2013 Annual Gathering: Workshop#11B: Using ANSA for Client Assessment

7/27/2019 2013 Annual Gathering: Workshop#11B: Using ANSA for Client Assessment

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Using ANSA for Client Assessment and Program

Evaluation

Catholic Charities USA Conference, 2013

Dan Bowersox

[[email protected]]

Shona Q. Baum, LCSW[[email protected]]



• Who we are, and how we got here

• Choosing ANSA

• A deeper look at ANSA

• Examples and vignettes

• Our implementation and results

• Discussion

Agenda



• Who we are – Founded in 1989

– Serving 3,300 families per year

– Diverse staff of 70

• Education

• Work experience,• Case management skill level

• What we do

– Case Management

• Substance Abuse

• Domestic Violence• Child Welfare

– Housing

– Wellness Center

In partnership with our families, break the cycle of childhood poverty

Homeless Prenatal Program (HPP)



• Intensive job training program

• Participants are low-income parents – Many are former clients of the agency

– Limited education/employment experience

• Majority of HPP case managers are graduatesof the program

– First agency in San Francisco to hire former clients

CHW Training Program



The Challenges

• Ensure consistent quality of client service

• Meet increasing need from funders for data and formal program

evaluation

Or: We know we are doing great work. How do we prove it?



• Ensure consistency in assessing clients’ needs and strengths

• Facilitate creation of service plans

• Allow monitoring of outcomes

• Standard language for communication between team members

The Solution:

Standardized Assessment



Why ANSA?

• Open domain tool, widely used

– Interface with other agencies

• DPH, Child Welfare

• Cross-disciplinary

• Focus on necessary actions• Non-judgmental

• Appropriate for multi-cultural environment



About ANSA

• Developed and copyrighted by the Praed Foundation*

• Free to use

• Training and certification available

* Copyright 1999, the Praed Foundation, www.praedfoundation.org



ANSA Categories

Life Domain Functioning

– Physical/Medical

– Family Functioning

– Employment

– Social Functioning

– Recreational

– Intellectual

– Sexuality

– Living Skills

– Residential Stability

– Legal

– Sleep

– Self Care

– Medication Compliance

Acculturation

– Language

– Identity

– Ritual

– Cultural Stress

Mental Health Needs

– Psychosis

– Impulse Control

– Depression

– Anxiety

– Interpersonal Problems

– Antisocial Behavior

– Adjustment to Trauma

– Anger Control

– Substance Use

– Eating Disturbance

Risk Behaviors

– Suicide Risk

– Self Injurious Behavior

– Other Self Harm

– Exploitation

– Danger to Others

– Sexual Aggression

– Criminal Behavior

Strengths

– Family Involvement

– Social Connections

– Optimism

– Educational

– Job History

– Talents/Interests

– Spiritual/Religious – Natural Supports

– Resiliency

– Resourcefulness

– Volunteering

– Community Connection



HPP Assessment Categories

Life Domain Functioning

– Physical/Medical

– Family Functioning

– Employment

– Social Functioning

– Recreational

– Intellectual

– Sexuality

– Living Skills

– Residential Stability

– Legal

– Sleep

– Self Care

– Medication Compliance

Acculturation

– Language

– Identity

– Ritual

– Cultural Stress

Mental Health Needs

– Psychosis

– Impulse Control

– Depression

– Anxiety

– Interpersonal Problems

– Antisocial Behavior

– Adjustment to Trauma

– Anger Control

– Substance Use

– Eating Disturbance

Risk Behaviors

– Suicide Risk

– Self Injurious Behavior

– Other Self Harm

– Exploitation

– Danger to Others

– Sexual Aggression

– Criminal Behavior

Strengths

– Family Involvement

– Social Connections

– Optimism

– Educational

– Job History

– Talents/Interests

– Spiritual/Religious – Natural Supports

– Resiliency

– Resourcefulness

– Volunteering

– Community Connection



ANSA Ratings: Needs

0 1 2 3

Evidence of

need

No evidence of

need

Mild degree of

need

Moderate

degree of need

Severe or

disabling

degree of need



ANSA Ratings: Needs (Action-based)

0 1 2 3

Need for

Action

No need for

action

Watchful

waitingNeed for action

Need for

immediate or

intense action



ANSA Ratings: Strengths

0 1 2 3

Presence of

strength?

Significant

strength

Moderate

level of

strength

Mild

level of

strength

No

strength

present



ANSA: Physical/Medical



Physical/Medical Rating

0 1 2 3

Evidence of

physical/

medical

problems?

