The Therapeutic Group Home Performance Improvement Center: An

Transcription

The Therapeutic Group Home
Performance Improvement
Center: An Innovative Approach
to Improving Congregate Care in
Connecticut
March 23, 2015
Copyright 2014 ValueOptions Connecticut.® All rights reserved.
National Literature
Approximately 56,000 children under the supervision
of child welfare systems live in congregate care
settings.
(U.S. Department of Health and Human Services, 2014)
2
Congregate Care- National Literature
 Ongoing debate regarding whether or not
congregate care treatment is effective
 No evidence based model of treatment for the
delivery of behavioral health services to youth in
congregate care
 High degree of variability among programs
(Leichtman, 2006)
3
Connecticut Context
There are 40 Therapeutic Group Homes (TGHs) in CT
with a total bed capacity of approximately 210
4
What is a Therapeutic Group Home?
A small (4-6 bed)
community based
congregate care
facility for youth
with complex
behavioral health
needs
5
Therapeutic Group Homes in CT
Were intended to provide a comprehensive array
of integrated behavioral health treatment and
rehabilitative support services within a therapeutic
milieu
6
Therapeutic Group Homes in CT
Funded by the Department of Children and Families
(DCF), TGHs represent an approximately 40 million
dollar annual investment in the future of some of CT's
most vulnerable youth (CT DCF, 2011)
7
Therapeutic Group Home
Performance Improvement Center (TGH PIC)
 In 2014, DCF partnered with
ValueOptions Connecticut to
implement a new system of
performance management for
the TGHs
 The TGH PIC is built on the core
principles of Implementation
Science (Fixsen, Naoom, Blase,
Friedman & Wallace, 2005)
8
Implementation Science
A core set of practices and principles necessary for
effective program implementation and consistent
sustainability of positive outcomes
9
Further research has demonstrated that the
application of implementation science to promising or
"best" practices also improves outcomes and costeffectiveness.
10
In CT, Implementation Science has been used to implement
various EBPs and support best practices in the children’s system.
11
Performance Improvement Center
PRIMARY FUNCTIONS
Data Collection,
Analysis and
Reporting
Quality
Improvement
Activities
12
Performance Improvement Center
GOALS
Reduce variability in performance
Maximize quality and cost-efficiency
Improve practice and outcomes for the
youth and families served
13
Methodology
Data is collected from multiple sources and is aggregated
into quarterly and annual reports at the statewide, provider
and individual program levels.
14
Methodology

