"Integrated Performance Monitoring Report"
Integrated Performance Monitoring Report Performance Period April 2007-June 2007 July 2007 This report is published quarterly by the: STATE OF HAWAII Department of Education Department of Health Child and Adolescent Mental Health Division Early Intervention Section Integrated Performance Monitoring Report Department of Education Department of Health April 2007-June 2007 Introduction This performance report provides information about the necessary infrastructure and level of system performance for the Departments of Health and Education in providing a comprehensive system of educational, behavioral and mental health supports and services during the fourth quarter of fiscal year 2007 (April 2007-June 2007). It is published quarterly and reflects a part of the commitment of the Departments to maintain an accountable system of care through systematic reporting about the status of the youth with special needs, services, and core aspects of the service system infrastructure. It presents the most current data available so that stakeholders have access to accurate information about outcomes for youth and how well services are provided for them. The quarterly analysis and publication of trends regarding the population, services, and performance indicators provides Hawaii with a key mechanism for tracking the provision and sustainability of service provision. It provides for recognition of system strengths, and early detection of emerging issues. Status of Key System Commitments Over the past decade of service system development, key commitments have remained on the “front burner” because they represent the infrastructure and practices necessary for Hawaii to maintain an effective system of service delivery that reflects community values. These commitments are tracked and reported on in this report primarily through data presentation, including the tracking and interpretation of trends. Key findings for this reporting quarter are: 1. The system will continue to hire and retain qualified teachers and other therapeutic personnel necessary to educate and serve children consistently. For this reporting period, the Department of Education allocated more than 2151.5 special education teacher positions in the classrooms throughout the state. Eighty- nine percent of the positions were filled by qualified special education teachers. The Department maintains its continuous recruitment and hiring of qualified teachers to meet the ongoing needs for all schools and complexes across the State. The Department continues to deal with the challenge of filling all of the educational assistant positions needed in the classrooms. More than 93% of School-Based Behavioral Health services continue to be provided to students by employee-based personnel within the Department and the balance through contracted providers. July 2007 Page 1 of 6 Department of Education Department of Health Integrated Monitoring During the quarter, the Child and Adolescent Mental Health Division (CAMHD) continued to experience high numbers of vacancies in most of the Family Guidance Centers and the CAMHD Central Offices. Over the reporting period, CAMHD had an average of 76% of Care Coordinator positions statewide filled, which was 19% below the performance goal of 95% filled positions, and 1% below last quarter’s performance. This quarter’s result reflects over four full years, or the fourteenth consecutive quarter the performance goal was not met. CAMHD also did not meet its performance goal for adequate administrative infrastructure of filled position in its Central Offices as an average of 69% of positions in the central administrative offices were filled during the quarter. This marks the seventh consecutive quarter CAMHD has not achieved the desired performance for this indicator. Although these data may reflect an overall difficulty in filling State and/or healthcare positions in Hawaii, it hampers the ability to provide intensive case management and core administrative functions in CAMHD. In the quarter 26%, or 68 positions across CAMHD were vacant, roughly the same result that has been seen over the past several quarters. Family Guidance Centers (FGCs) are particularly affected by vacancies and the time it takes to fill positions. In the quarter, only Leeward Family Guidance Center met the goal for having 95% of their care coordinator positions filled. The range among all FGCs was between 53% and 96% filled care coordinator positions. The effect of vacancies was compounded by the increase in the overall registered population in most areas of the State. Since the same period as last year, CAMHD experienced a 7% growth in population, which is a positive trend as it shows progress toward assuring more timely access to services for youth with serious mental health issues. These two factors, high vacancies and growth in population, continue to result in higher caseloads for individual Care Coordinators. The statewide average was slightly above the expected range of 15-20 youth per care coordinator, and there was a slight improvement in the caseload average since last quarter. Caseloads were over the range in Central Oahu, Leeward Oahu, Windward Oahu, and Hawaii FGCs. Maui and Windward FGCs experienced modest decreases in caseload. The gain at Windward was the result of filling of care coordinator positions. Maui FGC, which had peaked as having the highest caseload among the FGCs over time, is now within the expected range. Maui caseloads were maintained within range not because of filling positions, but because of a steady decrease in the registered population, which may reflect an issue with access to services. Leadership from the Department of Education and CAMHD are studying these issues on Maui, and engaging in dialogue with the community to better understand any potential barriers to accessing services for youth and families who need more intensive mental health services. 