COMMUNITY FAMILY PARTNERSHIP BIANNUAL REPORT MARCH … · BIANNUAL REPORT MARCH 2015 A Cooperative Venture of: ... CFP outcomes at the system, practice, and youth/family levels. Local

COMMUNITY FAMILY PARTNERSHIPBIANNUAL REPORT MARCH 2015

A Cooperative Venture of: Dorothy A. Johnson Center for Philanthropy at Grand Valley State University Community Family Partnership Kent County System of Care.

Trusted Guidance for Doing Good.

This report is a cooperative venture of the Dorothy A. Johnson Center for Philanthropy’s Community Research Institute at Grand Valley State University and the Community Family Partnership Kent County System of Care. This report represents a collaboration as many individuals dedicated significant time to

accessing the data contained in this report, running the analysis, interpreting the data and verifying the accuracy of the findings. Therefore we would like to thank the key members of the team responsible for this report.

Research and Data TeamAmber Erickson, M.S.W.Research Manager, Community Research Institute

Chyna GroveResearch Coordinator, Community Research Institute

Alexa ThompsonResearch Assistant, Community Research Institute

Anderson DesignGraphic Design and Layout

Johnson Center’s Leadership TeamTeri Behrens, Ph.D. Director, Special Projects

Julie Couturier, C.P.A. Financial Manager

Matthew Downey, M.P.A. Program Director, Nonprofit Services

DeDe EsqueInterim Director, The Grantmaking School

Beverly Grant, L.M.S.W.Associate Director

Jerry Johnson, Ph.D. Research Director, Community Research Institute

Michael Moody, Ph.D. Frey Chair for Family Philanthropy

ACKNOWLEDGEMENTS

TABLE OF CONTENTSIntroduction ......................................................................................................................1Key Highlights ..................................................................................................................2Enrollment and Referral Snapshot ...............................................................................3Demographics ............................................................................................................... 10Placement ...................................................................................................................... 11Service Array Utilization .............................................................................................. 13Service Experience ....................................................................................................... 14

School Attendance and Performance ...................................................................... 17Delinquency ................................................................................................................... 19Natural Supports .......................................................................................................... 21Functioning .................................................................................................................... 23Outcomes at 18 Months ............................................................................................. 28Methodology and Data Limitations ........................................................................... 29Appendix A. Descriptions of Data Collection Instruments ................................... 30

Community Family Partnership Kent County System of Care | Dorothy A. Johnson Center for Philanthropy | 2015 © 1

Within its system, CFP provides two types of service delivery models: Wraparound and Parent Support Partners (PSP). Wraparound is a team-based planning process used to bring all system providers and natural supports together with a youth and their family to create a shared plan that focuses on the youth and family’s identified needs and goals. PSP services are delivered by parents of children who experience emotional, behavioral, or mental health challenges. PSPs work to equip families with the skills, knowledge, and abilities necessary for them to successfully navigate multiple systems.

The Johnson Center for Philanthropy’s Community Research Institute (CRI) at Grand Valley State University conducts the evaluation for CFP. CRI evaluates CFP outcomes at the system, practice, and youth/family levels. Local needs, as defined by the CFP logic model and community stakeholders, and national requirements for Substance Abuse and Mental Health Services Administration (SAMHSA) funding determine data collection and analysis.

The evaluation utilizes a longitudinal design to examine change over the course of service duration and beyond. CFP staff and CRI interviewers collect data at baseline (enrollment into CFP services) and at six month intervals. Enrollment into the evaluation is on a rolling basis, as families are continuously enrolled into CFP services.

CFP began enrolling families into Wraparound and PSP services in January 2012. CRI began collecting baseline data at this time; enrollment into CFP services has since increased to the point that CRI has data for a sample of families who have been enrolled into services for six or more months. This report focuses on data for families who have both baseline and six or 12 month follow-up assessments to assess their change over time. The purpose of this report is to identify trends in CFP projected outcomes; it should be used to continue monitoring successes and challenges and also to provide direction on decision making and strategy.

INTRODUCTION

The Community Family Partnership Kent County System of Care (CFP) is a network of youth-serving public systems and community partners working together with youth and families to increase access to coordinated mental health services and supports. CFP strives to offer a broad array of services and supports for families and youth under 18 with serious emotional disturbances involved in at least two youth service systems (mental health, special education, juvenile justice, or child welfare).


• The profile of youth and families entering CFP continues to look the same as it has in the past. The majority of youth are male, in their teenage years, and from the city of Grand Rapids. Just under half of youth are referred to CFP from the mental health system, with the other half of referrals being mostly split between child welfare and juvenile justice.

• A key characteristic of the CFP population is that the majority of youth have had at least one out of home placement. At the time of referral, more youth of color (in comparison to white youth) are placed in detention (11% versus three percent) and foster care (19% versus 14%). More white youth are placed in the home (75% versus 61%).

• When examining time spent in an out of community placement (at least one day) in the 90 days before intake and exit, there was about a 50 percent decrease in youth who spent time out of the community (33% at intake and 17% at exit).

