November 30, 2010

Revised 11-30-09 Noteworthy findings are shown in boldface type.

IMPACT SYSTEM OF CARE INITIATIVE KEY OUTCOME INDICATORS AND MEASURES Findings are based on local data and data collected through the Longitudinal Outcomes Study (LOS) from February 2007 through August, 2009. The LOS data are based on responses from caregivers and youth at six months after intake, twelve months after intake, 18 months after intake, and 24 months after intake. While the sample size is increasing, the response sample is still small for some interview questions in this report, with the number of responses to specific survey questions ranging from 10 (at 24 months) to 155 (at intake).

Outcome 1: Maximized functioning of children with SED and their families

Indicator 1: Level of overall functioning; behavioral and emotional problems reduced/strengths improved

Measures:

Youth Services Survey for Families (YSS-F), national evaluation instrument administered to caregivers, question #16, measured on a 5-point Likert scale [As a result of the services my child and/or family received, my child is better at handling daily life.]

Youth Services Survey (YSS), national evaluation instrument administered to youth, question #16, measured on a 5-point Likert scale [As a result of the services I received, I am better at handling daily life.]

Child and Adolescent Functional Assessment Scale (CAFAS) scores recorded by CMH at intake and at intervals after receiving Impact system of Care services.

Columbia Impairment Scale (CIS), national evaluation instrument administered to caregivers to determine child and adolescent difficulty with particular behaviors, relationships, emotions, or activities. [New measure; approved 6-10-09]

Analysis of LOS Data:

Interviews were conducted at six months, 12 months, 18 months, and 24 months. At six months, about half of caregivers (47 percent) agreed or strongly agreed that

their child was better at handling daily life as a result of services they received, increasing to 61 percent at 12 months. This data is relatively unchanged from the last data reported (through January 2009).

At 18 months, 52 percent of caregivers agreed or strongly agreed that their child was better at handling daily life, decreasing to 46 percent at 24 months. The percent of caregivers who agree or strongly agree is more than 5 percentage points lower at the 18-month interview than the last data reported. This is the first time data from 24-month interviews has been available.

At six months, the majority of youth (65 percent) agreed or strongly agreed that they were better at handling daily life, increasing to 74 percent at 12 months. At 18 months and 24 months, that majority increased to 80 percent. Data from 6-, 12-, and 18- month interviews is relatively unchanged from the last data reported.

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EXHIBIT 1

Level of overall functioning at 6 month interview

{N}

Strongly Agree Agree Undecided Disagree

Strongly Disagree

My child is better at handling daily life (YSS-F #16)

89 15% 32% 26% 19% 9%

I am better at handling daily life (YSS #16)

71 23% 42% 23% 10% 3%

EXHIBIT 2 Level of overall functioning at 12 month interview

{N}


Strongly Disagree


46 22% 39% 20% 13% 7%


35 20% 54% 14% 3% 9%


{N}


Strongly Disagree


23 22% 30% 30% 17% 0%


20 40% 40% 15% 5% 0%


{N}


Strongly Disagree


13 15% 31% 39% 8% 8%


10 40% 40% 10% 10% 0%

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Analysis of CAFAS Data for October 2008 through September 2009:

83 percent of youth served by Impact have a clinically meaningful reduction in their CAFAS total score at the time their case was closed. (CAFAS data presented in December 2008 for the period October 2007 through September 2008, showed 75 percent of youth served by Impact had a clinically meaningful reduction in their CAFAS total score at the time their case was closed.)

32 percent of youth served by Impact are not SED at time of exit, i.e., they have a CAFAS score of 40 or less. (CAFAS data presented in December 2008 for the period October 2007 through September 2008, showed 31 percent of youth were not SED at time of exit, i.e., they had a CAFAS score of 40 or less.)

