Showing resettlement progress in 11 key areas of life using the Self-Sufficiency Matrix
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Showing resettlement progress in 11 key areas of life using the Self-Sufficiency Matrix

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Presentation given by Steve Lauriks from Amsterdam Public Health Service, The Netherlands at the FEANTSA/HABITACT seminar "Tackling homelessness as a social investment for the future: Looking at the ...

Presentation given by Steve Lauriks from Amsterdam Public Health Service, The Netherlands at the FEANTSA/HABITACT seminar "Tackling homelessness as a social investment for the future: Looking at the bigger picture", 12th June 2013, Amsterdam

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  • federal outcomes standard ‘Results Oriented Management and Accountability States and counties adapted the SSM for specific evaluation and accountability purposes.
  • 4 domains contribute significantly to the professional decision: Housing , Mental Health , Addiction and Judiciary
  • Average length of treatment = 32 weeks

Showing resettlement progress in 11 key areas of life using the Self-Sufficiency Matrix Showing resettlement progress in 11 key areas of life using the Self-Sufficiency Matrix Presentation Transcript

  • Self Sufficiency MatrixSelf Sufficiency MatrixComprehensive and reliable screening in Dutch Public Mental HealthCareS. Lauriks, T. Fassaert, M. de Wit, M. Buster, and S. van de Weerd
  • Self Sufficiency MatrixSelf Sufficiency MatrixComprehensive and reliable screening in Dutch Public Mental HealthCareS. Lauriks, T. Fassaert, M. de Wit, M. Buster, and S. van de Weerd
  • Introduction Self Sufficiency is the realization of an acceptable level offunctioning either by oneself or by adequately organizing care Clients of PMHC are oftencharacterized by not activelyseeking help or not having their care needs met by regularservices: limitations in self sufficiency The Dutch PMHC-system offersmultidisciplinary care to clients thatcope with psychosocial and socio-economic problems
  • The SSM (Dutch version) The Dutch version of the Self Sufficiency Matrix (SSM-D)distinguishes 5 levels of self sufficiency (columns)Acute problem, Not, Barely, Adequately, Completely The SSM-D assesses a persons’ level of self sufficiency on 11domains (rows)Income, Day-time activities, Housing, Domestic relations, Mental health, Physicalhealth, Addiction, Daily life skills, Social network, Community participation, Judiciary For each level of self sufficiency, domain-specific criteria arespecified (cells)1 acute problem 2 not self sufficient 3 barely self sufficient 4 adequately self sufficient 5 completely self sufficientIncome No income, high andincreasing debts.Inadequate income and/orspontaneous orinappropriate spending,increasing debts.Can meet basic needs withincome; appropriate spending; ifthere are debts, they are stable;Income management/ budgetcontrol by a third party.Meets basic needs without receivingsocial security benefits; manageshis/her debts without assistanceand they are decreasing.Income is sufficient, well managed;has income and is able to save.
  • Development Pearce et al. (1996): Economic self sufficiency standard The Snohomish county self sufficiency taskforce (2004): FirstSSM based on ROMA outcomes standards Arizona and Utah (a.o.) (2006): State-specific adaptations ofSSM– Adaptations of the SSM vary in number of domains.– Number of levels of self sufficiency and formulation of domain-specific criteriaremains consistent Public Health Service Amsterdam (2010): First Dutchadaptation of SSM (SSM-D)– The SSM-D was developed with feedback and input from professionals,policymakers, and researchers from the field of PMHC
  • Psychometric propertiesInternal consistencyGroup: 2686 clients Young adults office & Central Access PointPMHCMethod: Principal Component Analysis (PCA)Results: ■ One construct: self-sufficiency■ No redundant (unnecessary) domainsInter-rater reliabilityGroup: 2 social workers screened 20 clients & 36 professionals eachrated 3 fictitious casesMethod: Correlations, % exact agreement, KappaResults: ■ High correlations between raters■ Exact agreement smaller■ Access to information is of primary importanceFassaert T, Lauriks S, van de Weerd S, de Wit M, Buster M (2013) Ontwikkeling en betrouwbaarheid van de Zelfredzaamheid-Matrix. Tijdschrift voor Gezondheidswetenschappen 91(3): 169-177
  • Psychometric propertiesConstruct validityGroup: 81 clients Youth ACT & 86 clients with SMI in Long-term outpatienttreatmentMethod: Screening with SSM-D & HoNOS (ACT-group) and SSM-D & CANSAS(SMI-group). Correlations between overall and domain scoresResults: ■ Strong correlations betweenoverall scores■ Strong correlations betweendomains with related subscalesIn addition■ SSM-D was able to discriminatebetween both study-populations.Fassaert T, Lauriks S, van de Weerd S, Buster M, de Wit M. Psychometric properties of the Dutch version ofthe Self-Sufficiency Matrix (SSM-D). Submitted to Community Mental Health Journal
