase utilization of public insurance programs.

This study evaluated the relative effectiveness of two forms of publicly funded substance abuse treatment provided in Washington State: The full continuum (FC), in which clients receive approximately three weeks of inpatient treatment prior to outpatient care, and the partial continuum (PC), in which clients are admitted directly to outpatient treatment. Data on treatment process/proximal outcomes, such as psychological distress and readiness to change, were assessed at 8 weeks post intake, and data on treatment services received were obtained at 2, 4, 8, and 12 weeks. Multidimensional outcomes, including alcohol and drug use as well as a number of psychosocial functioning outcomes, were assessed at 3 and 9 months post intake. Results indicated that clients in the FC had greater alcohol, drug, and legal problem severity at intake than those in the PC, whereas medical and employment problem severity was greater in the PC. Clients in the FC received more treatment services in the first 2 weeks than those in the PC, but there were no differences at subsequent points. Outcome analyses at 3 and 9 months indicated that clients in the FC had greater improvements in alcohol, drug, and psychiatric severity than those in the PC. Matching analyses indicated that clients with greater substance-use severity at baseline improved to a greater degree in the FC as compared to the PC. Matching effects were not obtained with medical or psychiatric severity, or readiness to change., INTRODUCTION Current public policy in many states, including Washington, is based on the assumption that the multi-problem public patient needs a full continuum of care (FC) starting with an inpatient [...]

This article examines factors related to the failure of a welfare reform program in Washington that provided employment-related services to welfare recipients. Findings indicate that the failure of the pilot program was related to the inhibiting impact of gender roles on female recipients' perceptions of welfare acceptance and work responsibilities.

The initiative considered by Tennessee, Minnesota, Hawaii and Washington to offer health insurance coverage to moderate- and low-income families is analyzed. Additional information on implementation of sliding-scale premium health insurance programs in the above mentioned states is also included.

The states of Maine and Washington have launched social programs in 1989 that offered subsidized health coverage to low-income and previously uninsured populations. Evidences suggest that the abandonment of medical screening procedures have not increased the possibility of excess utilization. Moreover, there were no unusual level of chronic illness that necessitated costly medical management among the enrollees.

The Washington State Health Care Authority (HCA) implements health status risk adjustment and continues to refine the process by adapting a set of guiding principles that include being practical and feasible, focusing on data that are advantageous to plans, and assuring proper safeguards to protect individuals' rights to privacy on health status information. The groups also focus on refinement, rather than reinvention, and aim for better not for the best.

Health care reform and cost containment have become central campaign and policy issues in the United States. Although focus now centers on federal health care reform policy, state governments have been actively introducing health care reform legislation. Some of the health care reform initiatives on the state level have influenced deliberations on the federal level and President Clinton's health care reform initiatives will spur further state experimentation regardless of legislative success in Congress. In 1992 nearly all 50 states had either legislation introduced, or special task forces assigned that addressed health care reform issues. This exploratory research compares the content and process of health reform in four states that attempted major reform in 1992 - Florida, Washington, Michigan, and Wisconsin - and draws propositions for state reform based on comparisons of content and process. The four states chosen represent geographic diversity and a balance between legislation seeking partial change and legislation calling for universal health care reform. The principal reform bills in each state are compared and assessed on the degree to which they address eight reform elements: high tech medicine, administration, tort reform, long-term care, regulation, insurance mandates, small business insurance, and insurance portability. These initiatives are also compared on a series of reform process variables that relate to the political process for adopting reform: degree of health sector support, type of political strategy used, reform champion, degree of cooperation among policy stakeholders, and timing of initiative. Based on these four cases the phased/partial approach seems to have a greater chance for legislative success than immediate universal reform. Florida's partial, consensus-building approach resulted in the only signed bill of the four states. Washington's bill, which also took a partial approach, passed the state senate before ultimate defeat in 1992 and eventual passage in 1993. Neither of the more ambitious universal health care reform packages introduced in Wisconsin or Michigan got out of committee. Although some of the plans were thorough, none adequately addressed the tradeoff between increasing access to care and containing costs. In addition, this study will demonstrate that universal health care legislation, does not necessarily equate to comprehensive health care reform. The propositions derived from this research have implications for future state health care reform efforts, as well as for federal health care reform policy in terms of the substantive content of reform proposals and the political process by which they are advanced.

Studies of Washington's Family Independence Program indicate that the workfare program has little effect on recipient earnings and employment but significantly raised welfare benefit levels and receipt. However, the program has increased the number of recipients enrolled in employment and training activities.

I. Introduction The Family Support Act of 1988 aims to assist recipients of Aid to Families with Dependent Children (AFDC) in obtaining the skills needed for the employment that will [...]

A program implemented in Washington State in 1988 which offered tiered bonuses in addition to unemployment to persons who quickly returned to work is examined. The study showed that bonuses do provide an incentive to return to work more quickly, particularly if the bonus amount is substantial.

The use of evidence-based and research-based programs has been a part of juvenile justice in the state of Washington for more than a decade. Successful implementation of 'programs that work' [...]

In Washington State, a unique partnership is generating groundbreaking practice innovations and results for children and families. The partnership has several dimensions--state-local, public-private, practice-policy-research--and it continues to expand to engage [...]

A study showed that 75 superintendents in 37 counties of Washington State were against interdistrict school choice. Most of them represented small districts, and feared choice would lead to a decline in district enrollment. Moreover, proximity to a large district could result in district consolidation and enrollment loss. However, superintendents of larger districts with higher dropout rates and at risk students felt that a school choice would decrease the dropout rate.

Local educators worked with state legislators to incorporate into a juvenile violence bill the funding for an ambitious program for high school dropouts in the state of Washington. Skill schools which were underutilized for vocational training, already existed. With the new funding available, they are now used in an Extended Day Dropout Retrieval Program as well. The youth violence bill will generate more than $13 million in funds.