• Out of community placements are associated with lower functioning scores and a greater likelihood of not graduating from the CFP program.

• Overall, caregivers report a highly positive service experience at each follow up assessment point.

• About three-quarters of youth remain stable or improve their school performance and attendance.

• The majority of CFP youth (62%) indicate some type of criminal justice contact prior to intake.

• Overall, criminal justice contact decreases for youth from the baseline assessment to the 12 month assessment.

• There is a substantial discrepancy between white youth and youth of color in regard to their criminal justice history. Youth of color have been questioned by the police; adjudicated; told to appear in court; and taken into custody at double the rate (or more) of white youth.

• Child and Adolescent Functioning Assessment Scale (CAFAS) scores show a desirable decrease over time, with a clinically significant decrease from intake to exit.

• There is a statistically significant difference in the percent reduction of CAFAS scores from intake to exit between white youth and youth of color. White youth reduce their CAFAS scores by about 27 percent on average, while youth of color reduce their scores by about 16 percent.

• Youth anxiety, suicidality, and substance use all decrease from intake to the 12 month assessment point, but the proportion of youth who are affected by these issues has increased since the last biannual report.

• Caregiver strain improves from intake to the 12 month assessment point. The greatest improvement is seen in objective strain, i.e. observable disruptions in family and community life.

KEY HIGHLIGHTS


2013

January February March April May June July August September October November December

2012


4 5 17 7 18 16 6 8 19 17 5 3

12 24 24 21 19 12 25 17 18 22 21 13

2015

January February

8 12

2014


17 17 13 13 8 13 9 14 10 24 13 17

The profile of youth and families entering CFP continues, in many ways, to look the same as it has in the past. The majority of youth are male, in their teenage years, and from the city of Grand Rapids. The majority of families have a history of depression, other mental illness, and substance abuse, and live below poverty. Just under half of youth are referred to CFP from the mental health system, with the other half of referrals from child welfare and juvenile justice. Youth are involved in a wide range of systems at the time of referral, with the majority being

in mental health and special education of some sort. Most youth present with problems related to conduct/delinquency at the time of referral, with a majority also presenting with hyperactive/attention and anxiety related problems. More white youth are categorized as presenting with the internalizing type problems of suicidality and anxiety in comparison to youth of color, while more youth of color are categorized in the externalizing category of conduct/delinquency.

ENROLLMENT AND REFERRAL SNAPSHOT

Source: Referral Form; N = 541

Number of Authorizations Fig. 1




Enrollment Status Fig. 2

178Open Cases

536Total Served

There have been 92 newly enrolled youth since the last biannual report.

Location of CFP Youth at Time of Referral Fig. 3

Source: Referral Form; N = 5170 10 20 30 40 50 60

Grand Rapids

Belmont

Lowell

Sparta

Cedar Springs

Rockford

Grandville

Kentwood

Wyoming

Conklin

Hersey

Alto

Evart

Comstock Park

Caledonia

Byron Center

Ada

Walker

Sand Lake

Gowen

Muskegon

Kent City

Kalamazoo

Hudsonville

Greenville

Wayland

58.4%10.8%

8.5%

2.51%

2.3%

2.3%

2.1%

1.7%

1.1%

1.1%

0% 10% 20% 30% 40% 50% 60%

1.1%

1.1%

0.9%0.9%

0.9%

0.7%

0.5%

0.3%

0.3%

0.3%

0.1%

0.1%

0.1%

0.1%

0.1%

0.1%


48%

18%

17%

13%

3%1%

Mental Health

CFP

Juvenile Justice

Child Protective Services (DHS)

Foster Care

Special EducationOther

Juvenile Justice

Child Protective Services (DHS)

Foster Care

Special Education



Referral Source by System Fig. 4 System Involvement at Time of Referral Fig. 5


There has been an increase in youth involved in foster care since the last biannual report, from eight percent to 14 percent.

Mental Health

Special Education

Juvenile Justice

Child Welfare (DHS)

Foster Care

0% 20% 40% 60% 80% 100%

82%

57%

35%

22%

14%

CFP Services Fig. 6

Service Count PercentParent Support Partner Only 9 5%

Wraparound Only 124 70%

Wraparound and Parent Support Partner 45 25%


More families have been enrolled in Parent Support Partners since the last biannual report; enrollment in both Wraparound and Parent Support Partners rose by about 16 percent, while enrollment in Wraparound-only decreased by about 18 percent.



