The organization of the remainder of this report is:
Chapter 2 presents the Pathways to Healthcare evaluation’s conceptual framework and research questions; details the evaluation design; describes the study sample; and summarizes the evaluation’s data sources.
Chapter 3 describes the Pathways to Healthcare program’s context and administrative structure.
Chapter 4 describes the implementation study findings, including training programs and
instructional approaches, participation in training and comparisons of participation in education and training across the treatment and control groups, academic and nonacademic advising, employment supports, and financial assistance provided by the program.
Chapter 5 presents the impact study findings, focusing on two main impacts—hours of training, and credentials received over an 18-month follow-up period—as well as a series of other career and life outcomes.
Chapter 6 summarizes the implementation and impact findings and discusses their implications for the longer-term study.
The appendices provide additional details about the programs in the Pathways to Healthcare program (Appendix A); baseline data (Appendix B); college records data, a key source for the impact study Appendix C); survey-based outcomes (Appendix D); and the approach to outliers (Appendix E).
Abt Associates 2. PACE Evaluation Design and Data Sources ▌pg. 7
PACE Evaluation Design and Data Sources 2.
This chapter describes the larger PACE evaluation design and its application to Pathways to Healthcare.
It begins with a discussion of the PACE career pathways theory of change and the research questions that the theory of change implies. It then briefly describes the evaluation design and analysis procedures for the impact study, including the random assignment process and the outcome of that process. A brief description of the implementation study analysis follows.16 Finally, the chapter summarizes the main data sources for the implementation and impact studies.
2.1. Career Pathways Theory of Change
The career pathways theory of change guides both the implementation study (that is, it identifies which aspects of program services are expected to affect outcomes) and the impact study (that is, it identifies which outcomes the program is expected to affect). The theory of change also generates key hypotheses about the direction of expected effects that the impact evaluation will test for statistically significant change.17 In addition, the theory of change implicitly assumes time horizons by which the program is expected to have effects, and thus the theory determines the key outcomes at any particular time of follow-up.
Exhibit 2-1 depicts the PACE career pathways theory of change, as applied to Pathways to Healthcare.18 It shows how a program (inputs) is hypothesized to produce effects on intermediate outcomes, which in turn will lead to effects on main outcomes. Effects on intermediate outcomes are expected earlier than effects on main outcomes, but the exact timing depends on particular features of the program, such as the length of occupational training and what, if any, steps precede it. In addition, because effects on intermediate outcomes may persist over time, the study will also measure them at later points in time.
16 The research team developed a detailed evaluation design report for the PACE evaluation, including the evaluation of Pathways to Healthcare (Abt Associates, Inc. 2014).
17 The implementation study describes the set of services that students in the treatment group experienced. In addition to descriptive statistics, it includes a small number of impact estimates that show the difference in services received between treatment and control group members. The impact study focuses solely on estimates of the effects of the program on intermediate and main outcomes.
18 See Fein (2012) for an extended description of the framework.
Exhibit 2-1. Career Pathways Theory of Change
Abt Associates 2. PACE Evaluation Design and Data Sources ▌pg. 9 As shown in Exhibit 2-1, starting in the box at the left, the career pathways theory of change begins with two types of program inputs19:
Organization. Organizational inputs include the lead agencies (PCC and PCOS, in the case of Pathways to Healthcare), funding (HPOG), staff (HPOG-funded instructors, advisors), physical resources (PCC’s Center for Training and Development (CTD), which housed most of the occupational training programs), and the management structure.
Participants. This individual input includes the characteristics of the target population (being a low-income resident of Pima County and having an interest in a healthcare career, in the case of Pathways to Healthcare).
This same box includes four kinds of program components that are expected to improve participant outcomes by overcoming specific barriers that are hypothesized to impede successful entry into and completion of occupational training:
Assessment. Pathways to Healthcare used the TABE to determine whether a participant would be required to participate in one of the bridge programs designed to improve basic skills.
Instruction. For Pathways to Healthcare, these comprise the five pathways of 16 programs and the two bridge programs. Importantly, control group members could access the same
16 occupational training courses that treatment group members could, so any of the particular features of these courses do not differentiate the experiences of the two groups.
Supports. For Pathways to Healthcare, these were career and academic advising, advising on personal issues, and financial assistance in the form of scholarships.
Employment. For Pathways to Healthcare, these employment connections included workshops and networking opportunities for the study’s treatment group members.
The middle box shows the intermediate outcomes, where improvements are expected to lead to better main outcomes. These intermediate outcomes include improved basic skills for participants who need remediation and improved psycho-social skills such as grit and academic self-confidence; attainment of occupational-specific skills for those who enroll in one of the five healthcare pathways; career
knowledge and college success skills; and reduced financial hardship.
In the far right box, the main outcomes are the primary targets that programs seek to change. These include:
Increased postsecondary attainment, namely accumulated hours and credits (as measures of progress toward a credential), occupational training credentials, and engagement in the next step of the pathway.
19 Program inputs can include both components available only to treatment group members as well as those available to both treatment and control group members, because the interaction of the former components with the latter can lead to impacts.
Successful employment, including obtaining employment in the healthcare industry, increasing earnings and job benefits, and career advancement.
Improvements in other outcomes such as individual well-being.
Influencing expected effects are a number of contextual factors including the types and number of postsecondary training systems in the local area, the local economy (in particular healthcare jobs), and other community factors such as the size and characteristics of the target population, and the number and nature of service providers.