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Using Outcomes Data in Treatment Foster Care Program Planning

Using Outcomes Data in Treatment Foster Care Program Planning. FFTA’s 18 th Annual Conference on Treatment Foster Care July 18-21, 2004 Nashville, TN David J. Whelan, MSW Coordinator of Research and Quality Children’s Service Society of Wisconsin 223 Wisconsin Ave. Waukesha, WI 53186

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Using Outcomes Data in Treatment Foster Care Program Planning

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  1. Using Outcomes Data in Treatment Foster Care Program Planning FFTA’s 18th Annual Conference on Treatment Foster Care July 18-21, 2004 Nashville, TN David J. Whelan, MSW Coordinator of Research and Quality Children’s Service Society of Wisconsin 223 Wisconsin Ave. Waukesha, WI 53186 (262) 544-5333

  2. Workshop Agenda 1. Program Overview and Workshop Goals 2. Review Changes to our Program 3. Review Changes to our Outcomes Process 4. 2002 – 2003 Outcome Results 5. The Continuous Quality Improvement Worksheet 6. Moving Forward – what the future will bring

  3. Children’s Service Society of Wisconsin, is the only private, not-for-profit, non-sectarian, statewide child welfare agency in Wisconsin concerned exclusively with the needs of children. Children’s Service Society is over 100 years old and provides services through over 35 sites in Wisconsin communities. Children’s Service Society has a budget exceeding $21 million, and employs over 400 staff. AGENCY MISSION To build, sustain and enhance a nurturing environment for Wisconsin’s children. Children’ Service Society Treatment Foster Care Children's Service Society’s Treatment Foster Care Program serves more than 400 children annually out of 13 office locations across the state of Wisconsin. Our TFC Case Workers lead a treatment team that includes the TFC foster parents, the foster child’s parents, the child’s county social worker, and other treatment providers from the community. The TFC worker supports the TFC foster parent in their efforts to meet the child’s and the child’s family’s treatment needs. The TFC worker also advocates for the child in school, court, and with community providers. To help focus the treatment team on meeting the child’s need for a permanent placement, the first goal listed on all treatment plans is related to the youth’s permanency plan. © Children’s Hospital and Health System. All rights reserved.

  4. Program Demographics combined for 2002 and 2003 Number of Children in Care Year 2004 195 youth Year 2003 275 youth Year 2002 290 youth Average Age at Placement 11 years, 10 months Gender of Youth in Program Female 40.1% Male 59.9% Length of Stay Average 18.8 Months Median 10 Months Mode 7 Months Race of Youth in Program Caucasian 52.0% African American 33.7% Two or More Races 5.1% Asian 4.2% Native American 2.4% Hispanic 2.2% Other 0.4% © Children’s Hospital and Health System. All rights reserved.

  5. Workshop Goals • Describe how Children’s Service Society of Wisconsin has used TFC outcomes data in our Program Planning Process. • To simplify the discussion on tracking outcomes data and using outcomes information in an effort to encourage more agencies to do the same. • To support FFTA’s efforts to Benchmark TFC outcomes for member agencies. • To increase the number of positive outcomes - youth who find safety, stability, permanency and/or improved functioning at the end of our service.

  6. Three Levels of Measurement for Programs • Outcomes Measurement – on-going tracking of the status of the client during and/or at the end of service • Program Evaluation – One time in-depth study of a program’s stated goals, the program’s activities and the program’s outcomes. The evaluation attempts to understand if the activities lead to intended program outcomes • Research – One time controlled attempt to determine if an activity causes an outcome

  7. Program Changes We Have Made Due to Our Outcomes Data • !! First a note of caution, all the changes discussed were also influenced through the following events, processes, organizations or people • COA • The Federal Review of the State of Wisconsin Public Child Welfare Services • Creative TFC Supervisors • Quality Improvement Data • Client Satisfaction Survey Results • Incident Reports Tracking • Case Record Review • The Usual Program Planning Process

