TRACKING LONG-TERM OUTCOMES

The use of data to direct practice

BBI - 2017

OUR FOE IS NOW OUR FRIEND

Bad data….used for good Professing faith is not enough What is Success? What is Failure? Why Measure? What to Measure and How? Money = Importance

UPFRONT: THE MOST IMPORTANT THINGS THE DATA HAS TAUGHT US

Ø Business model must match best practices for long-term outcomes

Ø  “Head-in-bed” approach does not work for youth and families (or funders)

Ø Change in staff/providers and programs has negative impact on outcomes

Ø Congregate care has little positive effect and creates significant challenges

Ø Most significant critical incident = If 24-hours goes by and there is no interaction in or with family/community

THE PRACTICE MODEL

Philosophy and Approach Ø  Local services make a difference Ø Recidivism must be defined specifically Ø Home and community are most efficacious treatment

settings Ø  Family engagement is key Ø Real world settings are needed for real world gains Ø  Improvement in the course of treatment in residential

settings is not a good predictor of long-term outcomes Ø Data changes staff behavior – bottom to top approach

THE PRACTICE MODEL

The Clinical Model Ø  “Recidivism Variables”

--Family Engagement (most predictive) --School Attendance --Prosocial Peers --Self-Efficacy --Number of Days out of home --Behavioral Approach --Number of Medications

DAMAR SERVICES, INC.

� Established in 1967 as residential care setting for children with DD.

� Traditional Operations for 35 years � 2003 – Initiated Residential Reform � 2005 – Building Bridges Initiative � 2006 - Community-Based Res. Care appears to produced more favorable outcomes.

DAMAR SERVICES, INC.

� 2006 – Fully implemented BB principles

� 2006 - Local Pilot Approved for CBRT – DCS and DOE

� 2008 - Outcomes Study Comparing Traditional Res. Care with CBRT

26 KIDS THAT CHANGED OUR LIVES………FOREVER

---Controls Matched for age, gender, dx, parent involve, LOS, # of Placements

---Outcomes compared to baseline improvement vs. Control Group

Parental Contact/involvement – 60% More Aggressive Incidents – 73% - Less Prosocial Peers – 100% - More School Attendance – 35% More LOS – 4 months, Controls – 11 months Recidivism - 0% at 12 months, Controls 16% 12M Cost – $1,350,000 Decrease vs. Controls

DAMAR SERVICES, INC.

2009 Guaranteed Outcomes

If a youth requires re-admission post

“discharge,” it is FREE.

2010

INDIANA’S REFORM INITIATIVE THE INTEGRATED SERVICES MODEL

Indiana Outcome Measures

ü # of Days Out of Home ü Treatment in own Home/Community ü Recidivism ü # of Closed Cases (Referral Source) ü Cost (If N = 25 --1M reduction year 1 and

3.1M reduction in 2 years)

DEFINING RECIDIVISM

Residential Interventions/Programs are Complicated

6-1-3-5

Recidivism Youth/young adult requires admission to a

similar or higher level of care post discharge.

RECIDIVISM

Long-Term Outcomes (Recidivism)

Ø  Data dynamically collected to 5-years post “discharge”

2005 4% 2011 9% 2006 11% 2012 6% 2007 9% 2013 11% 2008 3% 2014 12% 2009 8% 2015 15% 2010 6% 2017 12%

Ø  Recidivism typically occurs within the first 12 months post discharge

MAKING IT SIMPLE

� Since leaving Damar on ____, have you been hospitalized or admitted to another residential facility?

� Are you living with your “family”/your chosen community? � Are you attending school/work/volunteering? � Have you been arrested/jailed? � On a scale of 1-10, how happy are you this week?

NOW WE KNOW!!

Our Job is not to cure kids but rather to help kids and their families negotiate the basic tasks of everyday life.

“Residential treatment” should be oriented not so

much around removing problems kids bring to care but toward establishing conditions that allow children and families to manage symptoms and crises more effectively at home and in the community.

CONTACT INFO

Jim Dalton, Psy.D. HSPP, CSAYC Damar Services, Inc.

www.damar.org 317-856-5201

jimd@damar.org