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Sacramento county part ii cps 06112012
- 1. Improving Practice through use of Research and Evaluation: Sacramento County’s Experience Measuring Effectiveness and Wraparound Fidelity Part II (CPS) Belle Darsie, Stanford Youth Solutions Gordon Richardson, EMQ Families First Jennifer Shebesta, Stanford Youth Solutions John Woolcott, Sacramento Children’s Home Karen Vang, River Oak Center for Children Kristy Schwee, River Oak Center for Children Maria Pagador, Mental Health Mary Ann Wong, EMQ Families First Rikke Addis, Sacramento Children’s Home Stephen Wallach, CPS June 14, 2012 at 1:30pm
- 2. Outline Part II CPS – Desired Outcomes – Youth Story – How we measure fidelity and outcomes – How we achieve those outcomes – Caregiver Story – Summary
- 3. Ultimate Wraparound Outcomes Youth are… At home In school Out of trouble
- 4. Goals of Wraparound 1. Community living situation 2. Improve quality of life 3. Improve functioning and resolve unmet needs 4. Maintain fidelity to Wraparound standards 5. Suspension and expulsion free or reoffend free at discharge from the program 6. Attend school or work regularly Specific Outcomes required by the Court
- 5. What does Wraparound Success Mean to CPS Safety Permanency/Lifelong Permanent Connection Placement Stability Well Being Accountability
- 6. Wraparound Spanish – Cubriendo Todo Italian – Andare a capo German – Umwickel Filipino – Nakapalibot Portuguese – Wrap
- 7. Wraparound A planning process that is strengths- based, family centered, and needs driven Identified nationally as a promising practice Usedin Sacramento County for youth in, or at imminent risk of placement in RCL 10-14 level of care
- 8. Wraparound Providers in Sacramento County EMQ Families First (since 1999) River Oak Center for Children (since 1999) Stanford Youth Solutions (since 2000) Sacramento Children’s Home (since 2003)
- 9. Referral Process How CPS has been able to maintain a steady stream of referrals to Wraparound – What does not work – A single method – Making referrals mandatory – What works – Multiple and simultaneous strategies – Supportive – WRAP-a-Thons – WRAP Walk Around – WRAP Resource Fairs – Celebrate successes – Food! – Directive – Communicate expectations – Discuss, discuss, discuss – Use data; outcomes, Safe Measures – Resolve conflicts quickly and openly
- 10. Danny’s Story Profile Priorto WRAP Referral Reasons for WRAP Referral WRAP Services Post WRAP Outcome
- 11. Demographics of Youth Referred by Sacramento County CPS (N=1053) Median Age = 14.3 years 40% Black/African American, 38% White/Caucasian Living Arrangement at Intake: 66% in Group Home RCL 12-14, 8% with Biological/Adoptive Parent(s) Primary Diagnosis: 36% Attention-Deficit and Disruptive Behavior Disorders, 29% Anxiety Disorders (incl. PTSD), 24% Mood Disorders
- 12. Assessments/Measures/ Tools/Instruments Child and Adolescent Needs and Strengths (CANS) Wraparound Fidelity Index (WFI) Team Observation Measure (TOM) Child and Adolescent Functional Assessment Scale (CAFAS) Youth Outcome Questionnaire (Y-OQ) and Self Report (Y-OQ-SR) Post-Discharge Research Interview
- 13. Engagement and Assessment Strengths, needs, cultural discovery Child & Adolescent Needs and Strengths (CANS) Countywide implementation as of January 2011
- 14. CANS Domains LifeDomain Functioning Child Strengths Acculturation Caregiver Strengths and Needs Child Behavioral/Emotional Needs Child Risk Behaviors Transition to Adulthood
- 15. The Promise of CANS: Engagement, Assessment and Outcome Data Comparing Mean Domain Scores Using the Reliable Change Index
- 16. CANS – Comparing Mean Domain Scores
- 17. CANS – Reliable Change Index
- 18. Implementation Evaluation Wraparound Fidelity Index Interview Team Observation Measure
- 19. “Are we doing what we say we are doing?” Assessing Fidelity to the Wraparound Model Team Observation Wraparound Fidelity Measure: Index Interview: Observation Form includes 20 items 4 Interview Forms: assessing fidelity in the Facilitator areas of: Youth Team Based Caregiver Collaborative Team Member Individualized Natural Supports Structured, Open-ended Interview format Persistence Cultural competence Average length is 20 Outcomes-Based minutes Voice and Choice Strengths-based In-Person or Phone Community-based Interview
- 20. Team Observation Measure Examples of Assessment areas: “Team Members demonstrate consistent willingness to compromise or explore further options when there is disagreement” “The youth, caregiver, and family members are given time to talk about the family’s values, beliefs, and traditions” “The youth prioritizes life domains, goals, or needs on which he or she would like the team to work”
- 21. Wraparound Fidelity Index Examples of Interview Questions: Facilitator Interview: Youth Interview: Caregiver Interview: • “Does the caregiver •“Do you feel •“Did you take part in feel comfortable comfortable expressing creating a written plan expressing her or his your opinions even if that identifies supports opinions even if they they are different from and services that meet are different from the the rest of the team?” your child’s needs at rest of the team?” home, at school, and in •“Does it ever seem the community?” like someone on the • “Do the youth and team does not respect •“Does the team family receive the who you are and the review your child’s supports and services things that you believe progress toward stated in the plan?” in?” specific goals at every team meeting?”