EXHIBIT 4 Child and Adolescent Functional Assessment Scale (CAFAS) Scores

IMPACT CAFAS DATA ON CLOSED CASES, October1, 2007 – September 30, 2009

Impact : October 2007 – Sept. 2008

Impact :

October 2008 – Sept. 2009

Court DHS Combined Court DHS Combined Number of Youth

83

23

106

81

23

104

Average length of stay in days

310

360

321

389

421

396

Average beginning CAFAS score

117

104

114

128

114

125

Average exit CAFAS score

67

79

70

73

68

72

Average improvement

50 pts

25 pts

44 pts

55 pts

46 pts

53 pts

Proportion of youth improved*

82%

48%

75%

85%

74%

83%

Proportion not SED at exit**

35%

17%

31%

30%

39%

32%

* Proportion of youth with clinically meaningful reduction in total score ** CAFAS score of 40 or less *** Level of Functioning (LOF) data

Background on the CAFAS: The Child and Adolescent Functional Assessment Scale measures how well a child functions in 8 domains: school, home, community, behavior toward others, moods/emotions, self-harmful behavior, substance use, and thinking. Possible total scores: 0 – 240

0 = No impairment in a domain 30 = Severe impairment, affecting ability to function in that domain 50 = Serious emotional disturbance (SED) 80 and above = Criteria for Impact (SED with risk of out-of-home placement)

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Analysis of LOS Data for the Columbia Impairment Scale (CIS):

At six months, 12 months, 18 months, and 24 months, the CIS score for the majority of youth was unchanged (remained stable).

Between the six-month interview and the 12-month interview, there is an increase in the number of youth who have an improvement in their CIS score, from 13 percent at six months to 23 percent at 12 months. The number of youth with an improved score remains steady at 23 percent at 18 months and increases to 28 percent at 24 months.

EXHIBIT 5 Columbia Impairment Scale (CIS) Change Index

6 Month Interview Number of Responses Percent Score Improved 13 13% Score Remained Stable 75 77 Score Deteriorated 9 9 Total 97 100




Background on the Columbia Impairment Scale: For the Columbia Impairment Scale (CIS), caregivers are asked to rate how much of a problem particular behaviors, relationships, emotions, or activities are for their child, ranging from “no problem” (0) to a “very big problem” (4). The scores for each of the four domains are aggregated to generate a global measure of impairment. The CIS is administered at intake and at all follow-up interviews as part of the Longitudinal Outcomes Study. The Reliable Change Index is a relative measure that compares scores at two different points in time (i.e., intake and follow-up interview) and indicates whether a change in score shows significant improvement, worsening, or stability (i.e., no significant change in the score).

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Indicator 2: School attendance

Measure:

Education Questionnaire (EQ-R), national evaluation instrument administered to caregivers, question #3, [When school was in session, did (child’s name) miss school for any reason in the past 6 months? This includes excused as well as unexcused absences.]

Evaluation Team recommends elimination of this measure.


Interviews were conducted at intake, six months, 12 months, 18 months, and 24 months. At intake, nearly all (95 percent) of caregivers reported their children missing school in

the previous six months, with 92 percent still reporting this at six months, 89 percent at 12 months, 84 percent at 18 months, and 88 percent at 24 months. Data are relatively unchanged.

EXHIBIT 6 School attendance by interview

{N} Yes No Did child miss school for any reason in the past 6 months? (EQ-R #3) [INTAKE]

155 95% 5%

Did child miss school for any reason in the past 6 months? (EQ-R #3) [SIX MONTHS]

88 92 8

Did child miss school for any reason in the past 6 months? (EQ-R #3) [12 MONTHS]

54 89 11


32 84 16


16 88 12

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Measure:

EQ-R, national evaluation instrument administered to caregivers, question #3a, [How often was he/she usually absent in the past 6 months? This includes excused as well as unexcused absences.]


At the intake interview, a majority of caregivers (59 percent) reported their children missing one or more days per week, with that decreasing to 48 percent at six months, 52 percent at 12 months, 55 percent at 18 months, and 35 percent at 24 months. The percent of caregivers reporting that their children missed one or more days per week at the 18-month interview is 14 percentage points higher than the last data reported (55 percent compared to 41 percent in January 2009).

