Developing a Resource Guide for CANS Data Analysis and Reporting Vicki Sprague Effland, Ph.D.

Youth Improved!

Did Youth Improve Enough?

Need for Resource Guide Standardize methodology for CANS data analysis Establish benchmarks for various data analysis methods Develop guidelines for reporting CANS results

Introduction to Choices

Choices, Inc. Non profit care management entity created in 1997 Developed around a community need: “high cost youth” Blended system of care principles with wraparound values and managed care technology.

Choices Care Management More than 220 employees $35 million annual budget More than 1300 youth served in child and family teams daily Working across ALL child serving systems – 60% child welfare Indiana Choices – Since 1997 Maryland Choices – Since 2005 DC Choices – Since 2008 Louisiana Choices – Since 2012

Choices, Inc. Adopted CANS in 2006 – Comprehensive version – 12 Life Domains Outcomes Champion – Agency in 2007

Outcomes Monitoring Internal – Program effectiveness – Quality improvement External – Adherence to contract requirements – Marketing to new partners and communities

Successes Have lots of CANS data Multiple resources to analyze and report data – Outcomes and evaluation – Software development – Communications Ability to look at trends over time

Challenges Difficult to compare our performance to others – Multiple versions of the CANS – Variation in how CANS is analyzed – Multiple tools used across communities Need to establish meaningful performance expectations – Minimum levels of change – % youth expected to improve

Important Points about the CANS

Critical Elements of Communimetrics Measures 1.Partner Involvement 2.Malleable to the Organization 3.Just Enough Information Philosophy 4.Meaningfulness to Decision Process 5.Reliability at Item Level 6.Utility of Measure Based on its Communication Value

“Unlike psychometric measures in which clinical significance is a more rigorous standard than statistical significance, any change on the CANS is clinically significant.” - Lyons (2009), Communimetrics: A Communication Theory of Measurement in Human Service Settings

Family & Youth ProgramSystem Decision Support Service Planning Eligibility Resource Management Quality Improvement Case Management & Supervision AccreditationTransformation Outcome Monitoring Service Planning & Celebrations Evaluation Performance Contracting Total Clinical Outcomes Management

Methods for Analyzing the CANS Dimension-Level Analyses Item-Level Analyses

Dimension-Level Analyses

Change in Dimension Scores Analysis Steps 1.Sum items in a specified dimensions 2.Divide by the number of valid responses 3.Multiply by 10 4.Conduct statistical analysis

Change in Dimension Scores Reporting Results – Intake and discharge means – Results of statistical analysis – Statistically significant change in scores between intake and discharge Benchmarks – Accepted statistical criteria – None available for clinical significance

Change in Dimension Scores Advantages – Uses well known statistical methods – Statistical significance has a commonly understood meaning Disadvantages – Statistical significance not always indicative of clinical significance – Does not communicate results in terms of number of youth showing improvement

Any Improvement in Functioning Analysis Steps 1.Calculate intake and discharge mean scores 2.Identify youth with lower scores at discharge Intake Mean Score > Discharge Mean score 3.Divide by # youth in sample

Any Improvement in Functioning Reporting Results – % of youth with any improvement in functioning Benchmarks – N/A

Any Improvement in Functioning Advantages – Simple to analyze – Easy to explain methodology Challenges – Lack of established benchmarks – Difficult to communicate that change is clinically meaningful

Reliable Change Equation – RCI = 1.28 * SD * SQRT(1 – Reliability) Analysis Steps 1.Compute the RCI 2.Calculate change in intake and discharge mean scores 3.Identify youth with change in scores >= RCI 4.Divide by # youth in sample

Reliable Change Reporting Results – % of youth with a reliable improvement in functioning Benchmarks – 60-80% of youth expected to improve in at least one of the dimensions measured – 20-40% of youth expected to improve in a specific dimension

Reliable Change Advantages – Clearly defined method – Available benchmarks Challenges – Difficult for program staff to interpret and communicate results – Results include youth with no needs at intake

Actionable Needs Analysis Steps 1.Count the number of needs rated as a 2 or 3 within each dimension 2.Compare needs at Intake and Discharge

