national evaluation data profile report findings from the 24-month outcome study
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National Evaluation Data Profile Report Findings from the 24-month outcome study One Community Partnership August 18, 2008. Adapted from work by the National Evaluation Team at Macro, International. Key Principles: System of Care. Community-based - PowerPoint PPT PresentationTRANSCRIPT
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National EvaluationNational EvaluationData Profile ReportData Profile Report
Findings from the 24-month outcome studyOne Community Partnership
August 18, 2008
Adapted from work by the National Evaluation Team at Macro, International.
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Key Principles: System of Care
Community-based Collaboration between multiple
service sectors Driven by family voices Individualized support based on
strengths and needs of child and family
Culturally competent Includes a system of ongoing
evaluation to assure data-based accountability.
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Study Population
Enrolled in Longitudinal Outcom e Study
Enrolled in Dem ographic & Diagnostic Study
Henderson M ental Health Center Youth Case M anagem ent
OCP Target Population: SED Youth
Brow ard County Youth Age 10-18 200,000
20,000
2,000
487
266
Data sources: US Bureau of Census 2000; SAMHSA (estimates SED prevalence rate in children to be 9-13%); Henderson Mental Health Center Youth Case Management Monthly Activity Reports
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MethodologyDemographic and Diagnostic Study
Describes children and families who enter the system of care and identifies their background factors and service needs.
Derived from data provided by case manager and chart reviews.
Includes 487 youth enrolled in ART, BART, or Connections between July 2004–September 2007 who consented to participate in the FMHI evaluation.
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Demographic Profile: Youth
Sources:* Enrollment and Demographic Information Form** http://www.fldoe.org/eias/flmove/broward.asp
OCP(N=487)
Broward Schools EBD**(N=1,724)
White NH 41% 43%Black NH 36% 37%Hispanic 24% 16%Other NH 1.8% 3.6%
Numbers in the OCP category do not add to 100% due to differences in how data are collected. Non Hispanic multiracial (n=16) children are counted twice.
6Data source: Demographic and Diagnostic Study, Enrollment and Demographic Information Form
Geographic Distribution(n=482)
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Insurance type(N= 487)
39%31%
11% 10% 7% 2%0%
10%20%30%40%50%
Med
icaid
Priva
teIn
sura
nce
SCHI
P
Non
e
SSI
Othe
r
Data source: Demographic and Diagnostic Study, Enrollment and Demographic Information Form
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Presenting Problems at Intake* (n=487)
4%
5%
11%
12%
14%
24%
24%
33%
35%
38%
42%
59%
0% 10% 20% 30% 40% 50% 60% 70%
Specific DDPDD
Psychotic BehaviorSubstance abuse
Learning diffi cultiesSuicide I deation
AnxietyAdjustmentDepression
School perf ormanceHyperactivity
Conduct/ Delinquency
*Because children may have more than one
presenting problem, this chart adds to >100%.
