FY16 Data Review Completed CANS-F Assessments by Jurisdiction, FY16 - - PowerPoint PPT Presentation

Child and Adolescent Needs and Strengths - Family Version for In-Home Services (CANS-F)

FY16 Data Review

Completed CANS-F Assessments by Jurisdiction, FY16

Jurisdiction Number of Families with at least one CANS-F Assessment Number of Caregivers with at least one CANS-F Assessment Number of Youth with at least one CANS-F Assessment Allegany 189 263 392 Anne Arundel 528 856 1109 Baltimore City 688 756 1422 Baltimore County 542 892 1156 Calvert 95 151 203 Caroline 53 90 120 Carroll 180 284 364 Cecil 191 255 387 Charles 176 238 419 Dorchester 114 143 267 Frederick 307 443 656 Garrett 42 55 85 Harford 108 143 227 Howard 144 203 303 Kent 32 43 68 Montgomery 224 312 441 Prince George’s 548 629 1178 Queen Anne’s 43 65 79 Somerset 58 82 137

• St. Mary’s

144 194 331 Talbot 50 67 106 Washington 295 424 618 Wicomico 117 161 263 Worcester 159 261 360 Families/Caregivers/ Youth 5,027 7,010 10,691 Total # of Assessments 7,906 10,905 17,015

Change Over Time

• In-home families that completed a CANS-F at two different

time points were examined to determine any changes in youth, caregiver, and family well-being.

• Initial and end of service assessments were selected for

mandatory needs and strengths sections of the CANS-F (family functioning, caregiver advocacy, caregiver assessment, and child functioning)

• Since non-mandatory sections of the CANS-F (child

behavioral/emotional needs and child risk behaviors) are filled

• ut less frequently, the earliest and latest assessments were

used, regardless of time frame.

Change Over Time

• Needs were calculated by creating sectional scores (items

were aggregated using the full range of responses 0-3), with scores reflecting both actionable and potential needs (scores

• f 1).

– Maximum score for a scale with 10 items = 30

• Strengths were assessed based upon counts of items (a

strength was either present or not).

– Maximum strengths for a scale with 10 items = 10

Family Service Breakdown

Among Families with an Initial and End of Service CANS-F

75% 12% 13%

Service Type (n=849)*

Consolidated In-Home Family Services Interagency Family Preservation Services Services to Families with Children - Intake

Service Type (n=602) Average Length

• f Stay (days)^

Consolidated In-Home Family Services 189 Interagency Family Preservation Services 147 Services to Families with Children - Intake 157

^Since some cases are only opened briefly to pay a bill; or had not been closed out, length of stay includes families served between 30 and 365 days. *Service types and length of stay are linked from a separate data file. Some families were not able to be linked to a specific service, or changed services, and are not included in the pie chart above.

Family Functioning

10 Need Items, 10 Strength Items

5.02 1.48 3.11 1.57

0.00 1.00 2.00 3.00 4.00 5.00 6.00 Needs Strengths

Needs and Strengths at Initial and End of Service (n=949)

Initial End of Service

61% 15% 23%

% of Family Change - Needs (n=949)

Improved (Fewer Needs) Declined (More Needs) No Change

Caregiver Advocacy

9 Need Items, 9 Strength Items

2.47 1.46 1.41 1.60

0.00 0.50 1.00 1.50 2.00 2.50 3.00 Needs Strengths

Needs and Strengths at Initial and End of Service (n=949)

Initial End of Service

46% 12% 42%

% of Family Change - Needs (n=949)

Improved (Fewer Needs) Declined (More Needs) No Change

Caregiver Assessment

12 Need Items, 5 Strength Items

4.13 0.87 3.10 0.90

0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 Needs Strengths

Needs and Strengths at Initial and End of Service (n=1,246)

Initial End of Service

49% 20% 31%

% of Caregiver Change - Needs (n=1,246)

Improved (Fewer Needs) Declined (More Needs) No Change

Child Functioning

16 Need Items, 13 Strength Items

3.44 1.58 2.52 1.69

0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 Needs Strengths

Needs and Strengths at Initial and End of Service (n=2,050)

