Block Grant Funds Research Articles

Reorganization of Craniofacial/Cleft Care Delivery: The Massachusetts Experience

Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s, the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE was the recommendation that the SHC direct care programs, including all craniofacial and cleft palate clinics, should be dismantled over a number of years. However, due to the economic recession, all government funding was suddenly withdrawn from cleft palate teams and the state-run SHC clinics were abruptly dissolved. To treat patients left without coordinated care, former team members reassembled and began a new craniofacial team based at the University of Massachusetts Medical Center. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordination of clinical/clerical responsibilities; identifying a physical locale to hold the clinics; and solicitation of referring health care provider referrals and follow-up. All these issues required specific interventions that are presented in this paper. Project SERVE, begun under federal auspices, in the Commonwealth of Massachusetts, has recently been promoted as a model for a new and improved approach to the management of cleft palate and craniofacial care delivery nationwide. Awareness of the potential for abrupt, radical change in funding for federally mandated cleft/craniofacial care is essential, and a successful transition to a medical center-based model is possible using the procedures established at our center.

Substance abuse treatment management information systems: balancing federal, state, and service provider needs.

There is increased interest in documenting the characteristics and treatment outcomes of clients served with Alcohol, Drug Abuse, and Mental Health Block Grant funds. The evolution of federal client-based management systems for substance abuse treatment services demonstrates that data collection systems are important but require continued support. A review of the Massachusetts substance abuse management information system illustrates the utility of a client-based data set. The development and implementation of a comprehensive information system require overcoming organizational barriers and project delays, fostering collaborative efforts among staff from diverse agencies, and employing considerable resources. In addition, the need to develop mechanisms for increasing the reliability of the data and ongoing training for the users is presented. Finally, three applications of the management information system's role in shaping policy are reviewed: developing services for special populations (communities of color, women, and pregnant substance abusers, and injection drug users), utilizing MIS data for evaluation purposes, and determining funding allocations.

Block grant nutrition services in Wisconsin: An empirical view

This research applies standard nomenclature and data collection techniques to block grant-funded nutrition services in Wisconsin in 1985 and 1986. We discuss the way public sector nutritionists spent their time and the health conditions of the clients they saw. Analysis reveals both positive and negative factors associated with block grant support of nutrition services. Block grants have afforded some local agencies the needed flexibility to hire nutritionists. Moreover, distributions of clients by demographic characteristics and diagnoses clearly reveal that the nutrition services reached their intended targets, among them several groups that were not likely to have been reached any other way. Especially noteworthy were the limited services provided to the homebound. On the other hand, because the funding was narrowly applied in the case of Maternal and Child Health Block Grants and was of very limited size in the case of Prevention Block Grants, needy groups continue to be missed. These include adolescent and adult males and the developmentally disabled. A final section of our analysis examines the average time spent by nutritionists per client visit. These results are presented in the context of service delivery and diagnostic categories. We conclude that use of block grant funding can add flexibility in meeting the need for nutrition services, but that it is restricted in scope.

The Politics of Birth Control

By the time Senate subcommittee hearings on the "population crisis" ended in 1968, a sizeable consensus had begun to emerge favoring government support of voluntary family planning programs at home and abroad. The goal to develop a national family planning program was easier to set than to accomplish, however, and there have been no lack of difficult questions to haggle over in the past 20 years. Beginning with the Johnson administration, the executive branch of government has tended to favor block-grant funding of family planning services, while Congress has insisted on categorical funding. Conflict has also existed over financial eligibility for government-supported services, over whether teenagers and unmarried women should be served in publicly supported clinics and over which services should be included in the definition of family planning. The Reagan administration has exacerbated the conflicts with attempts to redefine family planning by placing primary emphasis on natural methods and abstinence for those who wish to prevent pregnancy and attempts to deny funding to both domestic and foreign programs that support access to abortion. While future government support for family planning programs does not seem seriously threatened, funding has not grown in 15 years, once the effects of inflation are taken into account, and most programs have had to limit eligibility to survive. The Bush administration is unlikely to be as confrontational as the Reagan administration on the subject of family planning, but the political reality is that conflict can be expected to continue.

