Performance Outcomes System Children’s system of care presentation SEPTEMBER 22, 2016

agenda POS September 2016 Reports Exploring the Data UCLA Evaluation

Pos September 2016 reports All epsdt, open child welfare cases, foster care

POS September 2016 reports Three populations being reported on: All Medi-Cal SMHS Eligible Children/Youth – All EPSDT Open Child Welfare Case Children/Youth* Foster Care Children/ Youth* Three sets of reports produced: Statewide aggregate Population-based county groupings Individual county- specific reports*

POS September 2016 reports Population Definitions Open Child Welfare: Children/youth who are provided child welfare services either while living in their home, or while living out-of-home in a foster care setting. Excludes children: placed in California under the jurisdiction of another state (incoming interstate Compact on the Placement of Children (ICPC)) and who are placed with non-dependent guardians. Foster Care Placement: Children/youth who are removed from their home by a child placement agency, including county child welfare services and probation departments and placed in a foster care setting. Excludes children: placed in California under the jurisdiction of another state (incoming interstate Compact on the Placement of Children (ICPC)) and who are placed with non- dependent legal guardians.

POS September 2016 reports Data Sources Short-Doyle/Medi-Cal II (SD/MC II) claims with dates of service in FY 11/12 through FY 14/15 Medi-Cal Eligibility Data System (MEDS) data from the Management Information System/Decision Support System (MIS/DSS) FY 11/12 through FY 14/15 Child Welfare Services/Case Management System (CWS/CMS) data for children in FY 11/12 through FY 14/15

POS September 2016 reports Each report provides information on the following: Demographic characteristics (i.e., age, race, gender) Penetration rates 1+ contacts 5+ contacts Mental health service use Snapshot data Average time to step-down services post inpatient discharge

Exploring the data All epsdt, Open Child Welfare Cases & Foster Care groupings

Beneficiaries receiving smhs & medi-cal eligibles for FY14/15*   Unique Count Receiving SMHS Year-over-Year % Change Unique Count Medi-Cal Eligibles All EPSDT 266,915 1.1% 6,352,757 5.2% Open Child Welfare 56,867 0.8% 135,811 1.2% Foster Care 41,503 88,445 2.5%

Gender Fy14/15 FY14/15 Female Male All EPSDT 44.7% 55.3% Open Child Welfare 48.2% 51.8% Foster Care

All EPSDT Open Child Welfare Foster Care GENDER FY 14/15

Statewide Open Child Welfare Foster Care AGE FY 14/15

Alaskan Native/American Indian Asian or Pacific Islander Race/ethnicity FY14/15 FY13/14 Alaskan Native/American Indian Asian or Pacific Islander Black Hispanic White Other and Unknown All EPSDT 0.5% 3.3% 11.4% 50.9% 24.8% 9.1% Open Child Welfare 14.8% 38.9% 37.7% 8.7% Foster Care   14.9% 30.3% 46.7% 8.1%

Penetration rate 1+ CONTACT Calculated as: unique count beneficiaries receiving 1 or more SMHS in FY divided by total number unique beneficiaries eligible for SMHS in FY   Children/Youth with 1+ SMHS Visit Certified Eligible Children/Youth Penetration Rate FY14/15 All EPSDT 266,915 6,352,757 4.2% Open Child Welfare 56,867 135,811 41.9% Foster Care 41,503 88,445 46.9%   Penetration Rate FY11/12 Penetration Rate FY12/13 Penetration Rate FY13/14 All EPSDT 4.8% 4.5% 4.4% Open Child Welfare 42.1% 42.0% Foster Care 49.1% 48.3% 47.5%

Penetration rates 1+ Contact

Statewide Open Child Welfare Foster Care Gender By Penetration Rate 1+ Contact FY 14/15

Age by penetration 1+ contact Fy14/15 0-5 6-11 12-17 18-20 All EPSDT 1.7% 4.9% 6.9% 3.3% Open Child Welfare 28.1% 50.7% 58.5% 27.4% Foster Care 32.9% 59.1% 63.3% 28.9%

