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

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2500

3000

2008 2009 2010 2011 2012

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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

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(N

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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

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egis

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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

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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

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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

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400

600

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1,200

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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

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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

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800

1,000

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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

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500

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1500

2000

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2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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# 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

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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

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# 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

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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