Assessing a Healthcare Program/Policy Evaluation
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
Select an existing healthcare program or policy evaluation or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described.
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
Describe the healthcare program or policy outcomes.
How was the success of the program or policy measured?
How many people were reached by the program or policy selected?
How much of an impact was realized with the program or policy selected?
At what point in program implementation was the program or policy evaluation conducted?
What data was used to conduct the program or policy evaluation?
What specific information on unintended consequences was identified?
What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
Did the program or policy meet the original intent and objectives? Why or why not?
Would you recommend implementing this program or policy in your place of work? Why or why not?
Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
Assessing a Healthcare Program/Policy Evaluation
Healthcare Program/Policy Evaluation Analysis
Healthcare Program/Policy Evaluation
The Support Team Assistance Response (STAR) program
Description
The STAR program in Denver, Colorado responds to individuals experiencing substance abuse, poverty, homelessness, depression, and mental health issues. The Star response is composed of a paramedic and mental health staff who swiftly responds to and supports people in crisis by connecting them with appropriate resources and care. The healthcare personnel move in a specially equipped van. STAR began in June 2020 as a pilot program and operated for eight hours, between 10 a.m. to 6 p.m. The STAR program was designed based on Eugene’s Crisis Assistance Helping Out On The Streets (CAHOOTS) Program (Dee & Pyne, 2022). Waters (2021) indicates that CAHOOTS is a service in Eugene, Oregon that sends an emergency medical technician and a mental health crisis personnel, rather than a law enforcement officer, to individuals experiencing severe mental health distress.
STAR is dispatched via Denver’s 911 system with low risk for harm or violence to client, STAR teams or the public. Expansion of STAR program started in early 2021. The program increased to five vans, eight medics, ten mental health clinicians, and one back up van. Time of operation was expanded from 6 a.m. to 10 p.m. in late 2022, STAR collaborated with a local behavioral health service organization (Servicios de La Raza), to offer direct services as well as follow-up connections to community providers for individuals encountered by STAR teams (Gillespie et al., 2023).
How was the success of the program or policy measured?
The success of the STAR program was measured by the effectiveness of STAR teams in responding to 911 calls. According to Gillespie et al. (2023) when making a response to a call, the focus of the STAR team is de-escalation of crises, connecting individuals with follow-up services like long-term mental health services, and meeting individual’s basic needs, for instance, medicine, shelter, clothes, and food. STAR program has been effectively in responding to 911 calls that eliminates the police response in psychiatric crises and ensuring that individuals obtain needed follow-up services by connecting them to community resources and support.
How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?
For the initial six months of implementation, STAR van diverted 748 calls 0r about 3 5 of all 911 calls for help in that region, that would otherwise have been made to the police. (Waters et al., 2021). There was a notable increase of STAR- eligible calls from 2020 to 2023. STAR teams have responded to about 24% of STAR-eligible calls since the start of the program. Compared to 16% in 2020, STAR teams responded to 38% pf calls for service in 2023 and these responses include clinical as well as nonclinical encounters. Also, their response to incidents that were identified by 911 as eligible for response by STAR teams. These incidents usually happen when a response is made by another agency, but then identifies SAR as a suitable response agency. STAR made 7,899 such responses from June 2020 to December 2023(Gillespie et al., 2024). Assessing a Healthcare Program/Policy Evaluation
At what point in program implementation was the program or policy evaluation conducted?
The STAR was evaluated during the first six months of implementation and evaluation was continually done as the program continued its operations.
What data was used to conduct the program or policy evaluation?
STAR program evaluation was conducted by analysis of quantitative data. Calls made by 911 that were identified as eligible for STAR response utilizing data from Denver Department of Safety. The evaluation also was performed on clinical STAR encounters, that is, encounters with STAR teams which there was the identification and documentation of fundamental service needs, utilizing data from Wellpower. Another major component of the evaluation of the STAR programs was to understand community and client experiences with STAR and the way individuals who encountered STAR teams had connections to follow-up services. Data was obtained through interviews and surveys of individuals who had crises and STAR teams responded and referred them to the community partner network. Also, an electronic survey was conducted on community members who had interacted with the program (Gillespie et al., 2024).
What specific information on unintended consequences were identified?
Inadequate connection of people to follow-up services and lack of understanding of how STAR operates by hospitals and community service organizations were untended consequences of STAR. According to Gillespie et al. (2023), although the STAR program has effectively met the immediate needs of people, it is still challenging to connect people to long-term services. STAR staff stated that they were not able to connect individuals to geographically and culturally appropriate services due to their capacity and knowledge of providers. Many organizations are unaware of STAR or lack understanding of how the program works, made more complex by the plain clothes worn by STAR teams.
