Elements of Service Array Management: Assessment

1. Elements of Service Array Management:Assessment Community Services Development Workgroup April, 2009

2. Service Array Management: Assessment Elements of Managing the Service Array: • Clarify the roles of who will be leading assessment functions • Analyze existing sources of services data • Ask the questions that will explore the story behind the data • Develop improved data models to track services needs • Link service array reports to systems improvement

3. Clarify the roles of who will be leading assessment functions • Local programs with different economies of scale and resources will need to decide where to house responsibility for monitoring and managing changes in utilization. • Responsibility may be directly under the County or City Administrator’s offices, the CSA Administrator/Coordinator, local Chief of Services, Director of Family Services, rotating CPMT Chair, private contractor, or other. • Placement of this function will want to consider the different responsibilities and skill sets necessary to effectively track a) obligations, expenditures & use of alternative funding sources and b) program services and clinically oriented needs and changes. • Communities should develop clear procedures of how the utilization management staff interface with case workers, providers, the FAPT and the CPMT.

4. Clarify the roles of who will be leading assessment functions • Communities with evolved service array management have provided strong support from their agency and government leaders. Top down supports help to allocate resources, extend authority in collecting data and prioritize initiatives. • Communities with evolved service array management have open systems of communication so that direct services staff, FAPT members and families have an active voice in describing the needs of youth served in the community. • Communities with evolved service array management submit regular reports to their community leaders on changes in the services array.

5. Analyze existing sources of services data • Locality Data is available on the CSA website in the forms of: • CPMT Management Reports • Describing annual expenditures, unit costs comparisons by services categories • Located on the CSA website under Statewide Statistics • Statistical Profiles • Describing quarterly statistics on number of services utilized and outcomes • Located on the CSA website under Statewide Statistics • Vendor Reports • Describing vendor specific utilization and expenses of youth served by licensed providers • Located on the CSA website accessed by password under Local Government Reporting • Residential Utilization Report • Describing annual statistics on local residential utilization including length of stay • Located on the CSA website under CSA Publications • Critical Services Gaps Survey • Describing prioritized services gaps and barriers surveyed by the CPMT • Products of local CPMTs; also available through OCS Technical Assistance Coordinators

6. Analyze existing sources of services dataCPMT Management Reports • Report includes historical summary of CSA census & expenditures:

7. Analyze existing sources of services dataCPMT Management Reports • Report includes #, costs and % of services categories. • By comparing across years, localities can produce reports showing trends in how the landscape of services are changing • Data is available to compare services utilization with peer communities with similar demographics

8. Analyze existing sources of services dataStatistical Profiles • In addition to data on mandate types and services mix, quarterly reports show outcomes on cases discharged from CSA

9. Analyze existing sources of services dataVendor Reports with links to other reports • Vendor specific utilization reports are available under password protected Local Government Reporting link on the CSA website, under CSA Data Set and Federal ID Report • By quarter, locality’s utilization of licensed private providers are reported by vendor #, names, # children served, services & costs • By clicking on the vendor’s name, you are linked to their page on the service fee directory.

10. Analyze existing sources of services dataVendor Reports with links to other reports • By clicking on the vendor’s ID number on the previous slide, you are provided a listing of specific youth and costs associated with that provider. SSN are provided, but are deleted for this example:

11. Analyze existing sources of services dataVendor Reports with links to other reports • By clicking on the client’s SSN on the previous slide, you are linked to their CSA Data Card which includes demographics, financial eligibility and services history:

12. Analyze existing sources of services data Residential Utilization Report • Under the CSA Publications section of the website, you can access the annual Residential report on local utilization, length of stay & expenditures • A number of data schedules are available including historical reports by locality on number of youth in residential, length of stay and costs

13. Analyze existing sources of services dataCritical Services Gaps Survey • The annual survey conducted by the CPMT prioritizes local services gaps and indicates strategies related to barriers in services development

14. Ask the questions that will explore the story behind the data The Basics • Who are the children served by CSA? • Are the demographics and needs of youth changing over time? • How did these children come to CSA? • Are increased referrals the result of changes in the referral sources of the public agencies, schools, courts and families in the community? • Why are the children referred to CSA? • What are the primary reasons for service and how do they relate to existing resources and supports available to families? • What services are they receiving? • Are there shifts occurring in the blend of community and residential services? • How much do these services cost? • Are communities receiving effective value for the intensity of services purchased compared with the intensity of needs of the youth? • What is the outcome of the services provided? • Are services stabilizing and improving the lives of at risk youth?

