oversight

Older Americans Act: Dissemination of Research and Demonstration Findings Could Be Improved

Published by the Government Accountability Office on 1990-09-11.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

                     United States General Accounting Office    / ‘+a / 2 7
                     Testimony


                                                               llllllllllllllll
                                                                  142177

For Release             OLDER AHERICANS ACT:
On Delivery             DISSlU4INATION OF RESEARCH AND
Expected at             DEMONSTRATION FINDIWGS COULD
9:30 a.m. EDT           BE II'4PROVED
Tuesday
September 11, 1990




                       Statement  of
                       Joseph F. Delfico,  Director        of
                          Income Security Issues
                       Human Resources Division
                       Before the
                       Subcommittee  on Human Services
                       Select Committee on Aging
                       House of Representatives




GAO/T-I-W-90-53                                                      GAO Form 160 (12/87)

                         CYWRO         / F/ZU’7
                                       Summary
        Congress intended      Title     IV research     and demonstration
programs in the Older Americans Act as an innovative                     source of
ideas to improve services            for the elderly.       Translating       these
ideas into practice,         however,     requires    dissemination      of results
to agencies     serving    the elderly.         We are reporting      preliminary
findings     on dissemination       of Title     IV results    obtained     for a
broader    study we are doing on Older Americans Act reauthorization
issues.
         GAO surveyed state agencies          in all 50 states     and the
District     of Columbia regarding         their    use of Title    IV results
sponsored     by the Administration          on Aging (AOA).      We found that
all but a few state agencies           on aging are aware of some AOA
research     and demonstration      results.       Moreover,    most state
agencies     use this information        to shape their      programs and
operations,      and also think     that increased       AOA dissemination        would
help them improve their        programs.         State agencies    believe     that
AOA can improve dissemination           by publishing       a summary of
completed     Title  IV projects'      results     and by conducting      more
conferences      and seminars.
         AOA does not systematically         disseminate      Title   IV results   or
monitor     how these results      are used.       AOA officials      told us that
dissemination       efforts    were reduced in the 1980s, and that AOA
relies     mostly on others      to disseminate      results.       No single
official     or office      in AOA currently     is accountable       for
dissemination.
       While Title      IV dissemination        is having some positive      impact,
it is not achieving         maximum results       because AOA does not have a
comprehensive       dissemination     strategy.      Based on responses      from
the state agencies        and AOA officials,        results appear to be
disseminated      in an ad hoc and haphazard manner.           AOA officials
acknowledge     that more needs to be done to disseminate              results    and
indicate    that AOA is considering          ways to improve its efforts.
  Mr. Chairman               and Members of                the        Subcommittee:


          I am pleased               to be here            today         to discuss             the dissemination
of     research        and demonstration                       results         under         Title       IV of the         Older
Americans            Act.      You asked               us to .discuss                the     extent       and
effectiveness                of Administration                    on Aging            (AOA) and Title                IV
grantee        efforts         to disseminate                    these        results.               To respond,          we
collected            information          on how state                   agencies           on aging        obtain         and
use AOA research                and demonstration                        results.              (See appendix              I for
details        on our         scope      and methodology.)


          Congress           intended          Title      IV research                 and demonstration
programs        in the         Older      Americans               Act     to be an innovative                      source         of
new ideas         to        improve      services           for         the    elderly.                The importance             of
new ways to serve                  the    elderly           is     increasing               as fiscal           constraints
and changing                demography          strain          the      capacity           of existing           programs.
Projections            of     increasing               needs      for     services            and growing           stress
on conventional                sources          of      informal          care        for     the disabled             elderly
will      make innovative                service          ideas          even more important                     in the
future.


          The results           of     Title           IV projects             are     of     little       use if
agencies        serving         the      elderly          do not          have access                  to them in a
readily        usable         form.       Accordingly,                   among Title              IV’s     stated
purposes        is     the dissemination                    of     results            from      research         and
           1
demonstration               projects          to organizations                     serving            the elderly.1
Thus,      each grant              and contract               is       required           to contain        appropriate
provisions           for     dissemination.2                       These provisions                    include
distribution               of written          reports,                as well       as other           means of
dissemination               targeted          to different                 users.           For example,              work
sponsored          by AOA and others                     emphasizes               the      importance           of
interactive             dissemination              methods,              such as meetings,
presentations,               and other          oral          and visual             media       to supplement
written         products.


