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CAMHD Annual Data
Review & Presentation:
FY 2012
CAMHD Research and Evaluation Office
Scott Keir, Ph.D.
David Jackson, Ph.D.
Jarrett Ku, B.A.
Chuck Mueller, Ph.D.
1
February 20, 2013
Agenda for the Day CAMHD-Wide Review:
◦ Youth Profile, Services Procured,
Appropriations & Spending, Outcome Trends
Clinical Model Indicators: ◦ Very Brief Summary of the „Clinical Model‟ (Lesley)
◦ Potential Indicators of Progress Toward the Clinical
Model: Current and Future Data Collection
Short Break
Panel Discussion: ◦ Measuring CAMHD‟s Progress Toward the
„Clinical Model‟
2
CAMHD-Wide Review
Youth Profile
Services Procured
Appropriations & Spending
Outcome Trends
3
YOUTH PROFILE
4
Youth Profile
2265 2248
2110 1878 1954
1555 1518 1389
1197 1230
0
500
1000
1500
2000
2500
3000
2008 2009 2010 2011 2012
Nu
mb
er
of
Un
du
plicate
d Y
ou
th
Total Registered Youth # Youth with Svcs Procured
Number of Youth Registered and with Procured Services,
FY08-FY12 *
5
% Change FY11-FY12: +4.0%
% Change FY11-FY12: +2.8%
* - Not including Mokihana Program
Youth Profile
6
640 642 527
567 644
324 309 324 217 295
920 968
1047
840 825
0
250
500
750
1,000
1,250
1,500
2008 2009 2010 2011 2012
Number of Admissions & Discharges,
FY08-FY12*
Initial Admissions Repeat Admissions Discharges
44 -17 - 196 - 56 114 Gain
or
Loss
w/in
Year
* - Not including Mokihana Program
Youth Profile
7
0.22
1.38
0.67
1.45
3.29
1.69
0.0
1.0
2.0
3.0
4.0
5.0
0-12 13-17 18-20
Perc
en
t
Age Group
Youth with Serious Emotional Disturbance
Registered as Percent of Population, FY11
Hawaii Other SED Serving States
Youth Profile
8
732
291
218 185
160 141 139
87
447
216
154 113
82 107 93
18 0
100
200
300
400
500
600
700
800
900
2008
2009
2010
2011
2012
2008
2009
2010
2011
2012
2008
2009
2010
2011
2012
2008
2009
2010
2011
2012
2008
2009
2010
2011
2012
2008
2009
2010
2011
2012
2008
2009
2010
2011
2012
2008
2009
2010
2011
2012
Nu
mb
er
of
Yo
uth
(N
)
Fiscal Year by Family Guidance Center
Registered Youth Served Youth
Hawaii Leeward Honolulu Maui Kauai Central Windward Family
(Big Island) Oahu Oahu Oahu Oahu Court Liaison
Number of Youth Registered and with Procured Services
by Family Guidance Center, FY08-FY12
Youth with Procured Services
Youth Profile
Age: Average age =14.2 years
Gender: 62% Male; 38% Female
Race: 61% Multi-racial; 15% White;
13% NH-Pacific Islander; 9% Asian;
2% Black; 1% AI-Alaskan-Native
Diagnosis: 33% Disruptive; 20% Mood;
18% Attention; 12% Anxiety;
1% Pervasive Developmental
9
Youth Profile
10
53%
39%
33% 32% 35%
27%
18% 15% 14%
23%
52%
38% 33%
32% 35%
0%
10%
20%
30%
40%
50%
60%
2008 2009 2010 2011 2012
Perc
en
t o
f R
egis
tere
d Y
ou
th
Percent Race/Ethnicity Not Available,
FY08-FY12
National Origin NA Race NA Ethnicity NA
Youth Profile
11
29% 28% 28%
29%
33%
23% 24%
25% 25%
18% 19% 17%
16% 16%
20%
9% 11%
12% 11%
12%
3% 3% 4% 4%
1% 0%
10%
20%
30%
40%
2008 2009 2010 2011 2012
Perc
en
t o
f Yo
uth
Disruptive Behavior Attentional Mood Anxiety Pervasive Developmental
Youth Registered in CAMHD
by Primary Diagnosis, FY08-FY12*
* - Including Mokihana Program
Youth Profile
12
34% 33% 33% 34%
33%
16% 17% 18%
18% 18%
20% 19% 18%
18% 20%
10% 12%
13% 13% 12%
1% 1% 1% 1% 1%
0%
10%
20%
30%
40%
2008 2009 2010 2011 2012
Perc
en
t o
f Y
ou
