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

2. agenda
POS September 2016 Reports
Exploring the Data
UCLA Evaluation

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

4. 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*

5. 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.

6. 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

7. 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

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

9. 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%

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

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

12. Statewide Open Child Welfare Foster Care
AGE FY 14/15

13. 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%

15. 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%

16. Penetration rates 1+ Contact

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

18. 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%

19. 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%

21. 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%

22. Penetration rates 5+ contacts

23. 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

24. 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:
Reports-and-Measures-Catalog.aspx

25. UCLA Evaluation
Evaluation components

26. 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?

27. 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.

28. 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 minutes to complete
Only CANS, CBCL, and CAFAS were scored as taking longer than 60 minutes by at least one county

29. 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

30. 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

31. Questions?

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