- 22. Outcome Evaluation Placement CAFAS Y-OQ Y-OQ-SR For Longitudinal Data Post-Discharge Research Interview Outcomes as Measured by CPS
- 23. CPS Discharge Outcomes (N=929) Median duration of Wraparound = 14 months 58% Living in Community Placement 79% Maintained Placement Level or Transitioned to a Lower Level of Care
- 24. Child and Adolescent Functional Assessment Scale (CAFAS) Subscales School/Work Role Performance Home Role Performance Community Role Performance Behavior Toward Others Moods/Emotions Self-Harmful Behavior Substance Use Thinking
- 25. Outcomes Measured by CAFAS Statistically significant improvement (p<.001)
- 26. Y-OQ and Y-OQ-SR Subscales Intrapersonal Distress (ID) Somatic (S) Interpersonal Relations (IR) Social Problems (SP) Behavioral Dysfunction (BD) Critical Items (CI) Total Score
- 27. Y-OQ Data: CPS Youth Mean Y-OQ Subscale Scores & Total Score, Matched Pairs Since FY 07/08 - Dec 2011 (N=66) Intake Discharge Cutoff 70 62 60 50 46 44 40 30 20 20 16 15 16 12 12 10 5 8 5 4 7 7 5 4 3 4 3 5 0 ID S IR SP BP CI Total Score
- 28. Y-OQ-SR Data: CPS Youth Mean Y-OQ-SR Subscale Scores & Total Score, Matched Pairs Since FY 07/08 - Dec 2011 (N=54) Intake Discharge Cutoff 70 58 60 50 45 47 40 30 20 20 16 17 13 11 11 6 5 6 6 5 4 3 8 5 6 10 4 3 0 ID S IR SP BP CI Total Score
- 29. Post-Discharge Survey >Living situation >Current school placement >How many times has the youth run away in the past 6 months?
- 30. CPS Post-Discharge Survey – Living Arrangement 100% 80% 60% 58% 46% 46% 42% 40% 28% 29% 21% 21% 20% 17% 17% 13% 13% 13% 8% 8% 4% 4% 4%4%4% 0% 0%0% 0% 0% 0%0% 0%0% Bio/Adopt Kincare Foster Care Group Home Juvenile Hall AWOL Other Admit LA Discharge LA Current LA Predominant LA
- 31. CPS Post-Discharge Survey – Current School Placement N=24 35% in Regular School 22% in Alternative School 26% in Special Education 9% in Residential/DTP 9% in Home-Based Program 100% of youth are in school
- 32. CPS Post-Discharge Survey – Run Away Information N=24 77% youth with 0 runaway 9% youth with 1 runaway 6% youth with 3 runaways 6% youth with 5 runaways 6% youth with 6 runaways
- 34. SUMMARY Belle: Research+program+partners=better systems Gordon: Transparent data-driven decision making Jennifer: Unwavering commitment to families and permanency John: Team-work is essential Karen: The proof is in the outcome data Kristy: Collaboration and data collection are keys to successful outcomes Maria: Promoting wellness of families by serving their needs through collaboration and outcome evaluation Mary Ann: Wraparound works! Rikke: Assessing fidelity, we do what we say we do Stephen: Wrap is a necessary service to achieve the outcomes we need Yolanda: Open arms and meeting families and permanency
- 36. References Hodges, K. (2000) Child and Adolescent Functional Assessment Scale. Functional Assessment Systems, L.L.C. Ann Arbor , Michigan. Wells, G.M., Burlingame, G.M. and Lambert, M.J. (2005) OQ Measures, L.L.C. Salt Lake City, UT. Lyons, J. (1999) Child and Adolescent Needs and Strengths Tool, The Praed Foundation, Chicago, IL. Bruns, E. J. and Sather, A. (2007) Team Observation Measure. Wraparound Evaluation and Research Team, Seattle, W.A. Bruns, E. J. and Sather, A. (2007) Wraparound Fidelity Index - 4.0. Wraparound Evaluation and Research Team, Seattle, W.A.