          We found          that      state     agencies                on aging           are   receiving            Title    IV
research          and demonstration                    results           from many different                     sources
and are         using       the     information               to shape            their      programs.               State
agencies          believe          that   better             AOA dissemination                   of     these        results
would      help     them improve               their          operations             and they           suggested
several         ways that           AOA can improve                    dissemination.                   AOA currently
does      not     systematically              disseminate                 information,                monitor         its
dissemination,               or evaluate               its     effectiveness.                    AOA officials

IA purpose of the act is the ‘I.          dissemination      of information
on aging and the aging process acqiired         through such [Title       IV]
programs to public   and private   organizations       or programs for
older  individuals.”   Title   42 U.S.C.,    Section    3030aa(4) (1990 Supp.).
2The act requires           that “Appropriate       provisions       for the
dissemination        of resulting      information       shall     be a requirement       for
all    [research     and development]        grants made under this section.”
Title     42 U.S.C.,      Section   3035(a)     (1990 Supp.).          A similar
provision,       applicable      to demonstration        projects,      requires   that
“Grants made and contracts            entered      into under this section
 [demonstration        projects]    shall    include     provisions        for the
appropriate       dissemination      of project       results.”        Title   42 U.S.C.,
Section     3035a(d) (2) (1990 Supp.).

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indicate            they       are aware             of     inadequacies                     in dissemination,             and are
considering                ways of           improving             it.


State        Agencies           on Aging             Frequently                 Use Title             IV Results


         Our telephone                   survey            of state             agencies             on aging      showed that
almost        all      state          agencies             on aging             are aware             of AOA research            and
demonstration                  results.              All     but         two of            the     51 state      agencies
surveyed            said       that      they      had become aware                           of some AOA research                and
demonstration                  results         during          the           last         two years.


         State         agencies              receive         results                through          many different
sources,            including            AOA, organizations                               partly      sponsored        by AOA,
other        federal          agencies,            and private                      agencies          as shown in appendix
II.      The sources                  most      frequently                   used by state               agencies       are     the
Older        Americans            Report,          a private                  organization               newsletter       not
affiliated             with      AOA;          the         National             Association              of    State    Units     on
Aging        (NASUA), whose National                            Community-Based                        Long-Term       Care
Resource            Center       and National                  Center               for      State     Long-Term        Care
Ombudsman Resources                          are   funded           by        AOA; and other                  AOA-sponsored
national            resource           centers.3

30ther National       Aging Resource Centers include              programs at
Brandeis    University,      the University        of Minnesota,      the University
of South Florida,       a joint      effort   at the University         of California
at Los Angeles and the University              of Southern California,           Indiana
University,     San Diego State University,             the American Association
of Retired     Persons,     and the National        Aging Resource Center on
Elder Abuse.       National     resource     centers    that receive      grants    or
contracts    under the Older Americans Act are required                   to perform
research    and policy      analysis      and provide     technical    assistance      for
                                                                         3
         State        agencies           on aging         report             taking      many types             of actions
to access            multiple           sources      of    information,                  as shown in appendix
III.       The most            frequent       actions             are        reviews         of    the      Older
Americans            Report,       AOA memos and.correspondence,                                     and professional
literature.


         Perhaps         the most          significant                 finding          related          to the       use of
Title      IV dissemination                  is    that         all     but      five        state       agencies       on
aging      consider            AOA research              and demonstration                        results       in making
decisions            about      their      programs             and services.                     Of these,          32 have
made program             decisions          based         on such results.                         Nine      states
report        they      have used results                  to         make     changes            in long-term          care
community-based                 systems,          nine     states             have made changes                     in case
management,             five     in programs              for         persons         with        Alzheimer’s
disease,         and five          others         in planning                 service         delivery          (see app.
IV) .      Forty-one            states      report         that         they      value           information          on
these      results            from a moderate              to a great                 extent.            Thirty-nine          say
that     increased             AOA dissemination                      would      help        moderately          or greatly
in carrying             out     their      programs.




the Commissioner,                 policy   makers, service   providers, and the
Congress.   Title                42 U.S.C.,   Section  3032(a) (1990 Supp.).
                                                                 4
State           Agencies         See Room for                   Improved         Dissemination


           Although          most states                  currently            are able         to use Title                    IV
results,           almost          all      state         agencies           believe         AOA could            take      action
to make results                    easier          to access               and understand.                    They suggested
specific           ways that              AOA can improve                    dissemination.                    Twenty-nine
states           suggested          that         AOA compile                a summary of              final       results             of
projects           to complement                   its      compendium              of active           grants.
Seventeen               states      suggested               that       AOA increase             its      interactive
dissemination                of     results.                Nine       of these            suggestions            related                 to
more direct               contact           with         regional           offices,          and eight               to more AOA
conferences               and seminars.                     In addition,               11 states              expressed
support           for     improving              or enhancing                grantee         dissemination                 of
results.


