ANNUAL EVALUATION SUMMARY: FISCAL YEAR 2017 Child & Adolescent - - PowerPoint PPT Presentation

ANNUAL EVALUATION SUMMARY: FISCAL YEAR 2017

Child & Adolescent Mental Health Division Research, Evaluation & Training Program Improvement & Communications Office

Trina Orimoto, David Jackson, Max Sender, & Kalyn Holmes April 2018

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Overview

Review of major trends and findings in the following areas: Overall

• Youth Served
• Services Rendered

Special Analyses

• Decreasing average age of youth clients
• Trends in youth and family reported outcomes
• Risk profiles revisited

Summary

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YOUTH SERVED

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1954 2119 2225 2405 2496 2405 1765 1965 2089 2070 2209 2162 1230 1313 1337 1505 1528 1420 500 1000 1500 2000 2500 3000 2012 2013 2014 2015 2016 2017 Youth (N) Fiscal Year

CAMHD Youth Registered & With Procured & Direct Services Fiscal Year 2012-2017

# Youth Registered # Youth Enrolled and/or Receiving Services # Youth with Direct Services # Youth with Procured Services

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100 200 300 400 500 600 700 800 900 1000 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 Registered Youth (N) Fiscal Year by Family Guidance Center CAMHD Youth Enrolled & Receiving Direct & Procured Services by FGC Fiscal Year 2013-2017 Enrolled Procured Svc. Direct Svc.

Hawaii Leeward Central Honolulu Maui Kauai Family (Big Island) Oahu Oahu Oahu Court Liaison

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Primary Diagnosis # of Youth

Anxiety Disorders 79 Bipolar and Related Disorders 30 Depressive Disorders 235 Disruptive, Impulse-Control, and Conduct Disorders 406 Neurodevelopmental Disorders Attention-Deficit/Hyperactivity Disorder 307 Autism Spectrum Disorder 15 Intellectual Disability 6 Other Neurodevelopmental Disorders 1 Obsessive-Compulsive and Related Disorders 10 Schizophrenia Spectrum and Other Psychotic Disorders 20 Substance-Related and Addictive Disorders 20 Trauma- and Stressor-Related Disorders Adjustment Disorder 214 Posttraumatic Stress Disorder 156 Other Trauma- and Stressor-Related Disorders 25 Other Infrequent CAMHD Diagnoses 6 General Medical Conditions or Codes No Longer Used 136

50 100 150 200 250 300 350 400 450

# of Youth

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14.6 14.5 14.4 14.5 14.4 14.2 14.0 13.9 13.6 13.5 13.3 13.0 14.0 15.0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Mean Age Fiscal Year CAMHD Enrolled Youth Average Age Fiscal Years 2007-2017

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• Note. Data excludes Kauai from 2007-2011 because of Mokihana program.

28.6% 29.9% 33.1% 35.3% 37.5%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2013 2014 2015 2016 2017 Trend in % of Enrolled Youth 12 or Younger Older Than 12 12 or Younger

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62% 62% 62% 61% 61% 38% 38% 38% 39% 39% 0% 20% 40% 60% 80% 100% 2013 2014 2015 2016 2017 Gender % Fiscal Year CAMHD Enrolled Youth Gender Fiscal Year 2013-2017 Male Female

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Youth Served-Key Findings

• The number of enrolled youth has decreased slightly from FY 2016 to FY

2017.

• CAMHD client population continues to have a younger average age.

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SERVICES RENDERED

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14 25 35 38 29 77 74 70 69 85 14 13 10 7 8 10 8 127 111 192 168173 145 134 50 100 150 200 250 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 Youth (N) Services by Fiscal Year

CAMHD Out-of-Home Service Utilization FY 2013-2017

Out-of-State Hospital Residential Community High Risk Community Residential II Community Residential III Transitional Family Home

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812 878 1,016 1,044 995 213 207 185 187 157 101 89 77 51 67 51 53 23 21 18 16 13 32 27 20 6 4 181 160 248 230 138

200 400 600 800 1,000 1,200

Youth (N) Services by Fiscal Year

CAMHD Intensive Home and Community and Outpatient Service Utilization FY 2013-2017

Intensive Home & Community Services Outpatient Services

Multisystemic Therapy Intensive In-Home Functional Family Therapy Outpatient Therapy Assessment Comprehensive Behavioral Intervention Partial Hospitalization 13

30 39 34 39 39 162 142 152 148 136 20 40 60 80 100 120 140 160 180 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017 Youth (N) Services by Fiscal Year

CAMHD Supportive Service Utilization FY 2013-2017

Respite Home Ancillary Service

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$28,725 $27,898 $26,853 $25,187 $24,450 $23,235 $21,338 $20,835 $21,834 $0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 2009 2010 2011 2012 2013 2014 2015 2016 2017 Fiscal Year

Procured Service Cost Per Youth Within Each Fiscal Year

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Services Rendered – Key Findings

• The majority of services have shown slight declines in number of youth served.
• Use of Out-of-State services has declined.
• Increases in service use shown for hospital-based residential and functional

family therapy.