EXHIBIT 7 Days absent by interview

{N}

Less than 1 day per

month

about 1 day per month

about 1 day every 2 weeks

about 1 day a week

2 days per week

3 or more days per

week How often was child usually absent from school? (EQ-R #3a) [INTAKE]

146 12% 16% 13% 17% 19% 23%

How often was child usually absent from school? (EQ-R #3a) [SIX MONTHS]

81 24 16 14 15 19 14

How often was child usually absent from school? (EQ-R #3a) [12 MONTHS]

48 17 19 13 8 21 23


27 11 19 15 15 33 7


14 14 21 29 7 7 21

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Indicator 3: Family function Measures:

YSS-F, national evaluation instrument administered to caregivers, question #21, measured on a 5-point Likert scale [As a result of the services my child and/or family received, I am satisfied with our family life right now.]

YSS, national evaluation instrument administered to youth, question #21, measured on a 5-point Likert scale [As a result of the services I received, I am satisfied with my family life right now.]

CGSQ, Caregiver Strain Questionnaire scale, national evaluation instrument administered to caregivers to assess the extent to which caregivers are affected by the special demands of caring for a child with emotional and behavioral problems. [Replacement measure; approved 8-12-09.]

Analysis of LOS Data on Satisfaction with Family Life: Interviews were conducted at six months, 12 months, 18 months, and 24 months. At the six-month interview, about one-third (35 percent) of caregivers said they

agree or strongly agree that they are satisfied with their family life right now, with that increasing to 52 percent at 12 months, decreasing to 35 percent at 18 months, and increasing to 46 percent at 24 months. Data from the 6- and 12-month interviews are relatively unchanged compared to the last data reported (data through January 2009).

At the six-month interview, the majority of youth (56 percent) said they agree or strongly agree that they are satisfied with their family life right now, with that increasing to 72 percent at 12 months, 80 percent at 18 months, and decreasing to 50 percent at 24 months. These data, while relatively unchanged, contrast with data on caregiver satisfaction with family life (a greater proportion of youth are satisfied than the proportion of caregivers who are satisfied with family life). While the question asked is on satisfaction with family life “as a result of the services my child and/or family received,” caregivers’ responses may be influenced by other stressors on family life that do not affect the responses by youth.

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EXHIBIT 8 Family function at six month interview

{N} Strongly

Agree Agree Undecided Disagree Strongly Disagree

I am satisfied with our family life right now (YSS-F #21)

88 7% 28% 22% 27% 16%

I am satisfied with my family life right now (YSS #21)

71 21% 35% 18% 13% 13%

EXHIBIT 9 Family function at 12 month interview

{N} Strongly



46 11% 41% 11% 22% 15%


35 29% 43% 14% 6% 9%


{N} Strongly



23 9% 26% 39% 13% 13%


20 35% 45% 15% 0% 5%


{N} Strongly



13 15% 31% 23% 23% 8%


10 20% 30% 20% 20% 10%

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Analysis of LOS Data for the Caregiver Strain Questionnaire Scale:

The proportion of caregivers who show an improvement in their Caregiver Strain Questionnaire (CGSQ) global strain score increases from 37 percent at the six month interview to 45 percent at the 12 month interview, and remains steady at 18 months and 24 months.

The proportion of caregivers who show deterioration in their Caregiver Strain Questionnaire (CGSQ) global strain score is about 8 – 11 percent across all interviews.

The proportion of caregivers with no change in their score decreases from 55 percent at six months to 49 percent at 12 months (at the same time that the number of caregivers who improved is increasing).

EXHIBIT 11 Caregiver Strain Questionnaire (CGSQ), Global Strain Reliable Change Index





Background on the Caregiver Strain Questionnaire Scale: The Caregiver Strain Questionnaire (CGSQ) assesses the extent to which caregivers are affected by the special demands associated with caring for a child with emotional and behavioral problems. The CGSQ comprises three subscales. Objective Strain refers to observable disruptions in family and community life. Subjective Externalized Strain refers to negative feelings about the child such as anger, resentment, or embarrassment. Subjective Internalized Strain refers to the negative feelings that the caregiver experiences such as worry, guilt, or fatigue. A Global Strain score is calculated by summing the three subscales to provide an indication of the total impact of the special demands on the family. The CGSQ is administered at intake and at all follow-up interviews as part of the Longitudinal Outcomes Study. The Reliable Change Index is a relative measure that compares a caregiver’s scores at two different points in time (i.e., intake and follow-up interview) and indicates whether a change in score shows significant improvement, worsening, or stability (i.e., no significant change in the score).

