Maryland Evaluation & Treatment Services System (METS): Leading Change in Juvenile Justice Through Innovative Design,

Evidenced-Based Practices & Continuum of Care

In one word, what element comprises a quality case management information system?

Maryland Department of Juvenile Services Improving the lives of our Youth!

• Strategic Partnerships• Ongoing Research/Business Process Analysis• Evidenced-based Practices

o Risk-Needs-Responsivity Model• State of the Art Information System – METS

o Risk & Needs Assessment/Reassessment built into Treatment Service Planning

o One Treatment Service Plan Follows a Youth

Presenters

• John Irvine - Director, Office of Research and Evaluation, Maryland Department of Juvenile Services

• Jill Farrell, Ph. D. - Director of Research and Evaluation, The Institute for Innovation & Implementation, School of Social Work, University of Maryland, Baltimore

• Jennifer Conrad – Director, State Business Development, FEI Systems• Kathleen Lester, M.S. – Project Manager, Programming Applications, The

Institute for Innovation & Implementation, School of Social Work, University of Maryland, Baltimore

Maryland Comprehensive Assessment & Treatment Planning (MCASP)Reforming Juvenile Justice in Maryland

DJS Reform Focus

• DJS: Statewide Agency: Consistent policy, not justice by geography

Intake -> Detention ->

(Court) -> Probation ->

Commitment -> Re-Entry/Aftercare

DJS Reform Focus

• Make sure the right youth get the right level and type of services/security• Increase public safety: reduce recidivism• Improve the lives of our youth!

• Structured decision-making at each step• Information informs decisions and treatment plans• Real-time management reporting for key policy events and timelines• Diversion, Equity, Family Engagement• Strategic Partnerships – DJS, UMB, FEI, Casey

Maryland Comprehensive Assessment & Treatment Planning - Reform

Intake: MCASP Risk AssessmentDetention: Detention Risk Assessment Instrument (DRAI), AIM

(Court) Adjudicated Youth: MCASP Risk & Needs AssessmentProbation: Treatment Service Planning (TSP), AIM

Commitment: Facility TSPRe-Entry/Aftercare: Re-Entry Plan Checklists, TSP, AIM

SafeMeasures Management Reports

Evidenced-based PracticesOngoing Evaluation to Better Meet the Needs of Youth

What Works to Reduce Recidivism• Therapeutic approaches (counseling, skills training) are more effective than

control/coercion-based approaches (surveillance, discipline; Lipsey 2009).

• Interventions used with higher risk youth are more effective (Lipsey, 2009).

• Mixing low-risk youth with high-risk youth can increase their risk for recidivism (Lowenkamp & Latessa, 2004).

• When services are matched to youth’s criminogenic needs, the lower the chance of recidivism (Vieira et al., 2009).

• Interventions implemented with high quality are more effective (Lipsey, 2009).

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Risk-Needs-Responsivity (RNR) Approach

1) High-risk offenders should receive the most intensive monitoring and services to reduce their risk of reoffending, whereas low-risk youth should receive minimal attention (risk principle).

2) Only those factors associated with reductions in reoffending (i.e., criminogenic needs) should be targeted for services (need principle).

3) Services should be selected after considering the youths’ specific characteristics that may affect their response to treatment (responsivity principle).• E.g., learning style, motivation, abilities and strengths

• There should be room for professional discretion that can deviate from recommendations in certain circumstances.

11(Andrews & Bonta, 2010; Hoge & Andrews, 2010)

Effective Practices for Juvenile Case Management

• Screening and assessment with validated instruments*

• Individualized treatment/service planning (match to needs, use of EBPs when possible)*

• Use of community-based services

• Collaboration and coordination with service providers and other agencies

• Family involvement/engagement

• Use of graduated responses (sanctions and incentives)*

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Risk Assessment in Juvenile Justice• Risk assessments gauge the likelihood that an individual will reoffend.

• “Is this youth at relatively low or relatively high risk for reoffending?”

• Inform decision-making at several points in the process; reduce subjectivity, bias.

• Risk/needs assessment instruments assess what characteristics might be most relevant or responsible for a youth’s continued offending.

• Guide intervention planning by identifying and prioritizing criminogenic needs

• Instruments are typically comprised of factors related to delinquent behavior/offending.

• Risk Factors

• Protective Factors

• Static vs. Dynamic Factors

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Dynamic Risk FactorsCriminogenic

Needs=

Risk Assessment in Juvenile Justice• A “one size fits all” tool does not exist.

• The appropriate tool depends on the decision point.

• Risk assessment ≠ mental health assessment• May also use a screen mental health, trauma, substance abuse, etc.

• Instruments must be validated for the population, have good inter-rater reliability.

