Center for Evaluation and Program Improvement CFIT Clinical Annual Report: Executive Summary a joint quality enhancement initiative GEORGIA (revised) Providence Service Corporation

Introduction Providence's mission is to ensure the provision of accessible, effective, high quality community-based counseling and social services as an alternative to traditional institutional care. One of the primary goals of our youth programs is to prevent out-of-home placement and provide services in a least restrictive environment. We often talk about youth coming into our programs as being on a downward spiral and heading toward residential treatment or higher level of care if something doesn’t change. They are often in the middle of a crisis when they are referred to our services, and one of our first goals is to stabilize the current situation to prevent further decline. Once the client’s current condition is stabilized, then we work on interventions that assist the youth and family achieve goals that improve their situation over time. This report was generated by the Center for Evaluation and Program Improvement, Peabody College at Vanderbilt University for Providence Service Corporation. It provides descriptive information on clients enrolled in programs using CFIT and with whom CFIT is being used; information is not available for clients not using CFIT. CFIT is the continuous quality enhancement initiative of Providence Service Corporation and stands for Contextualized Feedback Intervention & Training. This report does not represent the effects of using CFIT, such results will be available after the evaluation of the initiative is completed. The report includes clients ages who were active in the CFIT system during the report period. The report includes clients who started using CFIT after they had already begun treatment (“current clients”) as well as those who started using CFIT at the beginning of their treatment (“new clients”). The determination of who is new or current is based on data as entered by regions. The data for clients served in home-based and foster-care programs are reported separately if both types are present in a state. Home-based programs include: 7 Challenges, After Care, Community Support Child, High Impact, Homestead, In-home Services, Intensive In-home Services, Medicaid-IN, Monitor Prime, Out Patient, Sex Offender Treatment, Voyage, and Wrap Around. The report includes only a selection of the available data. Other information available with CFIT is treatment motivation, treatment expectancy, severity rated by the counselor, therapeutic alliance of the youth and the counselor, therapeutic alliance of the caregiver and the counselor, the caregiver’s life satisfaction, as well as additional background information. In addition, for most clients there are more data points per measure available than reported here. If you would like additional information, please contact For detailed psychometric information on any of the scales, please see the manual of the Peabody Treatment Progress Battery at Data for this report are based on information as entered by local regional offices. The Center for Evaluation and Program Improvement cannot guarantee the accuracy of the data. Please note that the de- identified data for this report were extracted from the CareLogic-CFIT system on 01/10/08. IMPORTANTLY, the number of clients for whom data are available can be too small for some results to be useful or reliably interpreted. Small numbers can reflect a currently low enrollment in CFIT, or the unavailability of complete information for clients who are enrolled. For clinical findings, an asterisk (*) appears after the number of clients shown in parentheses when the number of clients is less than 10. For this report, some results (e.g., those reported by months between assessments) are combined if a category included less than 3 clients. Percentages are based only on those who provided information. Reports for new or current clients in foster care or home-based services are generated if 3 or more clients are in that category. If you have any questions or feel that information provided in this report is incorrect, please contact

New Clients This part of the report includes data on clients who started CFIT at the beginning of their treatment (“new clients”). The determination of who is new or current is based on data as entered by regions.

Home-Based Programs 19 youths (age 11-18) were active in one of our home- based programs and participated in CFIT this year 19 started CFIT during this year 5 stopped using CFIT during this year HB-1