Data sources
 ValueOptions Authorization data
 Monthly data submitted by TGH providers
 Discharge data submitted by TGH
providers
 Child and Adolescent Needs and
Strengths (CANS) Referral Data
 Department of Children and Families Risk
Events
 Department of Social Services Medicaid
Claims
 Department of Mental Health and
Addiction Services Episode Data
15
Demographics
Gender
Race
0.3%
29.6%
54.9%
26.9%
0.3%
45.1%
Female
Male (N = 178)
42.9%
African American
Asian
Caucasian
Hispanic
Native American
16
Age
70%
30%
Youth in Care (%)
25%
20%
15%
10%
5%
0%
11
12
13
14
15
16
17
18
19
20
21
17
Top 10 Behavioral Health Diagnostic Categories
Posttraumatic Stress Disorder
45.9%
Mood Depressive Disorders NOS
39.7%
Attention Deficit Disorders
37.2%
Disruptive Behavior Disorders
32.2%
Other Conditions That May Be The Focus Of
Clinical Attention
Other Disorders Usually First Diagnosed In
Infancy Childhood Or Adolescence
22.8%
13.8%
Autism Spectrum Disorders
12.8%
Intellectual Disability
12.2%
Bipolar Disorders
10.9%
Major Depressive Disorder
9.7%
0%
5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Youth in Care (%)
18
Youth in Care & Admissions
500
400
300
200
100
0
Admissions
Youth in
Care
2009
158
2010
201
2011
181
2012
190
2013
188
2014
146
363
397
405
421
376
324
19
90%
80%
0%
Provider X
Provider AJ
Provider J
Provider AK
Provider F
Provider K
Provider G
Provider B
Provider AL
Provider S
Provider AE
Provider I
Provider AB
Provider AI
Provider Z
Provider E
Provider L
Provider AC
Provider AF
Provider AM
Provider AN
Provider M
Provider P
Provider D
Provider T
Provider AG
Provider W
Provider AD
Provider O
Provider H
Provider Q
Provider R
Provider AH
Provider A
Provider C
Provider N
Provider U
Provider V
Provider Y
Provider AA
Occupancy Rate
Q4 2014
100%
Statewide Average = 77.7%
70%
60%
50%
40%
30%
20%
10%
20
Length of Stay Frequency Distribution for Youth in Care as of
December 31, 2014
40%
Youth in Care (%)
35%
30%
25%
20%
15%
10%
5%
0%
Years
21
Monthly Treatment Hours Per Youth Per Month
8
Average Hours of Treatment
7
6
5
4
3
2
1
0
Q4 '12 Q1 '13 Q2 '13 Q3' 13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14
Individual Per Youth
Group Per Youth
Family Per Youth
22
Average Treatment Hours
13
12
11
10
9
8
7
6
5
4
3
2
1
0
Provider AK
Provider AE
Provider K
Provider P
Provider A
Provider Y
Provider AC
Provider AA
Provider E
Provider M
Provider N
Provider AH
Provider AJ
Provider AI
Provider G
Provider I
Provider AG
Provider AM
Provider AL
Provider L
Statewide Average
Provider AF
Provider T
Provider F
Provider U
Provider O
Provider X
Provider R
Provider Q
Provider Z
Provider AD
Provider AN
Provider S
Provider D
Provider AB
Provider J
Provider V
Provider W
Provider H
Provider C
Provider B
Group Treatment Hours Per Youth Per Month
Q4 2014
Performance Expectation = 8.6 Hours
23
Average Treatment Hours
0
Provider N
Provider Y
Provider AM
Provider F
Provider D
Provider AF
Provider AK
Provider AD
Provider AG
Provider C
Provider AC
Provider I
Provider AA
Provider K
Provider E
Provider P
Provider AH
Provider A
Provider R
Provider X
Provider AJ
Provider J
Statewide Average
Provider B
Provider Q
Provider U
Provider W
Provider AI
Provider AB
Provider O
Provider AN
Provider Z
Provider AL
Provider T
Provider L
Provider M
Provider G
Provider AE
Provider H
Provider S
Provider V
Family Treatment Hours Per Youth Per Month
Q4 2014
8
7
6
5
4
3
2
1
24
Family Visits Per Youth Per Month
5.0
Average # of Family Visits
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
Q4' 12 Q1 '13 Q2 '13 Q3' 13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14
# of Scheduled Visits/Youth
# of Attended Visits/Youth
25
Emergency Department Utilization
 Approximately 40% of youth in TGH care utilized
the Emergency Department (ED) for a behavioral
health and/or medical evaluation during Q2 2014
 The volume of ED visits by TGH ranged from 0 to 17
visits
26
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Provider K (4)
Provider AH (6)
Provider Y (5)
Provider G (6)
Provider T (5)
Provider AM (4)
Provider J (4)
Provider O (5)
Provider N (4)
Provider B (4)
Provider AK (4)
Provider AB (7)
Provider AC (6)
Provider AL (6)
Provider AG (6)
Provider C (6)
Provider I (5)
Provider AF (5)
Provider S (5)
Provider P (5)
Provider U (5)
Provider Q (5)
Provider AI (5)
Provider AD (5)
Provider AE (5)
Provider Z (5)
Provider M (4)
Provider W (4)
Provider AA (6)
Provider D (5)
Provider AN (5)
Provider F (5)
Provider X (5)
Provider L (7)
Provider E (6)
Provider A (6)
Provider AJ (5)
Provider V (5)
Provider H (5)
Provider R (5)
Behavioral Health ED Rates
Percentage of Youth who have visited the ED for BH reasons
Statewide Average = 22.9%
Note: Number in the parentheses represents youth in care.
27
Risk Events
CY 2012 - 2014
500
450
Number of Events
400
350
300
250
200
150
100
50
0
AWOLs
Arrests
CY 2012
Police Calls
CY 2013
Restraint Episodes
CY 2014
28
Admission to a Residential Treatment Center 180and 365-Days Post TGH Discharge
30%
Admission Rate (%)
25%
20%
15%
10%
5%
0%
CY 2009
CY 2010
180 Day RTC Admission Rate
CY 2011
CY 2012
CY 2013
365 Day RTC Admission Rate
29
Readmissions to a TGH within 180 and 365 Days
Readmission Rate (%)
30%
25%
20%
15%
10%
5%
0%
CY 2009
CY 2010
180 Day Readmission Rate
CY 2011
CY 2012
CY 2013
365 Day Readmission Rate
30
Admission to an Inpatient Psychiatric Hospital 180and 365- Days Post TGH Discharge
30%
Admission Rate (%)
25%
20%
15%
10%
5%
0%
CY 2009
CY 2010
180 Day IPF Admission Rate
CY 2011
CY 2012
CY 2013
365 Day IPF Admission Rate
31
Number of Inpatient Days within 365 Days
Pre & Post TGH Episode
6,000
5,000
# IP Stay Days
4,000
-21.1%
- 45.5%
- 50.1%
3,000
- 4.8%
2,000
1,000
0
Total Discharges
# IP Days Pre TGH Stay
# IP Stay Days Post TGH Stay
CY 2010
112
4066
3210
CY 2011
138
2073
1974
CY 2012
181
5370
2928
CY 2013
170
5624
2806
32
Data Completion and On-Time Completion Rates
100%
90%
80%
Completion Rate (%)
70%
60%
50%
40%
30%
20%
10%
0%
Q4
Q1
Q2
Q3
Q4
Q1
Q2
Q3
Q4
'12
'13
'13
'13
'13
'14
'14
'14
'14
% Completed
97.4% 93.2% 97.2% 96.4% 97.7% 97.6% 97.9% 94.3% 98.1%
% Completed On-Time 66.0% 61.7% 69.7% 65.1% 68.9% 66.9% 65.7% 65.6% 77.5%
33
Challenges
 Small N’s in each program create challenges in
evaluating performance
 Variability in populations served makes selection
of standard measures more difficult
 Data standards are harder to enforce when data
is from multiple sources
 Absence of evidence based models makes
selection of best practices more difficult
34
Summary
 Ability to integrate multiple data sources is a
major improvement
 Complementary approach to quality
improvement incorporated in healthcare reform
 Transparency in reporting produces healthy
competition
 Significant improvements in program
performance can be expected when done right
 Requires upfront investment in infrastructure
 Improved quality outcomes more than pay for the
costs of Implementation Science
Acknowledgements
Department of Children and Families:
Sarah Gibson, J.D., M.S.W.
Program Director, Children and Youth in Placement
Linda Dixon, Ph.D.
Administrator, Adolescent and Juvenile Justice
Services
Karen Andersson, Ph.D.
Director, CT BHP
36
Acknowledgements
ValueOptions Connecticut:
 Stephanie Shorey-Roca, Quality Analyst
 Shweta Tiwari, Quality Analyst
 Melissa Williams, Quality Analyst
 Lisa Palazzo, Regional Network Manager
 Andrew LaVallee, Regional Network Manager
 Cynthia Petronio-Vazquez, Regional Network Manager
 Shatoya Russell, Auditor
 Lynne Ringer, AVP of QM
 Laurie Van der Heide, Chief of Research & Evaluation
37
Sources