Data source: Data source: Demographic and Diagnostic Study, Enrollment and Demographic Information Form
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System Involvement at Intake (n=487)
Data source: Demographic and Diagnostic Study, Enrollment and Demographic Information Form
89%72%
19%7% 7% 5%
0%
20%
40%
60%
80%
100%
Mental H
ealth
School-
SPED
J uvenile
J usti
ce*
Child W
elfare
Special
medical
Substan
ce Abus
e
* includes Corrections, Juvenile Court, Probation
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Referral Source, by Fiscal Year
Data source: Demographic and Diagnostic Study, Enrollment and Demographic Information Form
44%
14%
5%
24%
1%
41%
32%
2%7%9%
21%
4%6%
23%
41%
12% 6%
37%
26%26%
0%
10%
20%
30%
40%
50%
60%
MentalHealth
School J uvenileJ ustice
ChildWelfare
Caregiver
2004 (n=98) 2005 (n=196) 2006 (n=139) 2007 (n=54)
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Household Risk FactorsHousehold member - history of depression 55% Household member –
history of mental illness (other than depression) 31%
Household member - history of substance abuse 40% Single-adult household 34%Exposed to domestic violence 42%
Risk Factors Prior to Intake (n=251-260)
Data source: National Evaluation Outcome Study, Caregiver Information Questionnaire-Baseline
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94%
37%
99%91%
35%
98% 95%
42%
99%91%
42%
0%10%20%30%40%50%60%70%80%90%
100%
Caregiver Youth Other Family
2004 (n=93) 2005 Analysis (n=151) 2006 Analysis (n=120) 2007 Analysis (n=43)
Primary Participants in Wraparound
Meetings
Data source: National Evaluation Demographic Study, Enrollment and Demographic Information Form, Chart Reviews, as recorded in HMHC records
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43%
6%2% 2%
9%
48%
10%
2% 2%5%
13%
1% 3% 2%
33%
19%
4% 2% 4%
42%
0%5%
10%15%20%25%30%35%40%45%50%
Therapist Education ChildWelfare
J J FamilyAdvocate
2004 (n=93) 2005 (n=151)2006 (n=120) 2007 (n=43)
Other Participants at Wraparound Meetings
(n=395)
Data source: Enrollment and Demographic Information Form, Chart Reviews, as recorded in HMHC records
Case manager attendance ranged from 94% in 2004 to 100% in 2007
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Methodology Longitudinal Outcome Study
Assesses long-term impact of system of care.
Includes subset of demographic sample who agree to participate in longitudinal study.
Families are interviewed at 6-month intervals over a 3-year period.
For this report, youth/families were interviewed at baseline, 6, 12, 18 and 24-month intervals.
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Stability of living situation – past 6
months
56%68% 68% 67% 77%
44%32% 32% 33% 23%
0%20%40%60%80%
100%
Intake(n=266)
6M(n=190)
12M(n=147)
18M(n=110)
24M(n=92)
1 2 or more
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School Attendance Intake - 24 Months
(n=44)
50%
14%
36%47%
22%30%
0%
20%
40%
60%
Improved Maintained Declined
OCP National
Data source: Education Questionnaire-Revised
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Grades –Intake to 24 months
(n=54)
42%31% 27%
45%
30% 26%
0%10%20%30%40%50%
Improved Remained stable Declined
OCP National
Data source: Education Questionnaire-Revised
18Data source: Education Questionnaire-Revised
Disciplinary Actions at Intake
55%
43%
3%
50% 46%
5%
0%
20%
40%
60%
Neither Suspended Expelled
OCP Intake (n=141) National I ntake
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Disciplinary Actions at 24 months
66%
32% 25%
68%
30%
3%0%
20%
40%
60%
80%
Neither Suspended Expelled
OCP (n=73) National
20Data source: Delinquency Survey-Revised
Juvenile Justice Involvement Arrests Intake - 24 Months
48% 44%37%
26% 30%
9%8%9%10%22%
0%10%20%30%40%50%60%
I ntake(n=81)
6months(n=45)
12months(n=38)
18months(n=27)
24months(n=20)
Perc
ent o
f You
ths
OCP National
21Data source: Delinquency Survey-Revised
Juvenile Justice Involvement On Probation Intake - 24 Months
31%
48%
34% 33%
15%13%13%17%14%17%
0%
10%
20%
30%
40%
50%
60%
I ntake(n=81)
6 months(n=45)
12 months(n=38)
18 months(n=27)
24 months(n=20)
Perc
ent o
f You
ths
OCP National
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Delinquent Behaviors Intake - 24 Months
0%5%
10%15%20%25%30%35%40%45%
Intake 6M 12M 18M 24M
Hit someone
Out of control
Bullied
Damaged property
Skipped school
In the past 6 months, have you . . . ?
