COMMUNITY FAMILY PARTNERSHIP BIANNUAL REPORT March...

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COMMUNITY FAMILY PARTNERSHIP BIANNUAL REPORT March 2014

A Cooperative Venture of: Dorothy A. Johnson Center for Philanthropy at Grand Valley State University Community Family Partnership Kent County System of Care

This report is a cooperative venture of the Dorothy A. Johnson Center for Philanthropy’s Community Research Institute at Grand Valley State University and the Community Family Partnership Kent County System of Care. This report represents a collaboration as many individuals dedicated significant time to accessing the data contained in this report, running the analysis, interpreting the data and verifying the accuracy of the findings. Therefore we would like to thank the key members of the team responsible for this report.

Research and Data TeamRyan Ames, M.U.P.PResearch Coordinator, Community Research Institute

Joshua ChurchWeb Developer, Community Research Institute

Amber Erickson, M.S.W.Research Manager, Community Research Institute

Chyna GroveResearch Assistant, Community Research Institute

Alexa ThompsonResearch Assistant, Community Research Institute

Emily WaltersGraphic Design and Layout

Johnson Center’s Leadership TeamTeri Behrens, Ph.D. Director, Special Projects

Julie Couturier, C.P.A. Financial Manager

William Crawley, Ph.D.Interim Executive Director

Matthew Downey, M.P.A. Program Director, Nonprofit Services

DeDe EsqueInterim Director, The Grantmaking School

Beverly Grant, L.M.S.WAssociate Director

Jerry Johnson, Ph.D. Research Director, Community Research Institute

Michael Moody, Ph.D. Frey Chair for Family Philanthropy

Gustavo Rotondaro, M.U.P.D.D. Director of Information Services and Community Research Initiatives, Community Research Institute

Community Family Partnership Kent County System of Care | Dorothy A. Johnson Center for Philanthropy © 2013 2

ACKNOWLEDGMENTS

DEMOGRAPHICS11.

PLACEMENT13.

SERVICE ARRAY UTILIZATION17.

SERVICE EXPERIENCE19.

SCHOOL ATTENDANCE and PERFORMANCE21.

DELINQUENCY23.

NATURAL SUPPORTS25.

FUNCTIONING26.

METHODOLOGY36.

DATA LIMITATIONS36.

APPENDIX A: DESCRIPTIONS of DATA COLLECTION INSTRUMENTS

37.


TABLE OF CONTENTS

INTRODUCTION4.

KEY HIGHLIGHTS5.

ENROLLMENT and REFERRAL SNAPSHOT

6.

The Community Family Partnership Kent County System of Care (CFP) is a network of youth-serving public systems and community partners working together with youth and families to increase access to effective, coordinated mental health services and supports.


INTRODUCTION

CFP strives to offer a broad array of services and supports for youth ages 5 to 17 with serious emotional disturbances involved in at least two youth service systems (mental health, special education, juvenile justice, and child welfare) and their families.

Within its system, CFP provides two types of service delivery models: Wraparound and Parent Support Partners (PSP). Wraparound is a team-based planning process used to bring all system providers (school, court, child welfare, and others) and natural supports together with a youth and their family to create a shared plan that focuses on the youth and family’s identified needs and goals. Parent Support Partner services are delivered by parents of children who experience emotional, behavioral, or mental health challenges. PSPs work to equip families with the skills, knowledge,

and abilities necessary for them to successfully navigate multiple systems.

The Dorothy A. Johnson Center for Philanthropy’s Community Research Institute (CRI) at Grand Valley State University conducts the evaluation for CFP. CRI evaluates CFP outcomes at the system, practice, and youth/family levels. Local needs, as defined by the CFP logic model and community stakeholders, and national requirements for Substance Abuse and Mental Health Services Administration (SAMHSA) funding determine data collection and analysis.

The evaluation utilizes a longitudinal design to examine change over the course of service duration and beyond. CFP staff and CRI interviewers collect data at baseline (enrollment into CFP services) and at six month intervals. Enrollment into the evaluation is on a

rolling basis, as families are continuously enrolled into CFP services.

CFP began enrolling families into Wraparound and PSP services in January 2012. CRI began collecting baseline data at this time; enrollment into CFP services has since increased to the point that CRI has data for a sample of families who have been enrolled into services for 12 or more months. This report focuses on data for families who have both baseline and six or 12 month follow-up assessments to assess their change over time. The purpose of this report is to identify trends in CFP projected outcomes; it should be used to continue monitoring successes and challenges and also to provide direction on decision making and strategy.


KEY HIGHLIGHTS• The mental health system provides the most referrals of youth into

CFP, but Department of Human Services and Juvenile Justice have been referring at a notably high rate in the past six months and this has led to a changing demographic with outcome implications.

• The majority of CFP youth are male and in their teenage years, and most are White/Caucasian. About 31 percent of youth are African American, 14 percent are Hispanic, and 10 percent are multi-racial.

• Over two thirds of the CFP youth population has had at least one out of home placement prior to enrolling in CFP services. An out of home placement can include institutional settings, such as residential or detention, or community-based settings, such as foster care.

• At the time of referral, the majority of youth were at an imminent risk for out of home placement or a more restrictive level of care. African American/Black youth show a statistically significant higher risk.

• The overwhelming majority of CFP youth are living in a community setting at the time of their referral into CFP. An in community setting is defined as a setting where youth remain fully engaged with their school/work, community members, friends, place of worship, and other community services and supports.

• Informal Supports (defined as assistance from persons who provide support to a child and family without compensation from any formal service system) is the one type of service that had a statistically

significant increase in caregivers’ perception on how well the service met the needs of the family.

• On average, caregivers report high satisfaction with services, engagement with services, and perception of service providers’ cultural competency.

• The majority of caregivers responded they would return to CFP if they needed help again and they would recommend CFP to friends or family if they needed help.

• Youths’ school attendance stayed the same or improved for 73 percent of youth after 12 months of services.

• The number of youth who had previously been arrested, told to appear in court, and/or questioned by the police decreased at the 12 month follow up period.

