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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.

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step by step comprehensive culture and practice change and the cans mh

Step by Step: Comprehensive Culture and Practice Change and the CANS-MH

Suzanne Button, Ph.D.

Assistant Executive Director,

Quality & Clinical Outcomes

slide2
At the start of our initiative, Astor services had been delivering nationally-acclaimed behavioral health services for over 50 years.

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.

goals in 2002
To change the culture from one of “we do what we like/know/prefer” to “we do what we know is likely to be effective for our clients”

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 levels

Goals in 2002
slide4

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.

measurement as communication
Creating a System of Outcomes Management using the CANS-MH

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”
slide9
2002

Five evidence-based practices in use

2003

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

2004

Collaborative Problem Solving in select day treatment programs

CBT for Youth Sex Offenders

2005

CBT for externalizing disorders

General CBT intensive training for all clinical staff

UCLA PTSD Reaction Inventory for all clinical clients

slide10
2006

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

2007

School based CBT for depression

Norcross “tickler” questions in all clinics

RET in all clinics

2008

EBP for sexually reactive use

FFT in juvenile justice and adolescent day treatments

March OCD protocol in clinics

2009

CFIT pilot approved and applied for

Coping Cat in clinics

slide12
2002

Use of CANS-MH data led to increased rates in residential programs.

2007

The Joint Commission invited CEO to address membership on EBP at its national conference.

First publication of aggregate data (describing populations) in annual report.

2008

Short listed for TJC’s Codman Award, featured in national publication of TJC.

2009

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.

2010

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.

slide14
Visible shifts in outcomes began to emerge in 2007 (CANS-MH indicates client improvement in most areas across agency).

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.

2010 aggregate results
Analyzed over 3,500 CANS collected across programs over eight years.

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
practice based evidence
“.. the integration of best researched evidence and clinical expertise with patient values.”

Institute of Medicine, 2001

Practice-based evidence