ACL strives to evaluate programs in an integrated manner combining process, outcome, impact and cost-benefit analysis of evaluation activities. ACL has adopted a learning agenda approach, which involves annual reviews with each ACL center to support the generation and use of evaluation findings to inform agency strategies and decision making. ACL’s evaluation policy confirms our commitment to conducting evaluations and to using evidence from evaluations to inform policy and practice. ACL seeks to promote rigor, relevance, transparency, independence, and ethics in the conduct of evaluations. This policy addresses each of these principles. This site provides links to reports and results from ACL’s evaluation efforts.
Completed Evaluations and Studies
- The Caregiver Outcome Evaluation Study of the National Family Caregiver Support Program
The National Family Caregiver Support Program (NFCSP) represents a significant Federal investment in supporting caregivers who provide care and assistance to aging adults and to grandparents raising grandchildren. Through this program, the Aging Network helps meet the immediate needs of caregivers and care recipients while also being the catalyst for broadening the long-term care (LTC) service systems at State, Territory, local, and Tribal levels to better support families. Its ultimate goal is to support individuals who prefer to age in their own homes and communities—as opposed to institutional settings—through lower-cost, nonmedical services and supports. The National Family Caregiver Support Program, authorized by Title III-E of the Older Americans Act (OAA), provides information to caregivers about available services, assistance to caregivers in accessing supportive services, individual counseling, support groups and caregiver trainings, respite care, and supplemental services.
ACL recently conduced a two-part evaluation of the NFCSP program. The first part, conducted by the Lewin Group, was a process evaluation with the overall purpose of understanding and documenting the strategies used to meet NFCSP goals. This part was completed in March 2016 and produced a briefing of the results (PDF, 2.72MB), an executive summary of the results (PDF, 1.21MB), and a final process evaluation report (PDF, 2.31MB). In addition, State Units on Aging were asked to submit their assessment tools. The evaluation team compiled them and grouped them into the following categories:
The second part, conducted by Westat, was an outcome evaluation with the purpose of describing NFCSP participants’ demographic and caregiving characteristics, as well as examining the impact of the program on key caregiving outcomes such as burden and caregiving confidence. This part was completed in 2018 and produced a final outcome evaluation report, a webinar briefing, comments and responses from the briefing, and audio or transcript from the briefing (available on request). Appendices on the methodology, data collection instruments, and tabulations are available upon request.
Brief data profiles about NFCSP Outcome Evaluation participants are available. A data profile examining caregivers who have been providing care for two or fewer years, and caregivers providing care for longer than two years, on a set of demographic characteristics is available here.
A data profile examining caregivers of care recipients with Alzheimer’s disease or related dementias (ADRD), and caregivers of care recipients without ADRD, on a set of demographic characteristics is available here.
A data profile examining caregivers that are NFCSP service users and caregivers are not NFCSP service users on a set of demographic characteristics is available here.
A data profile examining caregivers of older veterans, and caregivers of older non-veterans, on a set of demographic characteristics is available here.
ACL also conducted a small, retrospective study of caregivers whose care recipient passed away. The resulting supplementary report highlights caregivers’ experiences in providing care and accessing services, and it provides “advice from caregivers to caregivers.” A factsheet also summarizes key themes and insights from this group of caregivers.
- Evaluation of Title III-C Elderly Nutrition Services Program (ENSP)
The Administration for Community Living (ACL) is conducting a three-part evaluation of its Title III-C Nutrition Services Program (NSP). Part one is a process evaluation that provides information to support program planning by analyzing program structure, administration, staffing, coordination, and service delivery as well as the interactions between the many levels and types of organizations that provide congregate meals, home-delivered meals, and collateral services under the Title III-C NSP. Part two is a cost study that estimates the costs of program operations, the most important being the cost of the congregate and home-delivered meals provided using Title III funds, and to examine cost variation within the program by cost component and program characteristics. And part three assesses program effectiveness (also called client outcome study), as measured by the program's effects on a variety of important outcomes (including nutrient adequacy, socialization opportunities, and health outcomes and, ultimately, helping older adults avoid institutionalization) through comparing program participants' outcomes with those from a matched comparison group of eligible nonparticipants. The Process Evaluation Report and the Cost Study Report are available now. In addition, you can watch a briefing on these reports or download the briefing handouts (PDF).