Race/ethnicity by penetration 1+ contact FY14/15 Black Hispanic White Other and Unknown All EPSDT 6.6% 3.8% 14.1% Open Child Welfare 42.7% 38.4% 49.3% 32.9% Foster Care 48.7% 41.9% 53.4% 35.7%

Penetration rate 5+ contacts Calculated as: unique count beneficiaries receiving 5 or more SMHS in FY divided by total number unique beneficiaries eligible for SMHS* in FY FY 14/15  Children/Youth with 5+ SMHS Visit Certified Eligible Children/Youth Penetration Rate All EPSDT 203,992 6,352,757 3.2% Open Child Welfare 43,653 135,811 32.1% Foster Care 32,301 88,445 36.5%   Penetration Rate FY 11/12 Penetration Rate FY12/13 Penetration Rate FY13/14 All EPSDT 3.7% 3.5% 3.4% Open Child Welfare 33.2% 33.1% 32.6% Foster Care 38.9% 38.3% 37.2%

Penetration rates 5+ contacts

Time to step down services following inpatient discharge FY 14/15   FY 14/15 Minimum # Days between Discharge & SD Maximum # Days between Discharge & SD Mean Time Next Contact - Days Median Time Next Contact - Days All EPSDT 365 21.9 3 Open Child Welfare 12.2 1 Foster Care 9.5

Where find these reports? Reports That Are Available: All EPSDT – Statewide and Population-Based Reports Open Child Welfare Cases – Statewide and Population-Based Reports Foster Care - Statewide and Population-Based Reports Available on POS Reports and Measures Catalog page: http://www.dhcs.ca.gov/provgovpart/pos/Pages/Performance-Outcomes-System- Reports-and-Measures-Catalog.aspx

UCLA Evaluation Evaluation components

Primary Evaluation question The University of California, Los Angeles, is conducting an evaluation to answer the question: What is a recommended statewide approach, supported by evidence from the field, to evaluate functional status for children/youth that are Medi-Cal EPSDT eligible and served by the California public specialty mental health service system?

Literature review/environmental scan Measures analyzed for potential to track functional status over time for children and youth served by a public mental health system. Total of 260 separate measures identified during literature search Priority was given to measures with more evidence of their use in evaluating outcomes in child/youth mental health care and currently being used by California county MHPs and/or other states. Of the 36 measures that had at least two articles, 34 were eliminated due to their inability to evaluate functional status outside 1 diagnosis. Eleven measures were being considered for further evaluation. Conducting literature review and environmental scan to identify evidence-based assessment tools used for evaluating outcomes.

survey 25 counties reported using tools that were diagnosis-specific or not functional assessment tools 48% of counties reported only using one tool, while some reported using up to six tools Nearly 1/3 of counties reported they had been using their tools for more than 5 years 21% of counties reported using tools they administered at least at the very beginning and end of treatment 87% of time counties scored tools as taking between 10-60 minutes to complete Only CANS, CBCL, and CAFAS were scored as taking longer than 60 minutes by at least one county

Modified Delphi panel Modified Delphi Panel conducted where SMEs evaluated tools identified from literature review/environmental scan and survey results in regards to their feasibility, utility, and validity. This was accomplished via a panel of subject matter experts representing various perspectives and stakeholders in the realm of child/youth mental health care. Panel “performed” well – diversity and breadth of perspectives Panelists agreed more in 2nd round than 1st as expected Ratings shifted towards those panelists with considerable expertise in a particular domain Positive experience for panelists

Final recommendations report UCLA will develop a draft final report summarizing the findings from each phase of the project, the final recommendation (including the pros and cons for each recommendation), and guidance regarding anticipated issues related to implementation of the methodology including, but not limited to: A plan for implementing the final recommendation(s). This includes identifying the impact of changes to State and local systems based on lessons learned from the counties, providers, and research on evidence-based best practices/research. Length of time required for data collection. Data reporting. Time intervals for data collection and reporting. Data analysis and interpretation. A statewide reporting template, indicating the data points that need to be collected and how they should be displayed, based on the recommended methodology. A plan to provide assistance to DHCS in using the recommended method to support a quality improvement process. Will be received September 30th

Questions?

For Questions Contact: cmhpos@dhcs.ca.gov Thank you for your time For Questions Contact: cmhpos@dhcs.ca.gov