Transcript slides from the first Sarah Taub Webinar.

How Do Services for
People with Intellectual
and Developmental
Disabilities Compare by
Race and Ethnicity?
Sarah Taub NCI Webinar Series
October 29th, 2013
National Core Indicators (NCI)
Agenda
• Mary Lee Fay, NASDDDS: Intro to NCI
• Dorothy Hiersteiner and Julie Bershadsky, HSRI: Race/Ethnicity
and the Use of Preventive Care Among Adults with
Intellectual and Developmental Disabilities
• Alberto Migliore, Institute for Community Inclusion, University
of Massachusetts: Employment Trends of People with
Intellectual and Developmental Disabilities,
by Race and Ethnicity: 2002–2012
• Brent Watkins, Oregon Developmental Disabilities Services:
Comparing Access to Services by Race and Ethnicity
National Core Indicators (NCI)
WHAT IS
NATIONAL CORE INDICATORS (NCI)?
• Multi-state collaboration of state DD agencies
• Measures performance of public systems for people
with intellectual and developmental disabilities
• Assesses performance in several areas, including:
employment, community inclusion, choice, rights, and
health and safety
• Launched in 1997 in 13 participating states
• Supported by participating states
• NASDDDS – HSRI Collaboration
National Core Indicators (NCI)
NCI State Participation 2013-14
MN
OR
CA*
ME
NH
WA
SD
UT
AZ
MA
WI
IL
CO
KS
OK
NM
OH*
IN
PA
NJ
VA
DE
MD
Wash DC
KY
MO
NC
TN
SC
AR
MS
TX
NY
MI
AL
GA
LA
FL
39 states, the
District of
Columbia and 22
sub-state regions
HI
State contract awarded in 2013-14 through AIDD
funding
CA*- Includes 21 Regional Centers
OH*- Also includes the Mid-East Ohio Regional Council
WHAT IS NCI?
• Adult Consumer Survey
 In-person conversation with a sample of adults receiving
services to gather information about their experiences
 Keyed to important person-centered outcomes that measure
system-level indicators related to: employment, choice,
relationships, case management, inclusion, health, etc.
• Adult Family, Child Family, and Family/Guardian Surveys
Mail surveys – separate sample from Adult Consumer
Survey
• Other NCI state level data: Mortality, Staff Stability
National Core Indicators (NCI)
Race/Ethnicity and the
Use of Preventive Care
Among Adults with
Intellectual and
Developmental
Disabilities
Sarah Taub NCI Webinar Series:
October 29th, 2013
Agenda
•
•
•
•
•
Data source
Methods, Measures and Sample
Findings
Conclusions
Limitations
Do NCI data demonstrate differences by race/ethnicity in use
of preventive healthcare?
National Core Indicators (NCI)
Data Source:
Adult Consumer Survey
• Standardized, face-to-face interview with a sample
of individuals receiving services
 Background Information
 Section I (no proxies allowed)
 Section II (proxies allowed)
• No pre-screening procedures
• Conducted with adults only (18 and over) receiving
at least one service in addition to case management
• Section I and Section II together take 50 minutes (on
average)
National Core Indicators (NCI)
Methods, Measures and Sample:
• 2011-2012 data collection cycle
• Background Information section: demographics,
residence, health, and employment information.
Generally collected from records by case managers.
