louisiana csoc outcomes: cans analysis · outcomes analysis •the following outcomes analysis...

Louisiana CSoC Outcomes:CANS Analysis

Wendy Bowlin, LPC, MBA

Director of Quality and Outcomes, Magellan of Louisiana

November 9, 2016

Agenda

1. CANS

• Overview

• Scoring

• Psychometric Properties

• Outcomes Monitoring

2. Member Characteristics

3. Outcomes

4. Modules

5. Next Steps

6. Questions/Feedback

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The Louisiana Child and Adolescent Needs and Strengths (CANS)

CANS

• The CANS Comprehensive Multisystem Assessment is completed based on a face-to-face interview with the child (and guardian(s) when possible) and additional supporting information.

• The CANS is a multi-purpose tool developed for children’s services to support decision making, including:

‒ Eligibility and service planning,

‒ Facilitating quality improvement initiatives, and

‒ Monitoring of outcomes of services.

• Versions of the CANS are currently used in 50 states in child welfare, mental health, juvenile justice, and early intervention applications.

‒ The Louisiana CANS was developed with Dr. John Lyons to meet the unique needs of the state at the initiation of the CSoC program.

• The CANS links the assessment process and the design of individualized service plans, including the application of evidence-based practices.

http://praedfoundation.org/tools/the-child-and-adolescent-needs-and-strengths-cans/

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Using the CANS

For needs:

0. No evidence1. Watchful waiting/prevention2. Action3. Immediate/Intensive Action

For strengths:

0. Centerpiece strength1. Strength that you can use in planning2. Identified-strength-must be built3. No strength identified

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• The CANS assesses the child in the following areas: Problem behavioral/emotional needs, child risk behaviors, life domain functioning, caregiver strengths & needs, youth strengths, and acculturation.

• The CANS measures Needs and Strengths using a 4 point scale to rate the highest level from the past 30 days:

• A rating of ‘2’ or ‘3’ on a CANS needs suggests that this area must be addressed in the plan.

• A rating of a ‘0’ or ‘1’ identifies a strength that can be used for strength-based planning and a ‘2’ or ‘3’ a strength that should be the focus on strength-building activities.

http://praedfoundation.org/tools/the-child-and-adolescent-needs-and-strengths-cans/

Reliable and Valid Tool

• The CANS has demonstrated reliability (tool produces similar results under consistent conditions) and validity (tool measures what it is purported to measure)

‒ The average reliability of the CANS is 0.75 with vignettes, 0.84 with case records, and can be above 0.90 with live cases.

‒ To further support reliability and validity, Magellan performed input validation (e.g., identifying and investigating outlier scores, duplicates, etc.) to ensure integrity of data.

• Statistical significance means the outcome is the result of a relationship between specific factors versus merely the result of chance.

‒ Measured using a p-value

‒ Anything equal or less than 0.05 is considered statistically significant

‒ The lower the number the more likely outcome is not due to chance

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Outcomes Monitoring

• Outcomes Monitoring can be accomplished in two ways:

‒ Items that are initially rated a ‘2’ or ‘3’ are monitored over time to determine the percent of youth who move to a rating of ‘0’ or ‘1’ (resolved need, built strength).

‒ The Global Score (sum of all items that measure outcomes) and Domain Scores can be generated by summing items within each of the dimensions (Problems, Risk Behaviors, Functioning, etc). These scores can be compared over the course of treatment.

http://praedfoundation.org/tools/the-child-and-adolescent-needs-and-strengths-cans/

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Outcomes Analysis

• The following Outcomes Analysis includes:

• All Population (n= 1278)

• Most Severe or Top 25% (n=332)

• Date Parameters: The date range of the report is from 3/1/2012 to 10/16/2016.

• Only electronic CANS submitted on or after 11/20/2014 are included. (Note: the actual assessment date may have occurred prior to this date.)

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Member Characteristics

Initial Assessments

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57.8

7.8

5.1

10.5

10.5

0.1

18.6

13.0

75.7

10.1

7.7

14.1

14.4

0.2

22.5

16.8

171

15

30

36

36

9

30

30

0.0 50.0 100.0 150.0 200.0

Global Score

School Behavior

Child Risk Behaviors

Child Behavioral/Emotional Needs

Caregiver Strengths & Needs

Acculturation

Child Strengths

Life Domain Functioning

Max Points Possible Severe: Initial Assessment (Average Sum) All: Initial Assessment (Average Sum)

Diagnostic Characteristics of Members

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0.5%

1.3%

1.4%

4.0%

4.9%

9.6%

10.5%

31.2%

36.5%

0.6%

1.8%

2.1%

4.8%

5.7%

8.4%

12.7%

27.7%

36.1%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

Alcohol and Substance Use

Other

Thought disorders

Developmental and Disorders usuallydiagnosed in childhood

Bipolar

Adjustment, Anxiety and PTSD

Depressive and NOS Mood

Conduct, Oppositional, and Impulse Control

Attention-deficit and NOS disorders

% Severe

% All

Average Length of Stay

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11.2 11.1

0123456789

101112

All Severe

Mo

nth

s

Mean LOS

Outcomes

Global Scores

CSoC Governance Board: CANS14

*All changes represent statistically significant improvement (p≤.001).