Source: LOS- EDIF N = 538; White N = 235; Youth of Color N = 297

Presenting Problems Fig. 7 Overall White Youth Youth of Color

Suicide-Related Problems

15%27%20%

Specific Developmental Disabilities

12%14%13%

Learning Disabilities

25%28%26%

School Performance Problems not Related to Learning Disabilities

60%54%56%

Eating Disorders

1%2%1%

Feeding Problems in Young Children

0%0%0

Disruptive Behaviors in Young Children

12%9%11%

Persistent Noncompliance

13%11%12%

Depression-Related Problems

41%48%43%

At Risk or Has Failed Family Home Placement

8%6%7%



Source: LOS- EDIF N = 538; White N = 235; Youth of Color N = 297

Presenting Problems (overall and by race) Fig. 7 Overall White Youth Youth of Color

Anxiety-Related Problems

45%60%51%

High-Risk Environment: Other

0%0%0

Other

9%14%12%

Hyperactive and Attention-Related Problems

54%62%57%

Conduct/Delinquency-Related Problems

87%78%82%

Substance Use, Abuse, and Dependence Problems

19%17%18%

Adjustment-Related Problems

27%24%25%

Psychotic Behaviors

8%8%8%

Pervasive Developmental Disabilities

7%19%12%


ENROLLMENT AND REFERRAL SNAPSHOTChild and Family History Fig. 8

80%0% 20% 40% 60%

48.7%

49.3%

68.0%

70.0%

80.0%100%

Family history ofdepression

Family history ofmental illness other

than depression

Family history ofsubstance abuse

Child has witnesseddomestic violence

Child has lived withsomeone who hasbeen convicted of

a crime

Source: LOS CIQ-I (Data Profile Report)N = 194-200

Youth enrolling in CFP share similar family histories that likely have an impact on youth and the family unit as a whole. The majority of families report a history of depression or other mental illness and substance abuse. Almost half of all families report that their child has witnessed domestic violence and lived with someone who has been convicted of a crime.


0%

10%

20%

30%

40%

50%

60%

70%

80%

19%13%

68%


Source: LOS CIQ-RC-I (Data Profile Report)N = 203

Fig. 9

39%Percent of youth with a recurring or chronic health problem at intake

Caregiver Income Fig. 11

Source: LOS CIQ-I (Data Profile Report)N = 140

Source: LOS CIQ-RC-I (Data Profile Report)CFP N = 201

Fig. 10

52%Caregivers Employed in the past 6 months

Above Poverty At or Near Poverty Below Poverty


About two-thirds of youth who have been enrolled in CFP are male and in their teenage years. Enrollment by race has remained steady over time: about 44 percent of youth are white, 31 percent are Black or African American,

14 percent are Hispanic, 11 percent are multi-racial, 4 percent are Asian, and 4 percent have been categorized as “Other.”

DEMOGRAPHICS

Gender CFP Data Fig. 12

67%

Male33%

FemaleSource: LOS EDIF (Data Profile Report)CFP N = 538

Age CFP Data Fig. 13

Birth to 3 Years 1% 4 to 6 Years 9% 7 to 11 Years 26% 12 to 14 Years 34% 15 to 18 Years 30% 19 to 21 years 0%

Source: LOS EDIF (Data Profile Report)CFP N = 538

Race/Ethnicity CFP Data Fig. 14

American Indian or Alaska Native .2%

Asian .2% Black or African American 30.7%

Native Hawaiian or Other Pacific Islander 0%

White 44.2% Hispanic/Latino 13.9% Multi-Racial 10.9% Other 0%

Source: LOS EDIF (Data Profile Report)CFP N = 534


A key characteristic of the CFP population is that the majority of youth have had at least one out of home placement. Eleven percent of youth have had four or more placements. The lack of placement stability should be a significant consideration when working with this population, although at the time of referral, the majority of youth are placed in the home. However, there are racial/ethnic discrepancies regarding youths’ placement at the time of referral. In comparison to white youth, more youth of color are placed in detention (11% versus 3%) and foster care (19% versus 14%). More white youth are placed in the home (75% versus 61%).

A central goal of CFP is to reduce the time youth spend in out of community placements. When examining time spent in an out of community placement (at least one day) in the 90 days before intake and exit, there was about a 50 percent decrease in youth who spent time out of the community (33% at intake and 17% at exit).

Overall, the large majority of youth (86 percent) enter and exit CFP with an in community setting as their current placement. These placements are mostly in the home and foster care.

PLACEMENT

Source: Referral Form N = 541

Fig. 15

62%Percent of youth with at least 1 placement that was not in the home prior to CFP enrollment

Number of Placements Prior to CFP Enrollment Fig. 16 Overall White Youth Youth of Color

19%13%

68%

0%

10%

20%

30%

40%

50%

38%41%

36%

26%

20%

30%

15%17%

12% 11% 11% 12% 12%11% 10%

Zero Placements

One Placement

Two Placements

Three Placements

Four or More Placements

Source: Referral FormN = 541; White N = 234 Youth of Color N = 297


Relationship Between Placement and OutcomesAnalysis shows that placement has an impact on certain outcomes. Youth who are placed in an in community setting at exit are about 5.7 times as likely to have a 20 percent reduction in CAFAS score from intake to exit. This demonstrates the value of community settings over institutionalized care in regard to a clinically and statistically significant improvement in functioning.

Additionally, youth who spent time out of the community in the 90 days before intake (at least one day) are half as likely to graduate compared to youth who did not spend time out of the community. This appears to show that there

is a risk associated with prior out of community placements in terms of a successful discharge from services.