• 19 states, one regional council
(AL, AR, AZ, CT, GA, HI, IL, KY, LA, MA, ME, MI, MO, NC, NJ,
NY, OH, PA, SC and the Mid-East Ohio Regional Council)
• Total N: 12,236 individuals
National Core Indicators (NCI)
Methods, Measures and Sample:
Race/Ethnicity
• Source: two items from Background Section
 Ethnicity (Hispanic, or non-Hispanic)
 Race (American Indian or Alaska Native, Asian, Black or
African American, Pacific Islander, White, or Other race
not listed)
• Items combined to create: Race/Ethnicity
 White, Non-Hispanic
 African American, Non-Hispanic
 Hispanic
• Other race/ethnic categories too small for analysis
National Core Indicators (NCI)
Methods, Measures and Sample:
Preventive Care
•
•
•
•
Person has a primary care doctor:
 No
 Yes
Last complete annual physical exam (routine):
 In the past year
 One year ago or more
Last dentist visit:
 In the past year
 One year ago or more
Last eye exam/vision screening
 In the past year
 One year ago or more
National Core Indicators (NCI)
Methods, Measures and Sample:
Preventive Care
•
•
•
•
Last hearing test:
 Within the past 5 years
 5 years ago or more (or never)
Flu vaccination in the past 12 months:
 Yes
 No
Ever had a vaccination for pneumonia:
 Yes
 No
“Don’t know” responses were excluded from these analysis – i.e. excluded from
both denominator and numerator
National Core Indicators (NCI)
FINDINGS
National Core Indicators (NCI)
Race/Ethnicity of Sample
Race/Ethnicity
Percent of total
African American, NonHispanic
Hispanic
20 %
White, Non-Hispanic
75%
5%
Total (N=11,199)
100.0%
20%
African American, NonHispanic
5%
Hispanic
White, Non-Hispanic
75%
National Core Indicators (NCI)
Preventive Care:
Primary Care Doctor (p < .001)
100%
92%
97%
96%
African American, Non-Hispanic
Hispanic
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
White, Non-Hispanic
National Core Indicators (NCI)
Preventive Care:
Physical Exam in Past Year (p < .001)
100%
90%
92%
Dentist Visit in Past Year (p < .001)
100%
89%
85%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
85%
75%
79%
0%
White, Non-Hispanic African American,
Non-Hispanic
National Core Indicators (NCI)
Hispanic
White, Non-Hispanic African American,
Non-Hispanic
Hispanic
Preventive Care:
Flu vaccine in past year (p < .001)
Ever had pneumonia vaccine (p < .001)
100%
100%
90%
90%
81%
80%
71%
74%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
45%
35%
34%
0%
White, Non-Hispanic African American,
Non-Hispanic
National Core Indicators (NCI)
Hispanic
White, Non-Hispanic African American,
Non-Hispanic
Hispanic
Preventive Care:
Eye Exam/Vision Screening in Past
Year (p =.09)
Hearing Test in Past Five Years
( p < .05)
100%
100%
90%
90%
80%
80%
71%
70%
62%
70%
63%
60%
57%
71%
60%
50%
50%
40%
40%
30%
30%
20%
20%
10%
10%
0%
67%
0%
White, Non-Hispanic African American,
Non-Hispanic
National Core Indicators (NCI)
Hispanic
White, Non-Hispanic African American,
Non-Hispanic
Hispanic
Small Area Variation
• Rates of health care use vary over well-defined
geographic areas.
• Significant variation has been shown to exist in the
rates of hospitalization for diagnoses such as:




chronic obstructive lung disease,
pneumonia,
hypertension,
surgical procedures.
• Potential sources of variation include differences in
underlying morbidity, access to care, physician
judgment, quality of care delivered, patient demand
for services, and random variation, etc.
• Need to control for State of residence.
Parchman, M. (1995) Small area variation analysis: A tool for primary care research. Family Medicine Journal. 27(4): 272-6
National Core Indicators (NCI)
Preventive Care:
Simple binary logistic regression
(odds ratios)
Controlling for state only (coefficients for state not shown)
Primary
care doc
Phys
exam
Dental
exam
ref
ref
ref
ref
ref
ref
ref
African American, Non-Hispanic
1.28
0.70*
0.57*
1.12
1.01
0.61*
0.72*
Hispanic
1.33
0.62*
0.72
0.87
0.96
0.65*
0.67*
White, Non-Hispanic
* p<.01
National Core Indicators (NCI)
Vision Hear test Flu vacc
screen
Pneum
vacc
Controlling for State of Residence…
• African American, Non-Hispanic respondents are
significantly less likely than White, Non-Hispanic
respondents to have:
•
•
•
•
Had a physical exam in the past year
Had a dental exam in the past year
Had a flu vaccine in the past year
Ever had a pneumonia vaccine
• Hispanic respondents are significantly less likely
than White, Non-Hispanic respondents to have:
• Had a physical exam in the past year
• Had a flu vaccine in the past year
• Ever had a pneumonia vaccine
National Core Indicators (NCI)
BUT…
• Differences may be due to other demographic characteristics.
