1. Children’s Functional Assessment Rating Scale (CFARS)

2. CFARS
Developed by the Florida Mental Health Institute at the University of South Florida
Provides a standard measurement to assess functional needs and progress and provide outcomes information

3. CFARS
Developed to monitor agency level quality improvement initiatives and assist clinicians with individualized treatment planning
Used statewide in Florida, Illinois, New Mexico, and Wyoming for Medicaid-funded mental health services

4. CFARS information Resource manual Website http://outcomes.fmhi.usf.edu
Each program manager should have the manual available for clinicians to review
Website
Manual
Training and test vignettes
Training certification

5. Learning how to complete the CFARS
Review the manual
Score the 2 practice vignettes and then check your scoring against the standards
Note: A range of answers is acceptable.
Complete the free on-line certification

6. Training is important Ratings need to be consistent across clinicians.
The CFARS may be used to make important decisions (e.g., service authorizations), therefore clinicians should have a strong understanding of what the scores mean

7. Training Logistics
Training should occur when clinicians are hired, before they start seeing clients, and during periodic refreshers
All clinicians should work through the vignettes and on-line training until their ratings are consistent with the standard.
On-line training is highly recommended by the County
Please keep a copy of the training certificate for your records, in case of a site visit.

8. CFARS official training
The self-paced training and certification process generally takes ~2 hours
It is not necessary to complete the training in one sitting
Instructions on how to register are on p. 7 of the manual, or on the website

9. CFARS 16 Functional Domains
Depression
Anxiety
Hyperactivity
Thought Process
Cognitive Performance
Medical/Physical
Traumatic Stress
Substance Use
Interpersonal Relationships
Behavior in “Home” Setting
ADL Functioning
Socio-Legal
Work/School
Danger to Self
Danger to Others
Security/Management Needs
*Refer to p in manual for definitions of words/phrases in each domain and specific anchor guidelines

10. CFARS Problem Severity Ratings
Each domain is rated on a scale of 1 (No Problem) to 9 (Extreme Problem).
Ratings should reflect the degree to which the youth is currently (within past 3 weeks) experiencing difficulty or impairment in the domain.

11. CFARS Problem Severity Ratings
Words and phrases (both positive and negative) that are associated with symptoms or behaviors in each domain are given to help identify issues and help make rating (p. 6 of the manual)

12. Guidelines for Determining Problem Severity Ratings
Within each domain, begin by marking the words/phrases that describes a behavior or symptom of the child you are evaluating.
Next, using the general principles and scoring rationale, assign a Problem Severity Rating to describe recent functioning in each domain.

13. Severity Ratings are associated with:
How immediate is the need for intervention in order to stabilize or correct deficits in functioning within the rated domain?
Is the need for intensive intervention imperative/immediate (scores 7-9), moderate intervention required (5) not urgent (3)?
For this rating, take into account the level of intervention necessary
*Refer to p. 13 in manual for “Basic issues to consider when assigning CFARS Problem Severity Ratings to individual functional domains.”

14. Severity Ratings are associated with:
How intrusive is the intervention that is needed to stabilize or correct deficits in functioning within the rated domain?
Consider the level of intervention that a child needs [e.g., Imminent need for hospitalization (7-9), outpatient treatment (5), no treatment (3)]
*Refer to p. 13 in manual for “Basic issues to consider when assigning CFARS Problem Severity Ratings to individual functional domains.”

15. Severity Ratings are associated with:
How much does functioning in the rated domain impact negatively on or interfere with healthy functioning in other domains? Consider the number of domains impacted.
For example, ADHD symptoms may slightly interfere with a child’s functioning at school (5)
Depression may be causing a severe problem in the danger to self and school domains (7)
*Refer to p. 13 in manual for “Basic issues to consider when assigning CFARS Problem Severity Ratings to individual functional domains.”

16. General Anchor Guidelines
1 = No Problem
Functioning is consistently average or better than what is typical for this person’s age, sex, and subculture.
2 = Less than Slight Problem

17. General Anchor Guidelines
3 = Slight Problem
Functioning falls short for a person of this age, sex, and subculture most of the time.
Problem may be intermittent or may persist at a low level.
Problem or symptoms have little or no impact on other domains or may be currently controlled by medications.
Need for treatment is not urgent but may require therapeutic intervention in the future.

18. General Anchor Guidelines
4 = Slight to Moderate Problem
5 = Moderate Problem
Functioning is clearly marginal or inadequate, not meeting the usual expectations of a typical person of this age, sex, and subculture.
Dysfunction or problem may persist at moderate level or become severe on occasion.
Problems may be related to problems in other domains and do require therapeutic intervention(s).

19. General Anchor Guidelines
6 = Moderate to Severe Problem
7 = Severe Problem
Functioning in this range is marked by obvious and consistent failures, never meeting expectations of a typical person of this age, sex, and subculture.
Dysfunction or problem may be chronic, extends to other domains, and generally interferes with interpersonal or social relationships with others.
Hospitalization or some other form of external control may be needed (Note: in San Diego, hospitalization only occurs if there is imminent need) in addition to other therapeutic intervention(s).

20. General Anchor Guidelines
8 = Severe to Extreme Problem
9 = Extreme Problem
Highest level
Situation is out of control, unacceptable, and/or potentially life-threatening.
The need for external control or intervention is immediate.

21. General Anchor Guidelines
A score of 4 or higher is considered “Clinically Elevated” by the CFARS developers
Areas of strength are those rated 1 or 2

22. Rating Caveat:
If a domain is being maintained or controlled by medication or other supports, that domain should not be rated as a “1” or “2”.
There are still costs associated with maintaining the intervention and it is possible that decreased functioning could return if the interventions were removed.
Refer to pg. 11 in the manual for more information

23. How does the CFARS relate to the GAF score?
You cannot say that a score of XX on the CFARS is equal to a score of YY on the GAF
You can use the same information to develop the CFARS and GAF scores.
The scores should be similar in nature: a child with severe problems on the CFARS should have a GAF score that reflects those problems.

24. What about SED?
There is no set score on the CFARS that correlates to the SED definition.
You can use the CFARS domain information to help determine if a child meets SED criteria.

25. What about SED?
The CFARS scores should be similar in nature to the SED classification
A child with severe problems (ratings of 7 and higher) on the CFARS would be likely to meet SED criteria
A child with slight problems (ratings of 3 and under) would be unlikely to meet SED criteria.

26. What happens with the 16 domain scores?
Entered on the County forms for UR / DPR
Entered into the Data Entry System (DES) and used to generate 4 Index Scores that summarize the domains

28. Index Scores & Related Domains
Relationships:
Hyperactivity
School / Work
Interpersonal Relationships
Cognitive Performance
Behavior in the Home
Danger to Others

29. Index Scores & Related Domains
Safety:
Socio-legal
Substance Use
Security Management Needs
Danger to Self

30. Index Scores & Related Domains
Emotionality:
Anxiety
Traumatic Stress
Depression

31. Index Scores & Related Domains
Disability:
ADL Functioning
Medical / Physical
Thought Process

32. What happens with the 16 domain scores?
The Index Scores will appear on the Assessment Summary printout from the DES
The Index scores are used in the County’s outcomes objectives
Example: For 80% of discharged clients whose episodes lasted 2 months or longer, the CFARS score shall be at least one level higher (improvement) at discharge than at admission in at least one index area.

33. Additional Resources in CFARS Manual
Examples of using CFARS ratings to develop individualized treatment plans or to monitor client change/improvement.
Using the clinical scales derived from the 16 domains.
Using CFARS domains to help gather info for the mental status exam.