Study Details | Pathways to Work

28666-Health Profession Op

Study quality: High

High

Reason for the rating: This study received a high study quality rating because it is a randomized controlled trial with low attrition, suggesting the findings can be attributed to the program.

Program: Health Profession Opportunity Grants (HPOG) 2.0

Characteristics of study participants:

At least a high school diploma or equivalent, Cash assistance recipients

Services provided:

Basic skills/bridge programs, Case management, Employment coaching, Integrated education and training, Job development, Job placement, Job search assistance, Occupational or sectoral training, On-the-job training, Tuition assistance/financial aid

Setting: Tested in multiple settings

Methods and Standards Protocol version used for review: Version 1.0

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Study design

Design:

Randomized controlled trial

Study group formation:

To be eligible for HPOG 2.0, people had to be participating in the Temporary Assistance to Needy Families (TANF) program or otherwise meet locally defined criteria for having low income. Programs had significant discretion when establishing these local definitions and other eligibility criteria, and each submitted descriptions of their recruitment, referral, and eligibility processes to ACF. Programs randomly assigned eligible applicants to the program and comparison groups using a lottery-like process. When the study began, two people were assigned to the program group for every one person assigned to the comparison group. In December 2020, this ratio changed to three program group members to one comparison group member, in response to recruitment and service provision difficulties posed by the COVID-19 pandemic. The new ratio remained in effect through the end of the grant period in September 2021. This study review focuses on findings for three cohorts: full pre-survey, early pre-survey, and survey. The full pre-survey cohort includes all study members randomized from February 2016 to February 2017, with 10,132 participants total. The early pre-survey cohort includes all study members randomized from February 2016 to June 2016, with 2,878 participants total. All outcomes for the full and early pre-survey cohorts are drawn from administrative data, which is available through 10 quarters post-randomization for the full cohort and through 13 quarters for the early cohort. The survey cohort includes all study members randomized from March 2017 to February 2018, with 12,964 participants total. Survey and administrative data are available through five quarters post-randomization for this cohort. The full pre-survey and survey cohorts are pooled into one sample. The study also includes education and training outcomes that are only available for the pre-survey cohort. A fourth cohort (post-survey) is expected to be included in future manuscripts.

Time period of study:

The program was launched in 2016 (at the beginning of the pre-survey cohort random assignment) and was rolled out from 2016 to 2021. Only people randomly assigned from 2016 to the beginning of 2018 are considered in this review. The follow-up period was 2.5 years from random assignment. For the pre-survey cohort, follow-up was through 10 quarters; for the survey cohort, follow-up was through 5 quarters.

Primary outcome domains examined:

Increase short-term earnings, Increase long-term earnings, Increase short-term employment, Increase long-term employment, Increase education and training

Other outcome domains examined:

Starting training, basic skills education and course-taking, use of cognitive skills and self-directed learning, receipt of support services, cost to participant, educational progress, health care labor market outcomes, precursors of career success, well-being, and participant satisfaction

Study funded by:

ACF, U.S. Department of Health and Human Services

Results

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Outcome domain	Measure	Timing	Study quality by finding	Comparison group mean	Program group mean	Impact	Units	Sample size
Increase short-term earnings	Total earnings over follow-up period	Quarters 1–6	High	23,364.00	22,915.00	-449.00	2018 dollars	22,443
Increase long-term earnings	Total earnings over follow-up period	Quarters 1–13	High	51,096.00	51,650.00	554.00	2018 dollars	2,798
Increase short-term employment	Cumulative number of quarters employed	Quarter 6	High	5.10	5.00	-0.10	Quarters	22,443
Increase short-term employment	Currently employed	Quarter 6	High	75.70	75.90	0.20	Percentage points	22,443
Increase long-term employment	Cumulative number of quarters employed	Quarter 13	High	10.00	9.90	-0.10	Quarters	2,798
Increase long-term employment	Currently employed	Quarter 13	High	74.90	72.90	-2.00	Percentage points	2,798
Increase education and training	Received a college credential	Quarter 10	High	11.80	13.70	1.90	Percentage points	10,117

Short-term outcomes are those measured 18 months or fewer after participants are first offered services. Long-term outcomes are those measured between 18 months and 5 years after participants are first offered services. Very long-term outcomes are those measured 5 years or more after participants are first offered services.

Means are not displayed when not reported or not aligned with the impact estimates. For example, if the impact estimate is regression-adjusted but only unadjusted means are reported in the study, the unadjusted means are not displayed as they are not aligned with the adjusted impact estimate.

Impact estimates are not shown when the estimate units cannot be converted to natural units.

Findings quality key:

High
Moderate

Study quality terms?

The findings quality describe our confidence that a given study’s finding is because of the program. We do not display findings that rate low.

