Division of Behavioral Health

Department of Health & Social Services

Clinical Application of the Alaska Screening Tool &

Client Status Review of Life Domains (CSR)

March , 2014

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Objectives:» Overview of the Alaska Screening Tool» Overview of the Client Status Review» Clinical Applications» CSR-2014

Division of Behavioral Health Mission

To manage a comprehensive behavioral health system that promotes quality services and improves outcomes for individuals, families, and communities.

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What is the AST?What is the CSR?

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Alaska Screening Tool (AST)

Mental Health

Depression

Anxiety

Risk: self/others

Trauma Symptoms

Substance Abuse

Co-occurring Disorders

Adverse Experiences

FASD

Traumatic Brain Injury

Major Life Change

Intimate Partner Violence

Client Status Review (CSR – 2014)

HealthPhysical HealthMental HealthSubstance UseHarm to SelfEmergency ServicesTobacco*Physical Activity*Nutrition*

SafetyLegal InvolvementDomestic ViolenceGeneral Safety

Productive ActivityEmployment/SchoolOther Productive Activities

Living with DignityHousingSupports for RecoveryMeaning in LifeLife in GeneralService Quality*Service Outcomes*

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What does the AST tell us?

Alaska Screening Tool (7/1/2013 to 3/4/2014)Agency ASTs Screening Outcomes

    SubstanceAbuse

Mental Health DualDiagnosis

TBI FASD AdverseExperience

Major Life

Change

IntimatePartner Violence

    Depression Anxiety Risk Self/Others

Trauma    

                         

Total Percentages

9,052 64% 56% 65% 33% 69% 58% 40% 8% 78% 65% 21%

   

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What does the AST tell us?

AST Adverse Experience by Population Types7/1/2013 and 3/4/2014

# Adverse Experiences

SUD % GMH % SMI % SED % COD % OTHER % Total # clients

% of Total

0 821 23.32% 464 27.37% 298 17.76% 179 21.16% 49 18.01% 234 22.50% 2,045 22.59%

1 to 2 990 28.12% 463 27.32% 426 25.39% 206 24.35% 71 26.10% 292 28.08% 2,448 27.04%

3 to 4 790 22.44% 366 21.59% 387 23.06% 226 26.71% 71 26.10% 253 24.33% 2,093 23.12%

5 to 6 531 15.08% 278 16.40% 359 21.39% 165 19.50% 53 19.49% 165 15.87% 1,551 17.13%

7 to 8 389 11.05% 124 7.32% 208 12.40% 70 8.27% 28 10.29% 96 9.23% 915 10.11%

  3,521   1,695   1,678   846   272   1,040   9,052  

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What does the CSR tell us?Individual Client Level

    

For Client: M119854AG218100 - Chart depicting CSR questions: Mental Bad Days, Suicidal Days, Alcohol/Drunk Days, Housing Situation, Legal Involvement 30 Days, Intimate Partner Abuse, Feelings about Life, Feelings about Service

   

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What does the CSR tell us?Statewide Level

RBA Scorecard: Treatment OutcomesAdult MeasuresClient Improvement in Quality of Life Domains between first and second CSR (percent of clients showing improvement)  FY2011 FY2012 FY2013 FY2014

Q1FY2014Q2

FY2014Q3

FY2014Q4

FY2014FYTD

SMI (CSR #2) 73.1% 71.9% 75.9% 77.2% 74.8% 70.5% 0.0% 74.8%SED (CSR #2) 69.9% 71.3% 73.5% 74.4% 64.3% 72.7% 0.0% 71.9% COD CSR #2,5,6)

75.0% 71.4% 79.0% 83.9% 75.6% 77.8% 0.0% 79.9%

MH (CSR #2) 84.7% 76.4% 74.0% 83.5% 77.7% 65.0% 0.0% 76.3%

SUD (CSR #5,6)

93.9% 93.3% 91.6% 90.8% 90.2% 91.6% 0.0% 90.8%

CSR #2: # of mentally unhealthy daysCSR #5: # of days used alcoholCSR #6: # of days used illegal drugs

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What does the CSR tell us?Statewide Level

RBA Scorecard: Treatment OutcomesAdult MeasuresClient Improvement in Quality of Life between first and second CSR (percent of clients showing improvement)

CSR #16 FY2011 FY2012 FY2013 FY2014Q1

FY2014Q2

FY2014Q3

FY2014Q4

FY2014FYTD

SMI 57.2% 55.9% 59.2% 60.7% 61.1% 54.4% 0.0% 59.4%SED 53.0% 58.4% 57.4% 56.4% 57.1% 54.5% 0.0% 56.3%COD 64.1% 65.7% 58.4% 59.7% 68.9% 59.3% 0.0% 62.7%MH 62.4% 57.0% 56.8% 62.4% 68.1% 50.0% 0.0% 60.8%SUD 61.6% 62.8% 62.9% 64.3% 66.1% 64.3% 0.0% 65.0%

CSR #16: How do you feel about housing/basic needs met, safety, supports, friendships, family, life etc.