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Outcome 2: Reduced need for out-of-home placements

Indicator 1: Length of stay in out-of-home placement for residential and foster care placements, broken out for DHS and court referrals

Measure:

Local evaluation data on average number of days in out-of-home placement for children and youth receiving system of care services (Definition of out-of-home placement to be determined by Sustainability Work Group.)

Indicator 2: Recidivism rates for those with juvenile offenses

Measure:

Proportion of children/youth who have a new delinquency petition on file with the Ingham County Circuit Court since receiving Impact system of care services

Analysis of Court Data:

Data reflect new petitions filed as of May 21, 2009 for youth referred to Impact by the Court. Neglect and abuse cases are not included in this analysis.

Out of 181 children/youth referred to Impact by the Court as of November 21, 2008, about 69 percent (124) have not had a new delinquency petition on file with the Ingham County Circuit Court since intake into Impact system of care services.

The recidivism rate ranges from 16 percent for youth within the first six months following intake into Impact to 10 percent for youth within the fourth six months following intake into Impact.

EXHIBIT 12

Proportion of Youth with New Delinquency Petition Filed

Table A {N} Number(%) of youth/children with one or more new petitions since beginning

Impact Services Youth/children who are at least 24 months from point of intake into Impact services

63 27 (43%)

Youth/children who are at least 18 months from point of intake into Impact services

31 11 (35%)


54 15 (28%)


33 4 (12%)

Total youth/children referred by Court* 181 57 (31% of 181) * Does not include neglect and abuse cases

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Table B {N} Number(%) of youth/children

with one or more new petitions during first six

months

Number (%) of youth/children

with one or more new petitions

during second six months



during third six months



during fourth six months


63 10 (16%) 12 (19%) 5 (8%) 6 (10%)


31 7 (23%) 3 (10%) 3 (10%)


54 8 (15%) 7 (13%)


33 4 (12%)

Total youth/children referred by Court

181 29 (16% of 181) 22 (15% of 148) 8 (9% of 94) 6 (10% of 63)

* Does not include neglect and abuse cases

Proposed Indicator 3: Substantiated complaints to DHS Children’s Services

Measure:

Proportion of families who have a substantiated complaint on file with children’s protective services since receiving Impact system of care services


Proposed Indicator 4: Permanency of DHS placements for children and youth

Measures:

For CPS, the proportion of children/youth that remain in their home and the proportion that are placed in foster care

For youth in foster care, the proportion of youth with moves toward permanency.

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Outcome 3: Efficient use of resources Discussion of potential indicators (below) deferred to the Sustainability Work Group:

Indicator 1: Proportion of Ingham County funds used for home and community-based services compared to the proportion of funds used for residential placement services. (Revised indicator, 9-28-09)

Outcome 4: Increased participation of families and youth in the development of the system

Indicator 1: Extent of family and youth participation in the development of the system of care compared to the extent of participation prior to the development of Impact

Measure:

Description of the partnership between ACMH and CMH-CEI and the mechanisms for family and youth participation that existed before Impact.

Analysis:

The mechanisms for family and youth participation prior to implementation of the Impact System of Care include the partnership between Community Mental Health of Clinton, Eaton, and Ingham Counties (CMH-CEI) and the Association for Children’s Mental Health (ACMH), the statewide family organization for Michigan. The years reviewed were from 2000 to 2005.

CMH-CEI promoted family and youth involvement through several structures including: • Providing funds to ACMH to promote family support • Utilizing block grant dollars funding a Mental Health Juvenile Justice Diversion

Project to include 0.125 full-time equivalent (FTE) of Family Advocate involvement

• CMH-CEI Children’s Advisory Council – 3 family members • Focus groups with families • Love & Logic parenting course facilitated by a family member • Parents involved in development of new initiatives such as Parent Management

Training Oregon Model and the Parent Mentor Program The ACMH promoted family and youth involvement through several structures

including: • Providing representatives on several community initiatives such as the

Community Coalition for Youth (CCY) • Family Advocate support within the CEI area – 1 FTE funded with block grant

dollars from Michigan Department of Community Health • Annual Parent Leadership Camp • Annual ACMH Conference • Support group

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Measure:

Description of the mechanisms for family and youth participation that exist in the Impact System of Care.

