Children s Behavioral Healthcare CFSD/BHC Client Services Entry Violetta Battle, 1544 Laura Ragins, 1592 Program Purpose Program Information Connect children who have behavioral health needs to services, divert them from court involvement, and engage their families. Client Services Entry connects children and families to ongoing services in the Children s Behavioral Healthcare Bureau. Services provided: o Information and Referral/Screening: Information and referral: Intake staff provides information on service options and community resources. Screening: Intake staff conducts phone screenings and schedules intake assessments. o Intake Assessment: Mental health therapists conduct mental health/substance abuse assessments, formulate diagnoses, and provide service recommendations. o Psychological evaluation: Psychologists conduct evaluations. o Court diversion: Juvenile-court-based liaison provides immediate screening and linkage to services. o Community outreach: Staff provides education about services. Services are licensed and regulated by the Virginia Department of Behavioral Health and Developmental Services. Oversight is provided by the Arlington Community Services Board. PM1: How much did we do? Staff Customers Units of Service Total of 4.75 FTEs: 1.0 FTE Supervisor (50% each of 2 staff) 0.5 FTE Mental Health Therapist Front Door Screening/Intake 1.0 FTE Mental Health Therapist Intake Assessments 1.25 FTE Psychologists (2 staff) 1.0 FTE Mental Health Therapist Court Liaison PM2: How well did we do it? Units of Service FY 2012 FY 2013 FY 2014 # of I&R/screening calls 742 835 822 # of intake assessments completed 204 199 205 # of psychological evaluations completed 58 47 45 # of youth served by court liaison 123 212 152 # of community outreach presentations 8 9 2 2.1 Referrals scheduled for assessments within identified time frames 2.2 Quality of intake assessment documentation PM3: Is anyone better off? 3.1 Children and families are connected to ongoing services 3.2 Usefulness of psychological evaluations in staff s work with clients 3.3 Diversion of clients from court involvement 3.4 Families believe they will get the help they need and know what to do next Children s Behavioral Healthcare CSE FY 2014 Page 1
Measure 2.1 Referrals scheduled for assessments within identified time frames 40% 20% 0% Referrals Scheduled for Assessments Within Timeframes Goal: Regular 90%, Urgent 34% 33/33 23/23 41% 61/180 74/182 FY 2013 FY 2014 FY 2015 Regular Urgent Appointments Appointments In FY 2014, 41% (74/182) of regular, non-urgent appointments were scheduled within 10 calendar days, an improvement over 34% (61/180) in FY 2013. Urgent appointments in FY 2014 continue to successfully be scheduled within two business days in (23/23) of the cases, as they were in FY 2013. Hospital, emergency services, and moderate to high risk referrals are classified as urgent. Prior to the final quarter of FY 2014, the projection of of regular-intake timeliness was not met. In the final quarter, due to implementation of use of dedicated intake staff and clarification of Managed Care process, 90% of regular intakes met the new standard. In FY 2013, the goal for regular (non-urgent) intakes was to get them scheduled within five business days of the request. This goal has changed to 10 calendar days for FY 2014 due to new managed-care requirements (see below). The FY 2013 data in the graph above have been adjusted to reflect the new 10-day requirement. One FTE is allocated to do intakes; given demand and timeliness expectations, continue to assess the need for expanding dedicated staff for intakes. Continue rating urgency of intakes and prioritizing scheduling. Continue tracking timeliness of non-urgent intakes. By the end of FY 2015, it is anticipated that of urgent appointments and of regular appointments will be scheduled within the expected time periods. Children s Behavioral Healthcare CSE FY 2014 Page 2
Measure 2.2 Quality of intake assessment documentation A random sample of intakes is reviewed for quality on a monthly basis. Charts are analyzed using the established CSB chart-review process and include completion of required data elements and clinical thoroughness. Sixteen data elements are rated each month for a sample of intake assessments. In FY 2014, 68 intakes were analyzed, for 1,088 data elements. Of these, 1,012 data elements (93%) met standards for clinical thoroughness. In FY 2014, quality increased 4% for a much larger sample size. FY 2014 is the first year in which intakes were completed by one dedicated staff person, and reviewed by one supervisor. Areas of strength include succinct, compliant statements of problem, needs and client history, and improvements noted in documentation of family strengths and motivation for treatment. Continue with current intake system using a dedicated staff person. Continue rating four randomly selected intake assessments monthly. Identify areas needing improvement; provide additional training as needed. By the end of FY 2015, 95% of data elements are expected to meet quality standards. Children s Behavioral Healthcare CSE FY 2014 Page 3