57.8

41.5

75.7

51.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Initial Discharge

All

Severe

Represents a 16.3 point decrease or a 28.2% decline.

Represents a 24.1 point decrease or a 31.8% decline.

Domain Scores: All Population

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18.6

13.813.0

9.0

0.1 0.1

10.5

8.2

10.5

7.3

5.1

3.1

7.8

4.6

0

2

4

6

8

10

12

14

16

18

20

Initial Assessment Transition DC

Child Strengths

Life Domain Functioning

Acculturation

Caregiver Strengths & Needs

Child Behavioral/EmotionalNeeds

Child Risk Behaviors

School Behavior

*All changes represent statistically significant improvement (p≤.001) except Acculturation Domain.

Domain Scores: Most Severe Population

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22.5

16.016.8

11.4

0.2 0.1

14.4

10.1

14.1

9.4

7.7

4.5

10.1

6.3

0

5

10

15

20

25

Initial Assessment Transition DC

Child Strengths

Life Domain Functioning

Acculturation

Caregiver Strengths & Needs

Child Behavioral/EmotionalNeeds

Child Risk Behaviors

School Behavior

*All changes represent statistically significant improvement (p≤.001) except Acculturation Domain.

Problem Presentation: All Population

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0.0

0.5

1.0

1.5

2.0

2.5

Initial Assessment Transition DC

Somatization

Beh Regression

Psychosis

Impulse/Hyper

Depression

Anxiety

Oppositional

Conduct

Adj to Trauma

Anger Control

Substance Use

Eating Disturbance

*All changes represent statistically significant improvement (p≤.001).

Problem Presentation: Most Severe Population

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*All changes represent statistically significant improvement (p≤.001).

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Initial Assessment Transition DC

Somatization

Beh Regression

Psychosis

Impulse/Hyper

Depression

Anxiety

Oppositional

Conduct

Adj to Trauma

Anger Control

Substance Use

Eating Disturbance

Other Notable Scores

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6.1

3.9

13.4

6.0

3.1

1.9

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Initial Assessment Transition DC

Juv Justice Avg Sum (n=386)

Violence Avg Sum (n=608)

Trauma Avg Sum (n=594)

*Includes all outcomes elements associated with the module. Average total scores at initial and discharge are reflected in the graph. **All changes represent statistically significant improvement (p≤.001).

% of Youth Triggering Modules

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92.3%

25.7%

16.3%

46.5%

13.8%

56.5%

4.5%

17.4%

29.7%

10.5%

27.2%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

School

Developmental Disability

Family/Caregiver

Trauma

Substance Use

Violence

Sexually Abusive Behavior

Runaway

Juvenile Justice

Fire Setting

Sexually Abusive Experience

Next Steps

National Benchmarking

• Magellan, with the approval of LDH, is sharing data with University of Washington to assist them with a study on using CANS data for benchmarking and outcomes monitoring in state-wide Wraparound initiatives.

‒ UW recently presented an analysis of three states, including de-identified Louisiana data.

‒ Louisiana CANS scores were close to the mean/average on intensity of needs.

‒ Study identified significant differences between states.

• UW is currently conducting an 8 state analysis to further explore similarities and differences.

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Regional Differences

• Present data to Wraparound agencies, providers, and stakeholders to explore:

‒ Regional differences in percent of youth triggering modules:

o Population differences?

o Referral sources (e.g., court system, community, providers, state agencies, etc.)?

‒ Regional differences impacting outcomes.

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Cross Tabulation Study

• Magellan is in the process of conducting an in-depth statistical analysis to look at other factors that could be influencing why some members are more likely to:

‒ Discharge successfully from CSoC

‒ Have statistically significant improvement on the CANS

• Magellan will compare groups against factors, such as:

‒ Member's DCFS/OJJ involvement

‒ Involved in Office of Citizens with Developmental Disabilities

‒ Number of out of home placements prior to CSoC

‒ Parent and/or Youth Support on Plan of Care

‒ At least one natural/informal support on Child and Family Team

‒ Number of placements in Alternative School Settings

‒ Youth has an Individualized Education Plan (IEP)

• If relationships are identified, we will be able to better target interventions to certain populations or factors to improve chances of positive outcomes.

• Results expected by the end of 2016.

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Feedback/Questions

Confidentiality Statement

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By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment.

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