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Evaluating the Impact of an Interconnected Systems Framework

Evaluating the Impact of an Interconnected Systems Framework. Kelly L. Perales, LCSW. About Community Care. Behavioral health managed care company founded in 1996; part of UPMC and headquartered in Pittsburgh Federally tax exempt non-profit 501(c)(3)

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Evaluating the Impact of an Interconnected Systems Framework

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  1. Evaluating the Impact of an Interconnected Systems Framework Kelly L. Perales, LCSW

  2. About Community Care • Behavioral health managed care company founded in 1996; part of UPMC and headquartered in Pittsburgh • Federally tax exempt non-profit 501(c)(3) • Major focus is publicly-funded behavioral health care services; currently doing business in PA and NY • Licensed as a Risk-Assuming PPO in PA; NCQA- Accredited Quality and Disease Management Programs • Serving over 750,000 individuals receiving Medical Assistance in 39 counties through a statewide network of over 1,800 providers

  3. HealthChoices Regions Served Erie Warren Susquehanna McKean Potter Tioga Bradford Crawford Wayne Forest Wyoming Cameron Sullivan Lackawanna Pike Venango Elk Lycoming Pike Mercer Clinton Jefferson Luzerne Clarion Columbia Monroe Lawrence Montour Clearfield Centre Union Butler Carbon Armstrong Northumberland Snyder Northampton Beaver Mifflin Schuylkill Lehigh Indiana Juniata Allegheny Blair Berks Perry Dauphin Bucks Cambria Lebanon Huntingdon Westmoreland Montgomery Washington Cumberland Lancaster Bedford Fayette Chester Somerset Franklin York Philadelphia Greene Fulton Adams Delaware Southwest Region Southeast Region North Central Region: County North Central Region: County North Central Region: County Lehigh-Capital Region Northeast Region North Central Region: County North Central Region: State Community Care Office

  4. CSBBH • Community and School Based Behavioral Health (CSBBH) • Families • Advocates • Providers • Schools • Other Child Serving Systems • Counties • Office of Mental Health and Substance Abuse Services (OMHSAS)

  5. CSBBH • 35 teams from 12 provider organizations • 58 school buildings in 21 school districts • 12 counties • 1000+ youth and families

  6. Stakeholder-Reported Outcomes • Gathering and reporting can improve care • Evaluation activities integrated into care • Desire for connection among families, schools, and community-based services & resources to aid youth • Routine tracking of progress can improve outcomes • Stakeholder-reported outcomes to improve care • Clinicians can make more informed adjustments to treatment plans • When discussed with stakeholders, engages & empowers

  7. Consumer-Reported Outcomes • Gathering and reporting can improve care • Challenges exist: • Burden to collection, scoring, and having information available to discuss in sessions • Community Care as a resource to support providers and schools in developing brief process to gather and use outcomes

  8. Collaboration with Multiple Sources • School administrators, staff, teachers • Providers • Parents/caregivers • Youth

  9. Functional and Behavioral Outcomes • Collaborative process with provider, teacher, and family input • Goal to measure progress in treatment and enhance therapy • Useful across children with multiple diagnoses and different ages • Brief enough to be completed and scored by busy clinicians and families • Sensitive to change, allowing scores to document improvement as child improves during treatment course • Strength based where possible • Can be used to facilitate conversations between families and clinicians

  10. Collection of Outcomes • Purpose to gather feedback from caregivers about how they feel treatment is going • Graph of results are available immediately via the secure Web portal: • http://secure.ccbh.com • Results of the survey are discussed with caregivers • Clinicians use feedback to help establish strength-based, appropriate treatment goals

  11. Children Served by CSBBH • 2009-present • 1,801 students • Majority are boys (71.4%) • 15.7% are Hispanic • 69.6% white, 14.2% black or African American, 0.2% Asian, and 15.6% other • Ages range from 4 to 19 years old, with a mean age of 9.5 years

  12. SDQ • The Strengths and Difficulties Questionnaire (SDQ) measures caregiver, teacher, and youth report of child behavior (Goodman 1997) • The SDQ contains four sub-scales for difficulties: 1) emotional symptoms, 2) hyperactivity, 3) peer problems, and 4) conduct problems • A summation of the four difficulties scales is made to compute Total Difficulties Score • One strength-based sub-scale – pro-social behaviors • The SDQ is completed every three months; the SDQY is completed by youth ages 14 and older

