Project Findings: Low Cost, Low Key Changes can Improve Outcomes

Work in behavioral science suggests that small changes can move people to act on personal goals. To test this approach in the realm of human services, MRDC along with sponsoring federal agencies, launched the Behavioral Interventions to Advance Self Sufficiency (BIAS) program with a goal of improving both the efficiency and outcomes of programming. Small changes or “nudges” to a program that facilitate the experience for clients, for example, the simplification of an application process, personalization of correspondence, or prominently highlighting a deadline, have an influence on decisions made by current or potential program participants. These adjustments are not major design changes, rather they are low cost, easily implemented ways to change the complexities many lower income families face .

Randomized trials at participating state and local human service agencies introduced specific behavioral interventions based on a period of review and identification of “bottlenecks.” Results indicate that these small changes had a statistically significant impact on outcomes in childcare and work support (including increased attendance at meetings or appointments) and child support (including increased rate of payment).

If small changes make a difference, why are larger-scale programmatic changes (that could result in increased benefits) so difficult to negotiate and implement? Perhaps examining program design through the lens of behavioral economics, where both staff and participant benefit from improved outcomes, is the path toward innovation in the provision of human services. The full report on the BIAS project and additional information on the MRDC’s work with behavioral interventions is available on their website.


Report citation: Richburg-Hayes, Lashawn, Caitlin Anzelone, and Nadine Dechausay with Patrick Landers (2017). Nudging Change in Human Services: Final Report of the Behavioral Interventions to Advance Self-Sufficiency (BIAS) Project. OPRE Report 2017-23. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

SAMHSA’s 2015 Behavioral Health Barometer: Pennsylvania Offers Look at Substance Use, Mental Health Treatment

Earlier this year The Substance Abuse and Mental Health Services Administration (SAMHSA) published the third edition of their Behavioral Health Barometer: Pennsylvaniapart of series of reports at both the national and the state level that provides a “snapshot of behavioral health.”  The Barometer pulls data on youth and adult behavioral health markers from the National Survey on Drug Use and Health, the National Survey of Substance Abuse Treatment Services, the Youth Risk Behavior Survey, the Monitoring the Future survey, and services used by Medicare enrollees. This free report is a great source of data for needs assessments and grant proposals, be sure to download the national and state (of your choice) report at the SAMHSA website.

Below are data from the report on aspects of youth and adolescent behavioral health and substance use. Overall, the state percentages are comparable to national percentages, with higher proportions in reported cigarette use and binge drinking.

For Pennsylvania in 2013/2013-14:

  • approximately 84,000 adolescents (12 to 17 years old), just under 9 percent of all adolescents, used illegal drugs during the month prior.
  • 6.6 percent of adolescents used cigarettes within the last month – this is higher than the national data point  of 5.2 percent.
  • 16.5 percent of adolescents binged on alcohol within the last month – again, higher than the national percentage of 14 percent.
  • 198,088 youth (under 18 years of age) received services from the public mental health system, with 63.5 percent reporting improvement post-treatment, lower than the national data point of 69.5 percent.




Report Citation:  Substance Abuse and Mental Health Services Administration. Behavioral Health Barometer: Pennsylvania, 2015. HHS Publication No. SMA–16–Baro–2015–PA. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.


Study Finds Overseas Tobacco Advertising Reaches Very Young Children

Tobacco marketing reaches children as young as 5 years old influencing their attitudes about smoking and smokers, according to a study of children in Brazil, China, India, Nigeria, Pakistan, and Russia recently published in the journal Child: Care, Health & Development. The research study, led by Dr. Dina Borzekowski, research professor in the Department of Behavioral and Community Health at the University of Maryland adds to her body of work on the impact of media on children’s health.

The research team assessed the children’s level of familiarity with tobacco branding, their intention to smoke in the future, and their overall exposure to media.  Among 5-and-6-year-old children in the six counties, nearly 68 percent were able to identify one tobacco logo and more than 25 percent could identify two or more. Higher levels of media exposure were not necessarily associated with better knowledge of tobacco brands. However, in three of the sample countries the presence of an adult in the home was also not a significant factor in brand knowledge, suggesting that advertising plays a role in the exposure of very young children to tobacco brands and smoking behavior.

Although tobacco companies face weaker regulations overseas, they spent $9.6 billion on advertising in the United States in 2012.  A U.S. Surgeon General’s report suggests that these companies continue to target marketing to American adolescents, portraying smoking or smokeless tobacco use as a desirable behavior. Considering the approximately 3.5 middle and high school students who used tobacco in 2012, it’s working.

Extensive information about tobacco marketing and promotion is available at the Stanford Research Into the Impact of Advertising (SRITA) webpage.



Study Citation: Pires, P. P., Ribas, R. C.,  Borzekowski, D. L. G. (2015).  Attitudes and intentions to smoke: a study of young Brazilian children. Child: Care, Health and Development.1365-2214


A Breakdown of Drug and Alcohol Usage in America

In 2013, 56% of adults in America classified themselves as "current drinkers", 24.6% reported that they were "binge drinkers".
In 2013, 56% of adults in America classified themselves as “current drinkers”, 24.6% reported that they were “binge drinkers”.

Alcohol consumption statistics have received much attention of late thanks to a Washington Post Wonkblog post citing material from the book Paying the Tab by Philip J. Cook and data from The National Institute on Alcohol Abuse and Alcoholism (NIAAA).  Those interested in alcohol consumption trends by adolescents and adults might also want to peruse the findings from the  National Survey on Drug Use and Health, an annual source of estimates on drug and alcohol use (although some categories are defined differently than those used by the NIAAA) and mental health in the United States.

According to a brief summarizing 2013 NSDUH data from the Substance Abuse and Health Services Administration (SAMHSA), last year more than half of Americans 12-years-and-over (52.2 percent) reported currently using alcohol, with approximately 23 percent classified as binge drinkers (defined as 5 or more drinks in one occasion).  Just over 6 percent self-reported as heavy drinkers – 16.2 million adults and 293,000 12-to-17 year-olds.  However, the use of alcohol within the past month and binge drinking both decreased among the 12-to-17-year-old group compared to 2012 data, from 12.9 percent to 11.6 percent and 7.2 percent to 6.2 percent, respectively.

Regarding drug use, 9.4 percent of adults used illicit drugs in 2013 with marijuana (7.6 percent), non-medical use of prescription drugs (1.7 percent)  and cocaine (0.6 percent) as the top three drugs currently used. Among adolescents, 8.8 percent reported currently using drugs. Again, marijuana (7.1 percent) and non-medical use of prescriptions (2.2 percent) were the most popular currently used illicit substances,  followed by hallucinogens (0.6) and inhalants (0.5).

Some of the reasons for not receiving drug and/or alcohol treatment by those who attempted to secure it (based on 2010-2013 data) include

  • lack of health care coverage or inability to afford the cost – 37.3 percent,
  • not ready to stop usage – 24.5 percent,
  • unsure of where to find treatment – 9 percent, and
  • health coverage that did not include rehabilitation – 8.2 percent.

The brief Substance Use and Mental Health Estimates from the 2013 National Survey in Drug Use and Health: Overview of Findings also contains data on the prevalence of mental and behavioral health issues among both adults and adolescents, including co-occurring mental health and substance abuse disorders.



Citation: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (September 4, 2014). The NSDUH Report: Substance Use and Mental Health Estimates from the
2013 National Survey on Drug Use and Health: Overview of Findings. Rockville, MD.

Photo Credit: M. Puzzanchera (Own Work) (CC By-NC-ND 3.0)