• The following demographic variables were tested and found to be
significantly different among the three racial/ethnic categories:








Age
Gender
Individual’s primary language
Individual’s primary means of expression
Level of intellectual disability
Mobility
Other diagnoses (in addition to ID/DD)
Residence type
National Core Indicators (NCI)
Demographic Differences:
Average Age (p < .01)
Gender, FEMALE (p < .01)
100%
49
90%
47
45
80%
44.9
70%
60%
43
50%
41.0
41
45%
41%
40%
37%
30%
39
37.8
37
20%
10%
35
0%
White, Non-Hispanic
African American,
Non-Hispanic
National Core Indicators (NCI)
Hispanic
White, Non-Hispanic African American,
Non-Hispanic
Hispanic
Demographic Differences:
Primary language – NON-ENGLISH (p < .01)
Primary means of expression (p<.01)
100%
100%
90%
90%
80%
80%
70%
70%
60%
60%
50%
50%
40%
40%
30%
21%
20%
10%
23% 22%
1% 1%
0%
National Core Indicators (NCI)
18%
Hispanic
10%
1%
White, Non-Hispanic African American,
Non-Hispanic
African American,
Non-Hispanic
78%
74%
71%
30%
20%
1%
White, Non-Hispanic
Hispanic
0%
3%
3%
2%
2%
1% 1% 1%
Demographic Differences:
Level of Intellectual Disability (p < .01)
100%
White, Non-Hispanic
African American, Non-Hispanic
90%
Hispanic
80%
70%
60%
50%
38%
40%
32%33%
30%
33%
30%
28%
20%
10%
15%14%
13%
3%
16%
12%
12%
1% 2%
3% 2% 2%
3% 2% 4%
Unspecified level
ID level unknown
0%
n/a - no ID label
Mild ID
National Core Indicators (NCI)
Moderate ID
Severe ID
Profound ID
Demographic Differences:
Mobility level (p < .01)
100%
White, Non-Hispanic
90%
80%
81%
African American, Non-Hispanic
81%
Hispanic
75%
70%
60%
50%
40%
30%
15%
20%
11%
11%
10%
10%
8%
8%
0%
Moves self around environment
without aids
Moves self around environment with
aids or uses wheelchair independently
‘person’s mobility’
National Core Indicators (NCI)
Non-ambulatory, always needs
assistance
Demographic Differences:
Other diagnoses
100%
White, Non-Hispanic
90%
African American, Non-Hispanic
Hispanic
80%
70%
60%
50%
36%
40%
30% 29%
30%
20%
11%
14% 14%
6% 4% 5%
10%
11%
6% 8%
0%
Autism-Spectrum Disorder
(p < .01)
National Core Indicators (NCI)
Mental Illness or Psychiatric
Diagnosis (p < .01)
Hearing loss- severe or profound
(p < .01)
Down Syndrome
(p < .01)
Demographic Differences:
Residence Type (p < .01)
100%
White, Non-Hispanic
African American, Non-Hispanic
90%
Hispanic
80%
70%
60%
47%
41%
50%
41%
40%
33%33%
30%
30%
20%
10%
13% 12%
8%
5% 5% 3%
5% 5% 5%
5% 4% 3%
0%
Institution
Community-Based
Residence
National Core Indicators (NCI)
Independent
Home/apt
Parent/relative’s home Foster care/host home
other
We see……
• There are significant differences in
demographic characteristics amongst
individuals of differing races/ethnicities.