Actionable Needs Reporting Results – Average number of needs at intake and discharge across dimensions Benchmarks – N/A

Actionable Needs Advantages – Easy to display graphically – Simple for audiences familiar with the CANS to understand Challenges – Requires additional explanation if audience includes individuals not familiar with the CANS – Lack of established benchmarks

Met Needs Analysis Steps 1.Identify youth with ratings of 2 or 3 on individual items at Intake 2.Determine whether item ratings decreased to a 0 or 1 by Discharge 3.Compute the number and percent of items met within each dimension 4.Calculate the percent of youth who met at least one (or more) needs within the dimension

Met Needs Reporting Results – Average number of needs met by dimension – Percent of needs met – Percent of youth who met at least one need Benchmarks – N/A

Met Needs Advantages – Effective way to communicate improvement – Simple for audiences familiar with the CANS to understand – Several options for reporting Challenges – Requires additional explanation if audience includes individuals not familiar with the CANS – Lack of established benchmarks

Dimension-Level Analyses Questions? Additional Methods? Thoughts?

Item-Level Analyses

Item Score Analysis Steps 1.Mean item score for all youth at Intake and at Discharge 2.Multiply by 10

Item Score Reporting Results – Graph of intake and discharge scores Benchmarks – N/A

Item Score Advantages – Easy to present graphically Disadvantages – Does not communicate results in terms of number of youth showing improvement

Any Improvement Analysis Steps 1.Identify youth with ratings of 2 or 3 at Intake 2.Identify youth with lower scores at Discharge Intake Rating > Discharge Rating 3.Compute mean number of youth showing improvement Note that need does not have to be met to count in this analysis

Any Improvement Reporting Results – % of youth with any improvement in functioning Benchmarks – N/A

Any Improvement Advantages – Simple to analyze – Allows for any improvement in functioning to be reflected Challenges – Lack of established benchmarks

Met Needs Analysis Steps 1.Identify youth with ratings of 2 or 3 on individual items at Intake 2.Determine whether item ratings decreased to a 0 or 1 by Discharge 3.Calculate the percent of youth who met the item

Met Needs Reporting Results – Percent of youth who met individual needs – Results for individual needs within a dimension Benchmarks – N/A

Met Needs Advantages – Effective way to communicate improvement – Simple for audiences familiar with the CANS to understand Challenges – Requires additional explanation if audience includes individuals not familiar with the CANS – Lack of established benchmarks

Item-Level Analyses Questions? Additional Methods? Thoughts?

Establishing Benchmarks Grab those pens and pencils!

Establishing Benchmarks 1.Youth 2.Service models 3.CANS versions 4.Availability of data 5.Analysis methods 6.Reporting results

Establishing Benchmarks 1.Youth a.Age b.Race/ethnicity c.Strengths and needs prior to intervention

Establishing Benchmarks 2. Service models a.Wraparound b.Residential treatment c.Crisis intervention d.Outpatient therapy e.Detention

Establishing Benchmarks 3.CANS versions a.Comprehensive b.Mental health c.Juvenile justice d.Child welfare e.Education f.Crisis

Establishing Benchmarks 4.Availability of data a.Number of youth served annually b.Method for completing CANS c.Data management d.Willingness/ability to share data

Establishing Benchmarks 5.Analysis methods Dimension-Level a.Dimension scores b.Any improvement c.Actionable Needs d.Met Needs

Establishing Benchmarks 5.Analysis methods Item-Level a.Item scores b.Any improvement c.Met Needs

Establishing Benchmarks 6.Reporting results a.Youth demographics b.Service context c.Amount, frequency and/or duration of services d.Sample size e.Length of stay f.CANS version used g.Data analysis method used

Next Steps 1.Compile your survey responses 2.Share survey with other CANS users 3.Form CANS Benchmarking Workgroup a.John Lyons b.Volunteers? c.Nominations 4.Develop action plan 5.Provide updates on progress

Thank You! Vicki Sprague Effland, Ph.D. Director, Outcomes and Evaluation Choices, Inc N. Keystone Ave., #150 Indianapolis, IN