Building on Each Other’s Strengths

Preliminary Baseline National Evaluation ResultsSeptember, 2005

•Identification of eligible families began in June 2004

•Idaho Data is forwarded to ORC MACRO for inclusion in National Evaluation

•Aggregate data for system level trends

•Family specific data shared with families; others w/family consent

•Data reflects information prior to adoption of practice model and EBP (Wraparound)

Jul-Sep04 Oct-Dec04 Jan-Mar05 Apr-Jun05 Jul-Sep05 Oct-Dec05

30

60

90

119

182

143

0 0 6 12

46

19

0

20

40

60

80

100

120

140

160

180

200

Dates

Idaho National Evaluation Activity

Enrolled Families Target Enrollment

257257

229202

182

143119

9060

46191260

0

0

50

100

150

200

250

300

1Q04 2Q04 3Q04 4Q04 1Q05 2Q05 3Q05 4Q05 1Q06 2Q06 3Q06

Enrolled Families

Target Enrollment

Enrolled Families

Target Enrollment

Idaho National Evaluation Activity

Enrollment and Demographic Information Form (EDIF-Baseline) n=46

Sources of Information

• Caregiver = 85%

• Staff-as-caregiver =

9%

• Youth = 6%

Demographics• 84% males; 16%

females• Average age = 13• 9% Latino• In Foster Care or other type of out-of-home placement due to family court decision = 15%

Enrollment and Demographic Information Form (EDIF-Baseline) n=46

Agency or Individual referring the child (multiple agencies may have referred)

• Mental Health = 48%• School = 20%• Juvenile Justice = 11% • Caregiver = 13%• Did not identify = 8%

Agencies involved with the child (multiple agencies are typically involved with each child)

• Juvenile Justice (corrections, court and/or probation) = 72%• Mental Health = 48%• School = 46%• Physical Health = 30%• Child Protection Services

= 13%

Enrollment and Demographic Information Form (EDIF-Baseline) n=46

Top 6 Problems leading to referral (often co-occurring)

• Conduct/delinquency = 74%• Depression related = 59%• Anxiety = 54%• Hyperactive, inattentive = 54%• School problems not related to

learning disabilities = 43%• Learning Disabilities = 37%

Enrollment and Demographic Information Form (EDIF) n=46

Who participated in the development of service planning to-date (e.g., MDT, Local Council meetings)?• Child’s caregiver = 87%• Case manager = 81%• Juvenile Justice = 67%• Education staff = 65%• Child Welfare = 64%• Therapist = 50%• Child = 39%

Enrollment and Demographic Information Form (EDIF-Baseline) n=46

Child Diagnostic Information• Diagnostic evaluation done = 59%

Year of evaluation-04-05=52%; 02-03 = 18%; before 02 or

missing = 30%• Most common Provider of Evaluation

Child or General Psychiatrist = 46% • ADHD = 39% (primary)• Mood Disorder = 13% (primary)• Oppositional Defiant = 11% (primary)• Physical problems = 30%

(most common- asthma = 11%, allergies = 11%)

Enrollment and Demographic Information Form (EDIF-Baseline) n=46

Psychosocial/Environmental Problems (multiple psychosocial problems were indicated)• Educational Problems = 48%• Social environment problems = 46%• Problems with primary support group (e.g, family) = 43%• Economic Problems = 33%

Functioning (Global Assessment) 17% indicate serious symptoms and impairment in functioning (e.g., suicidal ideation, no friends)

Enrollment and Demographic Information Form (EDIF-Baseline) n=46

Funding Sources• Medicaid (exclusively) = 35%

• Combination of Medicaid and SSI = 20%

• Combination of Medicaid and CHIP = 7%

• Private insurance (exclusively) = 18%

• (Not indicated = 20%)