 Could those differences be influencing the racial
and ethnic disparities we see in preventive
healthcare use?
• Logistic regression to control for these
demographic differences.
National Core Indicators (NCI)
Logistic Regression Results
• Controlling for:







State;
Age;
Gender;
Primary language;
Level of ID;
Diagnosis of mental illness;
Diagnosis of hearing loss;





Diagnosis of Down Syndrome;
Poor health status;
Residence type;
Mobility;
Primary mode of expression;
Coefficients not shown
Primary Phys exam Dental
care doc
exam
Vision
screen
Hear test Flu vacc
Pneum
vacc
White, Non-Hispanic
ref
ref
ref
ref
ref
ref
ref
African American, Non-Hispanic
1.6
0.82
0.60*
1.25*
1.14
0.68*
0.83
Hispanic
0.9
0.95
0.86
1.22
1.55
0.8
0.9
* p < .01
National Core Indicators (NCI)
Controlling for State & Demographics…
•
Race/ethnicity is still a significant predictor for :



•
Has had dentist visit in past year
• African American, Non-Hispanic respondents are significantly less likely to have had a
dentist visit in the past year
Has had eye exam in past year
• African American, Non-Hispanic respondents are significantly more likely than White, NonHispanic respondents to have had an eye exam in the past year
Has had flu vaccine in past year
• African American, Non-Hispanic respondents are significantly less likely than White, NonHispanic respondents to have had a flu vaccine in the past year
Controlling for other demographic factors, race/ethnicity is no longer a
significant predictor for:




Has primary care doctor
Has had physical exam in past year
Has had hearing test in the past five years
Has ever had pneumonia vaccine
National Core Indicators (NCI)
Conclusions:
•
There are apparent differences in likelihood of receiving preventive care by
race/ethnicity


•
White, Non-Hispanic respondents less likely to have a primary care doc
White, Non-Hispanic respondents more likely to have had a physical exam, a dental exam, a flu
vaccination and/or a pneumonia vaccination
Adults with IDD of different racial/ethnic backgrounds also differ in other
demographic factors







Where they live (both type of residence and state of residence)
Their age
Their means of expression
Their language
Their level of ID
Other diagnoses
Their level of mobility
• It is crucial to control for these demographic factors.
National Core Indicators (NCI)
Conclusions:
• After controlling for demographics and state:
 Many differences observed in descriptive analyses
are no longer significant.
• However, some differences remain:
•
Race/ethnicity is still a significant predictor for :



Has had dentist visit in past year
• African American, Non-Hispanic respondents are significantly less likely to have had a dentist visit
in the past year
Has had eye exam in past year
• African American, Non-Hispanic respondents are significantly more likely than White, NonHispanic respondents to have had an eye exam in the past year
Has had flu vaccine in past year
• African American, Non-Hispanic respondents are significantly less likely than White, NonHispanic respondents to have had a flu vaccine in the past year
National Core Indicators (NCI)
Conclusions:
•
State in which individual resides is a highly significant predictor of receipt of
all preventive care variables.
•
Residence type is strongly related to use of preventive care.
•
Speaking a language other than English has a negative effect on receipt of a
physical exam in the past year and receipt of a dental exam in the past year
•
Individuals with less mobility are significantly more likely than those who are
self-mobile (without using aids) to have been vaccinated against the flu and
pneumonia. However, individuals who move themselves without aids are
significantly more likely to have had a vision screening in the past year.
•
Age is significantly related to receipt of physical exam, dentist visit and flu and
pneumonia vaccines.
National Core Indicators (NCI)
Limitations
•
“Don’t know” responses are excluded from analyses. For some health care
variables, the rate of “don’t know” responses are fairly high.
