Using Outcomes in the Quality Improvement Process:
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Transcript of Using Outcomes in the Quality Improvement Process:
Using Outcomes in the Quality Improvement Process:
Setting System Level Standards
Erik R. Stewart, Ph.D. Vice President, System Performance
Renee Kopache, M.S.Recovery Coordinator
History/Purpose of Outcomes
• Ohio Mental Health Outcomes Task Force (OTF) – 1996– Charge
• Develop a statewide approach to measuring consumer outcomes in Ohio’s publicly-supported mental health system
Vital Signs (1998)
• Outcomes Implementation Pilot Coordinating Group– Final recommendations were made in 1999.
Adult Outcomes Domains
• Clinical Status– looks at symptoms that a person may experience
from their illness and how much they interfere with their daily living.
• Quality of Life– examines how “good” a person’s life is, and if their
needs are being met. Also examines how much control a person has over the events in their life (empowerment).
Adult Outcomes Domains
• Functional Status– This domain identifies how well a person is
doing in the community including areas such as work, school and social relationships.
• Safety & Health – Addresses how a person is doing physically
and the amount of freedom they have from psychological harm from self and others.
Adult Outcomes: Instruments
• Adult Consumer Form A
– This form is used by consumers with a severe mental illness. (case management)
– The survey consists of four parts: Quality of Life, Safety and Health, Symptom Distress and Empowerment.
Adult Outcomes: Instruments
• Adult Provider Form A – consists of two parts: Functional Status and
Safety & Health.
– Provider’s observations and clinical judgments about the consumer’s social & role functioning, housing status, activities of daily living, criminal justice involvement, harmful behavior and victimization.
Adult Outcomes: Instruments
• Adult Consumer Form B– Consists of three parts: Quality of Life
(excluding empowerment, Safety & Health and Symptom Distress.
– This shorter version of the Adult A form is used for adult outpatient clients. Providers of non-SMD consumers are not required to complete a provider survey.
Youth Outcomes Domains
• Four primary areas or domains of assessment were selected for Ohio Scales:
– Problem severity– Functioning– Hopefulness– Satisfaction with behavioral health
services
Youth Outcomes: Instruments
• Ohio Scales
Three parallel forms: – Y-form is completed by the youth (self-
report for ages 12 and older).
– P-form is completed by the youth’s parent (or primary caretaker).
– W-form is completed by the youth’s agency worker/case manager.
Administration Periods
• Initial• 6 Month• 12 Month• Annually thereafter
(Adult Consumer Form B: Initial and Discharge administrations only)
OCO History in Hamilton County
• Data collection begins – September, 2001• Regular and varied production reporting begins
at same time• Production performance abysmal, though
consistent with other participating areas of State
HCCMHB surveys agencies to discern impediments to production
Agencies React
HCCMHB representatives visit agencies to discern impediments to
production
Impediments (in no particular order):
1) Excuses:
• POV boxes don’t turn on (batteries)• Staff refuse to complete or administer• Multi-million $ agency has only 1 printer• POV box times out too quickly
Impediments (in no particular order):
2) Collection technology:
• POV data system interface with other agency data system(s)
Impediments (in no particular order):
3) Lack of agency/staff “buy-in”
• We know we do good work• We don’t care about consumer outcomes
Impediments (in no particular order):
4) Lack of products/information to staff following administrations (initially)
• Staff frustration with initial software• Introduction of ARROW with use limited to POV• Immediate red flags printout• Weekly reports to staff• Consistent supervisor response to problems• Use of data in “assessment update printout”
Impediments (in no particular order):
5) Diffusion of responsibility (a social phenomenon that
occurs in groups of people when responsibility is not explicitly assigned)
• Request made by QA/Outcomes member to resurrect regular IT/IS staff meetings at HCCMHB. Solicitation made. ONE response.