One factor that appears to be connected to placement is criminal justice history. Youth who had been taken into custody in the six months prior to intake are 3.5 times more likely to exit with an out of community placement than youth who had not been taken into custody. Therefore, it may be beneficial for CFP service providers to place particular effort into keeping youth with prior criminal justice contact in the community.

PLACEMENT

Placement at Time of Referral Fig. 17 Overall White Youth Youth of Color

0%

10%

20%

30%

40%

50%

60%

70%

80%

7% 5% 5% 5%3%

11%

18%14%

19%

67%

75%

61%

2% 2% 3% 2%1% 0%

Home Foster Detention ResidentialOther

Source: Referral Form, Overall N = 537, White N = 233 ,Youth of Color N = 293

Psychiatric

Out of Community Placement Fig. 18

Source: FSR, N = 196

33%Intake

17%Exit

Percent of youth spending time out of community in the previous 90 days

In Community Placement at Intake and Exit Fig. 19

86%Source: FSRCurrent Placement N=175


SERVICE ARRAY UTILIZATIONOver time, youth in CFP are using fewer services. For about one-third of the services listed, the proportion of youth utilizing these services decreased or

remained the same at each assessment period (six and 12 months). Service array utilization decreased for 61 percent of the services from intake to 12 months.

Service Array Utilization Fig. 20

Service Intake 6 Month 12 MonthAssessment or Evaluation 71% 53% 44%

Crisis Stabilization 27% 17% 14%

Family Preservation 11% 3% 3%

Group Therapy 33% 30% 13%

Individual Therapy 84% 92% 83%

Family Therapy 40% 30% 29%

Residential Camp 5% 6% 2%

Inpatient Hospitalization 22% 14% 11%

Residential Treatment Center 16% 14% 19%

Therapeutic Group Home 2% 2% 5%

Therapeutic Foster Care 2% 3% 3%

Recreation Activities 17% 8% 16%

After School Programs 8% 14% 6%

Transportation 16% 25% 11%

Respite 25% 31% 28%

Flexible Funds 2% 17% 17%

Informal Support 36% 40% 50%

Vocational Training 3% 6% 6%

Source: MSSCN = 63-64


SERVICE EXPERIENCEOverall, caregivers report a highly positive service experience. Ratings for cultural competency, satisfaction, and family engagement remain about the same over time, with caregivers on average responding favorably at each assessment point. Additionally, the large majority of caregivers say that they would come back to the program and recommend the program to others. There is a discrepancy, however, in how caregivers and youth view certain aspects of their service experience. Caregivers in CFP are less likely than

youth to report positively on the youth’s progress in outcomes and functioning. Additionally, youth are less likely than caregivers to report positively on their participation in treatment.

Wraparound fidelity, or how closely practitioners follow evidence-based models of Wraparound, is another aspect of service experience. The data shows a fairly high level of fidelity, with the exception of the Natural and Community Supports principle.

Cultural Competence and Service Provision Fig. 21 6 Month Average 12 Month Average

1 2 3 4 5

4.34.4

4.84.8

4.04.3

3.73.6

1.61.6

4.44.4

4.34.3

4.64.6

Provider understood child/family beliefs about mental health (n=62)

Provider speaks same language as child or caregiver (n = 62)

I am comfortable discussing with provider on alternative therapies or other ways to work with child (n = 61)

Provider asks about my family traditions, beliefs, and values when planning or providing services (n = 59)

I feel like other children have access to better services than my child (n=56)

Materials given to me (brochures/newsletters) about the program or available services are easy to understand (n = 58)

Provider attends to my and child cultural needs (n=52)

Provider is comfortable interacting with me and child (n=62)

Source: LOS CCSP


SERVICE EXPERIENCESatisfaction with Services Fig. 22

Source: TRAC NOMSN = 129

11%

6%

83%

9%

2%

89%

Caregivers’ Recommendations for CFP at 12 months Fig. 24

Family Engagement Fig. 23

Source: TRAC NOMSN =128

Source: LOS MSSCN = 63-64

6 Month Average 12 Month Average

6 Month Average 12 Month Average

1

2

3

4

5

4.5 4.74.4 4.6

4.0 4.1 3.94.2 4.2 4.3

Treated with respect

People stuck with us

Got help needed

Got help wanted

Satisfied with services

1

2

3

4

5

4.4 4.4 4.5 4.4 4.6 4.5

I helped choose my child’s services

I helped to choose my child’s treatment goals

I participated in my child’s treatment

Absolutely/Probably Not Sure Absolutely Not/Probably Not

Would you come back to the program?

Would you recommend the

program to others?


SERVICE EXPERIENCE

Caregiver and Youth Perception of Services at 12 months Fig. 25

Perspectives on Services Caregiver (n=64) Youth (n=35)Access to Services 84% 86%

Participation in Treatment 81% 63%

Cultural Sensitivity 95% 94%

Satisfaction with Service 67% 86%

Outcome 36% 69%

Functioning 38% 74%

Social Connectedness 73% 77%

Source: LOS YSS (Data Profile Report)N indicated in table

Figure 25 shows the percentage of respondents reporting positively to the listed service principles. The difference between caregiver and youth’s perspectives on participation in treatment, outcomes, and functioning is notable. As one of CFP’s goals is to ensure youth voice in treatment planning, the 18 point difference between the participation in treatment principle is important. The large discrepancy between caregivers and youth on whether youth are improving should also be considered.