th
Disruptive Behavior Attentional Mood Anxiety Pervasive Developmental
Youth Registered in CAMHD
by Primary Diagnosis, FY08-FY12*
* - Not including Mokihana Program
SERVICES PROCURED
13
Services Procured
14
604
389
1,094
894
211
274
429
159 34 71
0
200
400
600
800
1,000
1,200
Nu
mb
er
of
Yo
uth
Number of Youth with Procured Services
by Broad Categories, FY08-FY12
Out-of-Home
Services
Intensive Home &
Community Services
Outpatient
Services
Supportive
Services
Crisis
Stabilization
Decreasing over time
-36%
-18%
-63%
+109%
+30%
15
10 6
95
60
15 14
228
137
101
21
29
16
260
205
0
50
100
150
200
250
300
Nu
mb
er
of
Yo
uth
Out-of-State Hospital
Residential
Community
High Risk
Community
Residential
Therapeutic
Group Home
Multidimensional
Foster Care
Transitional
Family Home
Number of Youth with Procured Services
by Out-of-Home Sub-Categories, FY08-FY11
-21%
-45%
-79%
-40%
-37%
Decreasing over time
Services Procured
16
308
242
856
693
62 113
23 36
120 139
0
200
400
600
800
1,000
Nu
mb
er
of
Yo
uth
Multisystemic
Therapy
Intensive
In-Home
Functional
Family Therapy
Outpatient
Therapy
Assessment
Number of Youth with Procured Services by Intensive Home
& Community and Outpatient Sub-Categories, FY08-FY12
Decreasing over time
-19%
-21%
Services Procured
+83% +57%
+16%
APPROPRIATIONS & SPENDING
17
19
$47,135,776
$147,363,943
$38,968,998 $39,956,764
$48,754,025
$165,201,443
$63,841,906 $63,137,609
Ap
pro
pri
atio
ns
in D
olla
rs
CAMHD Total Appropriations and General Funds, FY94-FY12 (Adjusted for Inflation*)
General Funds TOTAL Appropriations
•- Based on „2013 Medical Services Inflation Adjustment‟ dollars
DOH/DOE enter into Felix
Consent Decree: Oct. 25, 1994;
Plan implemented: July 31,1996
„Substantial compliance‟ w/ Felix Decree met: April 15, 2004;
Obligations under Felix Consent terminated: May 27, 2005
DOH/DOE held in contempt for
not designing a „adequate‟ SOC:
June 1, 2000
Difference btw
FY00 TA & GF: $17.8M
Difference btw
FY12 TA & GF: $23.2M
Appropriations and Spending
Appropriations and Spending*
20
$44,190,395 $46,266,303
$43,605,220
$38,749,923
$32,143,028 $30,980,060
$0
$10,000,000
$20,000,000
$30,000,000
$40,000,000
$50,000,000
2007 2008 2009 2010 2011 2012
Servic
es
Co
sts
Total Costs for Services Procured, FY07-FY12
Decrease from FY07-FY12: -30%
* - NOT adjusted for inflation
Appropriations and Spending
21
$30,881 $29,753 $28,725 $27,898 $26,853
$25,187
1431
1555 1518 1389
1197 1230
0
500
1000
1500
2000
$-
$10,000
$20,000
$30,000
$40,000
$50,000
2007 2008 2009 2010 2011 2012
# o
f Y
ou
th S
erved
Co
st p
er Y
ou
th S
erved
Cost Per Youth with Services Procured,
FY07-FY12
FY11-FY12:
6.2% decrease
FY11-FY12:
2.8% increase
Appropriations and Spending
23
$4.9
$2.6
$2.0 $2.0
$10.8
$7.3
$5.0
$0.9
$1.3
$0.4
$8.5
$6.6
$4.1
$3.1
$5.0
$4.2
$1.0 $0.5
$-
$2
$4
$6
$8
$10
$12
Exp
en
dit
ure
s (
in U
S$ M
illio
ns)
Procured Service Expenditures by Level of Care,
FY08-FY12
Hospital Residential
Community High Risk
Community Residential
Therapeutic Group Home
Multidimensional Foster Care
Transitional Family Home
Multisystemic Therapy
Intensive In-Home
Functional Family Therapy
Decreasing over time
-2.3M
-3.5M
-4.1M
-.9M
-1.9M
-1.0M
-.8 M
-.5M
Good News . . . Bad News Good News :
More youth were registered (76 youth or 4% more) since FY11.