Findings key:

A moderate-to-large favorable finding that is unlikely to be due to chance
A moderate-to-large favorable finding that might to be due to chance
A small favorable finding that is unlikely to be due to chance
A small favorable finding that might be due to chance
A favorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
A favorable finding that might be due to chance, but we cannot determine the standardized effect size
A moderate-to-large unfavorable finding that is unlikely to be due to chance
A moderate-to-large unfavorable finding that might to be due to chance
A small unfavorable finding that is unlikely to be due to chance
A small unfavorable finding that might be due to chance
An unfavorable finding that is unlikely to be due to chance, but we cannot determine the standardized effect size
An unfavorable finding that might be due to chance, but we cannot determine the standardized effect size
A finding that is unlikely to be due to chance, but we cannot determine the standardized effect size or direction
A finding of no effect that might be due to chance

Favorable findings are impacts in a direction that is socially desirable. Statistical significance indicates the likelihood that a study finding is due to the program, rather than due to chance. Findings are described as moderate-to-large if the program produced a sufficiently large change in the outcome. An impact receives this designation if the standardized effect size is equal to or greater than 0.25 or equal to or less than -0.25.

Sample characteristics

A majority (91 percent) of the sample was female. Forty-seven percent were Black or African American, not Hispanic; twenty-three percent were Hispanic or Latino of any race; and twenty-four percent were White, not Hispanic. The average age was 32. The majority (62 percent) of the sample had dependent children. At baseline, more than 60 percent of participants were receiving the Supplemental Nutrition Assistance Program and/or Medicaid, and more than 20 percent were receiving Temporary Assistance for Needy Families and/or the Special Supplemental Nutrition Program for Women, Infants, and Children.

Age

Mean age	32 years
Young adults (age 16-24)	28%
Adults (age 25+)	72%

Sex

Female	91%
Male	9%

Race and ethnicity

Black or African American	48%
White, not Hispanic	23%
Hispanic or Latino of any race	23%
American Indian or Alaska Native	3%
Unknown, not reported, or other	4%

The race and ethnicity categories may sum to more than 100 percent if the authors reported race and ethnicity separately; in these cases, we report the category White, rather than White, not Hispanic.

Family status

Married	16%
Parents	62%

Employment and public benefit status

Were employed	45%
Were unemployed	55%
Public benefits recipients	22%
Had low incomes	100%
Cash assistance recipients	83%

Education

Had some postsecondary education	54%
Had a high school diploma or GED	90%
Did not have a high school diploma or GED	10%
Postsecondary credential	15%
English learners	7%

Specific employment barriers

Had a disability	9%
Were immigrants	16%
Were military veterans	3%

Program implementation

Implementing organization:

HPOG 2.0 grantees included community colleges, community-based organziations, workforce system agencies (such as workforce investment boards and one-stop career centers), and other state agencies (including state Departments of Social Services).

Program history:

HPOG 2.0 was the second round of grant awards for the HPOG Program. The Office of Family Assistance (OFA) of ACF, in the U.S. Department of Health and Human Services, issued the first round of grant funding (HPOG 1.0) in 2010. HPOG 2.0 began in 2015.

Program services:

HPOG 2.0 was an employment and training program that aimed to prepare participants for careers in health care occupations that paid well and were expected to experience labor shortages or increased demand. The program drew on a career pathways framework with three core components: basic skills training, health care occupational training, and wraparound supports and services. Local HPOG 2.0 programs varied in how they implemented the career pathways framework. Most programs did not develop or provide HPOG-specific training courses. Rather, programs provided navigation services to facilitate participant enrollment in existing job training courses, education programs, and other services. Clients received combinations of basic skills training, education, training, work-based learning opportunities, and assistance connecting to employment. Local HPOG 2.0 programs also offered or connected participants to an array of additional services, including case management, academic supports (for example, financial aid counseling or tutoring), personal supports (for example, assistance connecting to or paying for child care), employment assistance, and other skills development activities.

Mandatory services:

None

Comparison services:

People assigned to the comparison group did not have access to the HPOG programs but had access to education, training, and services available in the community. In some cases, comparison group members could enroll in the same courses as program group members if the courses were already taught at local community colleges.

Service receipt duration:

The manuscripts reviewed for this study review did not specify an intended duration for the HPOG 2.0 program. At 15 months after randomization, the program group had completed 5.7 months of training, on average, and 40.6 percent had completed at least 60 months of training.

Program funding:

The Office of Family Assistance of ACF, in the U.S. Department of Health and Human Services, funded HPOG 2.0.

Study publications

Klerman, Jacob Alex, David Ross Judkins, Sarah Prenovitz, and Gretchen Locke (2022). Health Profession Opportunity Grants (HPOG 2.0) short-term impact report, OPRE Report #2022-37, Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. Available at https://www.acf.hhs.gov/sites/default/files/documents/opre/hpog2-stir-feb2022_0.pdf

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Study of Health Profession Opportunity Grants (HPOG) 2.0