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What, if any, adjustments should be made?

DECREASING AVERAGE AGE OF YOUTH CLIENTS

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14.6 14.5 14.4 14.5 14.4 14.2 14.0 13.9 13.6 13.5 13.3 13.0 14.0 15.0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Mean Age Fiscal Year CAMHD Enrolled Youth Average Age Fiscal Years 2007-2017

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• Note. Data excludes Kauai from 2007-2011 because of Mokihana program.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Hawaii Island (N=712) Kauai (N=202) Maui (N=319) Central Oahu (N=368) Leeward Oahu (N=366) Honolulu (N=325) Family Court Liaison Branch (N=15)

Percent of Youth

Family Guidance Center

Percent of 12 and Under/13 and Over Youth by Center/Branch

12 and Under 13 and Over

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0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% 12 and Under 13 and Over

Percent of Male/Female Youth by Age Group

Male Female

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Percent of Youth

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0.00% 0.00% 6.70% 9.80% 16.70% 30.50% 31.60% 33.30% 37.80% 43.65% 44.10% 44.90% 50.00% 56.40% 66.70% 100.00%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Schizophrenia Spectrum and Other Psychotic Disorders (n=20) Substance-Related and Addictive Disorders (n=20) Bipolar and Related Spectrum Disorders (n=30) Depressive Disorders (n=235) Other Infrequent CAMHD Diagnoses (n=6) Disruptive, Impulse-Control, and Conduct Disorders (n=406) Anxiety Disorders (n=79) Intellectual Disabilities (n=6) Posttraumatic Stress Disorder (n=156) Trauma- and Stress-Related Disorders (n=25) General Medical Conditions or Codes No Longer Used (n=136) Adjustment Disorder (n=214) Obsessive Compulsive and Related Disorders (n=10) Attentional Disorders (n=307) Autism Spectrum Disorders (n=15) Other Neurodevelopmental Disorders (n=1)

Percent of 12 and Under/13 and Over Youth by Primary Diagnosis Area

12 and Under 13 and Over

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Individual Family Parent Teacher Pro Consult Group Phone

Percent of Youth Within Each Age Group Receiving Services by Service Format Type

12 and Under 13 and Over

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Percent of Youth

12 and Under - 10 Most Frequently Endorsed Treatment Targets

Target % Endorsed (N=569) Average Progress Rating (0-7) Positive Peer Interaction 86.82 4.83 Oppositional or Non-Compliant Behavior 71.35 4.68 Anger 61.16 4.46 Aggression 59.40 4.78 Social Skills 53.60 4.54 Treatment Engagement 52.90 4.4 Activity Involvement 51.49 4.91 Anxiety 49.91 4.51 Peer or Sibling Conflict 49.91 4.43 Attention Problems 47.98 4.18

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13 and Over - 10 Most Frequently Endorsed Treatment Targets

Target % Endorsed (N=1068) Average Progress Rating (o- 7) Positive Peer Interaction 86.61 5.21 Treatment Engagement 76.59 4.96 Oppositional or Non-Compliant Behavior 72.10 4.98 Activity Involvement 66.85 5.17 Anger 57.40 4.79 Anxiety 55.99 4.75 Depressed Mood 55.06 4.23 Aggression 54.12 5.14 Academic Achievement 48.50 4.92 School Involvement 47.66 4.81

• Note. Treatment targets not present in the top 10 targets for both groups are highlighted in yellow.

12 and Under - 10 Most Frequently Endorsed Intervention Strategies

Intervention Strategy % Endorsed (N=569) Relationship or Rapport Building 92.27 Supportive Listening or Client Centered 87.35 Psychoeducational Parent 86.99 Communication Skills 84.18 Family Engagement 82.60 Modeling 80.84 Therapist Praise or Rewards 80.14 Skill Building 79.09 Parent Coping 78.21 Problem Solving 75.92

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13 and Over - 10 Most Frequently Endorsed Intervention Strategies

Intervention Strategy % Endorsed (N=1068) Relationship or Rapport Building 95.13 Supportive Listening or Client Centered 90.54 Communication Skills 89.89 Problem Solving 89.04 Family Engagement 88.67 Goal Setting 87.73 Psychoeducational Parent 84.27 Skill Building 83.52 Family Therapy 82.49 Emotional Processing 81.74

• Note. Intervention strategies not present in the top 10 strategies for both groups are highlighted in yellow.