Fidelity to Wraparound Model Fig. 25.5

0 1 2 3 4

3.93.9

3.83.83.8

3.73.73.73.73.73.73.7

3.13.1

1.4

3.53.5

3.6

3.33.2

Source: TOMS N = 116

CFP Wraparound Coordinators are assessed on 20 principles of wraparound service fidelity. Observers rate their performance on a scale of zero to four, with higher ratings being more desirable. This chart shows the average ratings for the most recent Wraparound meeting for each youth. The vast majority of the principles, on average, have positive ratings. The one exception is Natural and Community Supports, with an average of 1.4. As past analyses have showed a positive relationship between natural supports and youth functioning, CFP may consider focusing their efforts on this specific aspect of wraparound fidelity.

Cultural and Linguistic CompetenceYouth and Family Voice

Focus on StrengthsYouth and Family ChoiceEffective Team Process

Positive Team CultureLeast Restrictive Environment

Facilitation SkillsCommunity Focus

Effective Decision MakingIndividualized processShared Responsibility

Team Mission and PlansTeam Membership & Attendance

Facilitator ParticipationOutcomes Based Process

Evaluating Progress and SuccessNatural Support Plans

Creative Brainstorming and OptionsNatural and Community Supports


SCHOOL ATTENDANCE AND PERFORMANCE

School Attendance and Performance at 12 Months Fig. 26 Neither Suspended Nor Expelled Fig. 27

64%48%46%48%

27%

25%

44%

32%

24%

Source: LOS EQ-R2 (Data Profile Report)

Source: EQ-R2 (Data Profile Report)N = 61

About three-quarters of youth in this sample remained stable or improved in their school performance and attendance. This is a positive finding, but it does leave about a quarter of youth who worsened in their school performance and attendance from baseline to the 12 month assessment

mark. The percent of those who did not experience any disciplinary actions (suspension or expulsion) remained about the same from baseline to the six month assessment, but increased by 16 percentage points from the six month assessment to the 12 month assessment.

Worsened Remained Stable Improved Baseline 6 Months 12 Months

Attendance(N=77)

Performance(N=41)


SCHOOL ATTENDANCE AND PERFORMANCE

School Disciplinary Actions (overall and by race) Fig. 28

Intake

Actions Overall WhiteYouth of

ColorSuspended 48% 54% 36%

Expelled 0% 0% 0%

Suspended and Expelled

7% 6% 8%

Neither Suspendednor Expelled

46% 40% 56%

Source: EQ-R2 (Data Profile Report)N = 61; White = 35; YOC = 25

When examining school disciplinary actions by race/ethnicity, it appears that white youth are getting suspended more than youth of color; youth of color, however, are getting suspended and expelled slightly more than white youth.

6 Months



Expelled 0% 0% 0%


3% 0% 8%


48% 51% 44%

12 Months



Expelled 2% 0% 4%


5% 3% 8%


64% 66% 64%


DELINQUENCYThe majority of CFP youth in this sample (62%) indicate some type of criminal justice contact prior to intake. However, there is a substantial discrepancy between white youth and youth of color in regard to their criminal justice history.

Youth of color are have been questioned by the police; adjudicated; told to appear in court; and taken into custody at double the rate (or more) of white youth.

Source: DS-R (Data Profile Report)N = 125

Fig. 29

62%of youth reported some type of criminal justice contact prior to intake

Youth Criminal Justice History Fig. 30 Overall White Youth Youth of Color

Questioned by the Police?

37%15%26%

Adjudicated?

45%19%33%

Told to Appear in Court?

45%19%33%

Taken Into Custody?

65%33%50%

Source: Intake DS-R White N = 62, Youth of Color N = 62, Overall = 124


DELINQUENCY

Youth Criminal Justice Contact Fig. 31

Intake


Color

On Probation 34% 40.0% 33%

Taken into Custody 29% 24.0% 33%

Told to Appear in Court 20% 12.0% 27%

Questioned by the Police 12% 12.0% 13%

Adjudicated 15% 16.0% 13%

Source: DS-RWhite N = 25, Youth of Color N = 15, Overall = 40

Overall, criminal justice contact decreases from the baseline assessment to the 12 month assessment for youth in this sample. When broken down by race/ethnicity though, there are some clear differences. The percentage of white youth on probation decreases by 16 percentage points from baseline to 12 months, but the proportion of youth of color remains the same at 33 percent. Similarly, the percentage of white youth who are adjudicated decreases by 16 points for the same time period, while the proportion of youth of color remains the same at 13 percent. However, the number of white youth who are taken into custody at the 12 month assessment is greater than the number of youth of color (16% versus 0%).