• Use of risk/needs assessment in juvenile probation lead to better intervention practices and conserve resources if a valid risk assessment instrument is used and sound implementation practices are followed (Vincent et al., 2011).

• Training, policies, protocols for use/case plans, data monitoring

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Maryland Comprehensive Assessment & Service Planning (MCASP) Initiative

• Martinez-Tjaden’s Integrated Comprehensive Client Assessment and Planning (I-CCAP) model www.i-ccap.com

• Derived from two bodies of research:

1. Risk and protective factors related to delinquency

2. What works to reduce recidivism

• Assessment instruments based on the Washington State Juvenile Court Assessment

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MCASPConduct

Assessment

DetermineRisk Level

Develop Supervision

Plan

DetermineNeeds

DevelopTreatment

Plan / Monitor

Reassess / MeasureProgressAn Integrated Assessment &

Planning Process

Martinez-Tjaden 16

MCASP Risk & Needs AssessmentDomains:

- Delinquency History- School- Use of free time- Peers - Employment- Family- Mental Health- Alcohol and Drug Use- Anti-Social Attitudes- Aggression- Neighborhood Safety

Results:

- Risk Level

- Need Levels

- Protective Factors

Uses:

- Recommendations at Disposition

- Developing the Supervision & Service Plans

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Risk & Needs Assessment Output

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Risk Assessment Validation• Predictive validity – how well a measure can predict future behavior

(e.g., recidivism)

• Validation analyses:• Correlations between the risk level and recidivism

• Area Under the Curve (AUC) indicates the % of correct classifications the instrument will yield overall.

• The degree of discrimination attained in outcomes for cases at different risk levels

• The distribution of cases throughout the risk levels

19(NCCD, 2013; Gottfredson & Snyder, 2005)

Recidivism by MCASP Risk Level

Probation Committed

Correlation .138*** .128***

AUC .593*** .588**

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10% 8%

17%12%

28%

18%

43%

25%

0%

10%

20%

30%

40%

50%

Probation Committed

Revised Assessment

Low Moderate High Very High

Probation Committed

Correlation .247*** .159***

AUC .664*** .614***

15%9%

30%

20%26%

23%

0%

10%

20%

30%

40%

50%

Probation Committed

Original Assessment

Low Moderate High

Probation: 19.3%Committed: 18.2%

WITS (Web Infrastructure for Treatment Services) The Information System Platform

FEI Systems

WITS Platform built by FEI Systems

• Founded in 1999

• 400+ Employees

• 20% annual growth rate

• Social Services Health IT

• Behavioral Health and Justice Services

• State enterprise solutions

• Integrated Reporting Platform

Ad-Hoc Reporting in Real Time

Integration with Industry Standard Reporting Tools

• Partnership Approach

WITS Collaborative

• User Group and Cost Sharing

– Agile Development

• Modular and Configurable

– CANS and other Risk/Needs Assessments

– Wrap Services

– Residential Health Record

– Monthly Updates

• Secure

– HIPAA and 42 CFR Part 2 compliant

– Role-based security access

• Integrated

Integrated Information SystemMaryland Evaluation & Treatment Services (METS)

Integrating METS in Maryland

• Moving from paper to electronic

• Integrates information to/from existing systems

• Reduces redundant data entry

• Streamlines business processes

• One Treatment Plan follows each youth• High domains of need forward to Treatment Plan

• Business flow validations built in

• One youth, one treatment plan

• Separate reports to meet respective needs

• Usability • User friendly/UX design

• Dashboards

• Staff Buy-in• Committees provide feedback throughout design

Caseload Summary Screen/Dashboard

Client Dashboard

Client Dashboard Context

Flexible Views on DashboardCan work on two modules at the same time

MCASP Risk & Needs Assessment

MCASP Risk & Needs Assessment Summary/Scores

Assessment Summaries, Somatic Health, Education

Treatment Service Plan

TSP – MCASP Risk & Needs Reassessments

TSP Court Ordered Conditions

TSP Outline – Goals, Objectives, Action Steps

TSP - Placement

TSP Summary

TSP Community Sign Off

Community TSP Report

TSP - Residential

Residential TSP Report

Sanctions/Incentives (AIM)

SafeMeasures - Case Manager TSP Status

SafeMeasures – Supervisor TSP Report

SafeMeasures – Executive Scorecard Overview Report

METS FutureOngoing Responsive System Design

• Aftercare/Re-Entry Planning

• Detention • Centralized Assessments (MAST)

• Detention Modified Treatment Service Plan

• Behavioral/Somatic Health • Customized BH Progress Notes

• Electronic Health Record

• Vendor Case Management• Portal to enter into TSP

• Consent/Referral Modification

• User Level – supports youth centered integrated case management

• Management Level – supports performance management, easy access to data

• System Level – supports quality assurance, evaluation, assess goals of agency

Question & Answer