What Types of Youths Do We Serve? Home-Based (New Clients) HB-2 Of 13 Youths, 39% are African American 46% are Caucasian Of 13 Youths, 39% are African American 46% are Caucasian Of 11 Youths, 18% have a Hispanic background Of 11 Youths, 18% have a Hispanic background Top 5 presenting problems (of 18 youths): 1.Depression (44%) 2.ODD (44%) 3.Aggression (39%) 4.ADHD / Impulsivity (each 33%) 5.Abuse victim / School problems (each 33%) Top 5 presenting problems (of 18 youths): 1.Depression (44%) 2.ODD (44%) 3.Aggression (39%) 4.ADHD / Impulsivity (each 33%) 5.Abuse victim / School problems (each 33%) Top referral sources (of 18 youths): 1.Dept. of Social Services (22%) 2.Family/Caregiver (17%) 3.Other (17%) 4.Law Enforcement (11%) Top referral sources (of 18 youths): 1.Dept. of Social Services (22%) 2.Family/Caregiver (17%) 3.Other (17%) 4.Law Enforcement (11%) Of 13 Youths, 69% have more than 5 presenting problems when they start services with us; 15% have 2 or fewer problems Of 13 Youths, 69% have more than 5 presenting problems when they start services with us; 15% have 2 or fewer problems This information is based on background forms, which only new clients complete. For some new clients, however, no background information was available or certain items were Missing. This can result in different numbers of clients for different items. Clients can have more than one presenting problem. Thus, the sum of the percentages for the top 5 presenting problems can exceed 100%. The percent reported for each problem represents the portion of clients for whom each problem was listed.

How Are Youths Doing in Our Services? Home-Based (New Clients) HB-3 Changes are reported as differences from the first available assessment (which does not need to correspond with the beginning of treatment if early assessment was missed) to the last available (which can occur before the current report period). If changes did not exceed the reliable change threshold, the difference was counted as stable. The reliable change threshold is based on the reliable change index, a statistical criterion that determines whether a change is due to something more than random fluctuations. Only if at least two assessments at two different time points were available, were the clients’ scores included. Changes are reported separately for when the time between the first and last assessment was 3 months or less apart, between 4-6 months apart, or more than 6 months apart. However, if the number of clients is less than 3 in one of these categories, they are combined with those in an adjoining category. All three categories are combined if there are less than 3 clients in all of them. Active Clients (N=9)* Discharged Clients (N=3)* Functioning & Symptom Severity as Reported by the Youth 44% improved 56% maintained stability 33% improved 67% maintained stability

How Are Youths Doing in Our Services? Home-Based (New Clients) HB-4 Functioning & Symptom Severity as Reported by the Caregiver Active Clients (N=8)* Discharged Clients (N=2)* 13% improved 50% maintained stability 0% improved 100% maintained stability Changes are reported as differences from the first available assessment (which does not need to correspond with the beginning of treatment if early assessment was missed) to the last available (which can occur before the current report period). If changes did not exceed the reliable change threshold, the difference was counted as stable. The reliable change threshold is based on the reliable change index, a statistical criterion that determines whether a change is due to something more than random fluctuations. Only if at least two assessments at two different time points were available, were the clients’ scores included. Changes are reported separately for when the time between the first and last assessment was 3 months or less apart, between 4-6 months apart, or more than 6 months apart. However, if the number of clients is less than 3 in one of these categories, they are combined with those in an adjoining category. All three categories are combined if there are less than 3 clients in all of them.

How Are Youths Doing in Our Services? Home-Based (New Clients) HB-6 Life Satisfaction as Reported by the Youth Active Clients (N=3)* Discharged Clients (N=1)* 0% improved 67% maintained stability 0% improved 100% maintained stability Changes are reported as differences from the first available assessment (which does not need to correspond with the beginning of treatment if early assessment was missed) to the last available (which can occur before the current report period). If changes did not exceed the reliable change threshold, the difference was counted as stable. The reliable change threshold is based on the reliable change index, a statistical criterion that determines whether a change is due to something more than random fluctuations. Only if at least two assessments at two different time points were available, were the clients’ scores included. Changes are reported separately for when the time between the first and last assessment was 3 months or less apart, between 4-6 months apart, or more than 6 months apart. However, if the number of clients is less than 3 in one of these categories, they are combined with those in an adjoining category. All three categories are combined if there are less than 3 clients in all of them.