The client outcome study (also known as part three of the evaluation for program effectiveness) was released in two parts. Client Outcome Study: Part I describes nutrition services program (i.e., congregate meal and home-delivered meal) participants’ demographic and household characteristics, health status, mobility, eating behaviors, diet quality, food security, socialization, and other characteristics, as well as program participants’ experiences with and impressions of the program and their valuation of meals and supportive services received through the program. In addition you can download the briefing handouts as well as responses to questions posed during the briefing for Part 1 of the client outcomes study. Client Outcome Study: Part II describes participants’ health and health care utilization and examines overall wellness measured using longer-term outcomes related to health and avoidance of institutionalization. Briefing handouts from the webinar for the Part II report are also available.
Additional issue briefs and reports from this evaluation include:
- An issue brief that examines NSP participants’ patterns of health care utilization, including hospital admissions and readmissions, emergency department care, doctor visits, home health episodes, and admissions to long-term care facilities (nursing homes) and skilled nursing facilities over a three year period. Prior reports that examined program impacts (effects) looked at outcomes over a one-year period.
- An issue brief that assesses how program entrance and retention vary with participant characteristics and evaluates how retention and program entrance have changed over time. These findings are important for understanding how to best target and retain participants who can benefit from services.
- An issue brief that examines the most common diagnoses underlying adverse health events experienced by NSP participants.
- An issue brief that assesses the types and prevalence of adverse health events experienced by new home-delivered meal participants; the timing of these events relative to starting to receive home-delivered meals; and how these events varied by participants’ characteristics.
- An issue brief that assesses prevalence of chronic conditions observed over approximately a 2.5-year period for a sample of nationally representative congregate meal participants.
- An issue brief that describes the nutritional quality of congregate and home-delivered meals offered through the NSP and examines their compliance with the 2010 Dietary Guidelines for Americans, which were in effect at the time of the data collection.
- A report that describes NSP participants’ needs, frequency of program use, and participation in other programs and use of services.
- An issue brief that examines the social activities at congregate meal sites and the role of those activities in improving socialization outcomes for participants.
- An issue brief that describes the types of foods that NSP participants consumed as part of the program and examines differences between participants and nonparticipants in foods consumed over 24 hours.
- An issue brief that identifies key food sources of sodium, saturated fat, empty calories, and refined grains in the diets of NSP participants and examines differences between participants and nonparticipants.
- Evaluability Assessment of the American Indian, Alaska Natives and Native Hawaiian Programs (Title VI)
In 2014, ICF International (ICF) was contracted by ACL/AoA to conduct the Evaluability Assessment (EA) of the Title VI Grant Program. The purpose of the contract was to provide ACL with:
- A description of the program model (What do grantees do, and how do they operate?)
- An assessment of how well defined the programs/program services are (Are the programs/program services stable, distinct, consistent and established?)
- Information about what federal and tribal stakeholders want to get from an evaluation and how the evaluation data findings would be used.
The study examined the program characteristics of Title VI grantees’ nutritional, supportive, and caregiver support services to assess the feasibility of, and best approaches for, formal evaluation of the Title VI Program. The Evaluability Assessment of the Title VI Grant Program Final Report (PDF, 1.26MB) includes program background, recommendations for enhancing Title VI grantees’ readiness for evaluation, and evaluation design recommendations. A comprehensive program logic model and a medicine wheel model are included.
