Performance and Outcomes that Demonstrate Effectiveness of Criminal Justice FADAA/FCCMH Annual Conference August 7 & 8, 2013 Neil Gaer, MPA VP, Senior Director Phoenix Houses of New England Jack M. Feinberg, LMHC, CAP VP, Clinical Director Phoenix Houses of Florida
Outline of workshop • Introduction • Project overview – what we set out to do • Demonstration of the integrated CEST assessment and EHR • Reports, data, and how to use it • Discussion and Q&A
What we set out to do Context: Organization was implementing an EHR nationally Aim: Standardize a process where every client in the NE region * receives a CEST assessment at intake * and gets re-assessed at periodic intervals (depending on length of stay) during treatment
Why do we want to do this? NIATx promising practice – Enhance Motivation • Tailor treatment to each client’s circumstances and needs • Offer motivation groups for clients to enhance treatment engagement • Identify clients at risk for dropping out and intervene • Map ongoing care at regular intervals (treatment plan reviews using assessment results)
Why CEST and what is it? • Client Evaluation of Self and Treatment • Developed by the Institute of Behavioral Research at TCU • decades of research, federal outcome studies • studies of treatment processes (what happens inside treatment, what are the elements of effective treatment)
Tailoring treatment TCU Treatment Process Model Readiness Interventions what’s inside the “black box”? Aftercare Services & Support Networks what’s inside the “black box”? Recovery Process Social Skills Training • Early Engagement • Participation • Therapeutic Relationship Client Factors Problem Severity & Treatment Readiness RecoverySkills Training Retention Threshold • Follow-up • Outcomes • Drug use • Crime • Social • Functioning • Early Recovery • Changes in • Thinking • Behavior Cognitive Interventions Behavioral Interventions
CEST assessments • Client self-report • 4 modules, about 30 questions each • Measures client changes in thinking and behavior • which may lead to more long term outcomes in housing, employment, legal involvement
sample questions PSYCHOLOGICAL FUNCTIONING SCALES E. Self Esteem (SE) 17. You have much to be proud of. 59. You feel like a failure. ® 71. You wish you had more respect for yourself. ® 88. You feel you are basically no good. ® 100. In general, you are satisfied with yourself. 109. You feel you are unimportant to others. ® F. Depression (DP) 57. You feel interested in life. ® 74. You feel sad or depressed. 76. You feel extra tired or run down. 90. You worry or brood a lot. 97. You feel hopeless about the future. 123. You feel lonely.
Recap of TCU’s Adaptive Treatment Model • manualized curricula for identified problem areas • evidence-based (listed on NREPP) • it’s FREE • download CEST assessments, curriculum manuals at www.ibr.tcu.edu
How did Phoenix House New England come upon and utilize the CEST • Searching for evidenced based practices • NREPP • Need for outcome studies for funding sources • Monitor Quality Performance Improvement (QPI) as part of management reporting • And it sounded like a good idea at the time
Meeting CARF definitions of • Effectiveness – measures the quality of care through measuring change over time. • Efficiency – measures how well resources are used to accomplish agency program goals. • Satisfaction – measures oriented toward the person served, family members, personnel, and funding sources.
What was the plan? • Build the assessments into EHR. Have automatic date triggers. Automate real-time scoring. • Build reports to look at change over time on aggregate level. • Create a Quality Performance Improvement (QPI) system to check how we are doing (efficiency & effectiveness).
CEST in New England • Residential • Adult • Adolescent • Corrections • Outpatient • Community Corrections
Welligent and CEST • Integration • Transparency • Individualized • Facility Averages • National Norms • Graph All Client Scores Over Time • REAL TIME
How many clients were receiving comprehensive assessments? • At admission/intake for initial treatment planning • many programs were using the ASI, some were using other tools • During treatment for ongoing monitoring of progress • none
Setting due date triggers example: Adolescent Residential Programs
III. Reports, Data, and How to Use it
Individual case example“John” • 44 y.o. male • crack (age 23), marijuana/alcohol (age 11) • referred by parole – was incarcerated 1 year • 5 prior treatment episodes • H.S. diploma, unemployed • depression, on medication • parole officer and client felt he needed treatment to maintain sobriety while transitioning back to community
Assessing client motivation levels
Assessing client risksand needs
Monitoring progress in treatment
Real time feedback monitoring progress and defining treatment goals • Reports can be reviewed with clients in clear, simple language “I see that your scores on feelings of anger have increased quite a bit (peer support decreased, treatment satisfaction decreased) since last month. Can you tell me what’s been going on?” • Opportunities for therapeutic intervention “So you’re having problems with your roommate. Have you and [roommate] talked about it? What skills might you use from your “Ideas for Better Communication” group? • Collaborative treatment planning “Last time we met you talked about how your feelings of anger sometimes get in the way of your relationships with others. What would you think about participating in the “Emotional Cartography” (or Anger Management) group?
Monitoring program deliverables(and adjusting evidence-base practices) • Our goal within the course of treatment is to • increase psycho-social strengths scores in • Self Esteem • Decision Making • Social Support • Expectancy for Recovery • and to decreasepsycho-social problems scores in • - Depression • - Anxiety • - Anger/Hostility • - Risk Taking
What was the plan? Build the assessments into EHR. Have automatic date triggers. Automate real-time scoring. Build reports to look at change over time on aggregate level. Create a QPI system to check how we are doing (efficiency & effectiveness).