Braam Benchmark Development

1
Braam Benchmark Development

• Overview of Progress

Childrens Administration Presentation to the
Braam PanelDecember 12, 2006
2
Benchmarks and Reports

• Products Delivered

3
Measure Development

• Measure Development Steps
• 16 weeks of meetings with Braam Panel staff
  (WSIPP) to collaboratively define measures
• approach to measurement shaped by limitations of
  administrative data, desire to have a sensitive
  indicator of policy/practice changes
• most measures represent a new way of describing
  populations/services/activities
• Multiple technical assistance meetings with Braam
  Panel Chairperson John Landsverk to discuss and
  resolve data measurement issues
• September 2005 delivery of baseline measures with
  available data
• Re-review of data sources and validation of
  measures with program staff
• Ongoing
• Adjustments to measures as needed
• Annual performance data with analysis of
  barriers, beginning January 2007
• Mental Health Division request for measurement
  modifications

4
Measure Summary
Braam Settlement Monitoring Report 2 (Nov06)
Summary of data availability by area of the
settlement agreement
notes
5
Area Stability
Measure Delivered
Active Licensed Foster Homes FY05
Beds in Active Licensed Foster Homes FY05

Children Placed With Unlicensed Caregivers
FY05 Unlicensed Caregivers
6
Area Stability
Measure Delivered
REPORT ONLY

7
Area Stability
Measure Delivered
Average Years of Activity for Licensed Active
Foster Homes FY05

i Data Sources Active foster home data from
Braam Active FH Measure
8
Area Stability
Measure Delivered
Braam Stability by Fiscal Year Placement Entry
Cohort and Time-in-Care Percent of Episodes with
lt3 Placement Events

1 Grand Episodes are meant to represent a
period of continuous responsibility, and are
defined as multiple CAMIS placement episodes
separated by less than 2 days, or a single CAMIS
placement episode if no other episode began
within 1 day of the end date. Grand Episodes must
last at least 30 days to be included in the
measure. Placement event counts exclude the first
relative placement, detention, juvenile
rehabilitation, hospital, respite, on-run, birth
and adoptive parent placements. First sibling
placement is not excluded.
9
Area Mental Health
Measure Delivered
Percent of Children Placed During FY05 With CHET
Screens Completed Within 30 Days of Placement

10
Area Mental Health
Measure Delivered
Percent of Children Placed During FY05 With an
EPSDT Screen Within 30 Days of Placement

• This measure was initially developed for the
  baseline year but has been re-evaluated based on
  field staff feedback about the extent of missing
  EPSDT dates in CAMIS. Medicaid billings are being
  re-evaluated as a preferred data source
• The CA is working with the DSHS Office of
  Research and Data Analysis (RDA) to acquire
  Medicaid billing data to run record matches with
  CA children in out-of-home care.

11
Area Mental Health
Measure Delivered

• This measure was initially developed for the
  baseline year but has been re-evaluated based on
  the extent of missing information in ITEIP
  provider records
• ITEIP providers may only record children who are
  found eligible, and
• ITEIP referrals may be made through a contracted
  agency (not directly to the ITEIP provider)
• The CA is evaluating how this benchmark can be
  measured

12
Area Mental Health
Measure Delivered
Percent of Children Placed During FY05 Assessed
as Needing Mental Health ServicesWith a Mental
Health Assessment Within 45 Days of Placement

i Data Source CAMIS placement records,
Kidscreen records, MHD records from RSN service
providers. Youth in their first CA placement
without a prior record of RSN services, days from
first intake/assessment to first non-crisis
service
13
Area Mental Health
Measure Delivered
Percent of Children With an Annual EPSDT
Screening

• This measure was initially developed for the
  baseline year but has been re-evaluated based on
  the extent of missing EPSDT dates in CAMIS.
  Medicaid billings will be evaluated as a
  preferred data source
• The CA is working with the DSHS Office of
  Research and Data Analysis (RDA) to acquire
  Medicaid billing data and run record matches with
  CA children in out-of-home care.

14
Area Mental Health
Measure Delivered
Percent of Children In Placement During FY05
Receiving a Mental Health Service Within 30 Days
of Assessment

i Data Source CAMIS placement records, MHD
records from RSN service providers.
15
Area Foster Parent Training
Report Delivered
REPORT ONLY

i Data source CAMIS licensing records
16
Area Unsafe/Inappropriate Placement
Report Delivered
REPORT ONLY

17
Area Sibling Separation
Measure Delivered
Percent of Children Placed in Regular Foster Care
Placed With All Other Removed Siblings (FY05)By
Sibling Group Size

i Measure looks at all children in their first
placement episode during the fiscal year, with a
length-of-stay of at least 30 days, placed
initially into the same licensed foster home or
unlicensed relative home with all concurrently
placed siblings.
18
Area Sibling Separation
Measure Delivered
Percent of Children Placed in Regular Foster Care
Who Were Placed With Some/Not All Other Siblings
By Sibling Group Size (FY05)

i Measure looks at all children in their first
placement episode during the fiscal year, with a
length-of-stay of at least 30 days, placed
initially into the same licensed foster home or
unlicensed relative home as some but not all -
concurrently placed siblings.
19
Area Sibling Separation
Measure Delivered