• Child and Adolescent Functioning Assessment Scale (CAFAS) scores dropped on average of 30 points from a youth’s first assessment to their fourth assessment at exit.

• An increase in natural supports continues to predict an increase in functioning according to caregiver ratings.

• Data displayed with the label National refers to SAMSHA System of Care programs funded between 2009 and 2010 across the country.

• The number of youth enrolled into CFP services rose in this past year, with the highest number of authorizations in the first quarter of 2013.


Mental health continues to refer the most youth to CFP. This is not surprising, given that the large majority of youth are involved in the mental health system at the time of enrollment. Department of Human Services and Juvenile Justice referred youth at a higher rate than in the past. These numbers support the goal of continued efforts to increase system coordination and collaboration among partner agencies. A focus has turned to involving the education system, though it is unclear what impact it will have on referrals going forward. As previous reports have shown, conduct/delinquency issues are the most considerable presenting problem for youth enrolling in CFP. Likely, this includes youth with general behavioral issues that may not have criminal justice involvement. Over half of youth have problems with school performance. This again highlights the need to engage with system partners, particularly the education system.

ENROLLMENT AND REFERRAL SNAPSHOT

Number of Authorizations Fig. 1

2012

January February March April May June July August September October November December

4 5 17 7 18 16 6 8 19 17 5 3

2013

January February March April May June July August September October November December

12 24 24 21 19 12 25 17 18 21 19 13

2014

January February

17 15

Source: Referral Form; n = 380


Location of CFP Youth at Time of Referral Fig. 2

Source: Referral Form; n = 329

189OPEN CASES

378TOTAL SERVED

Source: Enrollment Form; n = 378

ENROLLMENT STATUS:

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Ada

Solon

Byron

Alpine

Sparta

Tyrone

Bowne

Lowell

Nelson

Gaines

GrattanCannon

Algoma Oakfield

Spencer

Plainfield

Cascade

Courtland

Walker

Caledonia

Vergennes

Grand Rapids

Wyoming

Kentwood

Grand Rapids

Grandville

Lowell

Rockford

East Grand Rapids

Cedar SpringsCedar Springs

e r e C F P Y o u t h L i v e e C F P Y o u t h L i v e

Legend

× Address at Referral

Expressways

Cities & Townships

The majority of youth were living in the city of Grand Rapids at the time of referral, followed by Wyoming, Kentwood, and the remainder throughout Kent County.


• The mental health system refers approximately half of all youth to CFP.

• The number of referrals from foster care agencies has decreased since the previous Stakeholders Report in September 2013 (down from 19%).

• Referrals from the child welfare system have increased (up from 9%).

• There has been a rise in juvenile justice referrals (from 17 percent to 19 percent).


Referral Source by System Fig. 3

System Involvement at Time of Referral Fig. 4

0 % 20% 40% 60% 80%

Mental Health

Special Education

Juvenile Justice

Child Welfare (DHS)

Foster Care

Mental HealthMental Health

CFPCFP

Foster CareFoster Care

Juvenile JusticeJuvenile Justice

Child Protective Services (DHS)Child Protective Services (DHS)

Special EducationSpecial Education

OtherOtherSource: Referral Form; n=378

Source: Referral Form; n=378

The greatest involvement is in the mental health system. The majority of youth are also involved in some type of special education. The proportion of youth involved with juvenile justice is high in comparison to other SOC communities.


Source: Enrollment; n=379

CFP Services Fig. 5

Wraparound Only

Parent Support Partner Only

Wraparound and Parent Support Partner

Currently Recieving Services (189 youth)

98 (52%)

33 (17%)

58 (31%)

46%

19%

14%

14%

4%

1%

84%

60%

35%

29%

10%



Presenting Problems Fig. 6

CONDUCT/DELINQUENCY RELATED PROBLEMS

HYPERACTIVE and ATTENTION-RELATED

PROBLEMS

SCHOOL PERFORMANCE PROBLEMS NOT RELATED to LEARNING DISABILITIES

LEARNING DISABILITIES

87%85%88%

56%63%

51%

56%54%58%

ADJUSTMENT-RELATED PROBLEMS

DEPRESSION-RELATED PROBLEMS

ANXIETY-RELATED PROBLEMS

53%60%48%

47%

50%44%

27%28%27%

26%28%24%

OVERALL

WHITE

NON-WHITE




PRESENTING PROBLEMS Fig. 6

SUICIDE-RELATED PROBLEMS

SUBSTANCE USE, ABUSE, and DEPENDENCE

PROBLEMS

SPECIFIC DEVELOPMENTAL DISABILITIES

EATING DISORDERS

22%29%17%

19%16%21%

15%16%14%

PSYCHOTIC BEHAVIORSOTHERPERVASIVE DEVELOPMENTAL

DISABILITIES

15%23%8%

11%15%8%

8%8%9%

1%1%1%

• Most of the presenting problems have decreased over the past six months.

• Presenting problems for Whites compared to Non-Whites are notably different. Non-Whites have a higher percentage of conduct/delinquency and substance use. Whites have higher percentages of hyperactivity and attention, suicide related problems, pervasive developmental disabilities, depression, and anxiety.


• The CFP population is overwhelmingly male (68%) and between the ages of 12 and 18 (65%). These demographic characteristics should be taken into consideration when interpreting data results and trends, as these traits provide important context to the reported outcomes.

• There are significantly more males in CFP compared to the national cohort. • About 5% of CFP youth indicated they were not sure about their gender identity or the categories provided did not fit how

they identify (no youth selected “transgendered”)


DEMOGRAPHICS

Male 68%

Female 32%

Male 57%

Female 42%

Source: EDIF (Data Profile Report); CFP: n = 376, National: n = 3,712

Gender Fig. 7

CFP

NATIONAL

Age Fig. 8

Source: EDIF (Data Profile Report); CFP: n = 376 National: n = 3,704

Birth to 3 years 1%

4 to 6 year 9%

7 to 11 years 25%

12 to 14 years 34%

15 to 18 years 31%

19 to 21 years 0%

Birth to 3 years 13%

4 to 6 year 9%

7 to 11 years 20%

12 to 14 years 20%

15 to 18 years 33%

19 to 21 years 6%

CFP

NATIONAL

• The proportion of youth between 12 - 14 years increased to 34% (from 24.5%), which is considerably higher than the national average.