6 Months


Color

On Probation 42% 36% 47%

Taken into Custody 17% 8% 27%

Told to Appear in Court 12% 12% 7%

Questioned by the Police 5% 4% 7%

Adjudicated 17% 20% 7%

12 Months


Color

On Probation 24% 24% 33%

Taken into Custody 10% 16% 0%

Told to Appear in Court 2% 4% 0%

Questioned by the Police 2% 4% 0%

Adjudicated 5% 0% 13%

Youth Involvement with the Police Fig. 32 No times 1 Time 2-5 Times 6 or more times

Source: LOS DS-RN = 40

0%

20%

40%

60%

80%

100% 5%

20%

63%

13%

2%10%

75%

13%

0%10%

83%

8%

Intake 6 Months 12 Months


NATURAL SUPPORTSDeveloping natural supports is an important value in the CFP System of Care, and there is evidence to show that these natural supports increase over time in certain ways for both caregivers and youth. The data shows a couple of areas where youth natural supports may require some focus. Specifically, youth report decreases in having peers to rely on when they have problems.

Additionally, there are overall increases in youth resiliency factors, but there is still room for growth for specific factors that may help build natural supports.

As we have consistently seen in the past, caregiver ratings of natural supports increase over time. The greatest increase is seen with the item I have people with whom I can do enjoyable things.

Youth Perspective on Natural Supports Fig. 33 Intake 6 Months 12 Months

Source: LOS YIQN = 42-43

Youths’ perspectives on natural supports remained largely the same from the last biannual report, expect for a large increase in the number of youth who replied that they “usually or always” have an adult to have fun with or hang out with. At the 12 month assessment, the proportion of youth increased from 17 percent to 43 percent. However, this is still lower than the baseline assessment of 48 percent.

0% 10% 20% 30% 40% 50% 60% 70% 80%

33%

67%58%

26%26%

74%

52%40%

50%

48%40%

43%

If a problem or emergency rises, how often can you depend on having someone your own age to turn to for

help and support? If a problem or emergency arises, how

often can you depend on having an adult to turn to for help and support?

How often do you have someone our own age to have fun with or hang out

with when you want to?

How often do you have an adult to have fun with or hang out

with when you want to?


NATURAL SUPPORTS

Caregiver Perspective on Natural Supports Fig. 34

Source: TRAC NOMSN = 127

1

2

3

4

5

3.9

4.24.3 4.3 4.3

3.8 3.8

3.5

4.14.2

4.54.4

Youth Resiliency Factors Fig. 34.5

Source: FSRN = 164-189

All youth resiliency factors increased from intake to exit. Positive connections in the community and coping skills needed to manage stressful situations both increased by over 20 percentage points. Furthermore, involved in programs related to interests and hobbies increased by over 10 percent at the exit assessment compared to the last biannual report.

Intake ExitInvolved in programs related to interests and hobbies

44% 59%

Positive connections in the community

63% 86%

Positive connections at home 78% 87%

Coping skills needed to manage stressful situations

32% 58%


Listen and Understand

Comfortable Talking with

In crisis, support from

family or friends

People to do enjoyable

things with


FUNCTIONINGMany of the functioning indicators show positive findings for youth and caregivers, but there are mixed results. CAFAS scores show a desirable decrease over time, with a clinically significant decrease from intake to exit. Youth report decreases in anxiety and depression over time, but the overall proportion of youth with anxiety at intake almost tripled since the last biannual report. Similarly, youth suicidality decreases from intake to the 12 month assessment, but the percentage of those who are attempting and talking about suicide has increased overall. The same pattern is evident in youth substance

use, with decreased use over time, but increased proportions using at each assessment point. The improvements from intake to the 12 month point show progress in youth functioning; however, the increased proportions suggest that CFP should consider concentrating their efforts on some of these key issues as they have become problems for a larger number of youth.

Caregiver strain improves over the 12 month period. As we have seen the past, the greatest improvement is seen in objective strain, i.e. observable disruptions in family and community life.

CAFAS Total Score Average Fig. 35

Source: FSRN = 72-358

CAFAS scores have showed a consistent pattern in past analyses and continue to do so. Improvement is seen at the three and six month assessment, scores stay about the same from six to nine months, and there is a decrease in functioning at the 12 month assessment. However, there is an average 25 point decrease from intake to exit, indicating a clinically significant improvement in overall functioning at the time of discharge.

60

80

100

120 111N = 358

101N = 295

93N = 220

93N = 145

99N = 72

86N = 185

Intake 3 Month 6 Month 9 Month 12 Month Exit


FUNCTIONING

Moderate/Severe Functioning Problems by CAFAS Subscale Fig. 36

Intake Exit

0%

20%

40%

60%

80%

100%

76%

57%

89%

63%

50%

38%

84%

56%

77%

54%

20%

8% 8%12%

8%6%

Source: FSR, N = 162-165

Decreases in youth with moderate/severe problems is seen in each CAFAS subscale except for Thinking. While there is a decrease in substance abuse, the proportion of youth with moderate to severe problems in this area increased from the last report (from six to 12 percent at intake and one to eight percent at exit).