• Lack of departmental ownership
Impediments (in no particular order):
6) Agency-specific challenges
• Central Point of Access• New administration at agency intake?• Paper and pencil administration• Program support staff enter data
QA Approach Introduced
• Quarterly indicator measuring Initial Adult Provider compliance added to existing indicators
ODMH Introduces Missing Data Reports - Summer, 2003
• Hamilton County Performance– 23% Adult OR/OE– 34% Youth OR/OE
October, 2003 - HCCMHB and Agencies Form PI Sub-committee
to Develop Production Logic
February, 2004 – Ohio Department of Mental Health Presents State
Plan for Upcoming PI Requirements
PDCA Cycle
Plan
Do
Check
Act
April, 2004 – Proposed Logic for OCO Production Measures Shared
With Membership
Initial Adult Consumer Production Analysis
Initial Adult Consumer Production Analysis
• Claims data compiled for quarter under review
UCI First Svc. Date Min Age UPID Service Type
1000001 7/10/2005 42 10001 CPST
1000001 8/1/2005 42 10002 Counseling
1005002 9/2/2005 28 10001 CPST
2052520 7/20/2005 19 10005 Med Som
2052520 7/25/2005 19 10006 CPST
Initial Adult Consumer Production Analysis
• “Pre-quarter period” is determined by subtracting 120 days from first date of service in period
UCI First Svc. Date Pre-Quarter Period
1000001 7/10/2005 3/12/2005
1000001 8/1/2005 4/3/2005
1005002 9/2/2005 5/5/2005
2052520 7/20/2005 3/22/2005
2052520 7/25/2005 3/27/2005
Initial Adult Consumer Production Analysis
• Review of claims during pre-quarter period is conducted. Those exhibiting claims are removed
UCI First Svc. Date Pre-Quarter Period Pre-Quarter Claims
1000001 7/10/2005 3/12/2005 No
1000001 8/1/2005 4/3/2005 No
1005002 9/2/2005 5/5/2005 Yes
2052520 7/20/2005 3/22/2005 No
2052520 7/25/2005 3/27/2005 No
Initial Adult Consumer Production Analysis
• Unduplicate list by selecting case with highest order service
UCIFirst Svc. Date
Pre-Quarter Period
Min Age UPID
Service Type
1000001 7/10/2005 3/12/2005 42 10001 CPST
1000001 8/1/2005 4/3/2005 42 10002 Counseling
2052520 7/20/2005 3/22/2005 19 10005 Med Som
2052520 7/25/2005 3/27/2005 19 10006 CPST
Initial Adult Consumer Production Analysis
• Create date range for acceptable OCO administrations
UCI First Svc. Date 1st Svc. Minus 60 1st Svc. Plus 44
1000001 7/10/2005 5/11/2005 8/23/2005
2052520 7/25/2005 5/26/2005 9/7/2005
Initial Adult Consumer Production Analysis
• Merge Adult Consumer A and Adult Consumer B OCO administrations
• Match by date when acceptable date exists
• Determine production ratio/percentage
January 2005 February 2005 March 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
April 2005 May 2005 June 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Period under review
(4th qtr. FY 2005)
January 2005 February 2005 March 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
April 2005 May 2005 June 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
1st service in period
May 11, 2005
January 2005 February 2005 March 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
April 2005 May 2005 June 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Absence of service determined for 120 day period prior to first service (ensures client is new or in new episode of care)
January 2005 February 2005 March 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
April 2005 May 2005 June 2005
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Su Mo Tu We Th Fr Sa 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Outcome administration expected/sought between March 12 and June 24
HCCMHB OCO Production Performance Improvement Measures
• Initial Measures– Adult Consumer
HCCMHB OCO Production Performance Improvement Measures
• Initial Measures– Adult Consumer– Adult Provider– Youth Consumer– Youth Provider– Youth Parent
• Six-Month Measures– Adult Consumer– Adult Provider– Youth Consumer– Youth Provider– Youth Parent
• 12-Month Measures– Adult Consumer– Adult Provider– Youth Consumer– Youth Provider– Youth Parent
• Long-Term Measures– Adult Consumer– Adult Provider– Youth Consumer– Youth Provider– Youth Parent
June, 2004 – Contract Language Established Obligating Agencies to
70% Compliance on OCO Administrations
July, 2004 – HCCMHB Issues First “Test” Measures
PI Products Provided to Agencies:
UPIDType Number Type
Total Expected
Submitted
Not Submitted
Ratio expectation Ratiocalc
RatioMet
10000 11 Adult Consumer initial 52 43 9 70
82.69230769 yes
10000 12 Adult Provider initial 43 29 14 70
67.44186047 no
10000 13 Child Provider initial 46 39 7 70
84.7826087 yes
10000 14 Child Parent initial 46 40 6 70
86.95652174 yes
10000 15 Child Consumer initial 18 14 4 70
77.77777778 yes
10000 21
Adult Consumer 06 month 20 5 15 70 25 no
10000 22
Adult Provider 6 month 20 4 16 70 20 no
10000 23
Child Provider 6 month 23 18 5 70
78.26086957 yes