- Evaluation of the Aging and Disability Resource Centers (ADRCs)
There are more than 550 ADRC sites across the nation. Since the inception of this initiative, ADRCs have had more than 4.8 million contacts with consumers, caregivers, providers, and professionals. The focus of the evaluation is to determine the extent to which Aging and Disability Resource Centers (ADRCs) are fulfilling the goal of improving awareness of and access to long term supports and services for older adults and individuals with disabilities and also how well ADRCs are contributing to the overall ACL mission. The process data collection, completed in the fall of 2013, had high response rates at 100% of State-level ADRCs and 84% of local ADRC grantees. The outcome study data collection was completed in the spring of 2014 with more than 600 respondents from 33 sites. Data from a presentation (PDF, 2.23MB) about the process evaluation is available as is the final study report (PDF, 5.85MB) with appendices (PDF, 9.84MB). The final report provides background on the ADRC program, study methodology and results for both the process and outcome studies. The results of this evaluation will influence future performance measures and indicators. This work was completed by IMPAQ International with Abt Associates under contract HHSP233201000692G.
- Process Evaluation of the Chronic Disease Self-Management Education Program (CDSME)
In September 2011, AoA awarded Contract HHSP233201100492G to IMPAQ International and Altarum Institute. This process evaluation examined state CDSMP programs funded through Communities Putting Prevention to Work: Chronic Disease Self-Management Program, an initiative of the Administration for Community Living/Administration on Aging (AoA) in collaboration with the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS). The research team employed a multi-method approach using multiple qualitative and quantitative data sources. The program data were also used to conduct regression analyses to examine the influence of various factors on participant completion rates. The report provides information about: characteristics of State grantees, CDSMP participants, CDSMP implementation, participant completion rates, site-level data collection, program sustainability, and recommendations for program improvements. The final process evaluation report (PDF) with Appendices (PDF) is now available. In addition to the process evaluation, ACL is coordinating with CMS’ efforts in evaluating evidence-based wellness programs. A copy of the CMS report which includes CDSMP outcomes is available at innovation.cms.gov (PDF). For additional information about this grant program please also see the reports created by ACL’s technical assistance grantee the National Council on Aging at www.ncoa.org/improve-health/center-for-healthy-aging/capping-reports.html.
- Evaluation of the Ombudsman Programs of the Older Americans Act
Real People Real Problems: An Evaluation of the Ombudsman Programs of the Older Americans Act (The National Academies Press)
- 2004 Survey of Adult Protective Services
2004 Survey of Adult Protective Services: Abuse of Adults 60 Years of Age and Older (PDF) (National Center on Elder Abuse)
- Title III-B Supportive Services Evaluation
- Developmental Disabilities Act Program Outcomes
State Councils on Developmental Disabilities
Individuals Trained by State DD Councils
Protection and Advocacy for Individuals with Developmental Disabilities
The Developmental Disabilities Assistance and Bill of Rights Act of 2000 requires Administration on Intellectual and Developmental Disabilities (AIDD) grantees to report annually on progress achieved through advocacy, capacity building, and systemic change activities.
P&A Agencies, using their annual Program Performance Report (PPR), submit data to AIDD. The following tables provide select data for each state/territorial P&A as well as for the nation.
Report Title Year Clients Served 2012 | 2013 | 2014 | 2015 Clients by Age 2012 | 2013 | 2014 | 2015 Clients by Race and Ethnicity 2012 | 2013 | 2014 | 2015 Clients’ Living Conditions 2012 | 2013 | 2014 | 2015 Reasons for Closing Cases 2012 | 2013 | 2014 | 2015 Intervention Strategies 2012 | 2013 | 2014 | 2015 Problem Areas/Complaints of Clients Served 2012 | 2013 | 2014 | 2015
University Centers for Excellence in Developmental Disabilities
Training Count by Areas of Emphasis
Technical Assistance Participants
Performing Research or Evaluation
Direct Clinical Services / Model Services
Community Education Participants
Community Training Participants
Products Created By UCEDDs
- Adult Protective Services Client Outcome Study
The Adult Protective Services (APS) Client Outcome Study is a new three-year data collection that examines if and how APS programs make a difference in the lives of APS clients.