Initial End of Service

42% 19% 39%

% of Youth Change - Needs (n=2,050)

Improved (Fewer Needs) Declined (More Needs) No Change

Child Behavioral/Emotional Needs

10 Need Items

4.77 4.76

0.00 1.00 2.00 3.00 4.00 5.00 6.00 Needs

Needs at Earliest and Latest Assessments (n=291)

Earliest Assessment Latest Assessment

33% 31% 36%

% of Youth Change - Needs (n=291)

Improved (Fewer Needs) Declined (More Needs) No Change

Child Risk Behaviors

12 Need Items

5.85 5.51

0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 Needs

Needs at Earliest and Latest Assessments (n=101)

Earliest Assessment Latest Assessment

34% 33% 34%

% of Youth Change - Needs (n=101)

Improved (Fewer Needs) Declined (More Needs) No Change

CANS-F Summary

• Overall, most families, caregivers, and youth appeared to improve.

– 61% of families had fewer family functioning needs at discharge, while nearly half of families, caregivers, and youth improved in caregiver advocacy, caregiver assessment, and child functioning sections. – Improvement differed by service (not shown), as IFPS cases experienced the greatest reduction in needs, partially because they had the most needs to begin with

• Strengths tended to remain unchanged and may suggest that

strengths are harder to develop in a short period of time. However, there were several limitations to the data:

– Strengths were not measured on a scale as needs were; rather strengths were present or not. – Both caregiver assessment and child functioning strengths contained fewer items than their respective needs sections

CANS-F Next Steps

• CANS user supports will be administered to

local jurisdictions to assess baseline data needs regarding each worker’s comfort and ability in using the CANS/CANS-F instruments.

• County-specific plans will then be created

from the baseline data collected.

Case Review Process

• A pilot assessment was conducted on 20 in-home cases
• The following two questions were examined:
• 1. What was the quality of CANS-F implementation?
• 2. Did workers link identified needs from the CANS-F to

referrals for services and/or their in-home service plan?

Sample

• a case had to contain an initial and end of service CANS-F

entered between July 1, 2015 – March 31, 2016.

• Multiple steps:

1) cases were sorted by jurisdiction 2) at least 5 families were randomly selected from five of the largest jurisdiction 3) 35 additional cases were randomly selected from the remaining jurisdictions 4) From the 60 cases, a sample of 20 families were selected for review.

– Reviewers started with Howard, Anne Arundel, and Allegany counties, and then began to select cases from additional jurisdictions.

15% 20% 5% 10% 10% 20% 10% 10%

Jurisdiction

Allegany Anne Arundel Calvert Cecil Charles Howard

• St. Mary's

Wicomico

65% 25% 10%

Program

Consolidated In-Home Family Services (IHFS) Interagency Family Preservation Services (IFPS) Service to Families with Children (SFC-I)

Methods

• a case review instrument was created in Qualtrics

(a web-based survey system used for recording data from the case reviews)

– instrument examined 8 sections of the CANS-F:

1) family functioning; 2) caregiver functioning; 3) caregiver advocacy; 4) acculturation; 5) child functioning; 6) trauma experiences; 7) child behavioral/emotional needs; and, 8) child risk behaviors.

① What was the quality of CANS-F implementation?

• For each section of the

CANS-F, the reviewers examined whether the CWW provided a rating for each item, and then reviewed the comments to determine whether the CWW justified the rating (comments were required for all ratings ≥ 1).

② Did workers link identified needs from the CANS-F to referrals for services and/or their in-home service plan?

• For all items with a rating of 2

(ACT to address need) or 3 (ACT immediately, intensely), the reviewers explored case documentation (e.g., service plan, service plan tasks, contact log, CWW comments) to identify whether the need was reflected in the service plan, and whether the need resulted in a referral to a service.

What was the quality of CANS-F implementation?

6.7% 6.7% 9.1% 20.0% 20.0% 25.0% 33.3% 33.3% 100.0% 93.3% 93.3% 90.9% 80.0% 80.0% 75.0% 66.7% 66.7%

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

Acculturation (n=2) Caregiver #1 ratings (n=15) Child #1 ratings (n=15) Child #2 ratings (n=11) Caregiver Advocacy (n=10) Child #3 ratings (n=5) Child #4 ratings (n=4) Family Functioning (n=18) Caregiver #2 ratings (n=3)

Quality of Implementation

Without comments Comments provided

Did workers link identified needs from the CANS-F to referrals for services and/or their in-home service plan?