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What does the CSR tell us?Statewide Level

RBA Scorecard: Treatment OutcomesAdult MeasuresClient Perception of Treatment Services on their second CSR (Percent of clients indicating satisfaction of services).

 (CSR #18a & 18b)

FY201

1

FY2012 FY2013 FY2014Q1

FY2014Q2

FY2014Q3

FY2014Q4

FY2014FYTD

SMI 77.0% 78.0% 77.0% 79.0% 80.0% 84.0% 0.0% 80.0%SED 79.0% 65.0% 66.0% 80.0% 43.0% 88.0% 0.0% 79.0%COD 82.0% 86.0% 85.0% 87.0% 85.0% 89.0% 0.0% 87.0%MH 82.0% 74.0% 81.0% 90.0% 87.0% 89.0% 0.0% 89.0%

SUD 79.0% 77.0% 83.0% 85.0% 87.0% 85.0% 0.0% 86.0%

CSR #18a: I was treated with respect.CSR # 18b: I was able to get all the services I needed.

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What does the CSR tell us?Statewide Level

RBA Scorecard: Treatment OutcomesAdult MeasuresClient Perceptions of Treatment on their second CSR (percent of clients satisfied that services have improved the quality of their life)

 (CSR #18c)

FY2011 FY2012 FY2013 FY2014Q1

FY2014Q2

FY2014Q3

FY2014Q4

FY2014FYTD

SMI 77.0% 76.0% 73.0% 76.0% 79.0% 79.0% 0.0% 78.0%SED 74.0% 63.0% 60.0% 75.0% 43.0% 76.0% 0.0% 71.0%COD 81.0% 83.0% 79.0% 79.0% 78.0% 85.0% 0.0% 80.0%MH 79.0% 73.0% 80.0% 86.0% 84.0% 83.0% 0.0% 85.0%

SUD 77.0% 80.0% 82.0% 85.0% 86.0% 84.0% 0.0% 85.0%

CSR #18c: The services improved the quality of my life.

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Alaska Screening Tool (AST)

Mental Health

Depression

Anxiety

Risk: self/others

Trauma Symptoms

Substance Abuse

Co-occurring Disorders

Adverse Experiences

FASD

Traumatic Brain Injury

Major Life Change

Intimate Partner Violence

Depression Scale (5 Levels): 56% of all clients

The level of accumulated Adverse Experiences:While the most reported adverse experience for any age group is “having lived with an addicted person” (44% children – 57% adults), a significant proportion have lived with someone who is physically abused, or been physically abused themselves.

Rates are highest for clients in treatment for Mental Health or Co-occurring Disorders.

38% of children have lived with an abused person, and 25% have been abused31% of youth have lived with an abused person, and 27% have been abused.35% of adults have lived with an abused person, and 46% have been abused

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Alaska Screening Tool

Levels of Depression

Volume/Type of Adverse Experiences-- necessitate active inclusion of other household members.--potential impact for all life domains

------------------------------------------------------Tobacco abstinence at the end of the 1st yr. of treatment may be the most robust predictor of abstinence from illicit drug use at a 9 year follow up Comorbid Medical Conditions and the related “Modifiable Risk Behaviors”

Client Status Review (CSR – 2014)

HealthPhysical HealthMental HealthSubstance UseHarm to SelfEmergency ServicesTobacco*Physical Activity*Nutrition*

SafetyLegal InvolvementDomestic ViolenceGeneral Safety

Productive ActivityEmployment/SchoolOther Productive Activities

Living with DignityHousingSupports for RecoveryMeaning in LifeLife in GeneralService Quality*Service Outcomes*

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Moving Forward

CSR – 2014» Coercion and motivation to seek services » Changes in Federal reporting requirements

◆ Modifications to “Legal Involvement” questions ◆ Modifications to “Housing” questions ◆ Modifications to “School” related questions ◆ Modifications to “Employment” questions

» Substance Use Disorder◆ Addition of “binge” drinking

» Co-Morbid Medical Conditions◆ Addition of “Health Risk Behavior” questions

» Client Feedback: Expansion of “Quality of Services” questions

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Moving Forward

CSR – 2014» Target Date for Full Implementation: April 1, 2014» AKAIMS has been programmed to allow CSR-2011

and CSR-2014 to be entered, until April 15. » The CSR -2014 will be sent to providers March 13,

2014» EDI Agencies:

◆ Coordinate programming with your EHR vendor to accommodate the new CSR-2014.

◆ Change data submission transactions to accommodate the new CSR-2014.

Thank you.

Questions?

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