  • Application – Decision Support Tool for PMHC accessPurposeTransparency in the professional decision to grant/denyaccess to PMHC at the Central Access Point in AmsterdamMethod Screeners at the CAP perform an interview, decide on theaccess to PMHC, and score the SSM-D for 612 clients SSM-D predictors of the professional decision are analyzedwith logistic regression modeling in one half of the researchgroup (N1) Cut-off points with optimal sensitivity and specificity areanalyzed with ROC-curves of decisions in the other half ofthe research group (N2)
  • Application – Decision Support Tool for PMHC access.0.1.2.3.4.5.6.7.8.91.0.0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1.0FALSE POSITIVETRUEPOSITIVEThe DST based on weighted SSM-Ddomains is accurate and useful to promotetransparency of the decision to allocateclients to PMHC.The information collectedwith the SSM-D is useableand relevant to theprofessional and theclinical care process.Income 2Day-time activities 2Housing 1Domestic relations 4Mental health 3Physical health 4Addiction 2Daily life skills 3Social network 2Community partipipation 2Judiciary 4Chance of True PMHC client PMHC Access Advice0.97 Certain PMHC accessAll domains are included in the model tooptimize predictive value
  • PurposeEvaluation of progress of clients over time and effectiveness ofinterventionsExample I 100 clients referred at the CAP were offereda social work intervention focused atstabilization of socioeconomic problems SW’s scored the SSM-D at the first andlast meeting with the client Primary problematic domains at intake: Income, Day-timeactivities and HousingApplication – Tracking client progress
  • Application – Tracking client progressSSM-D scores at intake (T0) and last contact (T1)0%10%20%30%40%50%60%70%80%90%100%IncomeDay-timeact.HousingDomesticrel.MentalhealthPhys.HealthAddictionDailylifeskillsSocialnetworkComm.part.JudiciarySSM-D domains%totalgroupCompletelyself sufficientAdequatelyself sufficientBarely selfsufficientNot selfsufficientAcute problemSignificant higher scores at T1 on 8 SSM-D domains and theSSM- D total score.
  • Example II 121 clients of ‘Vulnerable Households’ intervention-team Case workers scored the SSM-D at intake, and at intermediaryor exit interview. Primary problematic domains at intake: Income and Day-timeactivities Sig. proportion of group with secondary problems on Domesticrelations, Mental health, Daily life skills, Social network and/ orCommunity participationApplication – Tracking client progress
  • Application – Tracking client progressProgress on the SSM-D0%10%20%30%40%50%60%70%80%90%100%IncomeDay-timeactivitiesHousingDomesticrelationsMentalhealthPhysicalhealthAddictionDailylifeskillsSocialnetworkCommunitypartipipationJudiciarySSM-D domains%oftheresearchgroupPlus 4 levelsPlus 3 levelsPlus 2 levelsPlus 1 levelStableMinus 1 levelMinus 2 levelsMinus 3 levelsSignificant differences between T0 and T1 on all SSM-D domainsand SSM-D total score
  • Application – Tracking client progressThe SSM-D seems an useful and feasible instrument to evaluateclients over time and assess the effectiveness of interventionsBut: Sensitivity to change of SSM-Dstill needs to be determined Control group is needed forevaluation of effectiveness Specific interventions – specificoutcomes? SSM-D provides‘pixilated landscape picture’
  • Implementation
  • Amsterdam Public Health Service (GGD) – CAP– Screening of homeless people, access to PMHC Municipal work and Welfare service (DWI)– Identification of group at risk of social exclusion Community development service (DMO)– Evaluation ‘Vulnerable households intervention’Rotterdam Municipality of Rotterdam – Young adult office– Screening and assessment of young adults without qualificationsUtrecht Public Health Service (GGD)– Homeless management information systemThe Hague Public Health Service (GGD) – Central Coordination Point– Screening of homeless people, access to PMHC– Homeless management information systemImplementation – 4 largest cities
  •  Additional domains for parents/ guardians– Four domains to assess levels of self sufficiency with regard to care for (young)children Assessment of sensitivity to change– Pilot tests have been done but evidence for sensitivity to change is needed Accreditation of SSM-D as instrument for Routine OutcomeMonitoring– Mental health care branch organizations and PMHC- financiers recognize SSM-Das a feasible tool for ROM Development and dissemination of the SSM in the EU– The SSM-D has recently been translated in English and the English website isonlineFuture research and development
  • Future research and development
  •  One standard: truly achievable? Who are able to work with the SSM-D? SSM-D for underaged and elderly? OK for screening; OK for treatment planning? How does one set achievable goals for individuals? How do we set achievable goals for programs (financing)?Implementation – issues to be ‘solved’
  • Steve LauriksPhone: +31 (0)622 728 596E-mail: zrm@ggd.amsterdam.nlWebsite: www.zelfredzaamheidmatrix.nlwww.selfsufficiencymatrix.orgQuestions