Geomapping Approaches to Planning Service Systems & Improving Accessibility

1. Illinois Department of Children & Family Services/Northwestern University Dana Weiner, Ph.D. GeomappingApproaches to Planning Service Systems & Improving Accessibility

2. GIS Approaches to Planning/Evaluation • Statewide Provider Database • Geomapping Tools • Service Accessibility Study

3. Statewide Provider Database • Online Search Tool • Geocoded service delivery locations • Highly detailed descriptions of programs and services • Broad user base invested in helping to maintain current data

4. SPD Contents • Currently contains information on: • 1,320 agencies • 2,700 programs across the state • Over 15,000 services • Includes programs with and without DCFS contracts • Includes data on which of state departments contract for services

5. SPD Contents • Program Type • Mental Health • Substance Abuse • Domestic Violence • Parenting • Non-clinical • Early Childhood • General Medical • Target Population • Deaf/hard-of-hearing • Developmentally disabled • Young Children • Teen parents • Sexual offenders • Trauma survivors • GLBTQ • Foster care

6. Service Types • Anger Management • Advocacy • Art therapy • Case management • Crisis intervention • Drug testing • Educational testing • Family counseling • Food/meals • Gang awareness • GED preparation • Group counseling • Health education • HIV/AIDS counseling • Individual counseling • Life/Independent Living Skills • Medication compliance • Medication management

7. Service Types • Neuropsychological testing • Parenting assessment • Parenting skills training • Peer support group • Services for parent/guardian • Psychiatric evaluation • Psychological testing • Psychosocial assessment • Recreational activities • Tutoring/mentoring • Violence prevention • Vocational assessment/training

8. Program Information • Intake • Eligibility • Geographic • Financial • Clinical • demographic • Frequency of participation • Discharge • Features addressing barriers to access • Staffing patters & credentials • Use of evidence-based practices

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30. Accessibility Scores: Why Bother? • A score can allow us to study the relationship between access and other things, such as outcomes like placement stability • Scores can be used to understand gaps more precisely than visual maps • Scores can be used in efforts to maximize the impact of contracts

31. Previous Research: Does distance matter? Costs and disease burden increase as distance from providers increases (Billi et al) Conflicting findings on whether the utilization of community-based services can reduce the utilization of more costly inpatient mental health services (Curtis; Fortney et al;Mobley) Proximity increases utilization (Allard)

32. Barriers to accessing services Attitudes & cultural norms Perceptions of service availability Transportation/driving ability/license Language/acculturation Hours of availability

33. Shortcomings of prior GIS work on accessibility Studied in areas other than child welfare (veterans, teen parents, managed care participants) Access aggregated to broad areas, such as census tracts or zip codes Imprecise calculations without details on provider and client locations

34. Our Method • Incorporates variation in travel impedance by land use type • Uses individually-derived access scores (rather than those computed generally for an area and applied to all individuals within that area). • Tests relationship between access and other predictors of placement stability for kids receiving wraparound services • Uses SOC as a unique setting in which to study the impact of access • Broad range of service possibilities • Flexibility in model of service delivery

35. Model for Calculating Accessibility • Gravity models • 2-Step Floating Catchment Area (Wang & Luo) • Kernal Density (Guagliardo)

36. Measuring Service Accessibility • Mental health (797) and non-clinical (366) provider locations from SPD (71 locations offered both) • Modified gravity model • Divided the state into 3 land use types • Based on land use type, measured each child’s distance to providers within a radius of reasonable distance • Divided distance to each provider by a “rate of decay” – P value • Summed discounted values for each child to arrive at a score signifying their access

37. Reasonable Distance Rural Lt. Urban 10 m Urban 5 m 2.5 m

38. Sample 1448 participants in SOC during 2007-2009 48% (n=699) female Ages ranged from 2 to 20 with an average age of 10.2 (SD=4.6) years 57.4% African American, 32.3% White, 8.6% Hispanic, .1% Asian youth and .1% Native American youth

43. Independent variables • Age • Clinical characteristics – CANS scale scores • Risk behaviors • Emotional/behavioral needs • Strengths • Trauma experiences • Trauma stress symptoms • Acculturation • Life domain functioning • Service Accessibility

44. Overall Predictors of Placement Disruption

45. Predictors by Land Use

46. What does this say about access? Access was the only variable that exhibited a pattern by land use type Access means by land use type: rural=.20, light urban=.44, and urban=.75 Access had the largest effect in rural areas, followed by light urban, and was not significant in the urban land use analysis (statistically significant, F (df=2) = 89.81, p<.001)

47. Implications • Delivering wraparound in rural areas has additional challenges • Equitable distribution of resources cannot necessarily be accomplished by • distributing providers evenly over a service area • broadening a provider's coverage • Strategic approaches call for rural providers to increase • home-based services • transportation services

48. Limitations Comprehensiveness of provider data Single outcome measure Caregiver variables not included Data not analyzed between SOC providers

49. Future directions Incorporate features addressing barriers Relate specific needs to specific services Predict other outcomes Supplement CYCIS moves with other data for a more qualitative understanding of placement disruption Develop a threshold access score

50. By using provider and Child access scores we can rationalize how and where to allocate funding: • Optimize current contracts by placing them with providers that children can easily reach. • - i.e. The light green dots. • Identifies areas where DCFS needs to recruit new providers, or encourage providers to relocate, in order to improve service access for children. • - i.e. The dark blue dot. • Eliminates waste by indentifying contracted services that may be at locations which are inaccessible to children. • - i.e. The dark green squares.