Do Youths Feel Our Services Have a Positive Impact for Them? Home-Based (New Clients) HB-7 Of 8 Youths 75% reported that their last session gave them insight into their strengths Of 8 Youths 75% reported that their last session gave them insight into their strengths Of 8 Youths 75% reported that they used what they learned in counseling Of 8 Youths 75% reported that they used what they learned in counseling Of 8 Youths 50% reported that they feel better about themselves than before Of 8 Youths 50% reported that they feel better about themselves than before Of 8 Youths 75% reported that they have a better idea of how to deal with problems Of 8 Youths 75% reported that they have a better idea of how to deal with problems If a client endorsed any of these items either with “quite a bit” or “totally” (the two highest possible ratings), they were counted as reporting a perceived impact.

Home-Based (New Clients) Are the Families Satisfied with Our Services? HB-8 Of 4 Youths, 75% felt they did get the kind of services they thought they needed Of 4 Youths, 75% felt they did get the kind of services they thought they needed Of 4 Youths, 75% felt our services were the right approach for helping them Of 4 Youths, 75% felt our services were the right approach for helping them Of 4 Youths, 50% would recommend our services to a friend Of 4 Youths, 50% would recommend our services to a friend Of 4 Youths, 50% would select our services if they were to seek help again Of 4 Youths, 50% would select our services if they were to seek help again YOUTHS Of 4 Caregivers, 100% felt they did get the kind of services they thought they needed Of 4 Caregivers, 100% felt they did get the kind of services they thought they needed Of 4 Caregivers, 75% felt our services were the right approach for helping them Of 4 Caregivers, 75% felt our services were the right approach for helping them Of 4 Caregivers, 100% would recommend our services to a friend Of 4 Caregivers, 100% would recommend our services to a friend Of 4 Caregivers, 100% would select our services if they were to seek help again Of 4 Caregivers, 100% would select our services if they were to seek help again CAREGIVERS Only ratings of clients and their caregivers that were completed during the report period were included in this report. If the last available rating happened before the report period, the ratings were not included, even if the client was active during the report period.

Are we reducing caregiver strain? Of the 10 primary caregivers who provided background information, 70% are Birth Parents 30% are Foster Parents Of the 10 primary caregivers who provided background information, 70% are Birth Parents 30% are Foster Parents CAREGIVER STRAIN (N=0) Home-Based (New Clients) HB-9 NA% improved NA% maintained stability The number of caregivers who completed the background form, which includes the question about the relationship to the youth, can differ from the number of caregivers who provided at least two ratings of caregiver strain. Background forms are completed, thus reported, only for new, not current, clients. Too, the caregiver strain report is provided only for clients in home-based programs, not foster care. The changes in caregiver strain are based on the differences in the scores (first available to last available) from the Caregiver Strain Questionnaire – Short Version that exceed the reliable change threshold. The reliable change threshold is based on the reliable change index, a statistical criterion that determines whether a change is due to something more than random fluctuations. Changes are reported separately for when the time between the first and last assessment was 3 months or less apart, between 4-6 months apart, or more than 6 months apart. However, if the number of clients is less than 3 in one of these categories, they are combined with those in an adjoining category. All three categories are combined if there are less than 3 clients in all of them.

Current Clients This part of the report includes data on clients who started CFIT after they had already begun treatment (“current clients”). The determination of who is new or current is based on data as entered by regions.

Home-Based Programs 48 youths (age 11-18) were active in one of our home- based programs and participated in CFIT this year 44 started CFIT during this year 15 stopped using CFIT during this year HB-1

How Are Youths Doing in Our Services? Home-Based (Current Clients) HB-3 Changes are reported as differences from the first available assessment (which does not need to correspond with the beginning of treatment if early assessment was missed) to the last available (which can occur before the current report period). If changes did not exceed the reliable change threshold, the difference was counted as stable. The reliable change threshold is based on the reliable change index, a statistical criterion that determines whether a change is due to something more than random fluctuations. Only if at least two assessments at two different time points were available, were the clients’ scores included. Changes are reported separately for when the time between the first and last assessment was 3 months or less apart, between 4-6 months apart, or more than 6 months apart. However, if the number of clients is less than 3 in one of these categories, they are combined with those in an adjoining category. All three categories are combined if there are less than 3 clients in all of them. Active Clients (N=4)* Discharged Clients (N=11) Functioning & Symptom Severity as Reported by the Youth 42% improved 42% maintained stability 46% improved 46% maintained stability