15. Ask the questions that will explore the story behind the data Agenda items for the CPMT • What intensive care coordination or utilization review services would improve outcomes for our most involved youth? • Do we have adequate fiscal controls to ensure that we are maximizing Medicaid, Title IV-E and other sources of funding? • How are we assessing the quality of services provided by our vendors and how is this reflected in our contracts? • What training or resources would strengthen case worker and FAPT staff to more fully engage families and provide additional natural supports? • What linkages with major community stakeholders need to be improved? • What additional data reports do we need to effectively manage the service array?

16. Develop improved data models to track services needs Community based services • Many communities are enhancing their ability to track changes in community based services. • Selecting a model that is most effective will be influenced by existing local data systems and staff resources. • These have been used to target information on most utilized community vendors and track changes in unit costs by services types and vendors • Excerpts from two models shared on the following slides include: • A Comprehensive Community Based Service Array Guide • The one page survey from the Critical Services Survey • These survey documents are available on the CSA website under Systems of Care: and Assessment

17. Develop improved data models to track services needs Comprehensive Community Based Service Array GuideSample from page 2 of 7

18. Develop improved data models to track services needsAnnual Critical Service Gaps Survey

19. Develop improved data models to track services needs Family Satisfaction Surveys • Family satisfaction surveys are increasingly being used by localities to gather input on improving services and measure program progress. • Some localities report using them at the first FAPT meeting and discharge from services and some report using them at more frequent intervals. • Aside from supplementing feedback from the caseworkers, FAPT and statistical performance data, family surveys assist the shift in culture from one of purchasing existing services to customizing services to meet needs. • The following two excerpts are taken from surveys utilized by the state and a local agency. These documents are available on the CSA website under Systems of Care: and Assessment

20. Develop improved data models to track services needs Family Satisfaction SurveySample from page 2 of 7 of statewide survey 2. What type of services are you currently receiving in the home/community? (Select all that apply) - Do not receive services in home/community After school services Behavioral aides Case management Crisis intervention/stabilization Family support/education Independent living services Individual, group, family therapy Intensive in-home services Medical management Mentoring Residential Services Respite care School-based services Substance abuse services Summer child care Supervised social/recreational services Therapeutic day treatment Vocational services* 3. Were the services available when you needed them? Were the services available when you needed them?   Yes No N/AI f no, why not ?(please specify)* 4. Were the services affordable? Were the services affordable?   Yes No N/A If no, why not? (please specify)* 5. How was the service(s) funded? (Select all that apply) How was the service(s) funded? (Select all that apply)   Private (Private Insurance, Private Provider) Public (Medicaid, CSB, FAPT, CSA) Out of pocket 6. Has your family experienced any of these challenges related to a child with special health care needs? (Select all that apply) Has your family experienced any of these challenges related to a child with special health care needs? (Select all that apply)   Loss of job Change in career Loss of insurance Loss of or change in insurance's benefits Extra burden on family members and/or extended family Extra burden on friends "Case managing" your child with special health care needs Extra stress on the family Marital or relationship issues with significant Other (please specify)* 7. How has your child benefited from services received? (Select all that apply) How has your child benefited from services received? (Select all that apply)   Is showing less stress Is more likely to participate in community activities Is doing better in school Other (please specify)* 8. How has your family benefited from services received?(Select all that apply) How has your family benefited from services received? (Select all that apply)   Less stress in home Better able to participate in community activities Other

21. Develop improved data models to track services needs Family Satisfaction SurveySample from one page local survey Poor Fair Excellent How well is the communication from your case manager? 1 2 3 4 5 How well were you informed about the FAPT process? 1 2 3 4 5 How much input did you have in the selection of service providers? 1 2 3 4 5 How well is the provider meeting your child’s needs 1 2 3 4 5 Do you feel that your child/family 1 2 3 4 5 is treated with respect and dignity? How well did the FAPT use your 1 2 3 4 5 child/family’s strengths in planning for services? How successful are the services at this time? (Please check one) ___ Situation made worse ___ Minimal improvements ___ No change ___ Progress made, not complete ___ Desired outcomes obtained

22. Develop improved data models to track services needsVirginia Child and Adolescent Strengths & Needs (CANS) • As Virginia transitions to the use of the CANS as our mandatory uniform assessment instrument, a great potential exists for more effectively tracking specific changes across youth strengths and needs. • Further workgroup activity and consultation from Dr. John Lyons will enable Virginia to develop models for tracking client outcomes using the CANS. • For the latest fact sheets and information on trainings and policy concerning the CANS, please go to: http://www.csa.state.va.us/html/CANS/cans_information.cfm

23. Link service array reports to systems improvement • Communicate to community leaders whether services are child centered, family focused, community based and cost effective • Develop baselines for program performance and set goals for improvement • Identify service gaps for the purpose of allocating scarce resources to specific community service development initiatives • Use reports as a communication tool with community and regional partners to further strengthen local systems of care • Initiate conversations with the provider community to further develop the continuum of care and individualize services