•
Data less likely to be available in independent/family home settings – i.e. higher
rates of “don’t know” responses.
•
Choice is not taken into account - what if person does not want to get a specific test?
•
There may be other pertinent factors affecting likelihood of receipt of care that
were not controlled for.
•
Standards regarding recommended frequency of care used are for general
population.
•
No data on income or SES. Previous research has shown that racial/ethnic
disparities are often confounded by disparities based on SES.
•
It’s important to continue research on this topic in order to inform the
development of more targeted education and outreach.
National Core Indicators (NCI)
Contacts
• HSRI
 Julie Bershadsky: [email protected]
 Dorothy Hiersteiner: [email protected]
• NASDDDS
 Mary Lee Fay: [email protected]
• NCI website: www.nationalcoreindicators.org
National Core Indicators (NCI)
Employment Trends of People with Intellectual
and Developmental Disabilities,
by Race and Ethnicity: 2002–2012
Alberto Migliore
Institute for Community Inclusion
University of Massachusetts Boston
National Association of State Directors of Developmental Disabilities Services
Webinar on October 29, 2013 - 3:00 to 4:00 EST
Part I
American Community Survey
• Annual survey from a sample of about three million people randomly selected
from the 50 states and DC.
• Parallels the decennial census.
Total population ages 16–64 (in millions)
Cognitive disability
150
Other disabilities
No disability
146
135
White
Black
Hispanic
100
50
13
9
2010
2009
2008
2007
2006
2005
2004
2003
2002
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
25
21
0
2011
6
6
Race distribution within each group
80% 74%
No disability
71%
73%
72%
75%
72%
17%
15%
16%
12%
12%
2002
White
Black
Hispanic
100%
Other disabilities
2011
Cognitive disability
60%
2011
2010
2009
2008
2007
2006
2010
2009
2008
2007
2006
2005
2004
2003
2002
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
0%
2005
16%
2004
20%
2003
40%
Employed
Cognitive disability
Other disabilities
No disability
100%
White
Black
80%
74%
70%
Hispanic
53%
60%
66%
61%
42%
30%
23%
43%
31%
20%
21%
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2010
2009
2008
2007
2006
2005
2004
2003
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2002
17%
0%
2011
40%
Mean annual earnings in 2011 dollars (in thousands)
Cognitive disability
Other disabilities
No disability
$50
$45
White
Black
$40
$37
$36
Hispanic
$30
$29
$24
$43
$33
$32
$27
$20
$20
$19
$17
$10
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
$0
Mean weekly work hours
Cognitive disability
Other disabilities
39
40
35
30
32
No disability
38
40
39
39
38
37
36
34
31
20
White
Black
10
2011
2010
2009
2008
2007
2006
2005
2004
2003
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
0
2002
Hispanic
Below the poverty line
Cognitive disability
Other disabilities
No disability
100%
White
Black
80%
Hispanic
43%
40%
36%
27%
23%
19%
32%
20%
12%
2009
2008
2007
2006
2005
2004
2003
2002
2009
2008
2007
2006
2005
8%
2004
2003
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0%
2002
14%
2011
26%
2010
20%
2011
38%
2010
60%
Part II
Vocational Rehabilitation Program (RSA-911)
• Administrative case-reporting about people who exited the VR program
during the prior fiscal year
• Released annually
Number of people who exited VR, by disability
800,000
643,994
571,975
600,000
483,997
565,677
400,000
Total closures
Other disabilities
Intellectual disability
200,000
69,377
46,652
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Disability and race/ethnicity distribution
Intellectual disability
100%
Other disabilities
White
Black
Hispanic
Other
80%
67%
61%
60%
40%
64%
55%
30%
20%
7%
35%
22%
7%
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
9%
24%
10%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Received services
Intellectual disability
Other disabilities
100%
80%
67%
62%
59%
61%
55%
56%
60%
63%
59%
40%
White
20%
Black
Hispanic
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Employed after receiving services
Intellectual disability
100%
Other disabilities
White
Black
80%
Hispanic
58%
60%
40%
51%
55%
47%
55%
55%
51%
48%
20%
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Earned $10 per hour or more
Intellectual disability
100%
Other disabilities
White
Black
80%
Hispanic
60%
43%
40%
31%
20%
3%
8%
31%
21%
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Worked 30 hours a week or more
Intellectual disability
Other disabilities
100%
White
Black
80%
75%
Hispanic
60%
77%
54%
66%
65%
42%
40%
37%
20%
31%
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Got a job in less than one year
Intellectual disability
100%
Other disabilities
White
Black
80%
Hispanic
60%
45%
38%
40%
38%
35%
20%
36%
31%
27%
33%
0%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Already had a job at application
Intellectual disability
100%
Other disabilities
White
Black
80%
Hispanic
60%
40%
20%
0%
15%
9%
20%
19%
11%
6%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
13%
11%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Questions?
