Discussion Hour: Can Residential Care Providers Collect Post Discharge Outcome Data?

Gary Blau, Chief, Child, Adolescent and Family Branch,

Center for Mental Health Services, SAMHSA

Robert Lieberman, CEO, Kairos

Ronald Thompson, Vice President and Director,

Boys Town National Research Institute

Dana Weiner, Policy Fellow, Chapin Hall Center for Children

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Building Bridges Initiative (BBI)“Advancing Partnerships among Residential and Community-Based Service Providers, Youth

and Families to Improve Lives”

• BBI Started in 2006 (Omaha, Nebraska)

• Mission: Identify and promote practice and policy initiatives that will create strong and closely coordinated partnerships and collaborations between families, youth, community- and residentially-based treatment and service providers, advocates and policy makers to ensure that comprehensive services and supports are family-driven, youth-guided, strength-based, culturally and linguistically competent, individualized, evidence and practice-informed, and consistent with the research on sustained positive outcomes.

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BBI Core PrinciplesFamily Driven &Youth Guided Care

Cultural & Linguistic

Competence

Clinical Excellence &

Quality Standards

Accessibility & Community Involvement

Transition Planning & Services (between settings & from youth

to adulthood)

Building Bridges Initiative (BBI)Best Practices

• Lengths of stay < 6 months (and ideally < 3 or 4 months);

• Need to focus on partnerships and collaborations to address post discharge outcomes;

• Focus on permanency for every child;

• Comprehensive focus on family engagement;

• Moving away from standardized behavioral approaches such as points and levels and using individualized trauma-sensitive approaches in programs – in collaboration with the youth and families;

• Youth-guided care/self-regulation strategies;

• Robust QI practices and using data to inform practice improvement.

BBI Critical Elements for Success

• Shorter lengths of stay

• Increased youth and family involvement

• Stability and support in the post-residential

environment

(Walters & Petr, 2008)

Building Bridges Initiative

• BBI/Residential best practices are expanding throughout the country

• Visit www.buildingbridges4youth.org for resources

Creating & Maintaining CLC in Human Service Agencies:

Rationale & Recommendations for Promising Practices

Supporting Siblings When a Brother/Sister is Receiving Residential Interventions

Building Consensus on Residential Measures for Outcome & Performance

Measures

Tip Sheets for YouthSelf-Assessment Checklist for

Residential Staff

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TIP SHEETS INCLUDE:

Tip Sheets for Families

***New! Resource Guide for Judges and Legal Partners!!

Feasibility Trial: Post Discharge Outcome Assessment

• Survey development

• Provider recruitment

• Provider staff training and check-in

• Successes and challenges

• Discussion

Survey Development

• Review of existing tools

• Input from key stakeholders

• Dimensions• Relationship stability

• Housing stability

• Access to resources (health care, counseling)

• Community engagement (school, work, community)

• Recidivism (hospital, residential, JJ)

• Pilot test

Provider Recruitment

• Chapin Hall state child welfare agency

relationships

• State agency leads identified 13 residential

care providers of varied size and scope

• 7 providers in 2 states, agreed to participate

Provider Agency Staff Training

• Survey The survey is administered by phone, usually completed

within 10-12 minutes. All responses are written on the paper form unless electronic data entry is available

• Survey Call Log and Provider Staff Hours Staff use electronic call log and provider staff hour tracking to

document the staff person’s efforts to reach and engage with the youth’s identified caregiver as well as the staff resources needed in doing so

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Provider Agency Check-in

• Eligible youth: based on the 6 month post-discharge date• Smallest provider had no eligible youth

• Larger providers had 20 to 30 eligible youth

• Agency data used to identify youth• Using census and billing system and cross-

referencing with other lists

• About one-third already have processes in place to identify youth for follow-up

Successes and Challenges

• Successes• Average 10-12 minutes to complete• Most caregivers knowledgeable about youth 6 months post

treatment• Caseworkers or other service providers are interviewed if there is no

caregiver

• Challenges• Provider staff have personable relationships with families: no

separation between services and research• Caregivers are difficult to reach during daytime hours

• Just a few weeks into this, 13 of 29 attempted surveys have been completed (about 45%)• However, there is variability – some providers have been more

successful than others – one provider hasn’t had any success out of 5 surveys attempted

• Next Steps: provider focus groups, data analysis and reporting

Discussion

• Residential-community based services collaboration and long-term youth outcomes

• Benefits of residential post-discharge outcome assessment

• Taking youth outcome assessment to scale

– Theory of change

– Risk adjustment

– Admission, during care, end of care, & follow-up data collection

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