20
Area Adolescent Services
Measure Delivered
Percent of All Children In Placement During FY05
Who Ran From Placement During The Year

21
Area Adolescent Services
Measure Delivered
Percent of All Children In Placement on
6/30/05Who Ran During Their Placement

22
Area Adolescent Services

Measure Delivered
Percent of All Children In Placement on
6/30/05Who Ran More Than 1 Time Placement
23
Area Adolescent Services
Measure Delivered
Average (Mean) Days in a Runaway Event By Region
Median Days in a Runaway Event By Region
24
Benchmarks and Reports

• Measures in Development

25
Area Mental Health
Measure in Development
26
Area Unsafe/Inappropriate Placement
Measure in Development
27
Benchmarks and Reports

• Data Source Development Case Review

28
Area Stability
Case Review
29
Area Unsafe/Inappropriate Placement
Case Review
30
Area Adolescent Services
Case Review
31
Benchmarks and Reports

• Data Source Development Foster Parent Survey

32
Area Foster Parent Training
Foster Parent Survey
33
Area Unsafe/Inappropriate Placement
Foster Parent Survey
34
Benchmarks and Reports

• Data Source DevelopmentNew Administrative Data

35
Area Mental Health
Data source in development
36
Area Unsafe/Inappropriate Placements
Data source in development
37
Benchmarks and Reports

• Data Source DevelopmentAdministrative and OSPI

38
Area Adolescent Services
Data source in development
Modify use of existing administrative data
sources, request OSPI data
39
Area Sibling Separation
Data source in development
Selection of method not finalized
40
Benchmarks and Reports

• CHET Completion Analysis

41
CHET Completion

• The CHET Process
• CHET screeners are notified of placements via
  CAMIS
• Screeners initiate the CHET process for children
  who (the placing Social Worker believes) are
  likely to remain in care for at least 30 days
  process includes
• Review of available medical records and request
  for results from the EPSDT examination for
  inclusion in the CHET Screening Report
• Make initial request for education records from
  childs school
• Interview/visit children face-to-face in their
  placement (not required but best practice in
  FY05)
• Use standardized, validated screening tools such
  as the Child Behavior Checklist (CBCL) and the
  Ages and Stages Questionnaire (ASQ and the
  ASQ-SE) to determine a childs need for further
  assessment
• Document results of screening tools
• Consult with other program staff such as SSI
  social workers, Education Advocates, Foster Care
  Public Health Nurses and assigned social workers
  regarding identified / immediate needs
• Provide screening reports to caregiver and
  assigned social worker within 5 days of
  completion
• Participate in the staffing for the child
• Make appropriate referrals such as ITEIP, SSI,
  Educational Advocacy
• In FY05, al steps had to be complete before the
  CHET process could be considered complete

42
CHET Completion

i Children with LOS gt 30 days. Days from
recorded placement date to recorded CHET staffing
date. Includes children who were unavailable due
to running, children who changed legal custody,
children who moved out-of-state, youth in
Juvenile Rehabilitation and Detention, youth who
aged out of care and children who had a valid
assessment from another source. No adjustment for
delay in documentation of placement in CAMIS.
Total N includes children who do not have a
recorded CHET screen.
43
CHET Completion

i Children with LOS gt 30 days. Includes
children who were unavailable due to running,
children who changed legal custody, children who
moved out-of-state, youth in Juvenile
Rehabilitation and Detention, youth who aged out
of care and children who had a valid assessment
from another source. Total N includes children
who do not have a recorded CHET screen.
44
CHET Completion

i Children with LOS gt30 days. 163 children
were excluded due to running, changing legal
custody, moving out-of-state, Juvenile
Rehabilitation and Detention, aging out of care
and having a valid assessment from another
source. Total N includes children who do not have
a recorded CHET screen.
45
CHET Completion

i Excludes placements without a recorded CHET
date. Avg days to completion 60, Median days to
completion 45
46
CHET Completion

• The ability to complete any one CHET screen
  within 30 days depends on timely completion of
  each step in the CHET process - a delay in any
  one component delays completion of the CHET
  screen
• Entry of placement information into CAMIS
• Face-to-face interview of child
• Receipt of education records
• Completion or scheduling of the EPSDT
  examination
• Completion of screening tools by
  teacher/caregiver
• The ability to complete every CHET screen within
  30 days depends on the ratio of new placements to
  CHET screeners

47
CHET Completion

• Strategies to improve the CHET completion rate
  (completion within 30 days)
• The Administration requested 12 CHET FTEs (2
  per region)
• Some region are identifying floating screeners
  to temporarily fill vacant CHET screener
  positions or cover during extended absences
• Regional Quality Assurance Plans have been
  implemented to address
• timeliness of CHET completion
• timeliness of receiving required records
• improving the rate of EPSDT exam completion
• improving the quality of the information
  collected in the five (5) domains
• use of the information for shared planning
  meetings/decision making
• Regional CHET screeners and coordinators are
  meeting quarterly with HQ to review progress and
  identify barriers
• SACWIS replacement project is expected to
  improve documentation
• Reasons for CHET delays will be analyzed to
  identify areas for additional strategies