Contacts:
[email protected]
617-287-4306
More employment charts at:
http://www.statedata.info
With support from Frank Smith for data analysis of the American Community Survey dataset and Anya Weber for copyediting.
Supported in part by a cooperative agreement from the Administration on Developmental Disabilities, U.S. Department of
Health and Human Services, grant #90DN0295.
Oregon Office of Developmental Disability
Services
Comparing Access to Services by Race and
Ethnicity
FUNDAMENTALS
Routine Work
Increase
Citizen
Outcomes
Improve
Customer
Experience
BREAKTHROUGHS
Reduce
Costs
Problem Solving
QUARTERLY BUSINESS REVIEWS
Strategic Initiatives
MANAGING FUNDAMENTALS
OBJECTIVES
• To get the routine work done effectively
with efficient use of available resources
• To connect every individual to what matters
to the organization
• To create transparency about Fundamentals
performance by using measures
• To transfer accountability for results to
those who do the work
Race & Ethnicity Measures
Race and Ethnicity Measure: Compares distribution of services between
people in I/DD services and people that self-report a disability
Outcome:
Program Indicator:
O5: Service Equity - O5a, Access
DD: Percent of minority and special populations of all DHS users divided by those same populations’ % of the total disability population in the state or a geographic area.
Calculation specifications:
Program population
State Population for
Comparison
Calculation
Outcome Range
Distinct count of DD services recipients in quarter. Non-Hispanics of unknown race or of two or more races should be excluded from all calculations, including total number served
by the program. Also exclude those of races/ethnicities not listed below.
Source: Administrative Data
Oregonians with a self-reported disability. To be consistent with the way the administrative data are pulled, the total Oregon population excludes non-Hispanics of 'Some Other
Race' and of 'More than One Race' .
Source: 2011 American Community Survey PUMS file, DHS Office of Business Intelligence calculations
% of distinct DD services recipients of each race&ethnicity / % of Oregon disability population of each race&ethnicity = Disproportionality Ratio
The race/ethnicity with the greatest disproportionality ratio is entered into the QBR.
Red
Yellow
Green
<0.5 OR >1.5
0.5-0.74 OR 1.26-1.5
0.75-1.25
Period
Administrative Data
Population Data
Total Recipients of DD
% DD services
services (of races/ethnicities Number receiving DD services recipients of each
below)
of each race/ethnicity
race/ethnicity
QBR 2013_Q2
Non-Hispanic African
American
Non-Hispanic Asian
Non-Hispanic White
Hispanic (all races)
Non-Hispanic Native
American/Alaskan Native
Non-Hispanic Pacific
Islander
19,778
Oregonians with
disabilities (of
races/ethnicities
below)
Disproportionality Ratio
Number with
disability of each
race/ethnicity
% Oregonians with
disabilities of each
race/ethnicity
Ratio (indicator for QBR)
9,920
9,217
462,155
32,053
1.9%
1.8%
88.2%
6.1%
2.2
1.5
0.9
1.4
824
520
16,420
1,671
4.2%
2.6%
83.0%
8.4%
314
1.6%
9,645
1.8%
0.9
47
0.2%
1,091
0.2%
1.1
524,081
Data indicates some groups access services at a percentage
disproportionate to the larger disability community of the same race or
ethnicity
Race and Ethnicity Measure: Compares distribution of services within I/DD
service setting to total I/DD service popluation
Outcome:
Program Indicator:
O5: Service Equity - O5b, Outcomes
DD: % of distinct DD comprehensive services recipients of each race & ethnicity / % of Oregon DD population of each race & ethnicity
Calculation specifications:
Program population
Distinct count of DD comprehensive services recipients in quarter. Non-Hispanics of unknown race or of two or more races should be excluded from all calculations, including total
number served by the program. Also exclude those of races/ethnicities not listed below.