Editor's Notes
- Maria give overview Each person introduce themselves and role (one sentence or two, try to catch their attention like something personal)? Depts Say “Why you refer kids to Wraparound and what you expect from providers”? Providers Say a short blurb about the tool? Probation sees outcomes: stable lifestyle, not reoffending, not incarcerated,
- When talking about each measure tie into goals Reflect back on this during each measure These are talking points in relation to particular measure
- “Transitional Services to fill all the gaps that we can’t fill” Keith Note: KEITH TALKED ABOUT HOW ERIKA AND HE HAD DIFFERENT PERSPECTIVES ON SUCCESS
- Give candy for those who remember it
- Background, rcriminal history Role of provider
- Agency Frequency Percent EMQ FamiliesFirst 477 45.3 Stanford Youth Solutions 218 20.7 Sacramento Children's Home 69 6.6 River Oak Center for Children 289 27.4 Total 1053 100.0
- Research People Belle
- An EMQFF Facilitator(s) talk about how to use the CANS to engage youth and family Mary Ann talks about the scoring
- The CANS was implemented in the Sacramento County Wraparound Program in January of 2011. It is administered at intake to and discharge from the program as well as at three month intervals during program participation in order to assess changing needs while the youth is still enrolled in the program. Items on the CANS (ages 5+) are grouped into seven domains (six domains from the original CANS forms and one additional domain created by Sacramento County*): Life domain functioning Youth strengths Acculturation Caregiver strengths & needs Youth behavioral/emotional needs Youth risk behaviors *Transition to Adulthood Youth are rated on items contained within the domains using a four-level rating scale (0, 1, 2, and 3) where three indicates a severe or strong need and zero indicates a strength or minimal need. Life domain functioning: family, living situation, school behavior, school achievement, school attendance Youth Strengths: Interpersonal, optimism, talents/interests Acculturation: language, identity, ritual, cultural stress Caregiver strengths and needs: involvement, knowledge, social resources, mental health, safety Youth behavioral/emotional needs: psychosis, conduct, substance use, anger control Youth risk behaviors: suicide risk, danger to others, sexual aggression, delinquency Transition to Adulthood: independent living, transportation, financial resources
- A) Comparing mean domain scores is calculated by the following equation: (sum of scores for questions in domain)/(# of questions in domain)*10 B) The Reliable Change Index (RCI) is a measure that will indicate level of improvement in each domain. The tool will be fully integrated into our child & family assessment process. The RCI is a concept used in monitoring outcomes. RCI is a method that can be used to define when a change in a scale score is sufficient to be categorized as a real change. Put another way, RCI are the size of a change that would be difficult to explain as measurement error alone. The RCI works by asking how large of a change would need to observed on a scale to be replicable given the reliability of the measure.
- This is based on EMQ FF scores. No transition to adulthood data (n is small).
- RCI = 1.25 * (standard deviation) X SQRT(1-reliability) EMQ FF reliability (average reliability of EMQ FF staff who are certified in CANS) = .84
- Sacramento Children’s Home: John will talk about the TOM, Rikke will talk about WFI Put the principles of Wrap here
- CAFAS Belle and Jennifer Y-OQs by Karen and Kristy
- All Sacramento Wraparound Providers started collecting the Wraparound Post-Discharge Follow-up survey in February 2011. Caregivers or youth (18 years of age or over) whose services ended after September 2010 were interviewed by research staff over the phone. The survey was also mailed to the caregiver or youth if research staff was unable to contact them. The Post-Discharge Follow-up survey focuses on the long-term results of the wraparound services the youth and caregiver received. Each Wraparound provider has their own version of the Post-Discharge Follow-up survey. However, there are 3 main items that are common to all – post-discharge living situation, current school placement, and number of run aways.
- N=24 At admit – majority of youth were living in a group home (58%) At discharge – majority of youth were living with bio/adoptive family (46%) Post discharge current living arrangement (day of interview) – majority of youth were living with bio/adoptive family (42%) Post discharge predominant living arrangement – majority of youth were living with bio/adoptive family (46%)
- Limitations: Limited Research Staff Inaccurate caregiver/youth contact information – disconnected number Family moved out
- FOR PROBATION, THIS MIGHT BE A VIDEO