Analysis:

With the implementation of the Impact System of Care, mechanisms for youth and family participation have been developed in three categories. The first category is vehicles that support and encourage youth and family members to be champions and advocate for children with mental health needs through the Family Council and Speak Your Mind. The second and third are service delivery positions and the opportunities through Impact’s partner agencies respectively.

The continuum of family-driven care can be described as a ladder with the lowest level of family-driven care being no involvement, the next step of involvement being as an interested party, and then moving upward through levels of attendee, active participant, facilitating, and ultimately participating in leading the effort. For youth, the lowest level of involvement is manipulation, followed by steps of decoration; tokenism; assigned and informed; consulted and informed; adult initiated, shared decisions with youth; youth and adult initiated and directed; youth initiated, shared decisions with adults; and ultimately youth initiated and directed. The mechanisms created in the Impact System of Care are intended to support this evolution of youth and family involvement.

Through the Family Council and the Speak Your Mind youth council there are many opportunities for youth and family involvement: • Workgroup meetings • Stakeholders governance meeting • Cultural Coalition • Speak Up, Speak Out, youth speakers bureau • Speaking Opportunities

ο County Commissioner meetings ο Report to the Community ο City Council meetings ο School Board meetings

• Conference Participation at the local and national level • Power of We Consortium • Children’s Mental Health Awareness Day • Co-facilitation of trainings

ο Cultural Proficiency ο New employee orientation ο Conference trainings

• Parent Leadership Institute sessions through Impact • Youth and families regularly review materials and processes to ensure they are in

youth- and family-friendly language and formats • Participation in Evaluation Discussion Groups

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Service delivery by family members and/or youth through funded positions: • 2 full-time equivalents (FTE) promoting youth and family involvement • 7.5 FTE providing direct service to families through the Family Advocate Support

Program • 1 FTE data collection and evaluation • 2 FTE parent mentors • Love and Logic program facilitated by parent • Dialectical Behavior Therapy (DBT) groups co-facilitated by youth and parents

Partner agency opportunities for youth and family members: • Youth on advisory board for Ingham County Family Center • Team decision-making at DHS • Family Advocate as a member of the at Community Placement Program team at the

court • Parent groups at the court facilitated by a Family Advocate • Parents’ Coffee Club through CMH-CEI • ACMH Parent Leadership Camp • ACMH Youth Leadership Camp

Measure:

The level of family and youth participation (e.g., percentage of family and youth on the Family Council and Speak Your Mind).


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Outcome 5: A unified, family driven, youth guided, and culturally and linguistically competent system of care for children with SED and their families

Indicator 1: Caregiver satisfaction with involvement in planning services

Measure:

YSS-F, national evaluation instrument administered to caregivers, question #2, measured on a 5-point Likert scale [I helped to choose my child’s services.]

Indicator 2: Youth satisfaction with involvement in planning services

Measure:

YSS, national evaluation instrument administered to youth, question #2, measured on a 5-point Likert scale [I helped to choose my services.]


This interview was given at six months, 12 months, 18 months, and 24 months. At the six-month interview, the majority of caregivers (69 percent) said they agree or

strongly agree that they helped to choose their child’s services, remaining steady at 70 percent at the 12 months, 69 percent at 18 months, and increasing to 85 percent at 24 months.

At the six-month interview, about half of youth (44 percent) said they agree or strongly agree that they helped to choose their services. At 12 months, this decreased to 32 percent, while 45 percent said they disagree or strongly disagree that they helped to choose their services. At 18 months, 65 percent of youth agree or strongly agree that they helped choose their services, decreasing to 50 percent at 24 months. These data showed a similar pattern for the 6-, 12-, and 18-month interviews in the last data reported (through January 2009).

