Government Services

TTi thrives on multidisciplinary collaborations. In addition to our successes in the commercial market, we have successfully executed a wide range of scientific solutions in federal and state markets.

In 2015, TTi was awarded the Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion’s (NCCDPHP) Technical and Management Support for Health Promotion (TAMS) Indefinite Delivery, Indefinite Quantity (IDIQ) Contract, designed to provide CDC with focused, high-priority evaluation, research and technical assistance activities in support of NCCDPHP.

As part of this 5-year, approximately $61 million contract which offered our government client a simplified procurement process, TTi undertook research and evaluation studies to help improve the health and well-being of individuals, families, and communities; and has provided CDC/NCCDPHP with a variety of support services, including technical assistance, health education activities, assessments, demonstration projects, studies, and research activities.

TTi was under contract with CDC to conduct qualitative research and implement a pilot study to inform development of a national survey/study to address women’s health issues in immigrant and refugee populations, including the prevalence of FGM/C. TTi was responsible for building rapport and balancing the needs of various stakeholders including CDC, NORC, and community members. Refugee communities in the US are a highly sensitive, unique, and hidden population, notoriously difficult to gain access to for research purposes due to barriers including trust, language, customs, and gender-specific roles. TTi worked comprehensively with FGM/C survivors to coordinate a one-week site visit for data collection. TTi was responsible for leading the study design and protocol, including formal literature reviews, key informant interviews, preparation of a technical briefing document and presentation of current findings, as well as a study plan for a pilot study.

Working with the FGM/C survivors, experts eased access into the community by representing commonalities, encouraging trust, ensuring confidentiality, and providing understanding which paved the way for future work. TTi collected the data required through a variety of techniques including phone focus groups and observational studies, and was able to meet the deliverables in a timely manner. Continuing the work, TTi finalized conceptual framework to understand how attitudes and intention for FGM/C moves to behavior, in addition to developing a questionnaire on U.S. immigrant and refugee women’s health. TTi then worked with CDC on the OMB/IRB package and implementation of the pilot study. The formative work was accepted for presentation at two national conferences in 2017.

TTi assisted the Prevention Research Center’s (PRC) qualitative evaluation, which is intended to assist CDC in understanding the challenges, successes and impact of the PRC programs in advancing chronic disease research and prevention. Many of the PRC’s focus was on supporting efforts to treat CVD, and working with communities with a high rate of smoking, and/or obesity. TTi was contracted to conduct a qualitative evaluation, including in-depth interviews with staff from each of the 26 PRCs. Activities included development of the interview guide, development of a statistical analysis plan, scheduling and conduct of interviews with 26 sites in a one month period, qualitative data analysis and development of a final report that will be distributed to key stakeholders. TTi received first-hand experience with many of the health equity challenges associated with addressing lifestyle choices – such as food choice and tobacco use. The TTi Team also managed multiple stakeholders throughout the project duration. TTi brought value to the client by providing CDC with a senior team, highly dedicated to the project; this allowed our team to be more flexible in accommodating PRC schedules to maintain the project timeline.

TTi was contracted by the National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) of the Centers for Disease Control and Prevention (CDC) to update and expand an existing Chronic Kidney Disease (CKD) cost-effectiveness model in order to evaluate the cost-effectiveness of blood pressure targets for CKD patient. Our team completed the following phases of work:

• Evaluative literature reviews of CKD progression and of hypertension treatment in CKD and non-CKD populations [in both, individuals with diabetes form an important subgroup;
• Deconstruction of the existing CKD disease model (developed in TreeAge as a discrete event simulation) and documentation of model strengths, weaknesses, and areas for future improvement;
• CKD disease model updates to include the latest published data regarding CKD progression; implementation of a hypertension complications module and hypertension treatment protocol within the existing CKD disease model; and internal validation of the updated model.

TTi finalized the external and internal validation protocol as the final step prior to conducting the cost-effectiveness analysis, convening an expert panel to review the model and modeled findings, and preparing a manuscript for journal publication. As a part of its contract with CDC, TTi also generated detailed administrative reports, and creating summary and monthly reports that provided details on current tasks and their percentage of completion, problems encountered, and resolution.

TTi worked with CDC’s Division of Heart Disease and Stroke Prevention (DHDSP) to develop and conduct an evaluation of an intervention designed to promote health equity and reduce disparities in congestive heart failure treatment and outcomes. In this 2-year project, TTi developed a quasi-experimental mixed-methods design to evaluate the Grady Heart Failure Program at Grady Memorial Hospital in Atlanta, GA. The evaluation included development and implementation of measures indicative of barriers to health equity for program participants; collection of clinical and health equity data from program participants; development and implementation of a qualitative evaluation component including interviews with program staff and participants; and collection of billing data to examine cost savings realized by the program, based on hospitalizations prevented. A quasi-experimental design was necessary because patients could not ethically be randomized to treatment outside of the Program if they were eligible. TTi designed, implemented, and completed a pre-post longitudinal design in which patients served as their own controls through comparison of patient electronic medical record information on hospitalizations before and after they initiated participation in the program. Results developed by TTi formed the basis for multiple deliverables to DHDSP, including a briefing document, a program description, an implementation guide for sites interested in starting a similar program, an evaluation report including results of both quantitative and qualitative measures, multiple conference abstracts and presentations, and a draft manuscript for publication.