Source: Administrative Data
Comparison population:
Total DD Population
Total Developmental Disabilities Population receiving at least one funded service.
Source: Administrative Data
Calculation
Outcome Range
% of distinct DD comprehensive services recipients of each race&ethnicity / % of Oregon DD population of each race&ethnicity = Disproportionality Ratio
The race/ethnicity with the greatest disproportionality ratio is entered into the QBR.
Red
Yellow
Green
<0.5 OR >1.5
0.5-0.74 OR 1.26-1.5
0.75-1.25
Period
Administrative Data
Non-Hispanic Native
American/Alaskan Native
Non-Hispanic Pacific
Islander
6,954
Disproportionality Ratio
Number of each
race/ethnicity
% Oregonians in DD
services of each
race/ethnicity
Ratio (indicator for QBR)
265
99
6,213
223
3.8%
1.4%
89.3%
3.2%
824
502
16,420
1,671
4.2%
2.5%
83.0%
8.4%
0.9
0.6
1.1
0.4
143
2.1%
314
1.6%
1.3
11
0.2%
47
0.2%
0.7
Total Recipients of DD
Number receiving DD
Comprehensive services (of Comprehensive services of
races/ethnicities below)
each race/ethnicity
QBR 2013_Q2
Non-Hispanic African
American
Non-Hispanic Asian
Non-Hispanic White
Hispanic (all races)
Total DD Population
Total Oregon DD
% DD Comprehensive population (of
services recipients of races/ethnicities
each race/ethnicity below)
19,778
Data indicates some groups access services at a percentage
disproportionate to others within I/DD services--some over-utilizing and
others under-utilizing
Race & Ethnicity Scorecard
Scorecard Anatomy
LEVEL OF DESIRED
PERFORMANCE FOR THIS
PLANNING CYCLE
HOW THE
MEASURE IS
CALCULATED
WHAT WE
WILL
MEASURE
RANGES OF POSSIBLE
Organization Name
PERFORMANCE
Outcome Measures Worksheet
RANGE
No.
Measure Name
Measure Calculation
O 7: Customer Referrals
O 7a
Customer
% customers who do active
Referrals
web-based referrasl to new
customers
O 8: Revenue from New Products
O 8a
Revenue from Total $ in quarterly sales from
New Products products & services introduced
in preceding 24 months
O 9: Volunteer Hours
O 9a
Volunteer
Hours
Total # hours volunteered to
authorized community groups
Red
<7
<11
Yellow
7-8
Revised: mm/dd/yy
Green
>8
Target
≥9%
Data
Collection Data Source
Frequency
Weekly
Measure
Owner
Manny
SalesForce. Manny
com
Garcia
Raj
11-14.5 >14.5M ≥16M Quarterly General
Raj
HOW OFTEN WE
WHERE WE
Ledger
Rajahasan
WILL COLLECT THE
DATA
<300
THE PRINCIPAL
ADVOCATE FOR THIS
MEASURE
300-375
>375
≥390 Monthly
WILL GET THE
DATA
HRIS
Sarah
Sarah
Fridley
Scorecard: Service Equity--Access to Services
DHS
No.
