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Child and Adolescent Functional Assessment Scale
Jim Wotring, Director National Technical Assistance Center for
Children’s Mental Health
202-687-5052
Copyright 2006 by Kay Hodges and Jim Wotring.
Copyright 2006 by Kay Hodges and Jim Wotring.
CAFAS Assesses Day-to-Day Functioning Across 8 Domains
School/Work
Home
Community
Behavior Toward Others
Moods/Emotions
Self-Harmful Behavior
Substance Use
Thinking
Copyright 2006 by Kay Hodges and Jim Wotring.
Each of the 8 subscales has problems, strengths and goals.
For each Subscale, problems are divided into 4 levels of impairment:
Severe Moderate Mild Minimal/None
30 20 10 0
For problems, raters select behavioral descriptors that describe child’s severest functioning in the last 3 months.
CAFAS: The Essentials
Copyright 2006 by Kay Hodges and Jim Wotring.
CAFAS Profile Gives Overview
0
10
20
30
School/
Work
Home
Comm
unity
Behavior
Moods
Harmfu
l
Substance U
se
Thinkin
g
CAFAS Subscales
CAFAS Scale Scores at Intake
Copyright 2006 by Kay Hodges and Jim Wotring.
Charting Progress Sustains Hope
Comparison for Intake, 3 months, & Exit
CAFAS Scales
0
10
20
30
Intake
3 Months
Exit
6
6
Can track progress during treatment; modify plan as needed
Dashboard Tracks Change Over Time
© Hodges
2011
7
Driving Towards a Satisfactory Outcome: “Outcome-ometer”
7
Start with best array of services based on data
Check Progress – Setback! Change service array as needed
End result outcomes – Good!
Check Progress - OK
Being Accountable and Transparent to Consumers
Midway
Beginning of
service
End of
service Improved
functioning
Impaired
functioning
© Hodges
2011
Copyright 2006 by Kay Hodges and Jim Wotring.
• Outcome indicators for individual clients
• Outcome by client type for each provider
• Outcome indicator for supervisors
• Aggregated averages by provider
• Aggregated averages for state
Meaningful Feedback
Copyright 2006 by Kay Hodges and Jim Wotring.
Goal: Reduction in overall impairment
Criteria: Reduce total score by 20 points or more
Total Score
Intake 150
Exit 80
70 point improvement
Outcome Indicators
Copyright 2006 by Kay Hodges and Jim Wotring.
Goal: Reduce behaviors that jeopardize the youth
being in a “normal” environment
Criteria: No severe ratings on any subscales
Severe Impairments
Intake 3
Exit 0
No severe impairments
Outcome Indicators
11
Supervisors Can Identify Cases Making No Progress – Support!
11
Supervisor can identify cases deteriorating or staying the same.
© Hodges
2011
Can drill down to see specific cases.
Copyright 2006 by Kay Hodges and Jim Wotring.
Thinking Problems (irrationality) Maladaptive Substance Use Self-Harmful Potential (includes severe depression) Delinquency Behavior Problems with Moderate Mood Disturbance (School, Home, or Behavior Toward Others) Behavior Problems without Moderate Mood Disturbance Moderate Mood Mild Behavioral or Mood Problems
Adolescent
Specialties
Client Types
Copyright 2006 by Kay Hodges and Jim Wotring.
Median CAFAS Score for Client Types at Intake Shows Hierarchy
0
20
40
60
80
100
120
140
Thinking
Substance Use
Self-Harm Delinquency Behavior w/ Mood
Behavior Mild
Behavior or Mood
Aggregated Data
State
County
Organization
Program
Supervisor
Worker
Client
Copyright 2006 by Kay Hodges and Jim Wotring.
15
IMPACT Level: Data collapsed across children is Aggregated Data
Aggregated Data to Inform Policy and
Practice
Child3 Child3
Child2 Child2 Child1 Child1
15
© Hodges
2011
Copyright 2006 by Kay Hodges and Jim Wotring.
Example of Aggregated Data
0
20
40
60
80
Percen
tag
e o
f
Yo
uth
s
State Provider
Youths Improved by 20 Points or More
Copyright 2006 by Kay Hodges and Jim Wotring.
Who Do We Serve?
Percentage of Youths in Client Type
Mild Mood/Behavior Thinking
Substance Use
Self-Harm
Delinquency Behavior with Mood
Behavior
18
System Level Data: Which EBTs Could Help the Most Youths?
Mild Behavior/Mood Thinking
Substance Use
Self-Harm
Delinquency Behavior with Mood
Behavior
Parent Management
Training (PMT)
Cognitive Behavior
Therapy for Depression
(CBT) or Trauma (TFCBT)
© Hodges
2011
Providers Agreed on Dashboard Outcome Indicators
19
Outcome Indicators
Individual Data for Each
Youth
Aggregated Data for
Agency/Program
Meaningful & Reliable Improvement (Total reduced by 20 points)
No severe impairments at exit on CAFAS
Not pervasively behaviorally impaired (across settings) at exit
_____ %
_____ %
_____ %
20
Leading Before and After Implementation of an Outcomes
Management System
Before Opinions
Anecdotal information
Strident Voices
Data
Often unavailable
No client-level data
No outcomes
Outcomes Management
System (OMS)
After Data •Always available •Data on each client •Outcomes •Meaningful Opinions •Share with stakeholders •Obtain input Results •Transparency •Accountability
© Hodges
2011
CAFAS Link to FAS Outcomes
For Pricing
http://www2.fasoutcomes.com/Content.aspx?ContentID=12
Copyright 2006 by Kay Hodges and Jim Wotring.