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EXHIBIT 13 Satisfaction with involvement at six months

{N} Strongly


I helped to choose my child’s services (YSS-F #2)

89 23% 46% 6% 20% 6%

I helped to choose my services (YSS #2)

71 13% 31% 18% 31% 7%

EXHIBIT 14 Satisfaction with involvement at 12 months

{N} Strongly



46 33% 37% 13% 9% 9%


35 3% 29% 23% 31% 14%


{N} Strongly



23 17% 52% 9% 22% 0%


20 10% 55% 20% 10% 5%


{N} Strongly



13 8% 77% 8% 0% 8%


10 20% 30% 40% 10% 0%

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Indicator 3: Family and youth satisfaction with services

Measures:

YSS-F, national evaluation instrument administered to caregivers, question #1, measured on a 5-point Likert scale [Overall, I am satisfied with the services my child received.]

YSS, national evaluation instrument administered to youth, question #1, measured on a 5-point Likert scale [Overall, I am satisfied with the services I received.]

MSSC-RC, question #35, satisfaction with Family Advocate Support [How well did the (Family Advocate Support) service meet the needs of your child and/or family?]

YSS-F, national evaluation instrument administered to caregivers, question #10 and #11, measured on a 5-point Likert scale [My family got the help we wanted for my child.; My family got as much help as we needed for my child.]

YSS, national evaluation instrument administered to youth, question #10 and #11, measured on a 5-point Likert scale [I got the help I wanted.; I got as much help as I needed.]


This interview was given at six months, 12 months, 18 months, and 24 months. At the six-month interview, the majority of caregivers (68 percent) and youth (69

percent) agree or strongly agree that they are satisfied with services received. At the 12-month interview, that majority increases to 85 percent for caregivers and drops slightly to 63 percent for youth. At the 18-month interview, 87 percent of caregivers and 80 percent of youth report that they are satisfied. At the 24-month interview, 68 percent of caregivers and 69 percent of youth report that they are satisfied. The data from 6-, 12-, and 18-month interviews are relatively unchanged or slightly improved compared to the last data reported (through January 2009).

At six months, the majority of caregivers (64 percent) and youth (58 percent) said they agree or strongly agree that they got the help they wanted. At 12 months, that majority increased to 72 percent for caregivers and increased to 66 percent for youth. At the 18-month interview, 69 percent of caregivers and 90 percent of youth report that they got the help they wanted.

At six months, nearly half of caregivers (50 percent) and a majority of youth (54 percent) said they agree or strongly agree that they got as much help as they needed. At 12 months, this increased to 57 percent for caregivers—lower than previously reported data—and remained steady at 57 percent for youth. At the 18-month interview, 39 percent of caregivers and 70 percent of youth report that they got the help they needed. At the 24-month interview, 54 percent of caregivers and 70 percent of youth report that they got the help they needed.

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EXHIBIT 16

Family and youth satisfaction with services at six months

{N} Strongly


Overall, I am satisfied with the services my child received (YSS-F #1)

89

34% 34% 12% 16% 5%

My family got the help we wanted for my child (YSS-F #10)

89 30 34 18 9 9

My family got as much help as we needed for my child (YSS-F #11)

89 27 23 21 19 10

Overall, I am satisfied with the services I received (YSS #1)

71 17% 52% 17% 9% 6%

I got the help I wanted (YSS #10)

71 17 41 18 17 7

I got as much help as I needed (YSS #11)

71 10 44 25 16 6

EXHIBIT 17 Family and youth satisfaction with services at 12 months

{N} Strongly



46 39% 46% 9% 4% 2%


46 35 37 11 15 2


46 22 35 26 11 7


35 17% 46% 29% 3% 6%


35 20 46 20 3 11


35 20 37 26 6 11

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EXHIBIT 18

Family and youth satisfaction with services at 18 months

{N} Strongly



23 30% 57% 9% 4% 0%


23 30 39 17 13 0


23 22 17 30 26 4


20 35% 45% 20% 0% 0%


20 35 55 0 10 0


20 55 15 20 10 0

EXHIBIT 19 Family and youth satisfaction with services at 24 months

{N} Strongly



13 15% 62% 15% 8% 0%


13 23 46 15 0 15


13 15 39 23 8 15


10 40% 50% 10% 0% 0%


10 20 60 10 10 0


10 10 60 10 10 10

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Analysis of Data on Satisfaction with Family Advocate Support:

For the third and fourth quarters of 2009 combined (April through September, 2009), out of 22 respondents answering the question, 69 percent said that Family Advocate Support met the needs of their child and/or family “moderately well” to extremely well.” (See table below.)