10 20 30 40 50 60 70 80 90 100 Behavioral Management Coping and Self Control Family Interventions Average Percent of Intervention Strategy Factor Utilized Intervention Strategy Factors (Based on Monthly Treatment and Progress Summary)

Average Utilization of Intervention Strategy Factors by 12 and Under/13 and Over

12 and Under 13 and Over

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• Note. Youth ages 13 and over receive significantly more Family Interventions and Coping and Self Control Interventions than youth ages 12 and under.

Decreasing Average Age of Youth Clients

SUMMARY

• The average age of CAMHD clients has continued to decrease over the past

ten years.

• The proportion of younger clients varies by Family Guidance Center.
• The demographic and clinical profile of clients 12 and under differs slightly

from the profile of youth 13 and older.

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How should we adjust our services (e.g., LOCs, training, specific practices) to address this emerging trend?

TRENDS IN YOUTH AND FAMILY REPORTED OUTCOMES

*Based on CAMHD outcome measures

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28.1 22.8 18.7 14.2 5 10 15 20 25 30 35 40

Parent Youth OS Total Score

Earliest OS Latest OS

Average of Youth's Earliest and Most Recent Ohio Scale Total Problems Score: Youth Enrolled in FY 2017

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OS Total Score Range: 0-100 *Clinical cutoff recommended by a study by the Ohio Scales author.

16.1 11.2 9.7 9.3 10.9 7.2 6.2 5.8 5 10 15 20 25 Parent Youth Parent Youth Externalizing Internalizing OS Total Score

Earliest OS Latest OS

Average of Youth's Earliest and Most Recent Ohio Scale Problems Subscale Scores: Youth Enrolled in FY 2017

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OS Externalizing Scale Range: 0-40 OS Internalizing Scale Range: 0-45

26.0 20.4 24.9 18.8 28.9 24.1 30.6 23.3 31.2 23.9 28.0 24.5 14.6 18.2 14.3 16.0 12.3 18.5 17.5 19.5 12.6 20.8 15.3 18.5 13.9 9.4

5 10 15 20 25 30 35 40

Parent Youth Parent Youth Parent Youth Parent Youth Parent Youth Parent Youth Parent Youth Hawaii (Big Island) Kauai Maui Oahu Central Oahu Honolulu Oahu Leeward Family Court Liaison Branch

OS Total Score Family Guidance Center Earliest OS Latest OS Average of Youth's Earliest and Most Recent Ohio Scale Total Problems Score by FGC: Youth Enrolled in FY 2017

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OS Total Score Range: 0-100, Clinical cutoff=20

88.4 103.3 96.3 93.7 96.9 90.6 77.0 84.2 74.8 75.6 79.2 81.1 20 40 60 80 100 120 140

Hawaii (Big Island) Kauai Maui Oahu Central Oahu Honolulu Oahu Leeward Family Court Liaison Branch CAFAS Score

Family Guidance Center Earliest CAFAS Most Recent CAFAS

Average of Youth's Earliest and Most Recent CAFAS Total Score by FGC: Youth Enrolled in FY 2017

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CAFAS Total Score Range: 0-240

21.0 19.5 17.4 17.1 6.6 4.2 4.0 3.3 17.3 16.4 14.9 15.0 5.6 3.5 2.1 2.8 5 10 15 20 25 30

CAFAS Score

Earliest Score Most Recent Score

Average of Earliest and Most Recent CAFAS Subscale Scores: Youth Enrolled in FY 2017

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54.1% 58.6% 61.0% 66.6% 63.2% 69.3% 65.6% 66.2% 65.3% 64.1% 69.1%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% 2007 (N=679) 2008 (N=760) 2009 (N=805) 2010 (N=897) 2011 (N=806) 2012 (N=762) 2013 (N=809) 2014 (N=788) 2015 (N=796) 2016 (N=934) 2017 (N=808) Percent of Monthly Treatment and Progress Summaries with Discharge Data

Year Percent of Service Episodes with Successful Discharge Indicated on the Monthly Treatment and Progress Summary

• Note. Successful discharge was defined as “success/goals met” indicated on the MTPS. Not successful discharge was defined as “runaway/elopement,” “insufficient progress,” “refuse/withdraw.”

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0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

FY 2016 FY2017 Percent of Clients With at Least Two Ohio Scales Year Percent of Youth Demonstrating Improvement Between the First and Most Recent Ohio Scales Problems Scales (Youth and Parent) in FY 2016 and FY 2017

Parent Improvement Youth Improvement

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Outcomes– Key Findings

• On average, youth and families report statistically and clinically significant

improvements between their first and most recent Ohio Scales administrations.