Youth Behavioral and Emotional Problems (Percent in Clinical Range for Internalizing and Externalizing Symptoms) Fig. 37

Source: LOS CBCL (Data Profile Report)CFP N =70, White = 39, YOC =30

There are high percentages of youth in the clinical range for both internalizing and externalizing symptoms. Interestingly, there are increases over time for those with internalizing symptoms, especially for white youth. The numbers for externalizing decrease by about 10 percent overall at the 12 month assessment.

School role problems

Home role problems

Community role

problems

Behavior to others problems

Mood/Emotional problems

Moods/Self Harm problems

Substance Abuse

problems

Thinking problems

Internalizing Externalizing

Intake

Overall 70% 93%

White 69% 95%

Youth of Color 70% 90%

6 Month

Overall 76% 84%

White 78% 85%


12 Month Overall 77% 83%

White 85% 82%



FUNCTIONINGFactors Associated with FunctioningAnalysis shows that certain indicators of functioning are related to other CFP outcomes. Youth who reduce their CAFAS score by 20 percent or more between intake and exit are about 3.8 times as likely to graduate from CFP compared to youth who do not. While this is a fairly straightforward finding, it does show that youth who successfully complete the CFP program (indicated by the discharge status of graduation) are showing improved functioning.

There is a moderate relationship between CAFAS scores at intake and percent improvement in caregiver strain score. The higher the CAFAS score is at intake (indicating lower functioning), the less the caregiver will improve his/her strain

score. This finding warrants future analysis but lends evidence to the need to support the entire family in order to improve overall functioning and wellbeing.

Additionally, there are apparent racial/ethnic disparities related to outcomes. There is a statistically significant difference in the percent reduction of CAFAS scores from intake to exit between white youth and youth of color. White youth reduce their CAFAS scores by about 27 percent on average, while youth of color reduce their scores by about 16 percent. Furthermore, white youth are about 2.1 times as likely to graduate from CFP compared to youth of color.

Youth Impairment, Anxiety, and Depression Fig. 38

Intake 6 Months 12 MonthsTotal Impairment (CFP N=70) 93% 94% 89%

Total Anxiety (CFP N=31) 39% 39% 26%

Total Depression (CFP N=42) 26% 19% 7%

Source: LOS CBCL (Data Profile Report)

The large majority of caregivers report that their youth are in the clinical range for impairment (defined as problems experienced in different domains of life, such as interpersonal relations, school/work, and leisure time). There are smaller percentages of youth reporting clinical symptoms of anxiety and depression, but the number of youth with anxiety at intake almost tripled since the last report. Overall, there are improvements over time in all of these areas.

Youth Harm to Self Fig. 39 Intake 6 Months 12 Months

Attempt Suicide

7%2%22%

Talk About Suicide

21%29%62%

Source: LOS CIQ, N = 72-73

Youth suicidality decreases from intake to the 12 month assessment, but the percentage of those who are attempting and talking about suicide has increased overall since the last biannual report.


FUNCTIONING

Youth Substance Use Fig. 40


Cigarettes

24%29%31%

Alcohol

12%20%20%

Marijuana

14%17%17%

Caregiver Strain Fig. 41


Source: LOS CGSQ (Data Profile Report)CFP N = 72-73

Caregiver strain improves over time with the greatest improvement seen in objective strain.

1

3

5

7

9

11

13

15

3.53.2

2.8

3.83.5

2.8 2.7

4

10.39.7

8.8

2.4

Source: LOS SUS-R (Data Profile Report)N = 41-42

Substance use decreases from intake to the 12 month assessment, but the proportion of youth using substances has increased at all assessment points since the last report. This data appears to validate the increased proportion of youth indicating moderate/severe problems in the CAFAS Substance Abuse subscale.

Objective Strain

Subjective Externalized

Strain

Subjective Internalized

Strain

Global Strain(sum of all subscales)

Objective Strain: Observable disruptions in family and community life.Externalized Strain: Negative feelings about the child (anger, embarrassment, etc.)Internalized Strain: Negative feelings the caregiver experiences (worry, guilt, etc.)


FUNCTIONING

Caregiver Perspective on Services and Employment Fig. 42

Helped increase your ability to do your job?

Helped increase the hours you are able to work?Helped increase the money you have

earned or increase your income?Given you the opportunity to develop more job-related skills?

Allowed you to gain additional education or vocational skills?

Have services....

Source: LOS MSSCN = 132-136

At the 12 month assessment, most caregivers do not indicate that services have helped “quite a bit or a great deal” in regards to employment issues.

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

35%

24%

18%

24%

18%

Caregiver Perspective on General Functioning Fig. 43

My child is handling daily life

My child is doing well in school

My child gets along with friends and other people

My child is able to cope when things go wrong

I am satisfied with our family life right now

Source: TRAC NOMSN = 83-128

There are increases for each item from intake to the 12 month assessment, indicating that caregivers see an improvement in their child’s general functioning. There is still room for growth, however, as the highest rating remain between 3.0 and 4.0 on a five point scale.