AOA Agrees               Dissemination                   Efforts           Should      Be Strengthened


           AOA does          not         systematically                    disseminate          Title          IV results                  or
monitor           how these              results          are      used.        Agency officials                   told         us
that       dissemination                  activities               have been cut              back       in the          1980s and
that       AOA has relied                  on others               to disseminate               results.              No    single
official           or agency              unit      is accountable                   for     ensuring           the    adequacy
of     Title       IV dissemination                       efforts,           AOA officials               told      us.          But,
AOA officials                indicated              that        they        are aware         of shortcomings                        in
           i)

                                                                       5
dissemination                and are considering                ways to           improve         dissemination
of       research         results.


           AOA used          to disseminate            more results               directly             through      a
clearinghouse,                which        was eliminated             because         of budget           reductions,
and through               more active          AOA staff        participation                  in dissemination.
Appropriations                for     Title     IV grants         have dropped                 from      $54 million
in       1980 to      $26 million             today.      AOA officials                 told      us that         Title
IV staff           also     decreased          from    about      50 full-time                 equivalents
(FTEs)        in     1983 to about             25 today,        further           reducing             AOA's in-house
capacity           to disseminate.


           At this         time,     none of       the    current         Title         IV staff          work
exclusively               on dissemination,              according         to AOA officials,                      and no
single       official          or office          is   responsible             for      the dissemination                 of
Title       IV results.              AOA officials             also     said         that      staff      have
little        time        to devote         to dissemination              because           almost        all     of
their       time     is     required          to prepare        grant      announcements,                   evaluate
applications,               and monitor           the progress            of work.


           AOA publishes             the      Compendium of Active                    Grants,4           but     relies
primarily           on others          to disseminate            findings,             particularly               on
Title       IV grantees.               AOA plans         to rely        even more on “knowledge


4The annual compendium contains       listings     and descriptions    of
projects  underway, generated    through an automated production
system in which project   descriptions         and information    are keyed                                               in
from grant awards materials.
                                                           6
transfer"          projects,           which          focus       on better       dissemination           of
existing          information            rather         than        development        of new information.
AOA also          provides          results           to disseminating              agencies      for     their
databases,              including        the         American        Association           of Retired      Persons'
AGELINE,          the     National            Technical*Information                  Service,       the
Department          of      Health       and Human Services'                     Project      Share,      the
Government          Printing           Office,          and other         agencies.           AOA officials            do
not      know,     however,          what       information             is disseminated           to whom
because          AOA does not            systematically                monitor       dissemination             of
results.


Conclusions


          While     Title        IV dissemination                    is having       some positive             impact,
it      is not     achieving          maximum           results        because       AOA does not          have a
comprehensive              dissemination                strategy.          Based on responses                  from
the      state     agencies          and AOA officials,                   results       appear      to be
disseminated              predominantly                in an ad hoc and haphazard                      manner.
State      agencies          also      told      us that            increased       dissemination          by AOA
would      make     it     easier       for      them to be aware                 of and apply          results.
For example,              they      suggested           AOA prepare           a summary of completed
Title       IV projects'             results           and expand         use    of conferences,
seminars,          and other           interactive              forums.
                                                        - - - - -

          In a broader              study       of    Older         Americans       Act reauthorization
issues*,         we are      focusing           on ways AOA can better                     manage the          Title

                                                                7
IV dissemination              process.           In the    near    future,           we will     be
reviewing        AOA efforts:


         --    to designate        responsibility            for    dissemination               within    AOA,
         --    to monitor       and evaluateSdissemination                      efforts,
         --    to communicate            results      of completed           Title       IV projects,
               and
         --    to provide       interactive          dissemination            of      results      through
               conferences,        workshops         and other       activities.