No evidence

Mild or

well-managed

conditions

Chronic or

moderate

conditions

Severe or

life-threatening

conditions



ANSA Principles

• Rating pertains to the individual, irrespective of services theyare receiving

• Rating must be based on stated or observed need, not

assumed need

• Culture and development should be considered when rating – Examples: Housing, religion, family

• 30-day window to ensure "freshness"

• Needs rated 2 or 3 should appear in service plan



ANSA: Residential Stability



Residential Stability Rating

0 1 2 3

Current

Situation Stable Housing

Mostly Stable

Housing

Unstable

Housing Homeless

Risk Factors:Could the client

lose their housing due

to problems with

self-care, disruptivebehavior, financial

situation, or another

reason?

No Evidence of

Risk

Some Warning

Signs

Moderate Risk

Level

Severe Risk

Level



Brenda

Brenda left a DV situation last year and she and her daughter have been

staying in a DV shelter ever since. She is suffering from major depression

and speaks only limited English.



Anthony

Anthony and his family have been living in a rental apartment for the

past 2 years. He just got laid off from his job as a mechanic and is

worried about paying his bills. He has been in recovery for 1 year.



Courtney

Courtney was evicted a few months ago and went to

stay with her cousin. Her cousin wants her to leave,

but she has been unable to find another place due to

the eviction on her record.



The Client Interview

Coaching case managers on how to interview clients



Assess Current Living Situation

– How do you feel about your living situation? – Is it clean/safe/healthy there?

– Do you feel like you are in control of your housing?

– Are you and your kids sleeping well at night?



Assess History

– Have you ever been homeless?

– Have you ever been evicted?

– How did that happen?

– Where did you stay?

– How long?

– Who helped you?



HENRI (HPP database) Demo

• ANSA in HENRI

– Built-in 30-day time limit

– Rating, plus note for justification

– UNCOPE and other add-ons

– Exporting data (e.g. KFT assessments)

– Outsourced development



HPP’s Results So Far

Over 1700 assessments conducted in first year

E m ploym ent

P hysical/M edical

R esidential S tability

Fam ily Functioning

Legal

Living S kills

C ultural S tress

Fam ily Involvem entS ocial C onnectedness

D epression

A nxiety

A djustm ents to Traum a

S ubstance Abuse

0% 5% 10% 15% 20% 25% 30% 35% 40%

% w ith 2 or 3 R ating



Issues encountered

Data quality/consistency Instituted manager approval process

Resistance to change:

“This feels like a college exam”

Slow rollout with lots of training and

support

Issue Action



Benefits of implementation

• Winning federal demo grant – HPP's use of ANSA strengthened proposal

– Other grants require evidence-based assessment

• Linking assessment to case plans

• Smoother transfer of clients between case managers

• Using as basis for discussion of housing stability risks



HPP’s Future Plans

• Follow-up assessments

• Comparisons to baseline

– Individual -- tracking client's progress

– Aggregate -- several possibilities for doing

comparisons

• Number of clients who improved total score

• Number improved within a specific category



ANSA Certification

http://www.canstraining.com



Discussion

• Your experiences with assessment?

• Questions?



Backup



HENRI Screen Shots



Backup



Backup



Backup



Backup



Vignettes

• How would you interview the client to obtain the necessary information?

• What additional questions would you ask?

• How would you rate the client in the given category?



Vignette 1: Employment

• Client reports history of short-term employment.

• Client has worked at fast food restaurants, retail, hotels.

• Client's longest employment was working part-time with a friend's

mother in home daycare for one year, in 2009.

• Client reports most recent employment was at a supermarket in 2010.• Client states she has never been fired.



Vignette 2: Family Functioning

• Client has history of instability and trauma in her family life.

• Mother is in recovery for substance use.

• Client reports father is not in her life.

• Client reports older brother was murdered last year due to a possible

gang dispute.• Client reports has 2 sons from two different partners.

• Client states having no parental rights of 2 sons. Children are currently

staying with partners' families.

• Client reports she is excited about present partner's release from jail in

about 9 months. They are considering having a baby as soon as he is free.• Client does not want to disclose cause of partner's jail sentence.



Vignette 3: Mental Health

• Client is a 35-year-old mother of three children.

• Client lives with her partner and her children.

• She states "I don't know what is happening to me. I just want to sleep. I

have to force myself to get out of bed to cook, or to take the children to

school. I just don't have the energy to do anything. I feel tired, and have

no interest in doing things, or going out. I am often feeling very sad and

crying, but I don't want to talk to my family or friends about my feelings. I

sometimes wonder what is the point of having a life like mine."

Documents

2013 Annual Gathering: Workshop#11B: Using ANSA for Client Assessment