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Comprehensive Child Crisis Services and the CAT. 1/20/2011 N. Israel, Ph.D. OQM for CYF-SOC. Context. CAT in use for over two years Clinical ‘slippage’: the form vs tool problem Learning from your Numbers: Initial Pilot validation of use for CCCS effectiveness and decision support

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slide1

Comprehensive Child Crisis Services and the CAT

1/20/2011

N. Israel, Ph.D.

OQM for CYF-SOC

slide2

Context

  • CAT in use for over two years
  • Clinical ‘slippage’: the form vs tool problem
  • Learning from your Numbers: Initial Pilot validation of use for CCCS effectiveness and decision support
  • Talking through your Numbers: Finer-grained uses of the CAT
  • FutureCAT
slide3

The Tool Issue

  • What class of object is a hammer?
  • Do you need to know what you’re doing with a hammer?
    • Does how you use it matter?
    • Can a hammer be used for good? For evil?
  • Does it matter if you have a hammer if you don’t use it?
slide4

SF CAT

  • Basic Decision Support Algorithm:
  • What does “Decision Support” Mean?
slide5

PastCAT

    • Dr. Chen supervised this work with Ms. Booker
  • Initial look at:
    • Disposition based on CAT scores
    • Effectiveness of Crisis Case Management
      • To reduce acuity of Needs
      • To reduce likelihood of re-entry to CCCS
slide6

PastCAT

  • Disposition:
    • Looked at disposition for 278 consecutive clients
summary of current use
Summary of Current Use
  • The vast majority of decisions made (>90%) are consistent with recommendation of the CAT
  • For decisions in which either intensive community support or hospitalization would be appropriate, we see a gradient: higher severity leads to increased likelihood of hospitalization
  • This pattern is consistent with good clinical practice
slide8

Current Use: Following Up

  • Clinical Implications:
    • Want to see why 2 very-low-risk clients were hospitalized
    • Want to better understand why 1/3 of Moderate Risk clients were hospitalized
    • Want to understand why 5 high-risk clients were not hospitalized
slide9

Clinical Discussion

  • Decision Support:
    • What does a score of 2-4 generally mean?
    • What would indicate to you that a person with a score in the 2-4 range would need hospitalization?
    • So, what would Good use look like?
    • What would Bad use look like?
slide10

CCM Effectiveness

  • How effective is CCM in reducing acuity and re-entry?
  • Characteristics on Entry (92 clients):
    • Average CAT score of 2
    • About 20% with score of 4 or higher
slide11

CCM Effectiveness

  • Effectiveness:
    • On average, CAT Score cut in half
      • Statistically significant (reliable difference)
      • What is the clinical meaning of this?
    • Recidivism:
      • Percent returning to CCCS within 3 months:
        • CCM: 9% (9/96) Non-CCM: 7% (3/45)
      • Original Intake CAT Characteristics of returners:
        • CCM Avg: 3.1 Non-CCM Avg: 3.3
slide12

CCM Effectiveness

  • Recidivism Patterns: Days to recidivism
slide13

CAT for CCM

  • What is the goal of CCM?
  • How does the CANS inform communication around that goal?
    • What would you work on with a client who has one ‘3’?
    • What would you work on with a client who has two ‘2’s?
slide14

CAT for CCM: Good Use

  • What currently happens when people deny a problem (such as the reason for referral) exists?
    • What are the chances the referring event didn’t happen?
    • What are the chances it will come up again?
  • What is language you can use to make it non-threatening to work on this problem?
slide15

FutureCAT

  • What are ways the CAT can be used at the initial assessment to help clinical decision-making and clinical communication?
  • What are ways the CAT can be used in CCM to communicate with families and assess recidivism risk?
slide16

FutureCAT

  • What else can we provide centrally to make the CAT more useful to your work?
    • Assessment
    • Case Management
    • Supervision
slide17

We’re Done!

  • Thanks! Feel free to contact me at: nathaniel.israel@sfdph.org