More services were procured by youth (33 youth or 2.8% more) since FY11.
Increased use of Functional Family Therapy
Youth registered and served increased despite decreases similar funding allocated.
Bad News : Decreased use of Multisystemic Therapy and
Multidimensional Treatment Foster Care
Still have a ways to go to meet the need of SED youth (1.4% of youth aged 13-17 years are registered . . . while estimated 5% youth with SED)
24
OUTCOME TRENDS
25
•MTPS
•CAFAS
•CALOCUS
•Discharge Status
Outcome Trends: Remember Me?
26 Trend line = ‘+’ Trend line = ‘-’ Trend line = ‘-’
75.8% 74.8%
75.7% 75.8%
73.7% 73.2%
75.8% 77.7%
76.4%
78.5% 79.0% 80.7%
79.8% 79.8%
68.8% 69.3% 70.9%
68.4% 69.0%
68.4% 69.1%
67.8% 66.5% 66.5% 68.2%
67.3% 68.8%
66.9% 65.0% 65.1%
65.9% 65.9%
63.5% 63.3% 64.7% 64.1%
62.8%
60.1% 61.0% 59.7%
61.9% 62.9% 61.5% 59.2% 59.5% 60.4%
50%
60%
70%
80%
90%
100%
Perc
en
t Im
pro
ved
Percent Improvement: MTPS, CAFAS, CALOCUS,
FY09 - FY12
MTPS CAFAS CALOCUS
Outcome Trends
27
4.4% 3.2%
11.5%
19.9%
16.4% 13.8%
58.1%
3.3% 3.8%
11.0%
24.5%
11.0% 8.5%
61.5%
0%
10%
20%
30%
40%
50%
60%
70%
Eligibility
Change
Family
Relocation
Insufficient
Progress
Other Runaway/
Elopement
Refuse/
Withdraw
Success/ Goals
Met
Trends in Discharge Reasons,
FY08-FY12
2008 2009 2010 2011 2012
Outcome Trends
28
12.5%
3.9%
58.4%
3.6% 3.7% 4.6%
22.4%
7.3%
12.7%
1.0%
70.6%
1.4% 3.0% 4.2%
19.7%
5.0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Foster Home Group Care Home Homeless/
Shelter
Institution/
Hospital
Jail/
Correctional
Facility
Other Residential
Treatment
Trends in Discharge Living Situation,
FY08-FY12
2008 2009 2010 2011 2012
MTPS improvement levels have been slowly improving to around 80% over past 4 years (4% h since FY09 Q1)
CAFAS improvement levels have been slowly decreasing to around 65% over past 4 years (3.7% i since FY09 Q1)
CALOCUS improvement levels have been slowly decreasing to around 60% over past 4 years (5.5% i since FY09 Q1)
Discharge status of „Success/Goals Met‟ has slowly been increasing to around 62% (3.4% h since FY08)
Discharges to „Home‟ have been increasing to around 70% (12.2% h since FY08)
Good news and Not-so-Good News: CAMHD services have resulted in positive improvement over time for between 6 and 8 out of every 10 youth CAMHD serves.