What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
The STAR program staff, leaders, community partners, STAR clients and members of the community) were stakeholders identified in evaluation of the STAR program. Denver residents and the STAR staff would benefit most from the results and reporting of the program evaluation. This is because the program protects community members from traumatic police response and enables STAR team to appropriate de-escalate psychiatric crises. For example, the STAR program permits police to focus on the safety of the public since they are aware that STAR teams are increasingly effective in responding to behavioral health and mental health calls. Also, STAR has increased community and system awareness of behavioral and mental health resources and needs in Denver (Gillespie et al. 2023).
Did the program or policy meet the original intent and objectives? Why or why not?
The STAR program met the original intent and objectives. STAR staff, leaders, and community members reported that the program was immensely successful in its ability to offer an alternative response to crises fire, emergency medical services and police response community partners stress the gains of an alternative to calling the police when de-escalation is required during a mental health crisis. STAR works stressed their ability to utilize c problem-solving and creativity and take ample time to establish the best response, a process is not followed by first responders (Gillespie et al., 2023).
Would you recommend implementing this program or policy in your place of work? Why or why not?
I would recommend implementing this program in my workplace to reduce the number of people assaulted or killed by police who respond to emergency calls. According to Dee and Yee (2022), having armed police as a first responder to substance use or mental health crises might increase the probability of inappropriate care and costly outcomes Rafla-Yuan et al. (2021), emphasize when police respond to psychiatric crises, they offer harm patients, especially people of color. There is evidence that police-based responses do not meet psychiatric patients’ needs, and there is heightened risk of apprehensions and deadly encounters Assessing a Healthcare Program/Policy Evaluation
Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation.
Nurses are uniquely knowledgeable in the healthcare needs of populations and patients and thus can offer leadership in policy evaluation. As a nurse advocate, I can be involved in evaluating a policy/ program a year post-implementation by measuring if the policy/program has achieved its objectives and the economic efficiency of the policy/ program. According to Porche (2021), policy evaluation process measures the effect of a policy and its implementation as intended by policymakers. The impact of a policy is measured based on its intent and impact on targeted and non- targeted groups. Real-world impacts of a policy are measured impact on target problem, impact on target and non-targeted groups, effect on immediate and future conditions of the problem, direct and indirect cost, and net analysis of costs and benefits. Economic efficiency is evaluated by measuring the net benefits associated with reallocation or allocation of resources.
General Notes/Comments
The STAR program is a crisis response program that pairs behavioral health staff and paramedics to respond 911 calls. The program has been effective in offering an alternative to police responses, and psychiatric crises and has lessened the possibility of clients experiencing more trauma. Also, the program has been effective in connecting individuals with resources that assist them to stabilize and address long-term needs. Assessing a Healthcare Program/Policy Evaluation
References
Dee, T., & Pyne, J. (2022). A community response approach to mental health and substance abuse crises reduced crime.
Science Advances, 8
(23):eabm2106. Doi:
10.1126/sciadv.abm2106
Gillespie, S., Curran-Groome, W., & Rogin, A. (2024). Evaluating Alternative Crisis Response in Denver’s Support Team Assisted Response (STAR) Program: Interim Findings.
https://www.urban.org/sites/default/files/2024-09/Evaluating_Alternative_Crisis_Response_in_Denvers_Support_Team_Assisted_Response_Program-Interim_Findings.pdf
Gillespie, S., McGilton, M., & Rogin, A. (2023). Understanding Denver’s STAR Program
Alternative Crisis Response in Denver.
https://www.urban.org/sites/default/files/2023-08/Understanding%20Denver%E2%80%99s%20STAR%20Program.pdf
Porche, D. J. (2021).
Health Policy: Applications for Nurses and Other Healthcare Professionals
. Jones & Bartlett Learning.
Waters, R. (2021). Enlisting Mental Health Workers, Not Cops, In Mobile Crisis Response.
Health Affairs, 40
(6), 864
https://doi.org/10.1377/hlthaff.2021.00678
-869.
Rafla-Yuan, E., Chhabra, D. K., & Mensah, M. O. (2021). Decoupling Crisis Response from Policing — A Step Toward Equitable Psychiatric Emergency Services.
New England Journal of Medicine, 384
(18
),
1769-1773. DOI: 10.1056/NEJMms2035710 Assessing a Healthcare Program/Policy Evaluation
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