  8. Program Changes We Have Made Due to Our Outcomes Data 1) The outcomes data changed our perception of our program. We went from thinking we might be a “little better,” to knowing we have similar success rates as two other respected programs within our community. We match closely on 1) discharges to a less restrictive setting and 2) improved child functioning 2) Our Milwaukee Office used our baseline of 60% of kids moving into a less restrictive setting to note they were under performing (under 50% of the DC youth moving into less restrictive setting). In response the Milwaukee Supers, 1) Developed a process of bimonthly case staffing for placements at risk of failing 2) Put into place a process of rapidly scheduling a problem solving meeting with any parent who had given 30-day notice on a placement. The meeting includes the worker and worker’s supervisor in an effort to support the foster parent in maintaining the placement

  9. Program Changes We Have Made Due to Our Outcomes Data (Cont.) 3) We have been able to use the fact that we have tracked the data for the past two+ years to increase our focus on permanency planning from our first contacts with the purchaser and the youth and family Pushed worker to be energized to advocate for a realistic permanency plan with the County Social Worker and then in the Children’s Court Focus treatment plan toward completion of the permanency plan in a shorter time frame 4) Focused our foster parent education on individual mental health diagnosis including ADHD, depressive disorders, adjustment disorders, PTSD, and the role of the foster parent in a child’s individual psychotherapy assessment and treatment

  10. Program Changes We Have Made Due to Our Outcomes Data (Cont.) 5) We have increased our efforts to include the youth's parents in the treatment process regardless of the child’s permanency plan Document that all parents are invited to treatment team meetings, if not, the exception reason is documented Review and document visitation plans for each child at each treatment planning meeting Set a long term program goal of improving the youths’ relationships with their parents, with an emphasis on permanency plans other then reunification (a move away from a “child rescuer” view of the program) 6) We have added safety planning to all treatment plans The plan asks the workers to consider the following safety issues and if their is a affirmative response, then to create a plan.

  11. Safety Planning: If “Yes” to any of the following questions, please develop a safety plan, addressing each issue. 1. The child has a history of suicide attempts, suicidal actions, suicidal ideation, self-harm behaviors, or has expressed a desire to harm themselves. Yes  No  Safety Plan: 2. The child has a history of sexual assault. Yes  No  Safety Plan: 3. The child has a history of sexualized acting out. Yes  No  Safety Plan: 4.The child has been a victim of sexual assault and is in need of continued assistance regarding the assault. Yes  No  Safety Plan: 5. The child has a history of running away from past foster home(s).Yes  No  Safety Plan: 6.The child has a history of being physically aggressive in a manner that has caused physical harm to others. Yes  No  Safety Plan: 7.The child is placed in a home with other, unrelated children of the opposite gender. Yes  No Safety Plan:  The Treatment Team will review this plan on _________________. We set time frames for these questions, so events from years past wouldn’t trigger a safety plan

  12. Program Changes We Have Made Due to Our Outcomes Data (Cont.) 7) Our experience in our first two years have help focus the development of our computer case management system on both process and clinical outcomes. • Ability to track process outcomes that relate to the Federal outcomes standards and that we can be held accountable for • Track referrals in database to evaluate access issues • Outcomes data input will happen in real-time (when worker completes discharge summary – information is submitted to data-base) so our sample will be close to 100% of clients served 8) Cost is an outcomes indicator that our purchasers are interested in, and while we need to focus on “best practice standards”, which CSS has a strong commitment to, we need to accomplish our outcomes in the most efficient manner possible. In Wisconsin TFC is no longer the cheap alternative to Residential Treatment, TFC is the expensive out-of-home care placement

  13. How is this useful? • CSSW TFC program is using the outcomes process to better understand our client population. Who are we serving? (2004 - Achieved) • Reporting outcomes helps us stay competitive in our market (2004 - No Effect) • We drive the bus with the funders who haven’t defined what outcomes information they want collected ( 2004 -Did you ever hear of the Edsel)