  13. SDQ-Parent • For SDQ information, 4 subscales are totaled for a Total Difficulties score. This score is graphed against an indicator for the 10th Percentile score (green line). Children with Total Difficulties scores 25 or higher are reporting substantially higher problem behaviors than other children

  14. SDQ • There was significant improvement in parent (p<.0001) and teacher (p<.0001) reported total difficulties scores over time • Parents have significantly higher (p<0.05) average ratings of difficulties and pro-social behaviors compared to teachers’ ratings

  15. Child Outcomes Survey • Family functioning • Shared decision making, supporting each other • Child functioning • Success in getting along with family, friends, doing well at school, completing household tasks • Overall wellness • Caregiver perception of therapeutic relationship • Feeling respected, working on important goals, well-suited approach, caregiver confidence

  16. Is the COS being used? • How much is the Child Outcomes Survey (COS) being discussed in sessions? • Asked parents on a 1-10 scale how much the Child Outcomes Survey results were discussed with clinician? • Examined what factors are associated with use of the COS results in sessions

  17. Discussion of COS • Most discussion with families of children who are doing better in treatment • Least discussion with families of children who are doing least well in treatment

  18. COS: Child and Family Functioning • There was a significant increase in family functioning over time (p<.0001) • There was a significant increase in child functioning over time (p<.0001)

  19. COS: Therapeutic Relationship • There was an overall significant improvement in therapeutic relationship over time (p=0.002)

  20. Monitoring Care: BH Service Utilization • This chart represents the service utilization for 726 children who used mental health services Pre-CSBBH (red bars) and During (blue bars) and the 475 children who did not use any services Pre-CSBBH (green bars)

  21. Monitoring Care: Pharmacy Data Diagnoses Medications

  22. Feedback from School Personnel • Average ratings 7.2-7.3 on scale of 1-10

  23. Standardized Assessment of Academic Performance

  24. Use of Outcomes is Promising • Clinicians appear to be able to administer outcome measures and use information in therapy sessions • Discussion of information from COS associated with better therapeutic relationships and improves child and family functioning • Standardized assessments aid in understanding functioning and performance • Continued efforts to facilitate sustainable inclusion of outcomes and quality improvement

  25. Scranton, PAHistory and Time Line • District and Community Leadership Team – established in 2009-10 school year • Transformation of mental health services for children/youth and families • Utilized PBIS Implementer’s Blueprint and Stages of Implementation (Fixen) • Began in two schools, after reviewing data indicating positive outcomes, then expansion

  26. Scranton, PA“Current Conditions” • Eleven Elementary Schools (K-5) • 2 implementing ISF at all three tiers • 4 implementing PBIS at tier one and have SMH • 4 implementing PBIS at tier one • 1 will be trained/kick off PBIS this year • Three Intermediate Schools (grades 6-8) • 3 implementing PBIS at tier one and has SMH • 3 beginning tier two • Two High Schools (grades 9-12) • 1 with SMH and previously implementing PBIS • 1 implementing PBIS at tier one and has SMH

  27. 2013-14 School Year • 22 licensed mental health professionals • 44 bachelor’s level behavioral health workers • Closure of center-based partial hospitalization program • Closure of five school-based partial hospitalization programs • ROI – less restrictive educational placements, return to home schools, less restrictive mental health placements, cost savings • Increased collaboration, communication – improved outcomes

  28. Child Outcomes Survey (COS) Family Functioning:

  29. Child Outcomes Survey (COS) Child Functioning:

  30. Child Outcomes Survey (COS) Therapeutic Alliance:

  31. Strengths and Difficulties Questionnaire Parent (SDQ-P) and Teacher (SDQ-T) Total Difficulties:

  32. ISF Comparison • Significant improvement over time for child and family functioning • For PBIS schools, higher report of family functioning than non PBIS schools • Therapeutic Alliance ratings were higher in the PBIS schools.

  33. Family Functioning

  34. Child Functioning

  35. Therapeutic Alliance

  36. Contact Kelly Perales | peraleskl@ccbh.com

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