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Children’s Intensive Services Evaluation Results

Children’s Intensive Services Evaluation Results. Christian M. Connell, Ph.D. Hillary Heinze, M.A. Yale University School of Medicine Division of Prevention and Community Research The Consultation Center. Overview of Presentation. Review CIS performance prior to Standards

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Children’s Intensive Services Evaluation Results

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  1. Children’s Intensive ServicesEvaluation Results Christian M. Connell, Ph.D. Hillary Heinze, M.A. Yale University School of Medicine Division of Prevention and Community Research The Consultation Center

  2. Overview of Presentation • Review CIS performance prior to Standards • Describe clients served by CIS • Demographic & clinical characteristics • Patterns of service delivery • Discharge outcomes • Length of stay in program • Discuss findings & program implications

  3. Children’s Intensive Services (CIS) • Intensive community & home-based mental and behavioral health program for children with SED • Intended to provide a “continuum of care” for medically necessary services • Designed to address needs of the child within his/her environmental context

  4. Initial Evaluation of CIS • Purpose – Provide statewide and agency-level information on: • Demographic/clinical characteristics of clients • Service utilization patterns • Methods: • Annual administrative data pull • Provider time study • Sample: Nearly 3,000 children served in FY03

  5. Age % 0-2 0 3-5 10 6-11 37 12-17 51 18+ 2 Gender % Males 59 Females 40 Race/Ethnicity % African American 11 American Indian 2 Asian/Pac. Island 1 Caucasian 69 Hispanic 16 Other 9 Missing 6 Note: Participants may have indicated more than one race Demographic Characteristics

  6. Diagnosis % Adjustment 23 Anxiety 13 Behavior 57 Develop/LD 7 Mood 32 Psychosis 1 Personality 1 Substance Use 3 Missing 10 Note: Participants may have more than one diagnosis Functioning-CGAS % 10-30 2 31-40 11 41-50 35 51-60 40 61-100 11 Missing 11 Note: Lower scores indicate poorer functioning Clinical Characteristics

  7. Service Hrs/Wk by Clinical IndicatorJuly 2002 – June 2003

  8. Sharp increase in discharges: 6 months Median LOS: 4 months 5% of cases drop-out immediately or are never seen Length of Stay in CIS (Months Active) Length of Time in CIS (Months)

  9. Implications of Initial Evaluation • Children in CIS receive more service time than traditional outpatient therapy clients • Children are receiving a mix of service modalities • Services are being delivered by a mix of service providers • However: • Service delivery was less than anticipated for some clients • Child clinical characteristics not associated with service delivery patterns

  10. CIS “Levels of Care” • Level 1: Crisis Intervention • M-CGAS: 10-30 • 6-14 hrs of direct clinical service/week • Level 2: Standard Care • M-CGAS: 31-40 • 2-10 hrs of direct clinical service/week • Level 3: Intermediate Care • M-CGAS: 41-50 • 2-5 hrs of direct clinical service/week • Level 4: Maintenance Care • M-CGAS: 51-60 • .5-1 hr of direct clinical service/week • 2 hrs case management/month

  11. Current Evaluation Phase – Implementation Performance • Methodology: • Monthly MIS data extraction • New admissions demographic/clinical data • Monthly client updates • Service data • Discharge data

  12. Current CIS EvaluationApril 2004 – March 2005Demographic and Clinical Information

  13. CIS Admission & Discharge PatternTotal Population Served (N = 2606)

  14. Demographic Information

  15. Age at AdmissionTotal Population Served (N = 2606) mean age: 11.3 years

  16. GenderTotal Population Served (N = 2606)

  17. Race/EthnicityTotal Population Served (N = 2606)

  18. Referral SourceNew Admissions (N = 2606)

  19. Clinical Information

  20. CIS Level at AdmissionTotal Population Served (N = 2606) Mean M-CGAS Scores Overall: 44 Crisis: 31 Standard: 38 Intermed.: 44 Maint.: 51

  21. Clinical Diagnoses by Disorder TypeTotal Population Served (N = 2606)

  22. Axis IV Psychosocial Problems New Admissions (N = 2606)

  23. Ohio Scales Admission Scores

  24. CAFAS Analyses

  25. Admission CAFAS Sample • 78% of cases (2038 children) eligible for admission CAFAS (including those in care prior to Standards) • Enrolled 30 days or more • Age 6 or older • CAFAS data was available for 58% of eligible cases (1195 children)

  26. Admission CAFAS Results (Age > 6; N = 1195)

  27. Identification of Admission CAFAS Groups

  28. CAFAS Scores by Admission Group

  29. Service Utilization DataWhat did Children in CIS Receive for Treatment?

  30. What Happens in CIS in a Week? • Service Utilization Review examined several issues related to typical service week in CIS: • Average amount of service / week (Hours) • Break-down of service mix • Break-down of service provider credentials • Data are analyzed by calendar week and then aggregated to a monthly average (after weighting for # active clients / week). • Analyses are run at the provider and State level.

  31. Service Hrs/Wk by CIS LevelApril – December 2004 (1st 6 months)

  32. Service Hrs/Wk by CIS LevelJanuary – March 2005 (Most Recent Quarter)

  33. Average Service Mix for ChildrenJanuary – March 2005 (Most Recent Quarter)

  34. Weekly Service Hours by Provider TypeJanuary – March 2005 (Most Recent Quarter)

  35. Service Location (% of Time) January – March 2005 (Most Recent Quarter)

  36. Service Utilization DataHow is CIS Treatment being delivered to individual children?

  37. Child 1: White male, 8 years old

  38. Child 2: White male, 12 years old

  39. Child 3: Hispanic female, 14 years old

  40. Discharge DataWho exited CISthis year?

  41. Age % 0-2 1 3-5 10 6-11 34 12-17 53 18+ 2 Gender % Males 57 Females 42 Race/Ethnicity % African American 9 American Indian 2 Asian/Pac. Island 1 Caucasian 53 Hispanic 19 Other 5 Multiracial 5 Missing 6 Demographic CharacteristicsDischarge Population (N = 1517)

  42. Diagnosis (admission) % Adjustment 20 Anxiety 21 Behavior 63 Develop/LD 11 Relationship 13 Mood 34 Psychosis 1 Personality 1 Substance Use 2 Missing 2 Note: Participants may have more than one diagnosis Functioning-CGAS % 10-30 1 31-40 12 41-50 47 51-60 24 61-100 6 Missing 9 Note: Lower scores indicate poorer functioning Clinical CharacteristicsDischarge Population (N = 1517)

  43. CIS Level at Discharge Discharge Population (N = 1517)

  44. Reason for Discharge (%) Discharge Population (N = 1517)

  45. Discharge Placement (%) Discharge Population (N = 1517)

  46. Admission to Discharge Changes

  47. Discharge CAFAS Sample • 44% of cases (919 children) eligible for discharge CAFAS • Enrolled at least 90 days before discharge • Age 6 or older • CAFAS data was available for 56% of eligible cases (513 children)

  48. CAFAS at Discharge (N = 919) (Age > 6 yrs; in CIS 90 days or more)

  49. Admission to Discharge Changes CAFAS Total Score (N=424)

  50. Admission to Discharge Changes CAFAS Subscales (N=424)

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