Measure Name
DHS OUTCOMES
DHS O1: Service Equity
DHS
a Access
DD
DHS
DD
DD
b
Outcomes
DD
DD
DD
Measure Calculation
Red
Ratio: Number of members of a specific R <0.5:1
group that access/receive a specific
or
service divided by the number of
R>1.5:1
members of that specific group eligible
for that specific service.
Yellow
Green
Target
0.5<R>0.75
or
1.25<R>1.5
0.75<R>1.25
R=1
Data
Collection
Frequency
Data Source
2013 Q2
2013 Q1
TREND
2012 Q4
↓
0.8 (17.7%)
−
Comp 12.3%,
↑
0.8%
↑
1.7%
Quarterly Forcasting Group Carol Lamon
% of individuals enrolled in ODDS services
by race/ ethnicity in comparison to the
disability population as a whole.
% of Programs meeting established
R <0.5:1
equity goals as defined within the
or
program.
R>1.5:1
% of individuals receiving comprehensive
services by race/ ethnicity in comparison
to the total enrolled in DD services.
Measure
Owner
Brent Watkins
2.30%
0.5<R>0.75
or
1.25<R>1.5
0.75<R>1.25
R=1
Quarterly
TBD
Carol Lamon
1
Brent Watkins
0.4%
% of individuals receiving support
services by race/ ethnicity in comparison
to the total enrolled in DD services.
Brent Watkins
% of individuals receiving case
management only services by race/
ethnicity in comparison to the total
enrolled in DD services.
Brent Watkins
0.8%
2.1%
Comp 12.3%,
0.4
1.3%
2.1%
Each quarter, data is reviewed with department leadership by
measure owners. Trends are discussed and possible explanations
for the trends
Comments
How is Race & Ethnicity Data Used?
• To evaluate disproportionality of service
equity
• To engage department personnel and
stakeholders in a collaborative problem
solving process
PROBLEM SOLVING
OBJECTIVES
•
•
•
•
•
•
Ultimately, to improve performance
To use data to define the problem
To analyze the most significant root causes
To develop and implement solutions
Hold the gain and reflect based on learning
Engage all levels of the organization
What have we learned?
• Some races or ethnicities are “over or under
utilizing” some service settings
• The greatest disproportionality exists in our outof-home services vs. in-home services, in which
there is nearly no disproportionality
• We have more questions than answers at this
point—like…
Questions driven by the data?
•
What is the utilization threshold for out-of-home
services? At what point do we consider utilization as
“over-utilization” and conversely “underutilization”?
•
Is over-utilization a concern?
•
Are there cultural and economic considerations that
affect whether out-of-home or in-home services are
utilized?
Questions driven by the data?
•
What is the demographic breakdown of the Office of
Developmental Disability Services’ out-of-home provider
community? Does greater emphasis need to be given to
the diversification of the provider base? If so, would
more self-identified Asians and Hispanics utilize out-ofhome services?
•
Is there a shortage of culturally and linguistically
competent services and outreach in Hispanic and Asian
communities?
•
Is there a demand for out-of-home services that is going
unmet?
Current Activities
•
•
The Office of Developmental Disability Services (ODDS)
is making more bi-lingual forms available for public use
via paper and electronic format (Application for DD
services, Family Support forms, etc.). However, ODDS
needs to look at other materials utilized by race and
ethnicity groups for translation into native languages
A Communications Committee was created to look at
access issues related to race and ethnicity with the intent
of developing statewide policies and practices to
improve service equity
Next Steps
•
•
•
•
•
Multi-year data analysis to evaluate trends within the
race and ethnicity categories
Gather demographic information about out-of-home
provider base
Survey service participants to glean why a particular
service was chosen instead of another
Evaluate what forms of media would improve access to
information for service participants
Use race and ethnicity data in the development of
employment first policies that ensure equal access to
vocational services.
Thank You!