29
Outcome Trends
BREAK - TIME
30
10 Minutes, please!
INDICATORS OF THE CLINICAL MODEL
31
THE ‘OLD’ MODEL
32
MHCC
Facilitator
DOE,
DHS worker,
GAL,
PO, etc.
Youth and
Parent/guardian Joint
Decisions
focused on
Placement
CD
CP
Clinicians provide some
assessment information
and case consultation
when requested –
distanced from the
process
“Felix-Style” practice model
Focus on services and
team-based, multi-agency,
consensus decision-making
THE CLINICAL MODEL
33
Parents/
guardians
Youth
CC Facilitator
and
Other workers
Produces:
Clinical
Formulation
FGC Clinical Team
Clinically
appropriate
treatment
options
developed by the
FGC Clinical
Team are
provided to the
Youth-Specific
Team members.
Final Choices
about treatment
options are made
by the family.
Clinical
Psychologist
CC and
MHS1
Clinical
Director
Produces:
Choice of treatment
from options
Clinical
Lead
Clinical lead provides
back-up to CC; attends
meetings when needed;
authorizes treatment
Youth-Specific Team
New practice model –
Focus on Medicaid Billable
treatment and clinically-
informed decision-making
by the consumer
THE CLINICAL MODEL
34
Branch Child Psychiatrists and Clinical Psychologists are centrally involved in every case in the role of “Clinical Lead” (CL).
Consumer choice determines the treatment plan within a range of clinically appropriate treatment options.
The Clinical lead documents decisions about authorizing services and medical necessity in the Electronic Health Record (EHR)
The Care Coordinator is the main point of contact for the family.
Potential Indicators
Possible indicators of progress toward
“Clinical Model” vision. We‟ve broken
indicators up into 4 categories:
1. „Youth Access/Profile‟
2. „Coordination & Funding of Services‟
3. „Quality Services & EBS Standards‟
4. „Youth Outcome/Client Satisfaction‟
35
Potential Indicators
Possible Indicators of Progress toward
“Clinical Model” vision:
„Youth Access/Profile‟ Indicators
1. Increase number of youth served **
2. Decrease median age of youth served **
36
** - Indicator for which we currently collect data
37
Example of „Youth Access/Profile‟ Indicator:
Increase Number of Youth Registered and Served
2143 2265 2248
2110
1878 1954 1960 1980 1990 2000
1431 1555 1518
1389
1197 1230 1300 1350
1500
1700
0
500
1000
1500
2000
2500
3000
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Nu
mb
er
of
Yo
uth
# of Youth Registered # of Youth Served
38
0.22
1.38
0.67
1.15
1.55
0.78
1.55 1.65
0.85
1.75 1.89
0.99
0
1
2
3
4
5
0-12 13-17 18+
Perc
en
t o
f Y
ou
th
Youth with Serious Emotional Disturbance
Served by CAMHD as Percent of Population
Example of „Youth Access/Profile‟ Indicators:
Increase Percent of SED Youth Served
39
Example of „Youth Access/Profile‟ Indicator:
Decrease Mean Age of Youth Served
12
12.5
13
13.5
14
14.5
2007 2008 2009 2010 2011 2012 2013 2014 2015
Mean
Age
Mean Age of Youth
Potential Indicators Possible Indicators of Progress toward
“Clinical Model” vision:
„Coordination & Funding of Services‟
Indicators
1. Increase Medicaid reimbursement dollars**
2. Increase use of within-CAMHD direct services
3. Increase accuracy and timeliness of health
records, including med use
4. Increase interagency data sharing
40 ** - Indicator for which we currently collect data
Examples of „Coordination & Funding‟ Indicators:
Increase Medicaid reimbursement
41
15.8
24.6 25.1 26.1
24.2 23.2
25
28
35
0
5
10
15
20
25
30
35
40
2007 2008 2009 2010 2011 2012 2013 2014 2015
Do
llars
(in
Millio
ns)
Amount of Medicaid Dollars Collected
42
Examples of „Coordination & Funding‟ Indicators:
Increase CAMHD Direct Services
0 * 0 *
200
500
750
0
100
200
300
400
500
600
700
800
2011 2012 2013 2014 2015
Nu
mb
er
of Y
ou
th
# of Youth Served by CAMHD Direct Services
* - Data are collected and entered for some „Direct Services‟ but we are not able to download these data at this time.