  14. Our Current Outcome goals 1) Well-being - clients exhibit functional improvement 2) Safety - clients have safe placements 3) Permanency - clients have stable placements and their length of stay reflects a move toward permanency in a timely manner Permanency - clients will be discharged to a less restrictive setting 4) Foster parents will be satisfied with CSSW TFC worker service Outcomes our Funders Want to See 1) Well-being - parents exhibit functional improvement and are able to cope with their child’s special needs 2) Safety - clients have safe placements 3) Permanency – client’s are stabilized and moved into an less restrictive setting with and short length of stay 4) Access - client's are placed quickly and the program takes difficult youth and successfully stabilizes them.

  15. Permanency: Timeliness of Achieving Permanent Placement Program Length of Stay Average 18.8 Months Median 10 Months Mode 7 Months Children’s Service Society looks at the length of stay by discharge setting to get an indication of our success at achieving reunification or adoption in a timely fashion (“a child’s sense of time”). Based on the sample data, most of our failed placements occur past the usual timeframe for a reunification and prior to our normal timeframe for moving into another positive setting (adoption or independent living) © Children’s Hospital and Health System. All rights reserved.

  16. Permanency: Discharge Setting by Gender and Age © Children’s Hospital and Health System. All rights reserved.

  17. Permanency: Discharge Setting by Youth’s Permanency Plan *While 60% were discharged into a less restrictive setting, 40% of the Emancipation group were discharged into an independent living situation © Children’s Hospital and Health System. All rights reserved.

  18. Well-being: The Child will Exhibit Improved Functioning In 2002 Children's Service Society began using the CAFAS to measure change in the youth in our care. For the 2002 through 2003 time period 61.9% of the youth measured improved (20 point drop between the initial score and the last score completed) 61.9% (n=105) exhibited improved functioning as rated by the CAFAS while in care or at discharge The TFC case manager completes the Initial CAFAS at the time the Initial Treatment Plan is due (within the first 30 days). The CAFAS is then completed every six months and at discharge. The average total scores by rating period show that the youth improve by the first six month rating period and then maintain the improvement through a planned discharge Unplanned discharges show no improvement. © Children’s Hospital and Health System. All rights reserved.

  19. Well-being: The Child will Exhibit Improved Functioning We are beginning to flag youth in placement who have a high total score (120 or above), or who score a 10 or more on the Self-harm subscale, as high-risk placements. © Children’s Hospital and Health System. All rights reserved.

  20. There Were no Light-Bulb Moments • Instead change has been slow, but the tone is set. • After our first year of tracking and reporting our quality improvement department noticed two important obstacles to making use of the data. • Supervisors weren’t sure what to do with the data, weren't owning the data and therefore weren't invested in the outcomes process. • Supervisors were the key to the process - if the data could translate into action the supervisor was the point that was going to happen.

  21. CQI Worksheet To give the supervisors a tool to help them use the outcomes data, and to continue to institutionalize the tracking of outcomes in the programs, we developed a program "report card" The Continuous Quality Improvement Worksheet The worksheet is on the computer network, accessible to all administrative and program staff, which has increased supervisors motivation on to complete CQI activities including outcomes tracking

  22. Moving Forward • Children's Service Society is supporting the FFTA’s efforts to Benchmark Treatment Foster Care Outcomes. • We anticipate that our purchasers will contract a private third-party to track out-of-home care outcomes in the communities we serve. We will work to help create that process. The private agency will look at clinical outcomes that are focused on the child’s and the family’s service needs, and they will advocate for those needs, pushing us to be better providers of service, and pushing purchasers to be better consumers of services. • Philadelphia – PMHCC/Best Practices Institute • Kentucky – The Children’s Review Program

  23. The End Please Remember to Complete the Evaluation Form

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