2. The system will continue to purchase the necessary services to provide for the treatment of children appropriate to the individual needs of the child. The number of students identified with Autism Spectrum Disorders (ASD) in the State has increased 8.8% since last year. The Department of Education maintains 34 different contracts with private agencies to provide the following services: assessments, behavioral interventions, behavioral instructional support services, Performance Period April 2007-June 2007 July 2007 Page 2 of 6 Department of Education Department of Health Integrated Monitoring paraprofessional services, psychiatric services, and intensive learning centers and special school. CAMHD awarded a number of contracts for services through a Request for Proposals (RFP). The RFP was released to address specific services and service areas that were not awarded due to non-response to components of the RFP for Comprehensive array of services issued last Spring. Services awarded were: o Respite Home/Community Based Crisis Group Home /Community Mental Health Shelter (Oahu) o Community Based Residential (Level II) (Statewide) o Therapeutic Group Home for Gay, Lesbian, Bisexual, Transgender and Questioning Youth (GLBTQ) with Serious Mental Health Challenges (Statewide) o Intensive Outpatient Services for Substance Abuse/ Mental Health Treatment (Statewide) o Crisis Mobile Outreach Services (Maui Counties) There were no responses to the RFP for the following services, which will be procured through other means open to the State: o Community Based Residential for 7-12 year olds (Level III) (Statewide) o Crisis Mobile Outreach Services (Kauai) o Community Hospital Crisis Stabilization Services (Maui and Hawaii Counties) Two additional services are under formulation: o Assessment services for determining eligibility (Statewide) o Intensive Clinical Case Management or other alternatives to supporting provision of case management (Statewide) Several services continue to await implementation pending a signed Memorandum of Agreement between CAMHD and the Med-QUEST Division. 3. The system will monitor itself through a continuous quality management process. The Department of Education maintains an Information Management system (Integrated Information Management System-ISPED) to monitor and sustain high levels of system performance. Key system performance indicators for this quarter provided evidence of the system meeting the goals for timeliness, accessibility, and appropriateness of support and services. The Department is presently working on replacing the present ISPED system with an integrated system that will merge ISPED with two other separate web applications, CSSS and SSIS. This will enable relevant student data to be accessed through one integrated data base system. The cutover to the new eCSSS database is scheduled for June 2007. Beginning July 2007, eCSSS will be available to the field with both the CSSS and special education data and modules. ISPED will be available in “read- only” mode as a reference for data and reports verification. Performance Period April 2007-June 2007 July 2007 Page 3 of 6 Department of Education Department of Health Integrated Monitoring For this reporting period, 99.9% of students eligible for services through special education or 504 had no written complaints or telephone complaints. There were no internal or external reviews conducted during fourth quarter. CAMHD’s Performance Management system monitors performance at all levels of service delivery and actively uses data to make decisions about adjustments to its program. In the quarter, for many measures of CAMHD performance, the organization is functioning at a level comparable to that of previous quarters. Over 41% of CAMHD’s measures were not met in the quarter, which is the same result as last quarter. Since this period last year, CAMHD has been meeting only roughly half of its performance goals each quarter. Indicators of performance of the system impacted by position vacancies experienced across the Division continued to have an impact on a number of critical areas. These included the ability to fill positions in a timely way, caseloads, and quality committee/section performance. Currently, 26% of the positions in CAMHD, or 68 positions, are vacant. The lack of a full and stable workforce continues to challenge CAMHD’s ability to maintain an adequate service delivery infrastructure. The Performance Measures for filled Care Coordinator positions and caseloads within the expected range were not met for the entire fiscal year. The growth in the population of youth registered in CAMHD constitutes a steady trend over time. The total number of youth increased by 4%, which was a faster rate of growth than previous quarters. The population grew by full 7% over the same period as last year, which surpasses CAMHD projections for growth. Increases in population were seen in seven of the eight CAMHD Branches, as compared to four last quarter. Improving access to services, a core function of any service system, is a key initiative of the Division. The numbers of youth in out-of-state placements increased, which is a concerning trend that needs to be carefully monitored. Service utilization of Hospital-based Residential Services decreased slightly, as did the use of Community-Based Residential services. The percentage of families in the CAMHD population receiving intensive in-home services including Multi-Systemic Therapy remained fairly stable. Utilization of Therapeutic Foster Homes decreased over the previous quarter, and over the same period last year. The performance of contracted agencies providing services for youth and families remains above targeted levels, although performance declined from the previous year. Last year, 100% of agencies performed at an acceptable level. This year’s performance was 88% of agencies doing acceptably well. Overall, core infrastructure measures, primarily in the area of sufficient staffing, though improving slightly, continue to signal a compromised ability to provide comprehensive services to the intended population, which is growing steadily. Staffing to provide basic infrastructure tasks such as care coordination, training, utilization management, health plan management and contracting are stretched thin. Caseloads continue to be high in geographic areas that have high