• The majority of youth are White/Caucasian (45%). Approximately 31 percent are Black/African American and 14 percent are Hispanic.

• The distribution of race and ethnicity among CFP youth is similar to the national cohort except for Hispanics (14% versus 19%) and Multi-Racial (10% versus 4.2%) youth.

• In Kent County, there is a significant over representation of African American males in CFP who are in out-of-home settings such as detention and foster care in comparison to the national cohort.


Caregiver Employment and Income Fig. 10

Source: LOS-CIS (Data Profile Report); CFP: n=150, National: n=1,912

0

20

40

60

80

100

CFP National

67.9%

12.9%

19.3% 22.1%

12.2%

65.7%

52.7%Caregivers Employedin the Past Six Months

DEMOGRAPHICS

Source: EDIF (Data Profile Report); CFP: n = 374, National: n =3,678

White 45%

Black or African American 31%

Hispanic or Latino 14%

Multi-Racial 10%

Asian .3%

White 43%

Black or African American 29%

Hispanic or Latino 19%

Multi-Racial 4%

Asian 1%

CFP

NATIONAL

Race/Ethnicity Fig. 9

ABOVE POVERTY AT/NEAR POVERTY BELOW POVERTY



PLACEMENT

ZERO PLACEMENTS ONE PLACEMENT

TWO PLACEMENTS

34%37%31%

27%21%31%

16%19%14%

OVERALL WHITE NON-WHITE

THREE PLACEMENTS FOUR or MORE PLACEMENTS

13%12%15%

10%11%10%

Number of Placements Prior to CFP EnrollmentFig. 11

66%of youth have had AT LEAST ONE PLACEMENT that was not in the home before enrolling in CFP.

• The majority of youth (67%) are living at home at the time of referral. This represents a two percent increase from the last Stakeholders Report in September 2013.

• About 18 percent are in foster care or a guardian placement and 12 percent are in institutional care such as detention or residential. The proportion of youth in these institutions is slightly higher than the national average for other SOC communities.

• Eligibility criteria for CFP youth mirror national criteria for at risk for out of home placement; therefore CFP considers all youth who enter their services to be at risk for out of home placement.

• Additionally, African American/Black youth are more likely to be at risk for more restrictive care when they enter CFP services at the time of referral.

• A higher percentage of non-White youth (70%) have had at least one placement out of the home compared to White youth (63%).

• Non-whites are less likely to be at Home (61% vs. 77%), more likely to be in foster care (21% vs. 13%), and more likely to be in detention (9% vs. 3%) at the time of referral.



Placement at Time of Referral Fig. 12

PLACEMENT

HOME FOSTER CARE DETENTION

67%77%61%

18%13%21%

6%3%9%


RESIDENTIAL PSYCHIATRIC HOSPITALIZATION

5%5%6%

1%1%0%

OTHER

3%2%3%


The goal of CFP is to divert youth from the most restrictive placements (Detention, Residential, and Psychiatric). Most youth come into CFP at a time of being at risk for more restrictive care. When we look at placement change while in CFP, we find there are still a lot of placement changes happening. Information on placement was gathered at enrollment (baseline) and exit. The exit assessment includes youth who have withdrawn from services or changed placements. Seven percent of youth were living in an “out of community” (institutionalized care) setting at baseline and it dropped to 4 percent at exit.

*Data is not shown for 12 months due to a low sample size that was not statistically significant.

**Several of the placement categories were grouped in the following ways: Home consists of birth parent, adoptive parent, legal guardian, unpaid kinship, and independent youth; Foster care consists of pre-adoption, permanent foster care, temporary foster care, paid kinship, and therapeutic foster care; Psychiatric consists of state hospital and inpatient; Residential consists of group homes and drug/alcohol treatment centers;

****Out of Community (Institutionalized Care) is defined as Detention, Residential, and Psychiatric.

Source: Family Status Report; n = 48-218

7%BASELINE

OUT of COMMUNITY(INSTITUTIONALIZED CARE)

4%EXIT

OUT of COMMUNITY(INSTITUTIONALIZED CARE)

PLACEMENT

Assessment % days institutionalized care N=

Intake 7% 218

3 month 7% 178

6 month 7% 121

Exit 4% 48

Average Percent of Time in Institutionalized Care - Non-matched Fig. 14

Source: Family Status Report; n = 48-218

PLACEMENT CHANGE Fig. 13


Intake (n=24)

3 month (n=24)

6 month (n=24)

Exit (n=24)

Detention 13% 17% 17% 4%

Residential 8% 0% 8% 4%

Psychiatric 0% 0% 0% 0%

Foster Care 58% 58% 58% 46%

Group Home 0% 8% 8% 0%

Home 38% 38% 33% 46%

Emergency Shelter 4% 8% 4% 4%

Whereabouts Unknown

4% 0% 4% 4%

Crisis 0% 0% 0% 0%

Other 0% 0% 0% 4%

Placement in Last 90 Days for ‘Matched Pairs’ Fig. 16

Intake (n=261)

3 month (n=199)

6 month (n=135)

Exit (n=54)

Detention 13% 30% 8% 6%

Residential 8% 6% 10% 6%

Psychiatric 7% 2% 2% 0%

Foster Care 28% 34% 33% 46%

Group Home 4% 4% 4% 2%

Home 65% 62% 57% 46%

Emergency Shelter 7% 3% 2% 1%

Whereabouts Unknown

1% 3% 3% 9%

Crisis 3% 2% 0% 0%

Other 3% 3% 4% 2%

Placement in Last 90 Days for ‘Unmatched Pairs’ Fig. 15

When we look into placement for youth who have had at least 6 months of service, exit assessments show reduced placement in Foster Care, Detention, and Residential.