1 2 3 4 5

2.2

3.0

3.03.3

3.33.4

3.63.6

1.82.6

2.9

2.4

2.53.43.4



OUTCOMES AT 18 MONTHSThe sample size for those who have reached the 18 month assessment period is small, but there are enough participants to examine a few key outcomes. Most of the participants in this sample have been discharged from CFP for six or more months; therefore, this data will help to assess if the changes seen during services last beyond the duration of enrollment.

• School attendance stays about the same from 12 months to 18 months, but those who remained stable or improved their school performance increased from 76 percent at the 12 month assessment to 87 percent at the 18 month assessment.

• Sixty-nine percent of youth were neither suspended nor expelled at the 18 month assessment (same as the 12 month assessment).

• At the 18 month assessment, most delinquency indicators show an improvement from intake, but a slight increase from the 12 month

assessment. Six percent of youth were questioned by the police (0% at 12 months); six percent were taken into custody (6% at 12 months); six percent were told to appear in court (0% at 12 months); six percent were adjudicated (0% at 12 months); and six percent were on probation (17% at 12 months).

• Youth impairment decreases from 12 months to 18 months (83% in clinical range to 72%). Depression remained steady with no youth reporting symptoms in the clinical range (a decrease from 21% at intake). However, more youth reported anxiety symptoms at the 18 month assessment than the 12 month assessment (33% versus 20%).

• Caregiver strain decreased overall and for each subscale at the 18 month assessment.


METHODOLOGY AND DATA LIMITATIONSMethodology

This report utilizes several sources of data. A list and description of the data collection instruments used can be found in Appendix A. Much of the data analysis employs a paired sample analysis whereas only cases that have both a baseline and follow-up assessment(s) are used to examine the change over time for a particular outcome. This allows for the most accurate examination of change.

For analysis that shows whether or not a finding is statistically significant over time, evaluators used a paired sample t-test. This analysis utilizes cases that have both a baseline and follow-up assessment(s) to compare the difference between two means and determines whether that difference is statistically significant. Statistical significance refers to a result that is not likely to occur randomly, but rather is more likely to be attributed to a specific cause(s). The Reliable Change Index (RCI) is also used to analyze change for particular outcomes. The RCI is a measure that compares a child’s or caregiver’s scores at two different points in time and indicates whether a meaningful change in score has occurred. “Improvement” and “worsened” indicate significance at the 95% level. “Remained stable” indicates no significant change. RCI corrects for measurement error and is a more conservative way to interpret outcome trends.

In order to calculate odds rations for two categorical variables and test for significance, the Cochran Mantal-Haenzsel method was used. Some variables were compressed into binary categories for the purpose of running this test. When testing the difference in means between groups, two-sample t-tests were used. Change in quantitative variables between assessment periods were tested as percent change with respect to the measure at intake.

Data Limitations

The data used in this report is derived from subsamples of CFP youth and caregivers who are enrolled in CFP evaluation studies. The analysis can only be representative of those enrolled in the evaluation and not necessarily of the entire CFP population. For many instances, the number of valid responses in each respective response options limits the confidence when interpreting trends due to a large margin of error.


APPENDIX A: DESCRIPTION OF DATA COLLECTION INSTRUMENTSEnrollment and Demographic Information Form (EDIF): collects information on agency involvement, demographics, presenting problems, diagnostic, and enrollment for each youth enrolled into CFP, as required by SAMHSA. The EDIF is incorporated into CFP’s Referral Form.

Referral Form: contains the EDIF, as well as additional information for local need: referral sources, out of home placement information, and presenting crisis/safety issues. The referral form is collected for each youth enrolled into CFP.

TRAC NOMs (baseline and follow-up): the Transformation Accountability instrument is completed for every family who is enrolled in CFP services, as is required by the Center for Mental Health Services. TRAC NOMs is administered at baseline (it is incorporated into the Referral Form) and is administered to families every six months for as long as a family is in services. It collects information on functioning, housing, education, crime, perception of care, social connectedness, and services received. The questions refer to the 30 day time period before the assessment.

Child and Adolescent Functional Assessment Scale (CAFAS): a widely used tool for assessing youth’s functioning across several life domains. CAFAS is administered at baseline for each youth and every three months, as is required by Kent County’s mental health providers. CAFAS measures functioning in school, behavior, moods/emotions, home, thinking, self-harm, substance use, and community.

Longitudinal Outcome Study (LOS): a voluntary study for enrolled families that is conducted by CRI and required by SAMHSA. The study examines several areas, including service involvement, living situation, education, behavioral and emotional issues, substance use, crime, and perception of care. Caregivers and youth are interviewed at baseline (enrollment into CFP services) and every six months for two years. The questions refer to the six month time period before the assessment.

Family Status Report (FSR): questionnaire completed for families in Wraparound services that addresses general topics of functioning, education, placement, and social connectedness. The tool is administered at baseline, quarterly, and exit.

TOM (Team Observational Measure): observers rate Wraparound meetings to assess adherence to wraparound principles and key elements.

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