See Figures 2 and 3

30.0% 10.0% 5.0% 10.0% 10.0% 10.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%

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

Family conflict Financial resources Safey Extended family relations Parental-Caregiver collaboration Family communication Relations among siblings Residential stability Social resources Family role appropriateness

Family Functioning – Identified Needs

No need (0) Monitor (1) Act to address need (2) ACT immediately (3)

Was Identified Need Linked to Referral for Services? Need was Addressed Mixed Response Need was not Addressed

• Social resources
• Residential stability
• Relations among siblings
• Safety
• Extended family relations
• Parental-caregiver collaboration
• Family communication
• Financial resources
• Family conflict
• Family role appropriateness

5.3% 5.3% 15.8% 5.3% 5.3% 10.5% 10.5% 15.8% 5.3% 10.5%

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

Developmental Boundaries Involvement with care Substance use Marital/partner conflict Physical health

Caregiver Functioning - Identified Needs

No need (0) Monitor (1) Act to address need (2) ACT immediately (3)

Was Identified Need Linked to Referral for Services? Need was Addressed Mixed Response Need was not Addressed

• Supervision
• Substance use
• Marital/partner conflict
• Mental health
• Boundaries
• Physical health
• Developmental

5.0% 5.0% 10.0% 10.0%

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

Satisfaction with service arrangement Satisfaction with youth's educational arrangement Knowledge of rights & responsibilities Ability to listen Ability to communicate Knowledge of service options Satisfaction with youth's living arrangement Knowledge of family-child needs Natural supports

Caregiver Advocacy - Identified Needs

No need (0) Monitor (1) Act to address need (2) ACT immediately (3)

Was Identified Need Linked to Referral for Services? Need was Addressed Mixed Response Need was not Addressed

• Satisfaction with youth’s living

arrangement

• Knowledge of rights &

responsibilities

• Knowledge of family-child needs
• Natural supports
• N/A

10.0%

84% 86% 88% 90% 92% 94% 96% 98% 100%

Language Cultural identity Gender/sexual identity Ritual

Acculturation - Identified Needs

No need (0) Monitor (1) Act to address need (2) ACT immediately (3)

Was Identified Need Linked to Referral for Services? Need was Addressed Mixed Response Need was not Addressed

• N/A
• N/A
• N/A

Was Identified Need Linked to Referral for Services? Need was Addressed Mixed Response Need was not Addressed

• Adjustment to trauma
• Risk behaviors
• Mental health needs
• School behavior
• Social functioning
• Speech language delay
• Relationship with siblings
• Relationship with primary caregiver
• Relationship with other family adults
• Relationship with biological mother
• Relationship with biological father

2.4% 2.4% 2.4% 2.4% 9.5% 9.5% 4.8% 9.5% 7.1% 7.1% 11.9% 9.5% 11.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Autism spectrum/PDD Speech language delay Intellectual (IQ only) Relationship with primary caregiver Medical/physical Relationship with siblings School attendance Relationship with biological mother Social functioning Adjustment to trauma Risk behaviors School achievement School behavior Mental health needs Relationship with other family adults Relationship with biological father

Child Functioning - Identified Needs (n = 42)

No need (0) Monitor (1) Act to address need (2) ACT immediately (3)

Recommendations

1. Quality of CANS-F documentation

a) When ratings are ≥ 1, comments should be added. a) Comments should reflect why the item was identified as a need, or how the situation impacted the caregiver/child, clearly justifying the justification for the rating was unclear.

2. Did workers link identified needs from the CANS-F to referrals for services and/or their in-home service plan?

a) Service planning and tasks can increasingly be linked to identified needs, connecting referrals to specific needs.

Next steps…

• 1. Collaborate with CANS-F trainers for TA

topics.

• 2. Continue case review of an additional 40

cases.

• 3. Conduct annual case review to monitor on-

going implementation and progress.