• The percent of CFP youth in institutional care decreases from baseline to exit for both the larger unmatched sample (8% less in Detention, 3% less in Residential, and 7% less in Psychiatric) and the matched sample (8 % less in Detention 4% less in Residential, and zero in Psychiatric) that only looks at the same youth who have essentially had a full dosage of service.

• Foster Care for unmatched is rising (28% at baseline and 46% at exit) and Home is decreasing (65% at baseline and 46% at exit), however when you follow the same kids (matched pairs) who have been in services for at least nine months the trends are improving (Foster Care drops 12% and Home increases 8%).

• The rise in Whereabouts Unknown (1% at baseline to 9% at exit) warrants further investigation as these youth potentially represent youth who could be diverted from going to Detention, Residential, or Psychiatric.

PLACEMENT

Source: Family Status Report; n = 54-261 Source: Family Status Report; n = 24


SERVICE ARRAY UTILIZATION Fig. 17

Services Children and Family Use at Intake and 6 Months Fig. 16

Medication Treatment Monitoring

Individual Therapy

Assessment or Evaluation

Informal Support

Family Therapy

Case Management

Recreation Activities

Residential Treatment Center

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

56% 72% 78%

88% 97% 78%

77% 53% 53%

34% 22% 47%

58% 42% 56%

70% 60% 37%

22% 6% 28%

25% 19% 28%

Group Therapy

Independent Living

Family Support

Respite

Crisis Stabilization

Behavioral/Therapeutic Aide

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

38% 38% 19%

0% 9% 16%

41% 16% 16%

28% 25% 16%

34% 19% 16%

19% 13% 13%

BASELINE 6 MONTHS 12 MONTHS


Source: LOS- MSSC-R (Data Profile Report); n = 30 - 32

SERVICE ARRAY UTILIZATION Fig. 17

Services Children and Family Use at Intake and 6 Months Fig. 16

Flexible Funds

Vocational Training

After School Programs

Inpatient Hospitalization

Family Preservation

Day Treatment

Therapeutic Group Home

Transition

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

0 50 100 150 200 250 300

3% 19% 13%

0% 9% 13%

3% 16% 9%

25% 16% 9%

9% 3% 6%

16% 9% 6%

3% 0% 6%

7% 3% 3%

Residential Camp

Therapeutic Foster Care0 50 100 150 200 250 300

0 50 100 150 200 250 300

3% 6% 3%

3% 3% 3%

• The use of informal supports increased from baseline to 12 months.• Medication treatment/monitoring is the one service that significantly rose at the 12 month mark. • The overall decrease in service utilization is a good indication that CFP helps families transition to less intensive and costly

services over time.• Satisfaction with services at the 12 month follow-up assessment improved. The average caregiver responded “very well” or

“extremely well” to the question “how well did the service meet the needs of your family?” The services included Medication Treatment Monitoring, Assessment or Evaluation, Family Therapy, Transportation, and Informal Supports.

Transportation

0 50 100 150 200 250 300

19% 25% 13%


Cultural Competence and Service Provision at 12 Months Fig. 18

Source: LOS-CCSP (Data Profile Report); Caregiver: n=30-31

SERVICE EXPERIENCE

1 52 3 4

Provider understood child/family beliefs about mental health

I am comfortable discussing with provider on alternative therapies or other ways to work with child

Provider asks about my family traditions, beliefs, and values when planning or providing services

Materials given to me (brochures/newslettrs) about the program or available services are easy to understand

Provider is comfortable interacting with me and child

Family engagement with services, satisfaction with services, and the cultural competency of service providers remain highly rated by caregivers at the 12 month mark. Caregivers overwhelmingly agree they would probably or absolutely come back to the program and recommend the program to others. The item “Provider asks about my family traditions, beliefs, and values when planning or providing services” rated slightly lower. Youth ratings regarding their participation and influence with services increase from the six month mark to the 12 month mark, where the majority (58%) agree they participate in guiding their services.

The findings regarding service experience consistently show families have a positive perception of the services they are receiving. While actual outcomes are not necessarily related to family perception and opinion, it is encouraging that this data continually affirms the positive service experience of families in CFP.

• Most items have an average score of four or greater out of five; on average, caregivers believe these items are happening “most of the time” at the 12 month mark. The one item below this rating (with a 3.4) was “Provider asks about my family traditions, beliefs, and values when planning or providing services.”

4.5

4.3

3.4

4.5

4.7

• Satisfaction has increased for all of these questions since the previous Stakeholders Report.

• Engagement has increased slightly since the previous Stakeholders Report.

• The majority of caregivers responded they would return to CFP if they needed help again and they would recommend CFP to friends or families if they needed help

• Over 50 percent of youth answered “often” or “always or almost always” to the items at 12 month follow-up. However, this does leave a large portion of youth who appear to not be using their voices to their fullest extent during service provision.


YOUTH MANAGEMENT of SERVICES Fig. 21

Would you recommend the program to others?

0

20

40

60

80

100

Would you come back to the program?

Source: LOS- MSCC-R (Data Profile Report); n = 29

Source: TRAC-NOMS; Caregiver: n=401 2 3 4 5

Treated With Respect

People stuck with us

Satis�ed with services

Got help needed

Got help wanted

54321

Participated in treatment

Chose services

Chose Treatment

Source: TRAC-NOMS; Caregiver: n=40

0

10

20

30

40

50

60

I work with providers to adjust my services or supports so they

fit my needs.

When a service or support is not working

for me, I take the steps to get it

changed.

I tell service providers what I think about the

services I get from them.

42%

58% 58% 58% 58%53%

86% 90%

7% 3%7% 7%

Source: LOS- MSCC-R (Data Profile Report); n = 19

Satisfaction with Services Fig. 19

Family Engagement Fig. 20

Caregivers’ Recommendations for CFP at 12 Months Fig. 21

Absolutely/ Probably Absolutely not/ Probably not Not Sure

Youth Management of Services Fig. 22

Baseline 12 Months

SERVICE EXPERIENCE

4.4

4.4

4.5

4.7

4.6

4.4

4.3

4.2


CFP youth attend over 200 schools throughout Kent County. The majority of them attend schools in the Grand Rapids Public School district (98), though Kentwood, Lighthouse, and Wyoming districts also have a notable amount of CFP youth.