How Are Youths Doing in Our Services? HB-4 Functioning & Symptom Severity as Reported by the Caregiver Active Clients (N=16) Discharged Clients (N=6)* 63% improved 19% maintained stability 67% improved 33% maintained stability Changes are reported as differences from the first available assessment (which does not need to correspond with the beginning of treatment if early assessment was missed) to the last available (which can occur before the current report period). If changes did not exceed the reliable change threshold, the difference was counted as stable. The reliable change threshold is based on the reliable change index, a statistical criterion that determines whether a change is due to something more than random fluctuations. Only if at least two assessments at two different time points were available, were the clients’ scores included. Changes are reported separately for when the time between the first and last assessment was 3 months or less apart, between 4-6 months apart, or more than 6 months apart. However, if the number of clients is less than 3 in one of these categories, they are combined with those in an adjoining category. All three categories are combined if there are less than 3 clients in all of them. Home-Based (Current Clients)

How Are Youths Doing in Our Services? HB-6 Life Satisfaction as Reported by the Youth Active Clients (N=15) Discharged Clients (N=8)* 40% improved 53% maintained stability 50% improved 38% maintained stability Changes are reported as differences from the first available assessment (which does not need to correspond with the beginning of treatment if early assessment was missed) to the last available (which can occur before the current report period). If changes did not exceed the reliable change threshold, the difference was counted as stable. The reliable change threshold is based on the reliable change index, a statistical criterion that determines whether a change is due to something more than random fluctuations. Only if at least two assessments at two different time points were available, were the clients’ scores included. Changes are reported separately for when the time between the first and last assessment was 3 months or less apart, between 4-6 months apart, or more than 6 months apart. However, if the number of clients is less than 3 in one of these categories, they are combined with those in an adjoining category. All three categories are combined if there are less than 3 clients in all of them. Home-Based (Current Clients)

Do Youths Feel Our Services Have a Positive Impact for Them? HB-7 Of 33 Youths 55% reported that their last session gave them insight into their strengths Of 33 Youths 55% reported that their last session gave them insight into their strengths Of 33 Youths 55% reported that they used what they learned in counseling Of 33 Youths 55% reported that they used what they learned in counseling Of 33 Youths 55% reported that they feel better about themselves than before Of 33 Youths 55% reported that they feel better about themselves than before Of 33 Youths 55% reported that they have a better idea of how to deal with problems Of 33 Youths 55% reported that they have a better idea of how to deal with problems If a client endorsed any of these items either with “quite a bit” or “totally” (the two highest possible ratings), they were counted as reporting a perceived impact. Home-Based (Current Clients)

Are the Families Satisfied with Our Services? HB-8 Of 16 Youths, 100% felt they did get the kind of services they thought they needed Of 16 Youths, 100% felt they did get the kind of services they thought they needed Of 16 Youths, 94% felt our services were the right approach for helping them Of 16 Youths, 94% felt our services were the right approach for helping them Of 15 Youths, 93% would recommend our services to a friend Of 15 Youths, 93% would recommend our services to a friend Of 16 Youths, 94% would select our services if they were to seek help again Of 16 Youths, 94% would select our services if they were to seek help again YOUTHS Of 10 Caregivers, 100% felt they did get the kind of services they thought they needed Of 10 Caregivers, 100% felt they did get the kind of services they thought they needed Of 10 Caregivers, 100% felt our services were the right approach for helping them Of 10 Caregivers, 100% felt our services were the right approach for helping them Of 10 Caregivers, 100% would recommend our services to a friend Of 10 Caregivers, 100% would recommend our services to a friend Of 10 Caregivers, 100% would select our services if they were to seek help again Of 10 Caregivers, 100% would select our services if they were to seek help again CAREGIVERS Only ratings of clients and their caregivers that were completed during the report period were included in this report. If the last available rating happened before the report period, the ratings were not included, even if the client was active during the report period. Home-Based (Current Clients)