Data source: Delinquency Survey-Revised
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Self-reported drug or alcohol use
(previous 6 months)28% 29%
26%32% 28%
0%5%
10%15%20%25%30%35%
Intake(n=248)
6 months(n=163)
12 months(n=115)
18 months(n=91)
24 months(n=74)
Data source: GAIN Quick-R
According to the 2006 National Survey on Drug Use and Health 3.9% of 12-13 year olds, 9.1% of 14-15 years and 16% of 16-17 year olds used illicit drugs in the previous. Source: http://www.oas.samhsa.gov/nsduh/2k6nsduh/2k6Results.pdf
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Degree of Substance ProblemsIntake - 24 Months
41%33%
60%55% 57%
53%58%
30% 31%38%
6% 8% 10% 14%5%
0%
10%
20%
30%
40%
50%
60%
70%
Intake(n=70)
6 months(n=48)
12 months(n=30)
18 months(n=29)
24 months(n=21)
Data source: GAIN Quick-RUrgency of substance problems are only calculated for youth that used in the previous six months.
Higher scores indicate greater dependence.
No/minimal
Moderate
High
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Internalizing Problem Behaviors and Symptoms Intake - 24 Months
56586062646668
Intake 6 Months 12 Months 18 Months 24 Months
OCP National
Data sources: Total Problem T-score: Child Behavior Checklist (6-18)
Clinical range
Ns range from 261 at Intake to 89 at 24 months
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Externalizing Problem Behaviors and Symptoms Intake - 24 Months
60
65
70
75
Intake 6 Months 12 Months 18 Months 24 Months
OCP National
Data sources: Total Problem T-score: Child Behavior Checklist (6-18)
Clinical range
Ns range from 261 at Intake to 89 at 24 months
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23% 20%15% 13% 12%
31% 29% 26% 26% 23%
0%10%20%30%40%
Intake 6 Months 12Months
18Months
24Months%
with
hig
h le
vels
of
anxi
ety
OCP National
AnxietyIntake - 24 Months
Data sources: Anxiety-Revised Children’s Manifest Anxiety Scale.Total T-scores>60 indicate high levels of anxiety on the RCMAS.
Ns ranged from 248 at Intake to 74 at 24 months
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DepressionIntake - 24 Months
19% 17% 12% 11% 8%
21% 18% 17% 16% 13%
0%
20%
40%
60%
80%
100%
I ntake 6 Month 12 Month 18 Month 24 Month
% sc
oring
in cl
inica
l ran
ge
OCP National
Data sources: Depression-Reynold’s Adolescent Depression Scale 2. Total T-scores > 60 indicate clinical levels of depression on the RADS. Ns ranged from 248 at Intake to 74 at 24 months
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Caregiver Perspectives of Youth’s Behavioral and Emotional Strengths
Intake - 24 Months
78 80 80 82 827983 85 85 85
50
70
90
110
Intake 6 Months 12 Months 18 Months 24 Months
Aver
age Sc
ore
OCP National
Data Source: Behavioral & Emotional Rating Scale-Caregiver and Youth
Higher scores indicate greater strengths.
Average range
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Youth’s Perspectives on their Behavioral and Emotional Strengths
Intake - 24 Months
9298 97 97
10193 95 96 97 98
50
70
90
110
Intake 6Months
12Months
18Months
24Months
Aver
age Sc
ore
OCP National
Data Source: Behavioral & Emotional Rating Scale-Caregiver and Youth
Higher scores indicate greater strengths.
Average range
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Caregiver Global Strain Intake - 24 Months
9.0
8.27.8
7.37.1
9.0
8.08.08.0
8.0
7.07.58.08.59.09.5
10.0
I ntake 6Months
12Months
18Months
24Months
Aver
age
Scor
e
OCP National
Lower scores indicate higher functioning
NOTE: Global Strain includes stresses due to resources (e.g., time & money), and feelings such as anger or resentment, guilt or fatigue due to caregiving responsibilities. Data Source: Caregiver Strain Questionnaire
OCP Ns range from 263 at Intake to 89 at 24 months
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Service definitionsCase management or service coordination involves finding and
organizing multiple treatment and support services, and may also include preparing, monitoring, and revising service plans; and advocating on behalf of the child and family. Case managers may also provide supportive counseling.
Individual therapy relies on interaction between therapist/clinician and child to promote psychological and behavior change.
Medication treatment and monitoring services typically include the prescription of psychoactive medications by a physician (e.g., psychiatrist) that are designed to alleviate symptoms and promote psychological growth. Treatment includes periodic assessment and monitoring of the child’s reaction(s) to the drug.
