Final Report: National Implementation Evaluation of the First Round Health Profession Opportunity Grants (HPOG 1.0)

The NIE is part of the Office of Planning, Research, and Evaluation’s (OPRE) multipronged research and evaluation strategy to assess the success of the HPOG Program. The NIE included the 27 non-tribal HPOG 1.0 grantees and had three major components: a Descriptive Implementation Study, a Systems Change Analysis, and an Outcome Study. Collectively, these three studies were designed to address the research questions listed above to describe the implementation of HPOG 1.0 grants, the associated systems changes, and the outputs and outcomes that occurred. Earlier reports—the NIE Descriptive Implementation and Outcome Studies and Systems Change Analysis—covered participant experiences, participant outcomes, and grantee program design and implementation over the first 3 to 4 years of HPOG 1.0 operation.

This report summarizes HPOG training and services offered to and received by participants during HPOG 1.0. It also describes the education, employment, and earnings outcomes for samples of participants at varying time periods after enrollment. Additionally, it provides a summary of findings from the NIE Descriptive Implementation and Outcome Studies and Systems Change Analysis.

Key findings from the report include:

• HPOG was successful in training high numbers of individuals in healthcare occupations. In just over 5 years of operation, HPOG 1.0 grantees served more than 36,000 individuals (well above the target of 31,000 participants) and engaged most of them in healthcare occupational training.
• Overall, employment and earnings continued to increase through 12 quarters following HPOG enrollment, with steeper increases in earlier quarters. Employment and earnings increased for all those who enrolled in training, but employment rates and earnings were higher for those who completed training than those who did not.
• Seventy-two percent of those employed after HPOG enrollment were employed in healthcare jobs. On average, those employed worked full-time, and those employed in healthcare jobs had higher hourly wages and better employment benefits than those who had jobs in other sectors.
• The demographic profile of HPOG participants did not vary much over the 5-year grant period. The majority of HPOG participants were female, from ethnic minority groups, never married, and parents.

The major research question for the NIE Outcome Study examines how HPOG participants fared in educational attainment and employment and earnings during and after program enrollment. The study measured education outcomes through course completions and credential attainment. The employment- and earnings-related measures include quarterly employment and earnings, hourly wage, and employee benefits.

For information on participation, outputs, and outcomes, the NIE Outcome Study relied on data primarily from the HPOG Program’s management information system, the Performance Reporting System (PRS), and on administrative data on quarterly employment and earnings from the National Directory of New Hires (NDNH). The NIE Outcome Study documented employment and earnings outcomes for HPOG participants, but did not address the question of whether HPOG caused increased employment and earnings for those individuals. The HPOG Impact Study addresses these questions in a separate report. A 15-month follow-up survey of HPOG participants provided information on participant experiences and aspirations.

Recommendations from the report include:

• Programs like HPOG may want to balance support of short- and long-term training. While the NIE findings show that those in longer-term training had better individual outcomes, programs could serve more low-income individuals in shorter-term training using the same level of grant expenditures. Such an approach may reach a less academically accomplished group with less work experience. (Note that although providing more short-term training may lead to serving more low-income workers, it does not by itself necessarily support career pathways or higher-wage jobs.) Many of those choosing the shorter-term training may have done so out of the need to obtain employment sooner rather than later.
• Given the study’s findings that those who completed longer-term training earned higher wages, programs like HPOG should support those in longer-term training while encouraging and creating incentives for those who complete shorter-term training to return to school and continue on a career pathway. One possible strategy is to increase outreach and recruitment for training of incumbent entry-level healthcare workers, whether HPOG graduates or others. Increasing support for incumbent workers through incentives to return to training and by developing more partnerships with healthcare employers could provide a stronger basis for more individuals to train for higher-paying jobs along their career pathways.
• Programs like HPOG could employ two strategies for program design and implementation in order to lower eligibility standards while increasing participation in healthcare training among academically underprepared individuals. One strategy would be to increase the degree to which programs integrate adult basic education with healthcare training. This approach—one prominent model of which is I-BEST (Integrated Basic Education and Skills Training)—has shown promising results in non-experimental studies and is currently being tested in an experiment as part of OPRE’s Pathways for Advancing Careers and Education (PACE) evaluation. A second strategy is to develop program structures that create a close connection or pipeline between basic skills instruction and occupational training.

Improving Economic Opportunity through Healthcare Training: Highlights from the National Implementation Evaluation of the First Round of the Health Profession Opportunity Grants (HPOG 1.0) (PDF)

Werner, Alan, Pamela Loprest, Deena Schwartz, Robin Koralek, and Nathan Sick (2018). Final Report: National Implementation Evaluation of the First Round Health Profession Opportunity Grants (HPOG 1.0), OPRE Report # 2018-09. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.