For the second quarter of 2009 (January through March, 2009), out of 17 respondents answering the question, 94 percent said that Family Advocate Support met the needs of their child and/or family “moderately well” to “extremely well.”

EXHIBIT 19

Satisfaction with Family Advocate Support

Possible response 2008 (% of responses) 2009 (% of responses) Qtr 1

n = 11 Qtr 2 n = 12

Qtr 3 n = 15

Qtr 4 n = 19

Qtr 1 n = 21

Qtr 2 n = 17

Qtr 3 and Qtr 4 n = 22

1. Not at all well 9% 8% 7% 11% 10% 0% 14% 2. Somewhat well 18 0 7 26 19 6 18 3. Moderately well 18 25 20 16 24 12 23 4. Very well 9 42 33 26 33 29 23 5. Extremely well 45 25 33 21 14 53 23

Respondents: Families who have been participating in the Longitudinal Outcome Study for 6 to 30 months and completed a 6-, 12-, 18-, 24- or 30-month interview for the LOS during the quarter.

N= 22 (Respondents replied “Yes” to the question “Did your family receive Family Advocate Services within the last six months?)

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Indicator 4: Reported satisfaction with their providers’ respect for their family’s beliefs and understanding of their family’s traditions Measures:

YSS-F, national evaluation instrument administered to caregivers, question #12, measured on a 5-point Likert scale [Staff treated me with respect.]

YSS, national evaluation instrument administered to youth, question #12, measured on a 5-point Likert scale [Staff treated me with respect.]


This interview was given at six months, 12 months, 18 months, and 24 months. At the six-month interview, most caregivers (91 percent) and youth (82 percent)

agree or strongly agree that providers treated them with respect. At the 12-month interview, this increased to 98 percent for caregivers and decreased to 80 percent for youth. These data are relatively unchanged compared to the last data reported. At the 18-month interview, 92 percent of caregivers and 90 percent of youth report that providers treated them with respect (compared to 85 percent of youth in the last data reported). At the 24 month interview, 93 percent of caregivers and 100 percent of youth report that providers treated them with respect.

EXHIBIT 20 Satisfaction with providers’ respect for beliefs and traditions at six months

{N} Strongly


Staff treated me with respect (YSS-F #12) [caregiver]

89 57% 34% 6% 3% 0%

Staff treated me with respect (YSS #12) [youth]

71 31% 51% 10% 6% 3%

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EXHIBIT 21

Satisfaction with providers’ respect for beliefs and traditions at 12 months

{N} Strongly



46 59% 39% 2% 0% 0%


35 46% 34% 14% 3% 3%

EXHIBIT 22 Satisfaction with providers’ respect for beliefs and traditions at 18 months

{N} Strongly



23 48% 44% 4% 0% 4%


20 60% 30% 10% 0% 0%

EXHIBIT 23 Satisfaction with providers’ respect for beliefs and traditions at 24 months

{N} Strongly



13 39% 54% 0% 8% 0%


10 50% 50% 0% 0% 0%

Indicator 5: Cross-agency collaborative activities and shared funding strategies

Measure:

Description of cross-agency collaborative activities and shared funding strategies drawn from work group progress reports

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Outcome 6: Increased community knowledge of the system of care and decreased stigma

Indicator 1: Attitudinal and behavioral changes made by priority audience #1: Judiciary, Family Division of Circuit Court administration, Department of Human Services administration, and Community Mental Health administration

Measure:

Annual interviews with representatives of Judiciary, Family Division of Circuit Court administration, Department of Human Services administration, and Community Mental Health administration to identify their views

No new data available

Indicator 2: Decisions made by priority audience #2: Ingham County Board of Commissioners

Measures:

Annual review of the content of recommendations related to the Impact system of care that are made by board committees and the decisions made by the board.

Annual review of the progress made on the activities in the Sustainability Work Group work plan that require support from the Board of Commissioners.

No new data available

Indicator 3: Degree to which families, agency partners, and community-based organizations speak in a unified voice about the Impact system of care

Measure:

Discussion groups with families, agency partners, and community-based organizations

Refer to report on discussions with agency partners.

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November 30, 2010