Percentage of Families FY 2014 PERFORMANCE PLAN Measure 3.1 Children and families are connected to ongoing services Families Connected to Ongoing Services 90% Goal is 90% 70% 72% 85% 50% FY 2013 126/175 FY 2014 163/205 FY 2015 In FY 2014, 205 of the families who received intake assessments were recommended for ongoing services. Of those, (163/205) began services. With an 8% increase from FY 2013, the result for FY 2014 is consistent with last year s projection of of families connecting to services. In FY 2014, supports continued to be provided to parents/guardians to access recommended services. Supports include evening appointments, transportation vouchers, and advocacy with collaterals. Families reported that transportation, taking time off work, and dealing with competing demands were barriers to accessing services. Continue to focus on process using designated staff and more focused screening. Continue to track families who receive intake assessments to learn more about those who connect to services and those who do not. Develop client/family reminder efforts, such as phone calls about upcoming appointments, to assist families with connecting to services. By the end of FY 2015, it is anticipated that 85% of the families who receive intake assessments and are recommended for ongoing services will begin services. Children s Behavioral Healthcare CSE FY 2014 Page 4
Percent of Responses FY 2014 PERFORMANCE PLAN Measure 3.2 Usefulness of psychological evaluations in staff s work with clients Psychological Evaluation was Helpful in Work with Client/Family Goal: 12% 9% Green 5% 40% 59% 82% 65% 20% 0% 29% FY 2013 17 responses 9% FY 2014 11 responses 30% FY 2015 Strongly Agree Agree Disagree 91% of CFSD staff surveyed reported that the psychological evaluation was useful in their work with the client. Survey was conducted in June 2014. CFSD staff who requested and received psychological evaluation(s) for their clients in the prior eleven months were surveyed. 65% (11 of 17) responded to the survey in FY 2014. Since FY 2013, there was a small increase in percent of clients and family who agreed or strongly agreed that psychological evaluations were helpful. Psychological evaluations are almost always requested by CFSD staff rather than clients themselves. The primary objective is to produce a report that provides new and useful information for both staff and clients. Other survey responses indicated that timeliness was a factor in dissatisfaction. It may take up to 30 days to complete a report after the last scheduled face-to-face appointment. Continue surveying CFSD staff; monitor the usefulness of psychological evaluations for client work. Consider strategies to reduce the length of time it takes to complete a psychological evaluation report. For FY 2015, at least 95% will strongly agree or agree that the evaluation reports are useful. Children s Behavioral Healthcare CSE FY 2014 Page 5
Percentage of Clients FY 2014 PERFORMANCE PLAN Measure 3.3 Diversion of clients from court involvement Diversion of Clients From Court Involvement Goal is 75% 40% 20% 46% 69% 75% 0% FY 2013 70/152 FY 2014 38/55 FY 2015 Of the 152 total youth served by the court liaison, 55 (36%) met diversion criteria: they had not appeared in court before but were at risk of becoming court-involved. In FY 2014, 69% of diversion clients (38/55) had no court involvement at least 60 days after intervention. The number of clients diverted has decreased since FY 2013. One contributing factor is the staff changes in the court s intake unit. The primary referral source for court liaison diversion cases left the court system, consequently, there is no longer a Spanish-speaking court intake worker available (52% of the DHS liaison s clients/families are Spanish-speaking). The goal is set at 75 percent because Court and CFSD staff believe some youth referred for diversion services would benefit from court involvement; the goal for these youth is not diversion. Continue efforts to educate court staff regarding who is appropriate for diversion including addressing any language or cultural sensitivity issues. Discuss with court supervisory staff strategies for enhancing Spanish language capacity. Continue to provide feedback to court staff regarding those youth who would benefit from diversion and those who require an additional level of accountability for criminal behavior. Explore adding a performance measure that focuses on maintaining courtinvolved youth in their homes in the community. For FY 2015, goal is for 75% of youth referred for diversion services will not have court involvement within 60 days following initiation of services. Children s Behavioral Healthcare CSE FY 2014 Page 6
Measure 3.4 Families reporting they believe they will get the help they need and know what to do next For FY 2014, 95% of survey respondents agreed with the statements that they would get the help they need and that they understand what the next step is for obtaining services. The survey results are based on responses from 40 parents, and 40 youth, who were provided separate surveys at the time of intake. Response rate will be captured in FY 2015. Satisfaction levels for parents and youth in FY 2014 show an improvement. Upon completion of an intake assessment, the parent and child are asked to complete separate surveys about their experience at the intake and their expectations about services. Stay the course. Continue to clarify with staff timeframes for administration of surveys. Seek participation by providing surveys to every family who completes an intake assessment. Break out the youth responses from the parent responses to identify discrepancies in levels of satisfaction. For FY 2015, it is projected that 98% respondents will believe they got the help they needed and understand what the next steps were. Children s Behavioral Healthcare CSE FY 2014 Page 7