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Child Services Received6 - 24 Months
Data Source: Multi-Sector Service Contacts-Revised-Caregiver
92%
80%
51%
71% 73%
65%
49%
66% 68%61%
66%
50%
0%
20%
40%
60%
80%
100%
Case Mgmt I ndividual Therapy Med Mgmt
6 Months (n=179) 12 Months (n=112)18 Months (n=77) 24 Months (n=56)
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Service definitionsFamily therapy involves a variety of family members such as caregivers
and/or siblings with or without the child present. Interaction among family members is typically facilitated by a therapist or counselor.
Caregiver or family support services are provided to caregivers or siblings (e.g., family activities, behavior management training, parent classes, support groups, individual therapy for caregiver or other family members). These do not recreational activities, behavioral/therapeutic aide, transportation services, respite care, after-school activities or child care which are described in other questions.
Informal supports are defined as assistance from persons who provide support to the family without compensation from any formal service system. This type of support includes asking a relative or friends to baby sit a child, support received from someone’s church, etc.
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Family Services Received6 - 24 Months
Data Source: Multi-Sector Service Contacts-Revised-Caregiver
40%
21%
9%
43%
21%14%
31%
17%9%
34%
9% 7%
0%
20%
40%
60%
80%
100%
Family Therapy Family Support I nformal Support
6 Months (n=178) 12 Months (n=112)18 Months (n=77) 24 Months (n=56)
NOTE: Family therapy is typically facilitated by a therapist or counselor. Family support may include support groups, parenting classes,behavior management training for caregivers, etc. Informal support is assistance provided without compensation from any formal service system (e.g., support from friends, church, etc.).
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Cultural Competency at Intake and 24 Months
55%
80%93% 90% 96% 98%
74% 74%89% 85%
96% 98%
0%20%40%60%80%
100%
Usedknowledge of
family'sculture tomeet our
needs
Told me howto get
additionalservices when
needed
Respectedfamily'sreligiousbeliefs
Understoodmy needs
Spoke ourlanguage or
gotinterpreters
Treated uswith respect
6M (n=166) 24M (n=54)
My primary service provider:
Data Source: Cultural Competence and Service Provision-Caregiver
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3.53.9 4.2 4.1
4.53.9 4.0 3.8
4.14.4
00.511.522.533.544.55
Outcomes Satisf actionwith Services
Participationin Treatment
Access toServices
CulturalSensitivity
Caregiver (n=51) Youth (N=40)
Caregiver and Youth Perspectives on Services at 24 Months
Very Dissatisfie
d
Very Satisfied
Scores range from 0 (strongly negative) to 5 (strongly positive). Scores above 3.5 are regarded as positive
Data source: Youth Services Survey for Families-Caregiver and Youth Services Survey
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3.5
3.9
4.2
4.1
4.5
3.9
4.0
3.8
4.1
4.4
0 1 2 3 4 5
Outcomes
Satisfaction with Services
Participation in Treatment
Access to Services
Cultural Sensitivity
Caregiver (n=51) Youth
Caregiver and Youth Perspectives on Services at 24 Months
Very Dissatisfie
d
Neutral Very Satisfied
Scores range from 0 (strongly negative) to 5 (strongly positive).
Data source: Youth Services Survey for Families-Caregiver and Youth Services Survey
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Key Child Outcomes24 months after entering System of Care
• Most youth continue to live at home with their families.
• Youth’s behavioral and emotional functioning improved and remained stable over time:
At home: decrease in symptomatology, anxiety, and depression;
At school: improvement in grades and attendance; and
In the community: decrease in common delinquent behaviors and arrests
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Key Family Outcomes24 months after entering System of Care
• Caregivers report less strain over time.
• In general, families were satisfied with the services they received.
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• Use data to drive community decisions.
• Use data to drive ongoing fidelity of process in terms of training, cross system involvement, etc
• Continue to challenge OCP Oversight Committee to involve families and youth in identifying what families need.
•Support Family Voices to continue family, youth and informal support involvement at all levels of decision making (e.g., governance & family team service planning)
Recommendations