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Step by Step: Comprehensive Culture and Practice Change and the CANS-MH. Suzanne Button, Ph.D. Assistant Executive Director, Quality & Clinical Outcomes. At the start of our initiative, Astor services had been delivering nationally-acclaimed behavioral health services for over 50 years.
Suzanne Button, Ph.D.
Assistant Executive Director,
Quality & Clinical Outcomes
Programs included a broad array of inpatient, educational, and community based programs at 23 sites in the Hudson Valley Region and New York City area of New York State (we now have 28 sites).
Serving over 6,500 children, adolescents, and their families each year.
To increase the number of evidence based and best practices in application across the agency
To meaningfully measure outcomes in diverse contexts at the program and aggregate levelsGoals in 2002
Culture change is critical…. those variables that create organizational culture combine to become the single most predictive factor in the success or failure of innovation.
Use CANS-MH as a message of expectations
Use CANS-MH data as a meaning-making tool
Incorporate clinician and managerial experience, consumer input
Use data to focus and inform the discussion“Measurement as Communication”
Five evidence-based practices in use
Agency--wide use of Child Adolescent Needs & Strengths-Mental Health Version (Lyons, 2001) (CANS-MH) as standard treatment planning and outcomes tool
Barkley model for ADHD assessment and treatment
Goldstein social skills training in residential programs
Collaborative Problem Solving in select day treatment programs
CBT for Youth Sex Offenders
CBT for externalizing disorders
General CBT intensive training for all clinical staff
UCLA PTSD Reaction Inventory for all clinical clients
PCIT in 0-5 programs
TF-CBT in all clinics
Sanctuary in residential programs
Tool box skills training in foster care programs
Expansion of CPS to all day treatments
School based CBT for depression
Norcross “tickler” questions in all clinics
RET in all clinics
EBP for sexually reactive use
FFT in juvenile justice and adolescent day treatments
March OCD protocol in clinics
CFIT pilot approved and applied for
Coping Cat in clinics
Use of CANS-MH data led to increased rates in residential programs.
The Joint Commission invited CEO to address membership on EBP at its national conference.
First publication of aggregate data (describing populations) in annual report.
Short listed for TJC’s Codman Award, featured in national publication of TJC.
First aggregate clinical outcomes published in annual report, on website, and in press releases.
Substantial increases in county contracts for community based programs linked, in part, to demonstrable outcomes.
Residential programs shifted to 100% “hard to place” rates.
Co-sponsoring PCIT training conference with NYU Child Study Center.
Invited to apply for EBP award from NYS OMH.
Parent/caregiver satisfaction survey results suggest a shift from overall satisfaction with Astor staff to satisfaction with specific services and the reduction of specific symptoms.
Dimensions showing statistical improvement on the CANS-MH have steadily increased across the agency.
We are now routinely planning next steps of the initiative based on evidence, including our CANS-MH data.
Dimensions improve, with the exception of Caregiver dimension.
We are doing better, overall, with younger children,
Clear links emerge in the data between practices adopted and outcomes (anxiety, depression, attention deficit disorder, and oppositional behavior groups show improved outcomes).
Slow improvements in risk reduction for youth who cause sexual harm are emerging, further focus is needed.
Presenting problems only moderately impacted by new practices include attachment, trauma, and antisocial/criminal behavior – across age groups and program types.2010 Aggregate Results
Institute of Medicine, 2001Practice-based evidence