10000 24 Child Parent 6 month 23 13 10 70
56.52173913 no
10000 25
Child Consumer 6 month 12 4 8 70
33.33333333 no
10000 31
Adult Consumer 12 month 7 2 5 70
28.57142857 no
10000 32
Adult Provider 12 month 7 3 4 70
42.85714286 no
10000 33
Child Provider 12 month 12 8 4 70
66.66666667 no
10000 34 Child Parent 12 month 12 8 4 70
66.66666667 no
10000 35
Child Consumer 12 month 5 0 5 70 0 no
10000 41
Adult Consumer Annual 274 231 43 70
84.30656934 yes
10000 42 Adult Provider Annual 274 214 60 70
78.10218978 yes
10000 43 Child Provider Annual 62 58 4 70
93.5483871 yes
10000 44 Child Parent Annual 60 57 3 70 95 yes
10000 45
Child Consumer Annual 28 24 4 70
85.71428571 yes
Agency A
31.58%
50.67%
82.76% 83.13%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
FY 05 Qrt1 Initial AdultConsumer
FY 05 Qrt2 Initial AdultConsumer
FY 05 Qrt3 Initial AdultConsumer
FY 05 Qrt4 Initial AdultConsumer
Pe
rce
nt
Co
mp
lete
Spreadsheet containing:
• UCI• First service in period date• Last service in period date• OCO time period parameters• Submission status• Date of administration for submission• Age of client• Service type by numeric rank• Instrument type of submission• Admission date
Agencies may formally dispute findings on a case-specific basis
Measures allow agencies to look closely at specific cases missing administrations to
discern issues
Had to educate agencies on intricacies of logic
Tracking based upon most recent intake date
Had to cut through many “trivial” issues that impacted few clients but served as a distraction from dealing with larger issues (those effecting many expected administrations)
Had to deal with misunderstandings or “loose” understandings of the
administration criteria (ex. Use of “person unable to complete” disposition for unplanned termination/discharges)
Had to move past focusing upon issues related to the logic used in the PI
exercise to focus on agency issues needing attention
Had to manage areas subject to manipulation (ex. Use of “B” consumer administrations when “A” is warranted)
….And in the End…..(Measures of Progress Over Time)
The Heavens Opened!!!!
OCO Production Progress (Outcomes Received/Outcomes Expected)
37.80%
43.00%
51.57%
64.98%
76.60%
86.10%
33.60%
39.60%
47.67%
61.68%
68.44%
76.30%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
4/ 2003-3/ 2004 7/ 2003-6/ 2004 10/ 2003-9/ 2004 1/ 2004-12/ 2004 4/ 2004-3/ 2005 7/ 2004-6/ 2005
Youth Adult
Measures of Progress Relative to Other Board Areas
State Missing Data Report #5 - ADULT Outcomes Received/Outcomes Expected (Oct 1, 2003 - Sep 30, 2004)
17.73%25.52%
47.67%55.28%
70.23%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
State Missing Data Report #6 - ADULT Outcomes Received/Outcomes Expected (Jan 1, 2004 - Dec 31, 2004)
5.50%
73.63%
61.68%59.16%
46.86%
34.52%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
State Missing Data Report #7 - ADULT Outcomes Received/Outcomes Expected(Apr 1, 2004 - Mar 31, 2005)
38.49%
55.80%
56.48%
68.44%
78.51%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
State Missing Data Report #8 - ADULT Outcomes Received/Outcomes Expected (July 1, 2004 - June 30, 2005)
43.2%46.2%
57.6%58.2%
85.8%
76.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
State Missing Data Report #9 - ADULT Outcomes Received/Outcomes Expected (Oct 1, 2004 - Sept 30, 2005)
58.0%
49.7%
63.4%
81.7%
61.2%
85.3%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
State Missing Data Report #5 - YOUTH Outcomes Received/Outcomes Expected (Oct 1, 2003 - Sep 30, 2004)
10.11%10.24%
38.64%
78.94%
63.11%
51.57%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
State Missing Data Report #6 - YOUTH Outcomes Received/Outcomes Expected (Jan 1, 2004 - Dec 31, 2004)
82.33%
69.58%64.98%
39.51%
30.32%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
State Missing Data Report #7 - YOUTH Outcomes Received/Outcomes Expected (Apr 1, 2004 - Mar 31, 2005)
50.4%
76.6%82.5%
68.9%
42.7%40.1%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
State Missing Data Report #8 - YOUTH Outcomes Received/Outcomes Expected (July 1, 2004 - June 30, 2005)
47.4%
55.0%57.8%
72.5%
84.7%
86.1%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
State Missing Data Report #9 - Youth Outcomes Received/Outcomes Expected (Oct 1, 2004 - Sept 30, 2005)
69.5%
55.7%
59.9%
75.2%
88.7%89.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
• Additional “learnings”– 120 day absence without new OCO/tx. Plan
update – not clinically sound practice– Delayed tx. Following assessment
Data Use
Ohio Scales Data
Ohio Scales
State Data Report
Youth Consumer Findings
Youth Consumer Problem Severity Scores Statewide (Cross-sectional data)
23.89
18.86 18.68 18.9918.56
18.96 18.9818.37
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Mea
n S
core
Youth Consumer Functioning Scores Statewide (Cross-sectional data)
55.94