APS programs are provided by state and local governments nationwide and serve older adults and adults with disabilities in need of assistance due to maltreatment, which can include: physical, emotional, and sexual abuse; financial exploitation; neglect; and self-neglect. APS is an important avenue through which maltreatment is reported to law enforcement or other agencies.
Specifically, the data collection will help examine:
(1) What changes clients report as a result of receiving APS services;
(2) How satisfied clients are with the APS services they receive;
(3) To what extent clients report APS helps them achieve their goals;
(4) To what extent clients report APS supports their right to self-determination;
(5) To what extent APS programs affect client safety (risk of maltreatment);
(6) How APS program intervene to reduce client risk of maltreatment;
(7) What factors help or hinder APS efforts to reduce risk of maltreatment;
(8) To what extent APS programs affect client well-being (e.g., quality of life, financial, physical health, etc.);
(9) How APS programs intervene to improve client-well-being; and
(10) What factors help or hinder APS efforts to improve client well-being.
The data collection project began in October 2018 and is expected to end in September 2021.
- Living Well (a Project of National Significance)
During the last two decades, the number of individuals with intellectual and developmental disabilities (I/DD) living in community settings and receiving home and community based services (HCBS) increased dramatically. While this led to better outcomes, including people with I/DD making more of their own choices and being a part of the community, there are great variations in the accessibility of quality HCBS across the country.
In 2017 and 2018 ACL awarded Living Well grants to help develop and test model approaches for enhancing the quality, effectiveness, and monitoring of home and community-based services (HCBS) for people with developmental disabilities. These Model Approaches for Living Well grants, awarded as Projects of National Significance by ACL’s Administration on Intellectual and Developmental Disabilities, are focused on building the capacity of HCBS systems and enhancing community monitoring to prevent abuse, neglect, and exploitation.
The Lewin Group (Lewin), as a subcontractor to New Editions Consulting, initiated the cross-site evaluation of all eight grantees from cohorts one and two in 2018. Each grantee has designed one or more models integrating community monitoring and capacity building with the goal of enhancing health, safety, integration, and independence of individuals with I/DD living in the community. The cross-site evaluation of the Living Well grants focused on eight key features, organized into three categories. The evaluation has produced the first annual report broken into several interrelated products:
- Executive Summary
- Volume I: Introduction and Grantees
- Volume II: Findings
- Volume III: Methodology
- Volume IV: Conclusion and Next Steps
- Living Well State Profiles
- Living Well Emerging Practices
- Living Well Final Report Tables
- Supporting Families Community of Practice Evaluation
In 2012, the Administration for Community Living (ACL) funded a National Community of Practice for Supporting Families (CoP) to build capacity across and within states to create policies, practices, and systems to better assist and support families that include a member with intellectual and developmental disabilities (I/DD) across the lifespan. In 2018, ACL funded a retrospective evaluation to inform the Administration on Disabilities (AoD) by providing outcomes data and recommendations to improve supports to families of individuals with I/DD, including potential future application of the Charting the Life Course (CtLC) framework and CoP platform; and provide AoD with an updated systematic description of the range of CoP organizational structures, practices, and development across CoP states, which include consideration of the degree to which CoP states apply the principles and tools of the CtLC framework.
