Using CANS Data to Drive Team Process and Treatment Planning

1. Using CANS Data to Drive Team Process and Treatment Planning Representatives of the Maryland Treatment Foster Care Learning Collaborative Paul Brylske Chris Kelly Shannon Jones Nelson Johnson Neil Mallon

2. Objectives • Understand issues and lessons learned in the clinical implementation of the CANS in Treatment Foster Care • Take away at least one useful practice that can be applied in your program • Help us better utilize the CANS in the delivery of Treatment Foster

3. Presentation Outline • Introduction • Background • Implementation • Panel presentation • Staff • Youth • Treatment Parent • Discussion and Questions

4. Maryland and CANS • Legislated Outcomes and CANS • Initial Implementation July 2008 • TFC – July 2009 • Local DSS – July 2011 • Currently limited discussion at the service level

5. KIDnet Data System • Children Outcome Management System (COMC) www.comc.umaryland.edu • Devoted to improving quality of behavioral health treatment for children and adolescents through outcomes evaluation • Through integrating outcomes evaluation into clinical and administrative decision-making enables programs to understand and apply an evidenced based approach to goal attainment and quality improvement

6. KIDnet DATA • Demographic & Diagnostic Information • Youth, Parent, and Teacher input • Therapeutic Alliance • Family Apgar, Family Adaptation • Burden/Contribution • Risk Scale • CANS –Over time • Treatment Plan – Tracking progress over time • Treatment notes • Contact notes

7. Treatment Foster Care … is a family-based service delivery approach providing individualized treatment for children, youth and their families. Treatment is delivered through an integrated constellation of services with key interventions and supports provided by treatment parents, who are trained, supervised and supported by qualified program staff. FFTA Standards

8. MD TFC Learning Collaborative • Forged around a commitment to outcomes management - Maryland TFC Coalition • Belief that outcomes can guide and inform client, program and system level effectiveness • July 2009 five private Treatment Foster Care providers in partnership with the University Maryland’s Children’s Outcome Management Center (COMC), to use data for program and practice improvement “learning collaborative” • Use of KIDnet and CANS

9. MD TFC Learning Collaborative • Baptist Family and Children Services • Center for Family Services • Kennedy Krieger Institute • Kennedy Krieger Family Center • Progressive Life Center • Williams Life Center

10. MDTFC Best Practice Implementation • Initial implementation: Champions; User Groups; Creating buy-in with Leadership; and Development of Training for TFC parents on the CANS and KIDnet tools---created a remarkable culture shift in many organizations • Full Implementation: Webinars and use of the priority and consensus matrix became critical in creating sustainable buy-in; Tracking compliance • MDTFCLC is currently in the innovation stage---making fidelity adaptations and examining data for client and program level improvement opportunities

11. Implementation: The Bear Den Challenge

12. Buy-in and Resistance to Change • Buy-in at the “Top” • Support of mid level managers/supervisors • Commitment of Resources • Resistance is positive • How do you address it is critical • Recognition of: • Significant change in program culture “new paradigm • Tools seen as impersonal • Loss of autonomy • Creation of dissension

13. TFC -Team Process & Treatment Planning • Core team – Clinical social worker, treatment parent, youth and family • Initial treatment plan and quarterly updates • Treatment goals based on “actionable items” • Regular meetings in the home with treatment parents and youth • “Extended” team • Local department of social service • School • Outpatient treatment

14. How do we use the CANS most effectively and efficiently in the delivery of treatment foster care?

15. TFC Team Presentation • Nelson Johnson - Youth • Shannon Jones – Treatment Parent • Neil Mallon – TFC Staff

16. Implementation • “Out with the old” • Significant change in program culture “new paradigm” • Tools seen as impersonal • Loss of autonomy • Creation of dissension • “In with the new” • Why do we think it works?

17. Nelson’s CANS Scores Over Time

18. Life Domain Functioning • Family Relationships • Living Situation • Social Functioning • Recreational • Developmental • Job Functioning • Legal Issues • Medical Needs • Physical Limitations • Sexual Development • Sleep • School Behavior • School Achievement • School Attendance

19. Life Domain Functioning

20. Risk Behavior • Suicide Risk • Self-Mutilation • Other Self Harm • Danger to Others • Aggression • Runaway • Delinquency • Judgment • Fire Setting • Social Behavior

21. Risk Behavior

22. Caregiver Needs & Strengths Needs • Physical • Mental Health • Substance Abuse • Developmental • Safety Strengths • Supervision • Involvement • Knowledge • Organization • Social Resources • Residential Stability

23. Caregiver Needs & Strengths

24. KID Net ScalesYouth and Parent Input Forms Family APGAR (Adaptability, Partnership, Growth, Affection and Resolve)

25. KID Net ScalesYouth and Parent Input Forms Burden and Contribution

26. Lessons Learned - Youth • Need to build relationship first • Individual understanding is needed, “what is it” “what is being used for” “who will see it” “how are you coming up with those stats” • Use can increase trust • Transparency “everyone knows what I know” • Can see progress • Increases communication • Helps you to “open up”

27. Lessons Learned – Treatment Parent • Training helps • Increases communication and information (especially at placement) • Quantity • Quality • Old parents vs new parents “its part of the job” • Minimizes effect of turnover of staff

28. Lessons Learned -Staff • Seasoned staff vs new staff “its part of the job” • Limits “triangulation” • Training essential • Useful tool in relationship building • Creates “context” for treatment • Supports essential relationships • Staff & treatment parent • Youth & treatment parent • Staff & youth

29. Lessons Learned – Program • Initial buy-in at administrative level essential • Need to continued Administrative buy-in and leadership • Use of “purveyor group” (TFC Collaborative) • Internal structure to train, coach, support, communicate problems, hold accountable • Use and support of champions • University partnership has been crucial • Regular Webinars have been critical • Accountability and continued quality assurance • Continued need to adapt and innovate

30. Next Steps • Develop “cheat sheets” for youth and “extended” team members • Continue training and retraining • Integration with Local DSS case planning and Maryland’s Family Center Practice Model • Integration with TFC Program models • Continue to support staff • Continue to support supervisors • Develop best practices which is adapted based on age, developmental level, and needs of youth

31. Towards Best Practice • CANS at referral and intake • Continue training for staff and treatment parents • Education of youth’s family and “extended team” (cheat sheet) • Use as a tool in the engagement of treatment parent, youth, others • Use to develop communication and relationships • Staff & Treatment Parent • Staff & Youth • Treatment parent & youth

32. Towards Best Practice • Use in service and treatment planning – development of goals • Use to measure progress in meeting goals and barriers • Use in supervision, case consultations and presentations • Explore use of mobile access • Integration with Maryland’s Family Centered Practice Model • Continue TFC Collaborative ( University partnership & webinars) and the CANS “community”

33. Discussion and Questions