58.8759.72
59.5259.4159.3558.75
59.57
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth
Youth Parent Findings
Youth Parent Problem Severity Scores Statewide (Cross-sectional data)
28.57
22.15
24.0923.64
22.98
23.1423.12
22.21
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Mea
n S
core
Youth Parent Functioning Scores Statewide (Cross-sectional data)
45
48.29
46.8146.9147.9
48.1648.9549.34
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth
Youth Worker Findings
Youth Worker Problem Severity Scores Statewide (Cross-sectional data)
28
21.41 21.43
21.51
21.13
21.14
22.76
21.54
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Mea
n S
core
Youth Worker Functioning Scores Statewide (Cross-sectional data)
43.33
45.8246.66
46.2646.9146.9146.946.87
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Does Hamilton County data look like Statewide data?
Youth Consumer Findings
Youth Consumer Problem Severity Scores Comparison (Cross-sectional data)
23.89
18.86 18.68 18.9918.56
18.96 18.9818.37
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth Hamilton Youth
Youth Consumer Functioning Scores Comparison (Cross-sectional data)
55.94
58.8759.72
59.5259.4159.3558.75
59.57
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth Hamilton Youth
Youth Parent Findings
Youth Parent Problem Severity Scores Comparison(Cross-sectional data)
28.57
22.15
24.0923.64
22.98
23.1423.12
22.21
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth Hamilton Youth
Youth Parent Functioning Scores Comparison (Cross-sectional data)
45
48.29
46.81
46.9147.948.16
48.9549.34
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Mea
n S
core
Statewide Youth Hamilton Youth
Youth Worker Findings
Youth Worker Problem Severity Scores Comparison (Cross-sectional data)
28
21.41 21.43
21.51
21.13
21.14
22.76
21.54
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Youth Worker Functioning Scores Comparison(Cross-sectional data)
43.33
45.8246.66
46.2646.9146.9146.946.87
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Does a longitudinal design change the picture?
Youth Consumer Findings
Youth Consumer Problem Severity Scores Over Time
24.26
18.22
17.12
20.09
16.82
18.52
15
17
19
21
23
25
27
29
31
33
35
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,358)=48.747
p=0.000
F(1,327)=16.923
p=0.000 F(1,140)=6.498
p=0.012
Youth Consumer Problem Severity Scores Comparison (Cross-sectional data)
23.89
18.86 18.68 18.9918.56
18.96 18.9818.37
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth Hamilton Youth
Youth Consumer Functioning Scores Over Time
58.43
55.96
59.37
57.8
58.84
58.64
40
45
50
55
60
65
Initial 6 Month 1 Year 2-4 Years
Group 1 Functioning Group 2 Functioning Group 3 Functioning
F(1,344)=15.416
p=0.000F(1,319)=1.104
p=NS
F(1,135)=0.018
p=NS
Youth Consumer Functioning Scores Comparison (Cross-sectional data)
55.94
58.8759.72
59.5259.4159.3558.75
59.57
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth Hamilton Youth
Youth Parent Findings
Youth Parent Problem Severity Scores Over Time
30.35
24.89 24.5825.41
27.0526.36
15
17
19
21
23
25
27
29
31
33
35
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,1048)=122.748
p=0.000
F(1,689)=10.413
p=0.001
F(1,307)=.679
p=NS
Youth Parent Problem Severity Scores Comparison(Cross-sectional data)
28.57
22.15
24.0923.64
22.98
23.1423.12
22.21
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Statewide Youth Hamilton Youth
Youth Parent Functioning Scores Over Time
47.33
42.73
46.88
45.59
45.2146.09
40
45
50
55
60
65
Initial 6 Month 1 Year 2-4 Years
Group 1 Functioning Group 2 Functioning Group 3 Functioning
F(1,1014)=75.959
p=0.000
F(1,670)=1.324
p=NS
F(1,294)=.647
p=NS
Youth Parent Functioning Scores Comparison (Cross-sectional data)
45
48.29
46.81
46.9147.948.16
48.9549.34
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Mea
n S
co
re
Statewide Youth Hamilton Youth
Youth Worker Findings
Youth Worker Problem Severity Scores Over Time
28.27
22.3821.8822.97
23.8
22.99
15
17
19
21
23
25
27
29
31
33
35
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,1881)=255.721
p=0.000
F(1,369)=1.111
p=NS
F(1,598)=2.251
p=NS
Youth Worker Problem Severity Scores Comparison (Cross-sectional data)
28
21.41 21.43
21.51
21.13
21.14
22.76
21.54
15
17
19
21
23
25
27
29
31
33
35
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Youth Worker Functioning Scores Over Time
41.74
44.91
43.9545.04
44.53
45.62
40
45
50
55
60
65
Initial 6 Month 1 Year 2-4 Years
Group 1 Functioning Group 2 Functioning Group 3 Functioning
F(1,1810)=152.229
p=0.000
F(1,1132)=8.610
p=0.003
F(1,582)=1.162
p=NS
Youth Worker Functioning Scores Comparison(Cross-sectional data)
43.33
45.8246.66
46.2646.9146.9146.946.87
40
45
50
55
60
65
Initial 90 Days 180 Days 270 Days 1 Year 2 Years 3 Years 4 Years
Does looking at everyone together make sense?