Behavioral and Emotional Rating Scale (BERS- Parent form- Baseline) n=31

• Highest Rated Strengths– Attends school regularly

= 97%– Trusts someone = 81%– Accepts a hug = 80%– Demonstrates a sense of

belonging to family = 78%

– Participates in Family activities = 74%

– Expresses affection for others = 73%

• Lowest Rated Strengths– Completes a task at 1st

request = 10%– Considers consequences

of own behavior = 19%– Accepts criticism = 21%– Accepts responsibility =

25%– Accepts no for an answer

= 25%– Reacts to

disappointment in a calm manner = 30%

Child Behavior Checklist (CBCL- Parent form- Baseline) n=31

• Highest Rated Problems– Impulsive or acts w/o

thinking = 88%– Argues a lot = 87% – Stubborn, irritable = 85%– Demands a lot of attention =

81%– Nervous, high-strung, or

tense = 81%– Easily jealous = 77%– Easily distracted = 77%– Acts too young for age =

77%– Feels worthless = 73%

• Lowest Rated Problems

– Overweight = 23%

– Sets fires = 23%

– Feels sick = 27%

– Speech problems = 27%

– Smokes, chews, or sniffs tobacco = 31%

– Too shy or timid = 31%

– Feels too guilty = 35%

– Overeating = 35%

– Sleeps a lot = 35%

National Evaluation Tools to be added at 6 months

• Multi-Sector Service Contacts (MSSC)– Caregivers’ reports of services used, where and when the

services were received, and how much of each service type.• Family Satisfaction Questionnaire (FSQ)

– Assesses caregivers’ satisfaction with services, including progress, family’s involvement, providers’ cultural competence, and impact on caregivers’ ability to work outside the home.

• Youth Satisfaction Questionnaire (YSQ)– Assesses satisfaction with services as a whole, the youth’s

perception of his or her progress in treatment, and the cultural competence and individualization of services received.

Percent

Se

rvic

es

Services Received by Children Referred by Juvenile Justice System

Building on Each Other’s Strengths

Joint Report on Practice Model, Wraparound, and System of Care Implementation September 05

PRACTICE MODEL UPDATE

October - November 2004: Local Council Business Practice Model drafted and adopted

January – March 2005: Implementation begins/ Wraparoundcurriculum acquired / M.Grealish training

March - May 2005: DHW FACS dedicates 8.0 FTE for Local Council Service Coordinator roles / Councils receive Orientation to Wraparound Parts I & II

June – August 2005: RCs and DHW CMH PMs agree on qualifications, implementation guidelines / First and Second SOC Leadership Meetings guides roles for councils and Wraparound Specialists (formerly LCSCs)

PRACTICE MODEL UPDATE

Update retains six phases (steps) and two track format

Details qualifications for Wraparound Specialists

Greater alignment to Core Values and Guiding Principles of Systems of Care and Family Centered Practice

Local Councils will rarely meet “en banc” for service planning

Local Councils able to rebalance service coordination with community capacity/resource development

WRAPAROUND IMPLEMENTATION

Highlights:

• Wraparound “Train the Trainer” attended by 20 from the community• All Local and Regional Councils received Wraparound Orientation• Local Councils received Wraparound Team Orientation• Consensus on Wraparound Specialists Qualifications• DHW first agency to dedicate FTE to Implementation• DHW reports several regions over or near capacity • Wraparound orientation now a part of DHW CMH Academy• Skills curriculum for wraparound in Idaho’s SOC near completion• Local Evaluation set to collect data to monitor fidelity to approach

WRAPAROUND IMPLEMENTATION

Concerns:

• Insufficient Number of Wraparound Specialists• Available FTE distributed on regions not council activity• Waiting lists and outstanding referrals (60-90 days reported)• Pressure to design “shortcuts” to increase case turnover • Some CMH staff given Specialist role as additional duty • Staff assigned to Wraparound Specialists w/o training• Tracking and reporting coming from multiple sources

SYSTEM OF CARE IMPLEMENTATION

Highlights:

• National Evaluation Data collection and reporting underway• Local Evaluation set to being tracking of wraparound fidelity• SOC Leadership Meetings built needed consensus on model• SOC website launched to aid outreach and communication• Councils with previous community activities progressing well

SYSTEM OF CARE IMPLEMENTATION

Concerns:

• Parents are leaving the system of care

• Councils focused on “staffing” not transitioning to wraparound well

• Single Agency support for wraparound implementation • Councils feel ICCMH is distant and not participatory

• Lack of comprehensive strategic plan for advancing and sustaining Idaho’s SOC