Community Programs Office of Quality Management Tom Bleecker, Ph.D. - - PowerPoint PPT Presentation

Community Programs Office of Quality Management Tom Bleecker, Ph.D. Nathaniel Israel, Ph.D. Monica Rose, Ph.D. Deborah Sherwood, Ph.D. 8/20/2013

Adult Needs & Strengths Assessment (ANSA)

Domains



Behavioral Health Needs: Psychosis, Depression, Anxiety, Adjustment to Trauma, Impulse Control, Interpersonal Problems, Substance Use



Life Domain Functioning: Physical/Medical, Family Functioning, Living Skills, Social Functioning, Residential Stability, Employment



Risks: Danger to Self, Danger to Others, Self-Injurious Behavior, Grave Disability, Exploitation, Criminal Behavior



Strengths: Optimism, Community Connection, Spiritual/Religious, Involvement in Recovery/Motivation for Treatment



Other: Cultural Stress, Medication Adherence NEEDS are rated as follows: 0 = no evidence, no need for action 1 = mild degree of the dimension, need for watchful waiting to see whether action is needed 2 = moderate degree of the dimension, need for action 3 = severe, profound, dangerous, or disabling level, need for immediate or intensive action STRENGTHS are rated as follows: 0 = a significant strength that is present 1 = a moderate level of the strength is present 2 = a mild level of the strength is present 3 = the strength is not present.

2

3

Top Behavioral Health Needs:

1.

Depression (70%)

2.

Anxiety (59%)

3.

Adjustment to Trauma (39%) Top Life Domain Functioning Needs:

1.

Residential Stability (46%)

2.

Social Functioning (45%)

3.

Family Functioning (44%) Top Life Domain Functioning Needs by Age:

• Age 18 to 25: Family Functioning (55%)
• Age 26 to 59: Residential Stability (48%)
• Age 60 & above: Physical/Medical (48%)

Behavioral Health & Life Domain Functioning

30.1% 70.0% 59.0% 38.8% 31.5% 24.5% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Psychosis Depression Anxiety Adj to Trauma Impulse Control Interpers Probs

Percent Actionable

Clients Overall Behavioral Health Needs

N=11,297 32.9% 43.5% 27.9% 45.4% 45.7% 29.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Percent Actionable

Clients Overall Life Domain Functioning

N=11,297

Risks Twice as many clients were rated with an actionable level of need on “Danger to Self” (21%) compared to all other risks. Risks and Gender Twice as many Males (12%) than Females (5%) were rated with an actionable level of need on Criminal Behavior risk. Conversely, twice as many Females (7%) than Males (3%) were rated with an actionable level of need on Exploitation

Strengths Community Connection* (32%) was rated the lowest overall client strength. The developer of the ANSA suggests that Community Connection is the most important strength in terms of recovery.

*Community Connection: An individual’s level of involvement in the cultural aspects of his community (e.g. community group activities or informal networks) 4

20.8% 5.2% 6.2% 8.6% 4.7% 9.2% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Danger to Self Danger to Others Grave Disabilities Self-Inj. Behavior Exploitation Criminal Behavior Percent Actionable

Clients Overall Risks

N=11,297 46.1% 31.9% 36.6% 60.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Optimism Community Connection Spiritual/Religious Involve in Recovery Percent Actionable

Clients Overall Strengths

N=11,297

Risks & Strengths

Medication Compliance, Cultural Stress, & Substance Use

Substance Use More than half of clients (57%) were rated with Substance Use as an actionable need (21% of this group used alcohol/drug daily)

Substance Use and Ethnicity African American clients (71%) had the highest proportion of clients with an actionable need on Substance Use followed by White clients (68%) Latino clients (56%), and Asian clients (26%).

Medication Compliance About 16% of clients had an actionable need related to Medication Compliance. Cultural Stress Overall, 14% of clients were rated with an actionable need related to Cultural Stress; however the proportion of Asian (28%) & Latino (23%) clients with a need related to Cultural Stress was 3 times higher than it was for White clients (6%).

5

15.7% 13.8% 57.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Medication Compliance Cultural Stress Substance Use Percent Actionable

Medication Compliance, Cultural Stress, & Substance Use

N=11,297

6

Association between Treatment Level of Care and ANSA Actionable Needs

5.1 7.4 8.3 2.8 3.5 4.0 2.1 3.2 3.2 0.3 1.0 1.1

1 2 3 4 5 6 7 8 9 10 Outpatient Services Intensive Case Management Residential Services

Level of Care

Average Number of Actionable Needs at Intake by Level of Care Total Needs Behavioral Health Needs Life Domain Functioning Risks

N=7,679 N=813 N=2,785

Client Improvement Over Time

Behavioral Health Needs Items: Psychosis, Depression, Anxiety, Adjustment to Trauma, Impulse Control, Interpersonal Problems, Substance Abuse Life Domain Functioning Items: Physical/Medical, Family Functioning, Living Skills, Social Functioning, Residential Stability, Employment Risks Items: Danger to self, Danger to Others, Gravely Disabled, Exploitation, Criminal Behavior, Self Injurious Behavior Strengths Items: Optimism, Community Connection, Spiritual/Religious, Involvement with Recovery

Number of client episodes with at least 2 ANSAs: 9,297 Number showing reliable improvement in at least one domain: 6,395 (68.8%) Number showing reliable improvement by Domain:

• Behavioral Health Domain:

3,142 (33.8%)

• Life Domain Functioning:

2,793 (30.0%)

• Risks Domain:

2,851 (30.7%)

• Strengths Domain:

3,441 (37.0%)

7

Nathaniel Israel, Ph.D. Office of Quality Management

• 2013. 08.07 v2.2

Background

 Have tools in place to understand clinical and

functional improvement at the client, program, and system levels

 In the past two fiscal years, used these tools to

benchmark system performance and to understand performance in relation to best practice

 Moving from description to evidence-informed,

collaborative action

9

*Each diamond represents a Children’s Behavioral Health program

10 20 30 40 50 60 70 80 90 100

% Clients Who Improve

Program

High Quality System Current Performance in SF

10

Problem

 High-quality, effective care is the exception, not

the norm

 Effectiveness of care often depends on whether a client

gets the ‘right’ clinician in the ‘right’ agency

 Strong belief from many providers that they are

able to effectively treat some clients and some conditions

 How do we build on this to facilitate more effective

practice?

11

Method

 Use ways of formulating decisions which are already

accessible to clinicians (clinical formulation)

 Add in structured clinical data (CANS) to help select

important concerns and orient decision-making

 Construct a program-wide clinical formulation based

• n the data

 Use these pieces of data to better understand and

disseminate what practices are effective in our local context

12

13

14

Putting Practices Together

 Is this site effective at addressing this Need?  List approaches (general framework and specific

practices) used by each site with evidence of promising practices

 Look for common practices across sites  Look for unique practices at sites  Identify context considerations which may

influence practice (age, language, culture, setting)

15

Integration and Learning

 Existing System-wide Initiatives

 Trauma-Informed System  Performance Contracting

 Existing Forums for Practice Conversations

 SuperUser Calls, Provider Meetings, CYF Executive

Leadership

 Affinity Groups

 How was this practice developed, taught, sustained?

 Dissemination and Training Champions

 Learning must translate into practice change

16