In 2019, ACL collected information regarding changes made to policies, programs and services, and initiatives, as well as the impact or anticipated impact of these changes. These findings are available in the reports:
and the presentation:
See individual and state-level success stories based on this work:
- Sharing Information and Creating Partnerships: Angela's Story
- Changes in Knowledge: Maggie's Story
- Changes in Practice: Ty's Story
- Improvements in Performance: Crystal's Story
- Redefining Success: South Dakota's Story
- Alabama Data Brief
- Connecticut Data Brief
- Delaware Data Brief
- Hawaii Data Brief
- Indiana Data Brief
- Kansas Data Brief
- Maryland Data Brief
- Missouri Data Brief
- Pennsylvania Data Brief
- Ohio Data Brief
- Oklahoma Data Brief
- Oregon Data Brief
- South Dakota Data Brief
- Tennessee Data Brief
- Washington Data Brief
- Washington, DC Data Brief
- Evaluation of the Long-Term Care Ombudsman Program (LTCOP)
In 2015 ACL/AoA contracted with NORC at the University of Chicago to conduct an evaluation of the Long-Term Care Ombudsman Program to determine:1. The data collection capacity and practices of state and local LTCOP programs;
2. How the program operates at the federal, state, and local levels independently and in conjunction with each other;
3. The range of ways that Ombudsmen
- identify, investigate and resolve complaints about the care residents receive with respect to their health, safety, welfare and rights;
- represent residents’ interests before government agencies and analyze, comment on, and monitor federal, state and local regulations, policies, and actions that potentially affect residents of long-term care facilities; and
- provide information and consultation to facilities and residents and their families as well as collaboration with other agencies.
5. Program reach including inclusion of residential care communities;
6. Program characteristics that exist at some sites but not at others and the contextual differences that contribute to those differences; and
7. Program innovations or adaptations being implemented at multiple sites that show promise in terms of strengthening program effectiveness and/or efficiency.
A report answering these questions is expected in mid-2019.
Preliminary results were presented at the 2017 Consumer Voice conference Ombudsman Program Process Evaluation: Progress and Initial Data, at the 2017 HCBS conference Process Evaluation and Special Studies Related to the Long-Term Care Ombudsman Program, at the 2018 HCBS conference The Role of Long-Term Care Ombudsman Programs in HCBS: Overview and Findings from the National Evaluation of the LTCOP, and at the 2019 SLTCO conference Findings from the National Evaluation of the Long-Term Care Ombudsman Program. The research team presented preliminary findings about Challenges and Innovations in Systems Advocacy by the Long-Term Care Ombudsman Program at the 2018 Consumer Voice Conference.
In 2017, started work with NORC at the University of Chicago to measure program results. Specifically, this study will determine the efficacy of LTCOP in carrying out core functions as described in the Older Americans Act, the long-term impacts of the LTCOP’s for various stakeholders, what system advocacy among Ombudsman programs looks like, and effective or promising Ombudsman program practices. The final report from this effort is expected in mid- 2021.
- Evaluation of Home and Community-Based Support Services for Older American Indians, Alaskan Natives, and Native Hawaiians (Title VI Programs)
In 2016 ACL/AoA contracted ICF International (ICF) to conduct a participatory evaluation of the Title VI Grant Program, which provides home and community-based supportive services for older American Indian, Alaskan Native, and Native Hawaiian populations. The evaluation seeks to answer the following questions:- How do tribes/organizations operate their Title VI Programs?
- What is the impact of Title VI programs on elders in the community? Are there differences nationally or by tribe/organization?
- Do Title VI programs that are sole-sourced funded have a different impact than programs that are funded through multiple sources?
The evaluation, still ongoing, has released its Evaluation of the ACL Title VI Programs: Year 1 Interim Report outlining the approach to and the design of the evaluation. In addition, the report provides information on the evaluation participants, timeline of the project, and initial findings.
In the second full year of the Title VI Evaluation, the ICF evaluation team focused on understanding the Title VI Programs from the perspective of program staff and elders. The evaluation uses mixed methods, including quantitative (primary and secondary) and qualitative (primary) data sources to understand the context and the impact of the Title VI Program through an implementation and outcomes study. The evaluation team analyzed multiple data sources to present a first look at the Title VI Programs. Emerging themes include elders’ met and unmet needs, social connectedness, and independence and quality of life. The evaluation found that Title VI Evaluation grantees were representative of the overall population of Title VI grantees across several components including elders’ health characteristics, health and nutrition status, and level of services they receive. Further, the evaluation uncovered how important the nutritional, social, and cultural aspects of the Title VI program are for Native elders. View the Evaluation of the ACL Title VI Programs: Year 2 Interim Report.