• On average, youth tend to report fewer problems on the Ohio Scales than

parents.

• On average, CAMHD staff report statistically significant improvements for

youth and families between the first and most recent CAFAS administrations.

• On average, therapists report a slight increasing trend in successful

discharges.

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How can we continue to support positive outcomes for our youth and families?

RISK PROFILES: INITIAL RISK

(REVISITED)

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Risk Profiles: Initial CAFAS

CBRIII Discharge Success Rate by Initial CAFAS Score

Initial CAFAS Score Success Rate at This Level

• r Higher

N at This Level or Higher (Denominator) All 70.4% 81 90+ 71.4% 77 110+ 71.6% 67 130+ 66.0% 47 150+ 47.8% 23 170+ 20.0% 5

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Initial CAFAS is a significant predictor of discharge success

Lower Risk Higher Risk

Risk Profiles: Initial CAFAS

Levels of Care in Which Initial CAFAS Significantly Predicted Discharge Success. Level of Care CAFAS Cutoff For Higher Risk Cases Probability of Successful Discharge

Community Based Residential III 150+ 47.8% Transitional Family Home 120+ 45.2% Intensive In-Home 130+ 46.7%

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Risk Profiles: Initial CAFAS

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Average Total Procured Service Cost Per Youth Starting From Service in Which Initial Risk Indicated

$194,451 $195,376 $- $50,000 $100,000 $150,000 $200,000 $250,000 Lower Risk Higher Risk Risk Indicator Level

Transitional Family Home

$140,007 $152,249 $- $50,000 $100,000 $150,000 $200,000 $250,000 Lower Risk Higher Risk Risk Indicator Level

Community-Based Residential III

$74,560 $198,859 $- $50,000 $100,000 $150,000 $200,000 $250,000 Lower Risk Higher Risk Risk Indicator Level

Intensive In-Home

Risk Profiles: Initial CAFAS

SUMMARY

• Initial CAFAS significantly predicts success at discharge for TFH, CBRIII, &

IIH

• Initial CAFAS Risk Indicator
• In TFH, CBRIII, & IIH: Indicates the dysfunction level where youth has <50%

probability of success in that level of care

• In IIH: Indicates a dysfunction level where cost of services is significantly greater

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RISK PROFILES: EARLY PROGRESS

(REVISITED)

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1 2 3 4 5 6 7 Month1 Month2 Month3 Month4 Month5 Month6 Month7 Month8 Month9 Month10 Month11 Month12 Month13 Month14 Month15 Month16 Month17 Month18 Month19 Month20 Month21 Month22 Month23 Month24 Mean MTPS Progress Rating Treatment Episode Month Intensive In-Home Average MTPS Progress Ratings With 95% CI Successful Unsuccessful

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Risk Profiles: Early Progress

Levels of Care and Their Early Progress Risk Indicators That Were Predictive of Discharge Success with Cutoff Scores Where Probability of Discharge Success <50%.

Level of Care Assessment Early Progress Risk Indicator Community Based Residential III 4th (Month) MTPS Average MTPS Progress Rating Below 2.9 2nd (Quarter) CAFAS CAFAS Score 150 or higher Transitional Family Home 3rd (Month) MTPS Average MTPS Progress Rating Below 3.6 2nd (Quarter) CAFAS CAFAS Score 140 or higher Intensive-In Home 2nd (Month) MTPS Average MTPS Progress Rating Below 2.0 2nd (Quarter) CAFAS CAFAS Score 120 or higher Hospital-Based Residential 2nd (Month) MTPS Average MTPS Progress Rating Below 2.8 MultisystemicTherapy 3rd (Month) MTPS Average MTPS Progress Rating Below 3.3 Functional Family Therapy 3rd (Month) MTPS Average MTPS Progress Rating Below 3.6

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$- $50,000 $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 Lower Higher Lower Higher Lower Higher Lower Higher Lower Higher Lower Higher HBR TFH CBRIII IIH MST FFT

Cost Per Youth Risk Indicator Level by Service Type

Average Total Procured Service Cost Per Youth Starting From Service in Which Early Progress Risk Indicated

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Risk Profiles: Early Progress

SUMMARY

• Early progress is predictive of discharge success across levels of care.
• Cost of total services is higher for youth with early progress risk at all major

LOCs examined, although only minimally higher for MST.

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Reflections

• Dr. Kurt Humphrey
• Dr. Scott Shimabukuro
• Dr. Lesley Slavin
• Dr. M. Stanton Michels

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Mahalo!

• For more information, please contact:

David Jackson, Ph.D. David.Jackson@doh.hawaii.gov (808) 733-8354 Trina Orimoto, Ph.D. Trina.Orimoto@doh.hawaii.gov (808) 733-9255

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