The politics of evaluation research: A case study of community development block grant funding for human services

This paper examines the ramifications of conducting evaluation research within a very politically sensitive area. The evaluation project discussed in this paper involved an assessment of six human service agencies within a city that were receiving Community Development Block Grant (CDBG) public service funds. The city's Office of Policy Planning and Management (OPPM) contracted for this research in order to evaluate the CDBG funded agencies and to provide technical assistance so they could make informed policy decisions concerning the allocation of the Seventh Year Community Development public service funds. The Department of Housing and Urban Development (HUD) had stipulated that there be a 20% limitation in CDBG public service funding. The city involved in this study had allocated over 25% of its CDBG funding to public services. Thus, the city was over the stipulated limitation and was therefore requested by HUD to either justify the expenditure or cut back its allocation of funds to the 20% level. As a result of this mandate by HUD, the city requested and received a technical assistance grant from HUD. This paper provides a specific example of how the conduct of evaluation can become entwined in the politics of human service agencies and their funding sources, Moreover, the implications of this experience for evaluation as a field of endeavor are explored.

A history of drug and alcohol block grant funding and its effects on Pennsylvania's prevention services system.

The impact of the U.S. Government's block grant fiscal policy on the funding policies and program services in drug and alcohol abuse prevention are examined. A case history of the Commonwealth of Pennsylvania's experience with block grant funding mandates is used to document the administrative and programmatic considerations affecting policy implementation at the state level. The conclusion is drawn that a strong, decentralized system with adequate management capability and regulatory structure was able to respond to the mandated changes and demonstrate increased prevention services delivery.

Evaluation approaches in mental health: Implications of the new federalism

Since the introduction of federal mental health legislation in 1963, there has been a changing emphasis on evaluation and accountability. With direct federal funding of community mental health services, accountability demands were met through expectations for local agency evaluation activities which were overseen by federal authorities. The advent of the New Federalism and the shift to block grant funding of mental health services to state mental health authorities have shifted responsibility for evaluation to the states and local programs. This paper reviews federal mental health statutes to trace the extent and locus of required evaluation activities and discusses two approaches to carrying out program evaluation: “top-down” where the evaluation topic, method, and data collection are mandated by an administering or funding body; and “bottom-up” approaches where the subject, method of study, and data to be collected are developed in response to a felt need at the local agency level. A case study of each approach as used at the state level in mental health is examined. Based on the literature and the case studies, conclusions are presented on the pro's and con's of each method in meeting accountability demands and the barriers which must be overcome for either method to be successful.

Consultation and education in community mental health: a historical analysis

A historical analysis of consultation and education services within community mental health centers is presented with a focus on the two major tasks that these services were intended to address:prevention andcommunity service system enhancement. This analysis begins with events that shaped the development of the initial community mental health center (CMHC) legislation, then examines key factors that influenced the nature and scope of consultation and education services as the federal CMHC program was implemented, and ends with a look at the changes that have occurred in these services since block grant funding was instituted. Throughout the analysis, central problems are discussed that have seriously hindered the development of viable consultation and education programs, and key policy, definitional and organizational issues are identified that must be addressed if these services are to become a meaningful component of the mental health service system.

Block Grants and Funding Decisions: The Case for Social Indicators

This study examines the response of county public welfare departments to requests for child protective services in different environments. The findings suggest that departments receive more requests from regions with poor populations and attempt to respond to such requests with increased expenditures. Because funds are distributed on the basis of proportion of population, children in economically depressed environments do not appear to receive the same services as children in richer environments. With block grant funding assuming a greater role, states can use social indicators of the environment to assist in service planning and to correct this problem.

Issues in Health Block Grant Funding

Issues in Health Block Grant Funding

Block grants and state discretion: A study of the implementation of the partnership for health act in three states

This article examines the use of federal funds provided to state health departments under a grant consolidation of eight previously categorical health programs in Michigan, Pennsylvania, and Alabama in a comparative context. The primary question addressed is why the three states chose to describe their allocations of funds within the total health department budget differently, and what political, administrative, and bureaucratic factors explained the differences. Although certain factors were found to be at work in all states (e.g. each had an incentive to concentrate the reported use of federal funds to simplify federal audits) these factors combined with circumstances unique to each state to produce different expenditure patterns. After examining the experience of three states, general hypotheses are developed. For example, it is hypothesized that more volatile changes in allocations will result from grant consolidations in policy areas which do not address basic service needs. Finally the decision-making process with respect to block grant funds is characterized as one in which a small group of professionals determined allocations autonomously with relatively little input from interest groups or other actors within state government; nevertheless, the external political and administrative environment severely limited the possibilities of realistic choice in each of the three states studied.