SCHOOL ATTENDANCE and PERFORMANCESuspensions have decreased over time, from intake to the six month and 12 month mark. Those who were neither suspended nor expelled increased from six months to 12 months by over 20 percent. These outcomes around disciplinary actions are positive; however, the data for school attendance and performance remain a bit ambiguous. While attendance has improved for the majority of youth, the data shows that it actually worsened for 27 percent of the sample. Similarly, while school performance improved for 40 percent of youth, it also worsened for 30 percent. It is difficult to glean any precise meaning from these findings, but again, the data emphasizes the need for CFP to engage with different system partners (particularly education) to interpret these findings and work toward improving outcomes.

District CountGrand Rapids Public Schools 98

Kentwood Public Schools 27

Lighthouse Academy 19

Wyoming Public Schools 19

Northview Public Schools 11

Forest Hills Public Schools 10

Comstock Park Public Schools 9

Cedar Springs Public Schools 8

Kenowa Hills Public Schools 8

Godwin Heights Public Schools 7

Grandville Public Schools 6

Sparta Area Schools 6

Caledonia Community Schools 5

Lowell Area Schools 5

Other 28

* Schools with less than five CFP youth were added to other

LOWELL AREA SCHOOLS

CEDAR SPRINGS PUBLIC SCHOOLS

SPARTA AREA SCHOOLS

ROCKFORD PUBLIC SCHOOLS

CALEDONIA COMMUNITY SCHOOLS

KENT CITY COMMUNITY SCHOOLS

KENOWA HILLS PUBLIC SCHOOLS

GRANDVILLE PUBLIC SCHOOLS

GRAND RAPIDS PUBLIC SCHOOLS

FOREST HILLS PUBLIC SCHOOLS

BYRON CENTER PUBLIC SCHOOLS

KENTWOOD PUBLIC SCHOOLS

WYOMING PUBLIC SCHOOLS

NORTHVIEW PUBLIC SCHOOL DISTRICT

COMSTOCK PARK PUBLIC SCHOOLS

KELLOGGSVILLE PUBLIC SCHOOLS

GODWIN HEIGHTS PUBLIC SCHOOLS

EAST GRAND RAPIDS PUBLIC SCHOOL DISTRICT

GODFREY-LEE PUBLIC SCHOOLS

Legend

School DistrictsNumber of Youth

1

2 - 6

7 - 11

12 - 26

27 - 99

Where CFP Youth Attend SchoolFig. 23

• Over half of the caregivers reported that their youth’s attendance improved from baseline to the 12 month follow-up. This is a higher rate of improvement than the national System of Care cohort (39%).

• About a quarter of caregivers reported their youth’s attendance worsened.

• School performance improved for 40 percent of youth from baseline to 12 months according to caregivers. This is a lower rate of improvement than the national System of Care cohort (49 percent).

• Performance also worsened for 30 percent.

• Caregivers reported a 22 percent improvement from baseline to 12 months on youth not being suspended or expelled.

• White youth had a lower rate of school disciplinary actions at baseline (40% vs 54%) and the rate of being neither suspended nor expelled at the 12 month follow-up was much higher for White youth (35% improvement) than Non-White youth (5% improvement).


SCHOOL ATTENDANCE and PERFORMANCE

Source: LOS-EQ-R-2 (Data Profile Report); n=37

1

2

3

54%

19%

27%

1

2

3

40%

30%

30%

School Attendance and Performance from Intake to 12 Months Fig. 24

Source: LOS-EQ-R-2 (Data Profile Report); n=20

Improved Remained Stable Worsened

ATTENDANCE PERFORMANCE

Neither Suspended Nor Expelled:

46% at Baseline

68% at 12 Months

School Disciplinary Actions Fig. 25

BASELINE 12 MONTH

40%54%

75%59%

WHITE NON-WHITE


The percent of CFP youth involved in juvenile justice is increasing due to the increase in referrals from this system. Many of the delinquency data points show a desirable decrease from intake to six months to 12 months, including the number of youth arrested, told to appear in court, questioned by the police, and convicted of a crime.

Source: LOS-DS-R (Data Profile Report); n = 95

DELINQUENCY

Youth who reported some type of criminal justice contact prior to intake

64%Have You Ever Been? Fig. 26


CONVICTED of a CRIME? TOLD to APPEAR in COURT? ARRESTED?

34%22%43%

33%22%45%

50%34%66%


• The percent of youth reporting ever having criminal justice contact has increased at baseline (from 59% to 64%) from last Stakeholders Report.

• Non-White youth are about twice as likely to be told to appear in court, have been convicted of a crime, and arrested.

• Those who were on probation decreased from the six months to 12 months.

• Involvement with police at the 12 month mark decreased considerably.

Source: LOS-DS-R (Data Profile Report); n = 19

Source:LOS- DS-R (Data Profile Report); n = 27-31

DELINQUENCYYouth Criminal Justice Contact: Baseline and 12 months Fig. 27

BASELINE 6 MONTH 12 MONTH

CONVICTED of a CRIME

11%11%5%

TOLD to APPEAR in COURT

21%5%5%

ON PROBATION

32%37%26%

ARRESTED

26%16%5%

0 20 40 60 80 100

Youth Involvement with the Police: Baseline and 12 Month Fig. 28

BASELINE

12 MONTH

26%

61%

93%

13%

7%

0%

NO TIMES 1 TIME 2 or MORE TIMES

• Notable increases in use of natural supports were reported by youth in regards to having an adult who can help as well as having fun with others.

• The majority of youth responded “sometimes” or “usually/always” to all of the natural support questions at both assessment points.

• Only the responses to “If a problem or emergency rises, how often can you depend on having someone your own age to turn to for help and support?” decreased in the “usually/always” category at the 12 month follow-up.

• There are increases in natural support items from baseline to the 12 month follow-up and those increases are statistically significant predictors of functioning. Meaning, as caregiver ratings on natural supports increases, so do their ratings on functioning.