In an 18-month project, TTi worked with CDC’s Division of Heart Disease and Stroke Prevention (DHDSP) to complete evaluations of three separate programs, distributed across the U.S., that focused on changing lifestyle behaviors (particularly diet and exercise) as a means of reducing hypertension. An experimental design was not possible because the programs were fully implemented and interested participants could not ethically be randomized to no intervention. Instead, TTi designed and implemented a pre-post observational design in which measures of hypertension, other biomarkers related to cardiovascular health, and behavioral measures were compared from baseline to existing follow-up time points within each program. In addition to these quantitative participant outcomes, the evaluations included qualitative interviews with program staff and assessment of direct program costs for implementation and replication. Deliverables to DHDSP included both site-specific evaluation reports with quantitative and qualitative results, as well as a synthesis report incorporating results, conclusions, and lessons learned across all sites.

Georgia Study to Explore Early Development (SEED) is a national study to identify risk factors for autism spectrum disorder (ASD) and other developmental disabilities (DD). The Georgia SEED team is one of six sites that form the Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) network, which are regional centers of excellence for ASD and DD across the United States. The primary goal of the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) is to estimate the prevalence of ASD and DD in the Atlanta area. The program serves as the model for the larger Autism and Developmental Disability Monitoring (ADDM) Network and is now one of eleven sites across the United States.

TTi supports the Georgia SEED program to further identify risk factors and understand potential exposures and associated outcomes for ASD/DD through the implementation of a prospective cohort study. TTi was awarded the work in November 2017 and is currently collaborating with experienced nurse researchers, and public health professionals with deep experience in the study and clinical treatment of developmental disabilities, public health surveillance, and implementing prospective observational studies. A hallmark of our team is a centralized day-to-day point of contact for staff to improve the regular communication and management of the program and staff. Our experience proves that program staff retention and quality work depend heavily on a well-managed and communicative team.

TTi also helps support the operations of the MADDSP program, including operational activities required to support an active surveillance system. These activities include data abstraction, assessment services, task coordination, and program support. Active surveillance is critical to estimating the prevalence of ASD and other characteristics among children. Maintenance of an ASD/DD surveillance system is a complex enterprise that requires careful planning and ongoing field testing of its components to ensure optimal functioning. Screening and abstraction requires dedicated staff trained in the methodology and mindful that (a) each individual only appears once in the database, (b) interpret and determine the clinical severity of the case, such as low IQ to estimate the ASD burden, and (c) provide the necessary information for education, research, and program planning.

An additional part of our technical and project management work includes a systematized quality assurance methodology that will incorporate the standards established by the ADDM Network. We conduct quality assurance activities in the field (i.e., schools). Our team will negotiate and ease this process by furthering rapport and individual relationships between field staff and the abstractors and have managed the data abstraction and interpretation process.

Incumbent staff retention and new staff additions to bolster and support ongoing SEED and MADDSP efforts and minimize any potential disruption due to contract transition has been a critical success. Our team has provided the Birth Defects Center with rapid and successful staff transitioning during contract transitions, including several for CDC projects. Transitioning from the previous incumbent, TTi successfully brought on board six Autism Assessment specialists in under a month.

TTi was contracted by The Center for Tobacco Prevention and Control (CTPC) within the Maryland Department of Health and Mental Hygiene (DHMH) to perform focus groups and other qualitative research with youth tobacco users ages 13-17, to evaluate their needs, receptivity, perceived barriers, and challenges regarding tobacco use cessation to prevent future CVD events and co-morbidities. TTi lead the efforts on the evaluation and data collection support. TTi helped DHMD/CTPC develop knowledge that will enhance effective promotion and service provision of the Maryland Tobacco Quitline among youth. Tasks included establishing a project timeline, preparing discussion points for a kickoff meeting, preparing and assembling application and documents for DHMH IRB approval, focus group recruitment post-IRB approval, conduct the focus groups, and report on the focus group findings through data collection and analyses. Recruitment of adolescents who use tobacco products required careful, deliberative rapport building, along with constant engagement for focus group retention. TTi completed the final report, which included a summary of findings, conclusions, and recommendations across all sessions. This report included project background and methodology for designing the evaluation, participant feedback, summaries and analyses of key themes across all initial recruitment efforts, including brief survey questionnaires, all focus group sessions, with final recommendations and final transcripts.