         Mr.    Chairman,       this      concludes        my remarks.               I will     be glad      to
answer        any questions        at     this     time.




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          4




.
    APPENDIX I                                                                                                     APPENDIX I
                                      Objectives,             Scope,          and M ethodology

               Our objectives                   today       are    to       (1)    provide        users’     perspectives
    on AOA’s dissem ination                         of      research          and dem onstration                results,           (2)
    describe             the       current       system        of dissem ination,                  and     (3) present             the
    views        of AOA officials                   and other               experts       on the      effectiveness                of
    this       system .             The inform ation              we are providing                   represents            our
    prelim inary               analysis          of data          we obtained             as part         of a broader
    study        we are         doing         on Older        A m ericans           Act       reauthorization
    issues.



               We collected                  inform ation          on AOA dissem ination                    efforts         from        a
    num ber of sources.                        We obtained              the       views       of AOA officials
    regarding              their       dissem ination              efforts.              We interviewed           outside
    experts,             some       Title       IV grantees,                and officials            in other         agencies
    carrying             out    sim ilar         dissem ination               efforts.            We also       conducted           a
    telephone             survey            of state        agencies          on aging          in the      50 states            and
    the       District          of Colum bia,               and analyzed              their       responses       regarding
    the       accessibility                  of Title        IV results             and the        usef     m ade of        the
    m aterial            dissem inated.




                                                                        9
APPENDIX II                                                           APPENDIX II

         Frequent  Sources of Information  for State Agencies
     on Aging Concerning   AOA Research and Demonstration  Results

                                                          Number of states
Source                                                reporting  frequent    use
Older Americans       Report                                     32
National    Association      of State Units
   on Aging (NASUA)                                              31
Other AOA-Sponsored         National    Resource
   Centers                                                       28
AOA Memos and Correspondence                                     21
State and Area Agencies on Aging                                 14
National    Council     on Aging (NCOA)                          12
American Association         of Retired
   Persons (AARP)                                                12
AOA's Aging Magazine                                             11
Colleqes    and Universities                                      8
Other-Research       and Demonstration
   Grantees                                                       7
Government Printing         Office    (GPO)                       3
National    Technical     Information
   Service    (NTIS)                                              2
Project    Share                                                  2

Source:    GAO Telephone      Survey,    August    1990.




                                          10
APPENDIX III                                                           APPENDIX III
                 Actions   Taken Most Frequently  by State
                      Agencies on Aging to Obtain AOA
                   Research and Demonstration    Results

                                                         Number of states
                                                            frequently
Action                                                   taking    action
Review Older Americans Report                                  41
Review AOA memos and correspondence                            40
Review professional             literature                     35
Review AOA's Aging Maqazine                                    20
Request information             from National
   Association         of State Units on Aging (NASUA)         18
Attend conferences,             seminars,      or meetings     13
Request information             from any other AOA
   national       rsource     center                           9
Request information             from AOA                           8
Request information             from state and area
   agencies      on aging                                          7
Request information             from the American
   Association         of Retired       Persons (AARP)             7
Request information             from colleges      and
   universities                                                    5
Use consultants           or experts                               5
Request information             from other Older
   Americans Act Research and Demonstration
   Grantees
Request information             from the Government
   Printing      Office      (GPO)
Request information             from the National
   Council      on Aging (NCOA)
Request information             from the National
   Technical        Information        Service   (NTIS)
Request information             from Project      Share


Source:    GAO Telephone     Survey,   August    1990.




                                        11
APPENDIX IV                                                                     APPENDIX IV
                      Programs/Services              in Which State
                     Agencies on Aging              Have Made Change
          As a Result of AOA Research               and Demonstration         Results

                                                              Number of states
                                                                making changes
Program/services                                              in last 2 years
Long-term        care                                                     9
Case management
Alzheimer's         disease
Planningb
Targeting        minorities
Elder     abuse
Quality     assurancec                                                    2
Public/private          activities                                        2


Source:       GAO Telephone          Survey,   August     1990.
aAlthough    health    is not specifically      disaggregated,     it was
reported    as an integral     part of many of the social         services
the elderly     receive;   health   was specifically      mentioned by
nine states.
bPlanning    functions   reported     include   needs assessment,                unnet
needs determination,       coordination      and health  provider
regulations,     and housing.
cTwo other states  mentioned quality                    assurance   factors     of   in-home
and case management services.




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