Potential Indicators Possible Indicators of Progress toward
“Clinical Model” vision:
„Quality Services & EBS Standards‟ Indicators
1. Increase use of evidence-based practice
elements **
2. Increase use of treatment progress data
/reports
3. Increase congruence between CSP, Treatment
Plan, and TPS Treatment Targets
4. Increase parent engagement
43 ** - Indicator for which we currently collect data
Examples of „Quality & EBS Standards‟ Indicators:
Increase Use of Treatment Progress Data
44
0 500
5400
14500
0
2000
4000
6000
8000
10000
12000
14000
16000
2012 2013 2014 2015
Nu
mb
er
of
Pare
nt
Fo
rms
Number of Ohio Scales (Parent Version) Collected
Potential Indicators
Possible Indicators of Progress toward
“Clinical Model” vision:
„Youth Outcome/Client Satisfaction‟
Indicators
1. Increase improvement rates**
2. Decrease in median length of treatment (faster
improvement) **
3. Decrease number of arrests **
4. Increase school performance **
45
** - Indicator for which we currently collect data
Examples of „Youth Outcome/Client Satisfaction‟
Indicators: Increase rate of improvement
46
77.7% 78.5%
80.7% 79.8% 81.5%
82.3% 83.2% 83.4%
84.3% 85.2% 85.3%
66.5% 68.2% 68.8%
65.0% 65.3% 65.9%
70.3%
71.5% 72.3%
73.3%
75.2%
61.0% 61.9% 61.5% 59.5%
60.8% 61.7%
63.2%
64.5% 65.8% 66.5% 67.1%
50%
60%
70%
80%
90%
100%
Perc
en
t Im
pro
ved
Percent Improvement: MTPS, CAFAS, CALOCUS,
MTPS CAFAS CALOCUS
47
0
20
40
60
80
100
120
140
160
180
1
2
3
4
5
6
7
N (
Red
Do
tted
Lin
e)
Avg M
TP
S S
co
re (
Blu
e S
olid
Lin
e)
Episode Month
Length of Stay by Avg. TPS Score: HBR Current
4-6 months
Examples of „Youth Outcome/Client Satisfaction‟
Indicators: Decrease in Median Length of
Treatment
Examples of „Youth Outcome/Client Satisfaction‟
Indicators: Decrease in Median Length of
Treatment
48
0
20
40
60
80
100
120
140
160
180
1
2
3
4
5
6
7
N (
Red
Do
tted
Lin
e)
Avg M
TP
S S
co
re (
Red
So
lid
Lin
e)
Episode Month
Length of Stay by Avg. TPS Score: HBR Future
3-5 months
49
HOW DO WE KNOW IF WE ARE MOVING IN
THE RIGHT DIRECTION?
PANEL DISCUSSION
Stanton Michels – Chief Administrator, CAMHD
Lesley Slavin – Lead Psychologist (CSO)
Scott Shimabukuro – Asst. Admin. of Operations
Brad Nakamura – Assistant Professor, UH (RET)
Leah Chang – Branch Chief (HoFGC)
Susan Nillias – Senior Application Analyst (MIS)
50
PANEL: Questions to Consider
What will „look different‟ about CAMHD
when we are fully implementing the Clinical
Model?
How will we know we are successfully
implementing the Clinical Model?
What will look different in our data (e.g.,
youth, services, funding) over time?
What performance indicators should we
track to know how we are progressing?
51
We Want You!
52
To Complete your Evaluation Form!!
That‟s All Folks . . .
• We will be sending out the final 2012 Annual Factbook (on CD) near
the end of this month.
• We will also post the Annual Factbook to the CAMHD website.
• There will be a special Annual Factbook made for each Family
Guidance Center containing only that FGC’s information (for faster
access to each FGC). 53
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