Connecticut Department of Children and Families. (2011). Congregate Care
Rightsizing and Redesign: Young Children, Voluntary Placements and a Profile
of Therapeutic Group Homes. Retrieved from
http://www.ct.gov/dcf/lib/dcf/latestnews/pdf/cc_right_sizing_report__young_
children_and_voluntary_placements_8_4_11.pdf

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005).
Implementation Research: A Synthesis of the Literature. Tampa, FL: University
of South Florida, Louis de la Parte Florida Mental Health Institute, The National
Implementation Research Network (FMHI Publication #231).

Hair, H. J. (2005). Outcomes for children and adolescents after residential
treatment: A review of research from 1993 to 2003. Journal of Child and
Family Studies, 14(4), 551–575.

Leichtman, M. (2006). Residential treatment of children and adolescents: Past,
present, and future. American Journal of Orthopsychiatry, 76, 285–294.

U.S. Department of Health and Human Services [USDHHS], Administration on
Children, Youth and Families. (2014). The AFCARS report # 21. Retrieved from
http://www.acf.hhs.gov/sites/default/files/cb/afcarsreport21.pdf
38
Questions/Comments?
39
Contact Information
Carrie Bourdon, LCSW
Director, TGH Performance Improvement Center
ValueOptions® Connecticut
500 Enterprise Drive, Suite 4D, Rocky Hill, CT 06067
860-263-2060
Carol.Bourdon@valueoptions.com
Robert Plant, Ph. D.
Senior Vice President of Quality & Innovation
ValueOptions® Connecticut
500 Enterprise Drive, Suite 4D, Rocky Hill, CT 06067
860-707-1102; Robert.Plant@valueoptions.com
40

The Therapeutic Group Home Performance Improvement Center: An

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