Should the data be apportioned in some manner when considering outcomes?
By Diagnosis?
HCCMHB expenditures for treatment of youth with diagnosis
of 314.01 (AD/HD) from September 2001 (inception of OCO/OYS) to ~ July, 2005 =
$14,470,290 and provided care to 2,652 individuals under the age
of 18.
Youth Ratings - Children With AD/HD (314.01)Change Over Period in Treatment - Problem Severity
24.7
20.99
15
17
19
21
23
25
27
29
31
33
35
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,29)=1.49
p=NS
Parent Ratings - Children With AD/HD (314.01)Change Over Period in Treatment - Problem Severity
33.71
26.13
27.3827.18
26.28
24.56
15
17
19
21
23
25
27
29
31
33
35
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,178)=25.11
p=.000
F(1,24)=.002
p=NS
F(1,12)=.518
p=NS
Worker Ratings - Children With AD/HD (314.01)Change Over Period in Treatment - Problem Severity
29.01
24.09
21.25
18.59
22.2
22.6
15
17
19
21
23
25
27
29
31
33
35
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,324)=61.743
p=000
F(1,61)=.676
p=NS
F(1,45)=2.304
p=NS
Youth Ratings - Children With AD/HD (314.01)Change Over Period in Treatment - Functioning
55.72
58.34
40
45
50
55
60
65
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,29)=.747
p=NS
Parent Ratings - Children With AD/HD (314.01)Change Over Period in Treatment - Functioning
41.15
47.79
44.45
45.45
44.54
53
40
45
50
55
60
65
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,180)=12.53
p=.001
F(1,23)=1.42
p=NS
F(1,11)=2.62
p=NS
Worker Ratings - Children With AD/HD (314.01)Change Over Period in Treatment - Functioning
40.8
46.76
39.96
44.42
41.54
44.35
40
45
50
55
60
65
Initial 6 Month 1 Year 2-4 Years
Group 1 Problem Severity Group 2 Problem Severity Group 3 Problem Severity
F(1,308)=33.810
p=.000F(1,60)=.218
p=NS
F(1,45)=2.298
p=NS
Summary: Findings for all groups (Youth, Parents, & Agency Staff)
indicate that statistically significant gains are made during
the initial period (6 months) of treatment. Findings did not
discern statistically significant differences beyond this point.
Examination of CY 2001 data indicates that of all children with dx.=314.01, 45% receive greater than 180 days of treatment. 25% receive greater than 375 days of treatment. 11% receive greater
than 2 years of treatment.
Considerable disparity exists between agencies in regard to
the average period of treatment for children with this diagnosis.
% of 314.01 (ADHD) Children Receiving Tx. >180 Days by Agency(Agencies serving minimum of 10 ADHD children - CY 2001)
0 0
18.2
27.3
38.540
43.3
52.5
67.471.1
72.7 73.9
100
0
10
20
30
40
50
60
70
80
90
100
G L A C B J H E D F I M K
Ohio Consumer Outcomes Data Mart
http://mhwwwtest.mh.state.oh.us/Screen1/odmhFirstScreen.jsp
Erik R. Stewart, Ph.D. Vice President, System Performance
Renee Kopache, M.S.Recovery Coordinator