Youth Perspective on Natural Supports Fig. 29

Source: LOS-YIQ-R-I (Data Profile Report); n = 29-31

NATURAL SUPPORTS

0

20

40

60

80

100

Baseline 12 Months Baseline 12 Months Baseline 12 Months Baseline 12 Months If a problem or emergency arises, how often

can you depend on having someone your own age to turn to for help and support?

If a problem or emergency arises, how often can you depend on having an adult

to turn for help and support?

How often do you have someone your own age to have fun with or

hang out when you want to?

How often do you have an adult to have fun with or hang out with

when you want to?

Usually/Always Sometimes Never/Rarely

52%

19%

29%

24%

31%

45%

68%

26%

7%

10%

7%

83%

32%

58%

7%10%

66%

32%

52%

28%

58%

35%

10% 14%

Caregiver ratings for natural supports remain high. The data continues to show (at six months and 12 months) that as natural supports increase, so does functioning, according to caregiver ratings on both topics. The consistency of this finding supports the need to further explore how caregivers are defining natural supports and how CFP can promote utilization of these supports.

Caregiver Perspective on Natural Supports Fig. 30

1 - Strongly Disagree Strongly Agree - 5 % Change

Comfortable Talking

People For Enjoyable Things

Listen And Understand

Support From Family

3%

7.7%

13.3%

16.4%

Source: TRAC; n = 40


Child and Adolescent Functioning Assessment Scale (CAFAS)

FUNCTIONINGData on functioning covers a broad spectrum of issues, and the findings are varied. There is however a general theme that emerges, being that functioning outcomes are not always improving at a desirable rate. Positive areas include an overall decrease in CAFAS scores; Caregiver perception of their child’s functioning, where ratings increased from intake to 12 months; the percent of youth scoring within the clinical range for externalizing issues, which has decreased about 15 percent from intake to 12 months; youth reports of substance use, all of which decreased by the 12 month mark; and caregiver strain, which shows that 43 percent improved at 12 months, 54 percent remained stable, and only three percent worsened.

In contrast, youth who scored in the clinical range for internalizing issues steadily increased from intake to 12 months (from 62% to 79%). Additionally, an overwhelming majority of youth in this sample scored in the clinical range for impairment (defined as problems experienced in different domains of life, such as interpersonal relations, school/work, and leisure time) at intake, six months, and 12 months; however, only about 13 percent of youth showed improvement in this category at 12 months, and the large majority did not show any significant change. Youth continue to rate themselves higher than caregivers on perception of their behavioral and emotional strengths; however, at the 12 month mark, 24 percent of youths’ scores worsened in this category and 30 percent of caregivers’ scores did as well.

It is clear there are some areas for improvement when it comes to different aspects of functioning. It is important to note the distinction between the high ratings regarding service experience and these findings regarding functioning, which are less clear cut. While families may have a positive perception of services and providers that does not necessarily translate to positive outcomes. It will be important to explore why some of these outcomes are actually worsening at the 12 month mark.

• There has been a significant positive change in total functioning for CFP youth. The overall score dropped an average of 30 points from a youth’s first assessment to exit.

• The greatest decrease in scores occurred between the baseline to three month assessment and baseline to exit assessment.

• Home, School, and Behavior were the subscales with the most improvement from baseline to exit (average improvements of 7.06, 6.18, and 6.18 respectively).


Youth Harm to Self forIntake to Six Months Fig. 36

60

80

100

120111

99

9093

71

Baseline 3 Months 6 Months 9 Months Exit

Source: CAFAS; n=38-218

Source: CAFAS; n=31-146

Average CAFAS Score Difference Fig. 32

CAFAS Baseline to 3 mo. (n=142-146)

Baseline to 6 mo. (n=103-106)

Baseline to 9 mo. (n=52-55)

Baseline to Exit (n=31-34)

School 2.05* 4.91* 5.1* 6.18*

Home 1.78* 3.96* 6* 7.06*

Community 1.64* 4.34* 4.2* 4.12

Behavior 2.4* 4.91* 3.82* 6.18*

Moods/Emotions 1.4 3.02* 2.73* 3.24*

Moods/Self Harm 1.1 1.51 2.26 4.12*

Substance Abuse 0.28 0.87 1.73* 0.97

Thinking -0.42 -1.5 -2.4 -0.94

Total 10.2* 22.57* 22.45* 30.59*

*An asterisk indicates a statistically significant change (p<.05).

Child and Adolescent Functioning Assessment Scale (CAFAS) Fig. 31

FUNCTIONING

A decrease in CAFAS scores indicates greater functioning


Reliable Change Index of Youth Behavioral and Emotional Problems from Intake to 12 Months Fig. 34

Youth Behavioral and Emotional Problems Fig. 33

• Caregiver responses reveal a high percentage of youth scoring in the clinical range for externalizing behaviors, however there is a significant decrease at the 12 month follow-up.

• The sample of those with a 12 month assessment has higher externalizing scores on average, but show strong improvements over 12 months.

• The majority of youth display internalizing behaviors within the clinical range, and there is an increase at the 12 month follow-up, though 19 percent had statistically significant improvement and three quarter remained stable from baseline to 12 months.

• The majority of youth behavior and emotional issues remained about the same.

Source: LOS-CBCL (Data Profile report); n = 37

Source: LOS-CBCL (Data Profile Report); n = 34

INTERNALIZING

62%68%79%

Intake 6 Month 12 Month

EXTERNALIZING

91%82%77%

1

2

3

19%

76%

5%

1

2

3

24%

73%

3%

INTERNALIZING EXTERNALIZING


FUNCTIONING

• Caregiver responses show a high percentage of youth scoring in the clinical range for impairment.

• Youth responses show low percentages scoring in the clinical range for anxiety and depression.

• The majority of youth remained about the same in these three categories, but 21 percent showed significant improvement for anxiety and 25 percent for depression.