numbers of Performance Period April 2007-June 2007 July 2007 Page 4 of 6 Department of Education Department of Health Integrated Monitoring impoverished families. Continued focus on resolving these issues are critical for maintaining the stability of the system and the quality of services. Reviews conducted in the school complexes reflect an internally driven system for examining the performance of local service systems in providing services and supports for students with special needs. In the fiscal year, thirty-nine of the forty- one complexes (95%) conducting Internal or External Case-Based Reviews achieved the desired goal for acceptable system performance. This represents performance that mirrored last year when 95% of youth reviewed were found to have acceptable system performance. Likewise, child status was acceptable for 98% of the children reviewed, which is an improvement over last year’s results of 94% of those reviewed with acceptable child status. Previous and current performance data for the Departments are available through Departmental websites: (http://188.8.131.52/data/felix/index.htm and http://www.hawaii.gov/health/mental-health/camhd/index.html). 4. The system will ensure teachers, therapists, and other support staff continue their professional development and improve their skills and knowledge of effective educational and therapeutic methods and techniques. The Department of Education continued to conduct seminars and training for teachers in data collection and analysis, classroom management, and the referral process. Online courses continue to be offered statewide for teachers in a variety of subject areas to improve classroom instruction. Technical assistance by resource teachers were conducted with follow up observation and visits with special education and regular education teachers. Training for educational assistants continued to be offered this quarter to meet the requirements of the “No Child Left Behind” Act. As of June 2007, 439 of the newly hired special education teachers have been trained on reading strategies for special needs students. During the fourth quarter of FY07, CAMHD’s Practice Development Team continued to work on disseminating Evidence Based Practices to our contracted providers. A good deal of effort this quarter went toward launching a new Evidence Based program: Functional Family Therapy (FFT) in the Hawaii system of care. A "Kick-off" conference was held in April, followed by a weeklong clinical training series for clinicians in the agencies contracting to offer this service. Training was offered in the family guidance centers as well to familiarize care coordinators and clinicians with this new service. FFT is the third packaged Evidence Based program (along with Multisystemic Therapy and Multidimensional Treatment Foster Care) to be brought into the state of Hawaii in order to assure that our youth and families have access to state-of-the-art Mental Health Treatment. A weeklong training was also provided to family partners from Hawaii Families as Allies (HFAA) to prepare them to teach “Commonsense Parenting” to the parents with whom they work. The Commonsense Parenting curriculum includes many of the practice elements present in evidence-based parent training protocols, and the approach is designed to be taught by paraprofessional trainers. Performance Period April 2007-June 2007 July 2007 Page 5 of 6 Department of Education Department of Health Integrated Monitoring CAMHD’s quarterly six-day Care Coordinator Foundation training series was provided on the Big Island in May to five newly hired Mental Health Care Coordinators. In addition, the Practice Development team led the planning and organization of a conference attended by most of CAMHD’s care coordinators in June. The conference focused on the theme “Maximizing Youth Voice” and featured a panel presentation by five youth, representing four islands, who have been successful in CAMHD services. The conference included a brief keynote address by Dr. Hewitt B. “Rusty” Clark, a national expert in the area of transition to adulthood among youth with emotional challenges. Dr. Clark also was the facilitator for the youth panel. The CAMHD Practice Development Section continued the implementation of the federally funded SAMHSA grant project aimed at eliminating the use of coercive behavior management approaches and improving the quality of residential care in Hawaii. In the quarter, a daylong meeting of residential care providers was held to facilitate networking and provide training. Training materials for direct-care staff on alternatives to restraint and seclusion were distributed. A guest speaker, Dr. Steve Onken from University of Hawaii School of Social Work, provided training on the Recovery Model in Mental Health and on roles for consumers in residential settings. Report Format Following this brief introductory overview, the report format is as follows. The second section reports on the results of Integrated Monitoring conducted by the DOE and DOH during the quarter. Complexes and Family Guidance Centers conduct this evaluation of system performance through aggregated data and results of case-based reviews. Community members also participate in the reviews that continue to provide information for local service delivery improvements. Future reports written for public consumption will combine information on Internal Reviews and the Statewide Quality Assurance system into a new section titled Integrated Accountability System. The third section presents information specific to the DOE. This section has two major sections: Infrastructure and Performance. The fourth and fifth sections contains information specific to the Department of Health (DOH). Within this section are reports from Child and Adolescent Mental Health Division and Early Intervention Services. Within each of the sections, primarily in the summary, the Departments include their specific commitments to address issues that are identified. For issues related to Integrated Performance Monitoring, both Departments make the improvement commitments jointly. Performance Period April 2007-June 2007 July 2007 Page 6 of 6