In the third year of the Title VI Evaluation, the evaluation team focused on understanding the Title VI Part C, Native American Caregiver Support Program, from the perspective of caregivers. Multiple data sources were analyzed, including interviews and focus groups with informal (unpaid) caregivers, in order to understand the implementation and impact of the Pact C Caregiver Support Program. The evaluation found that the Caregiver program is implemented in uneven ways across grantees, an issue that ACL began to address immediately. Emerging themes from this year’s findings were that caregiving is a rewarding but challenging experience, that caregivers do not always see themselves as caregivers, but that the services received through Title VI Part C provide important support to improve caregiver’s overall quality of life.
Attachments include:- Title VI Evaluation Year 3 Interim Report
- Title VI Evaluation Appendix A – Medicine Wheel
- Title VI Evaluation Appendix B – Methods
- Title VI Evaluation Appendix C – In Their Own Words: Caregiver Quotes
- Title VI Evaluation Appendix D – Focus Group Summary
- Performance of Older Americans Act Programs
ACL collects information and reports on the performance of Older Americans Act programs through the several data collection systems under its National Aging Program Information System (NAPIS), its national surveys of OAA participants, and its evaluation studies. This is reported in the Program Performance Analysis section of the budget justification submitted to Congress along with the President’s budget each year, as well as through several other mechanisms.
Evaluation Design Projects
- Evaluation Design for the Long Term Care Ombudsman Program (LTCOP)
In September 2011 the Administration for Community Living (ACL) awarded contract HHSP233201100500G to NORC at the University of Chicago (NORC) to develop an evaluation study design to better understand and assess the effectiveness of Long-Term Care Ombudsman Programs (LTCOPs). The task included building the evidence base on LTCOPs in order to develop recommendations for a rigorous and comprehensive study design that investigates program efficiency and program effectiveness at multiple levels, including the resident/family, facility, local/state/program, and federal levels. Key tasks of the design process involved the development of a family of four logic models and a set of overarching research questions to guide the evaluation, as well as the identification of data collection tools and data sources that inform those questions. The diversity of proposed activities reflects the ACL’s goals for this evaluation, the commitment to a population health frame of reference, and seven critical LTCOP characteristics that influence design options. The final evaluation design report (PDF, 2MB) was completed in January 2013.
- Evaluation Design for a Global Evaluation of Older American Act (OAA) Services
Under this project, the Administration on Aging (AoA) seeks to study the impact of OAA programs and services, specifically services provided under Title III, on key outcomes including HCBS use, health care use, community tenure, and long-term services and supports (LTSS) expenditures. OAA services and programs are diverse, often integrated and/or provided in combination with other services, funded through multiple funding streams, and administered and delivered by different state and local-level agencies with varying data collection capacity. This design focuses on the impact of services provided through OAA funded HCBS programs authorized under Titles III-B, C, D, and E of the OAA. These programs include a range of supportive services, nutrition services, health promotion and disease prevention programs, as well as services for family caregivers. While the mix and type of services offered differ by state and locality, the vast majority of OAA funding is used for the provision of nutritional services. Proposed research questions include:
What is the impact of OAA funded HCBS programs and services on:
Health care utilization
Costs of care for older adults (e.g., LTSS, health care costs)
Physical, mental, and emotional health and wellness (e.g., preventive measures) of care recipients and caregivers
Unmet needs among older adults
Caregivers (e.g., strain, burden, depression, health, etc.)
Coordination of services (e.g., care management)?
What is the impact of OAA services alone or in combination with services paid for by other sources?
What is the impact of service mix and intensity on outcomes of interest? [if possible, we will isolate OAA services]
What subgroups had the most favorable outcomes? (e.g., health conditions, demographics, functional status)
A primary recommendation from the final evaluation design report (PDF) is that the Administration for Community Living (ACL) first facilitate an exploratory study to determine the feasibility and limitations of conducting this evaluation with state OAA data. Such a study will assist ACL in identifying actions needed to better position the states for participation in a nationwide evaluation.