• Only 5 percent of CFP youth were in the clinical range for depression at 12 months. This is lower than the Statewide rate (10%) for 14-17 years olds who have a Major Depressive Episode.1

1. Behavioral Health Barometer: Michigan, 2013. Substance Abuse and Mental Health Services Administration.


Impairment Source: LOS-CIS (Data Profile Report); n=30Anxiety Source: LOS-RCMAS (Data Profile Report); n=13Depression Source: LOS-RADS (Data Profile Report); n=20

Youth Impairment Anxiety, and Depression Fig. 35

The majority (85%) of youth were in the clinical range for Impairment at 12 months, but none of the youth were within the range for Anxiety and only 5% remained within the range for depression at 12 months.

IMPAIRMENT

91%91%85%

Baseline 6 Month 12 Month

ANXIETY

0%0%0%

DEPRESSION

15%15%5%

IMPAIRMENT ANXIETY


DEPRESSION

1

2

3

25%

67%

8%

1

2

3

21%

79%

0%

1

2

3

13%

82%

5%

Reliable Change Index from Intake to 12 Months Fig. 36

Impairment Source: LOS-CIS (Data Profile Report); n=39Anxiety Source: LOS-RCMAS (Data Profile Report); n=19Depression Source: LOS-RADS (Data Profile Report); n=24

FUNCTIONING


Source: CIQ (Data Profile Report); n=38

ATTEMPTED

16%1%

Baseline 12 Month

TALKED ABOUT

30%6%

CIGARETTES ALCOHOL

Baseline 6 Month 12 Month

MARIJUANA

Youth Substance Use Fig. 38

• This sample has much less suicidal ideation and attempts than the previous sample from last Stakeholders (26% attempted suicide at baseline in the previous sample versus 16% of those with complete 12 month assessments). The general trend of improvement remains the same, however.

• Youth report a strong decrease in both talking about and attempting suicide.

• Youth reporting a suicide attempt decreased from 16 percent to 1 percent at the 12 month follow-up.

Youth Harm to Self Fig. 37

25%15%

30%26%5%

16%15%10%

15%

FUNCTIONING

Source: SUS-R (Data Profile Report; n=19-20


Source: GAIN (Data Profile Report); n=33

• Research on a national level has found that youth with emotional and behavioral disturbances may be more susceptible to substance use. Early indications for CFP may suggest that the system of care model is having an impact on reducing substance use.

• Substance use decreased for cigarettes, alcohol, and marijuana from baseline to 12 months.

• This sample has a higher percentage at baseline than the previous Stakeholders Report but show a decrease in use at 12 months.

• CFP youth report cutting their cigarette use in half (30% to 15%), though it is still higher than the statewide rate of cigarette use among 12-17 year olds (8 percent). 1

• Alcohol use for CFP youth at 12 months is lower than the State average among 12-17 year olds (5% vs. 7% respectively).

• The Substance Problem Scale contains a range of questions about substance use and scores the youth along three levels of severity: No/Minimal Urgency, Moderate Urgency, and High Urgency. Almost half of CFP youth report some use and range from a moderate to high urgency level (46% and 3% respectively). 2

1. Behavioral Health Barometer: Michigan, 2013. Substance Abuse and Mental Health Services Administration2. Behavioral Health Barometer: Michigan, 2013. Substance Abuse and Mental Health Services Administration

Substance Problem Scale Fig. 39

NO/MINIMAL URGENCY

52%MODERATE URGENCY

46%HIGH URGENCY

3%FUNCTIONING


Caregiver and Youth Strength Index Fig. 40Strength Index scores improved over time

CAREGIVER YOUTH


1

2

3

35%

35%

30%

1

2

3

33%

42%

24%

Reliable Change Index for Caregiv-er and Youth Strength Index from Intake to 12 Months Fig. 41

Caregiver Source: LOS-CIS (Data Profile Report); n=33Youth Source: LOS-CIS (Data Profile Report); n=20

• The strength index scores youths’ strengths. The caregiver-reported score does not fall into the nationally representative average of scores; however, the youth-reported score does. The nationally representative average is meant to provide a guideline for service providers to see whether or not their clients fall above or below this average.

• For both caregiver and youth scores, about a third of the samples significantly improved their strengths from baseline to the 12 month follow-up. The youth reported version showed the highest increase in scores (94.0 to 101.5).

Caregiver Strength Index

Youth Strength Index

76.0

94.0

76.5

98.1

77.6

101.5

Intake 6 Months 12 Months

Source: LOS-BERS (Data Profile Report); Caregiver: n = 28, Youth: n = 17

FUNCTIONING

Objective strain: Observable disruptions in family and community life.

External strain: Negative feelings about the child (anger, embarrassment, etc.)

Internal strain: Negative feelings the caregiver experiences (worry, guilt, etc.)

The majority of caregivers report their strain remained about the same, but there was improvement across all subscales. The largest improvement is seen in objective strain, with 35 percent of caregivers reporting improved scores at the 12 month follow-up.


Caregiver Strain Fig. 42

OBJECTIVE


1

2

3

15%

83%

3%

Reliable Change Index of Caregiver Strain from Intake to 12 Months Fig. 43

Source: LOS-CGSQ (Date Profile Report); n=34-35

1 - Less Strain Greater Strain - 5 % Change

Objective Strain

Subjective Externalized Strain

Subjective Internalized Strain

-26.5%

-17.9%

-15.4%

GLOBAL

1

2

3

43%

54%

3%

SUBJECTIVE EXTERNALIZED

SUBJECTIVE INTERNALIZED

1

2

3

24%

70%

5%Objective Source: LOS-CGSQ (Date Profile Report); n=38Subjective Externalized Source: LOS-CGSQ (Date Profile Report); n=38Subjective Internalized Source: LOS-CGSQ (Date Profile Report); n=37Global Source: LOS-CGSQ (Date Profile Report); n=38

FUNCTIONING

1

2

3

35%

58%

8%


Source: LOS-MSSC; n = 14-20

Barriers to Caregiver Employment Fig. 44

CFP National System of Care

0

10

20

30

40

50

60

My health problems/ disability

Child’s behavioral and

emotional problems

Other Childcare problems

Other family responsibilities

I was not interested in employment during that

period

In school or other training

Could not find any work at the

desired pay

Transportation problems

Source: LOS-CIS (Data Profile Report); CFP: n=70, National: n=428

Caregiver Perspective on Services and Employment Fig. 45

0

20

40

60

80

100

Baseline 12 Months Baseline 12 Months Baseline 12 Months Baseline 12 Months Baseline 12 Months Helped increase your ability to do your job?

Helped increase the hours you are able to work?

Helped increase the money you have earned or

increase your income?

Given you the oppurtunity to develop more job-related skills?

Allowed you to gain additional education or vocational skills?

40%

40%

20%

36%

50%

14%

58%

26%

16%

50%

14%

36%

90%

5%5%

7%

71%

21% 15%

80%

5%

57% 63%

57%

7%5% 14%

36%32% 29%

Not at all/ A little bit A moderate amount Quite a bit or a great deal

• Most caregivers report the services they are receiving are helping “not at all” or are helping “a little bit” with their ability to do their job, increase work hours, increase income, and increase skills. Caregivers’ ability to do their job had the highest number of “quite a bit” or “a great deal” responses.

FUNCTIONING


Source: YSS; Caregiver n=64; Youth n=37*YSS: Considered positive if average is 3.5 or above

Caregiver Perspective on General Functioning Fig. 46

• Caregivers show an increase across all functioning items; however, the only statistically significant improvement is for “My child is able to cope when things go wrong.” Caregivers are still, on average, reporting they “disagree” or are “undecided” with these statements at both baseline and the 12 month follow-up.

• Youth report much better functioning than caregiver perceptions of their youth. The rate of youth reporting positively mirrors the national rate (71% versus 70%) and is higher than Michigan’s rate (58%) for youth reporting improved functioning from treatment in the public mental health system.

Predictor of Functioning

• When examining natural support items, family engagement items, and individualized care items, natural supports are the only items to predict a statistically significant increase in the functioning items.

• Therefore, the higher caregivers rated themselves on natural supports, the higher they rated themselves on their child’s functioning.

* The Reliable Change Index is a relative measure that compares a child’s or caregiver’s scores at two different points in time and indicates whether a change in score shows significant improvement, worsening, or stability (i.e., no significant change)

1 - Strongly Disagree Strongly Agree - 5 % Change

Handling Daily Life

Gets Along With Family

Gets Along With Friends

Doing Well In School

Able To Cope

Satisfied With Family

19.3%

16%

11.9%

20.8%

36.1%

23.9%

Source: TRAC; n=40 (except for doing well in school 30-34)

Caregiver and Youth Reporting Positively on Functioning Fig. 47

Perspectives on Services at 6 Months Caregiver: % Reporting Positively Youth: % Reporting Positively

Functioning 41% 71%

FUNCTIONING


METHODOLOGY AND DATA LIMITATIONSMethodologyThis report utilizes several data sources. A list and description of the data collection instruments used can be found in Appendix A. Much of the data analysis employs a paired sample analysis whereas only cases that have both a baseline, six-month, and 12 month follow-up assessment are used to examine the change over time for a particular outcome. This allows for the most accurate examination of change.

For analysis that shows whether or not a finding is statistically significant over time, evaluators used a paired sample t-test. This test compares the difference between two means and determines whether that difference is statistically significant. Statistical significance refers to a result that is not likely to occur randomly, but rather is more likely to be attributed to a specific cause(s). The Reliable Change Index (RCI) is also

used to analyze change for particular outcomes. The RCI is a measure that compares a child’s or caregiver’s scores at two different points in time and indicates whether a meaningful change in score has occurred. “Improvement” and “Worsened” indicate significance at the 95% level. “Remained Stable” indicates no significant change. RCI corrects for measurement error and is a more conservative way to interpret outcome trends.

The demographic composition of CFP youth was compared to other system of care communities who received grants in 2009 and 2010 as well as with the general Kent County youth population (5 – 17 years old). Chi-Square and Multi-Nominal Logistic Regression tests show significance at the 95% level of confidence. Chi-Square was also used to look at race and placement type. Chi-Square Goodness of Fit was used to compare CFP gender with the national

cohort population.

Evaluators used a multiple linear regression analysis for a particular set of data to examine the factors that predict functioning. A linear regression analysis models the relationship between a dependent variable and one or more independent (or explanatory) variables.

Data LimitationsThe data used in this report is derived from subsamples of CFP youth and caregivers who are enrolled in CFP evaluation studies. The analysis can only be representative of those enrolled in the evaluation and not necessarily of the entire CFP population. For many instances, the number of valid responses in each respective response options limits the confidence when interpreting trends due to a large margin of error.


APPENDIX A: DESCRIPTION OF DATA COLLECTION INSTRUMENTSEnrollment and Demographic Information Form (EDIF): collects information on agency involvement, demographics, presenting problems, diagnostic, and enrollment for each youth enrolled into CFP, as required by SAMHSA. The EDIF is incorporated into CFP’s Referral Form.

Referral Form: contains the EDIF, as well as additional information for local need: referral sources, out of home placement information, and presenting crisis/safety issues. The referral form is collected for each youth enrolled into CFP.

TRAC NOMs (baseline and follow-up): the Transformation Accountability instrument is completed for every family who is enrolled in CFP services, as is required by the Center

for Mental Health Services. TRAC NOMs is administered at baseline (it is incorporated into the Referral Form) and is administered to families every six months for as long as a family is in services. It collects information on functioning, housing, education, crime, perception of care, social connectedness, and services received. The questions refer to the 30 day time period before the assessment.

Child and Adolescent Functional Assessment Scale (CAFAS): a widely used tool for assessing youth’s functioning across several life domains. CAFAS is administered at baseline for each youth and every three months, as is required by Kent County’s mental health providers. CAFAS measures functioning in school, behavior, moods/

emotions, home, thinking, self-harm, substance use, and community.

Longitudinal Outcome Study (LOS): a voluntary study for enrolled families that is conducted by CRI and required by SAMHSA. The study examines several areas, including service involvement, living situation, education, behavioral and emotional issues, substance use, crime, and perception of care. Caregivers and youth are interviewed at baseline (enrollment into CFP services) and every six months for two years. The questions refer to the six month time period before the assessment.

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