Family-Driven and Youth-Guided Practices in Residential Treatment March 2010

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Purpose of the Project Family-Driven and Youth-Guided Practices in Residential Treatment March 2010 Presentation to the 23 rd Annual Children s Mental Health Research and Policy Conference Jonathan D.

1 Purpose of the Project Family-Driven and Youth-Guided Practices in Residential Treatment March 2010 Presentation to the 23 rd Annual Children s Mental Health Research and Policy Conference Jonathan D. Brown, PhD, MHS Kamala Allen, MHS Kirsten Barrett, PhD Henry T. Ireys, PhD Gary Blau, PhD Survey residential treatment providers to answer: To what extent do family members and youth participate in making decisions about treatment planning? Do residential treatment staff understand and apply the principles of family-driven, youth-guided care? What are the family visitation policies and family support practices of residential treatment facilities? To what extent are family members and youth involved in the oversight and operations of residential treatment? 2 Changes in Residential Treatment Pressure to offer higher-quality care and to improve outcomes while minimizing length of stay, controlling costs, and collaborating with community-based providers Several associations of residential treatment providers have endorsed family-driven, youth-guided principles Research has not systematically examined the extent to which residential treatment providers have adopted family-driven, youth-guided practices What Is Family-Driven Youth-Guided Care? Family-driven care: parents or caregivers are respected as the primary decision makers in the care of their children and in the development of policies and procedures governing care for all children in their community Youth-driven care: young people p take an active role in determining their treatment and are active participants in the design and oversight of services for youth in their community 3 4 What Are Family-Driven, Youth-Guided Practices? Some examples: Strength-based individualized treatment planning Incorporate family members and natural helpers Preserve family relationships through regular contact between youth and their families What Are Family-Driven, Youth-Guided Practices? More examples: Mentoring of youth peers and family-to-family support Participation of families and youth in oversight activities Agency advisory boards, management, staff training, and quality assurance reviews Collaborate with community-based providers to connect youth with home and community-based services 5 6

Survey of Residential Treatment Facilities Developed and conducted Survey of

facets of family-driven, youth-guided care Respondent burden Avoiding

facilities/respondents to participate in the survey 7 Survey Development

researchers, and advocates to select domains of measurement and develop

questions that were practice-oriented Pilot tested survey (revise, revise,

survey required 30 minutes to complete online or paper 8 Distribution of SRTF

Survey of Mental Health Treatment Facilities (SMHTF) Facilities that reported

children and youth age 17 and under Email invitation with 4 reminder emails

representative of SMHTF in terms of: Licensure Accreditation Payment Number

2 Survey of Residential Treatment Facilities Developed and conducted Survey of Residential Treatment Facilities (SRTF) Challenges and Caveats: Measuring all facets of family-driven, youth-guided care Respondent burden Avoiding socially desirable responses No way to independently verify responses Finding facilities/respondents to participate in the survey 7 Survey Development Advisory panel of residential treatment providers, family members, youth, researchers, and advocates to select domains of measurement and develop survey questions Reviewed the literature Key informant interviews Developed questions that were practice-oriented Pilot tested survey (revise, revise, revise) Developed web-version of survey/pilot test (revise again) Final survey required 30 minutes to complete online or paper 8 Distribution of SRTF Distributed in spring 2009 to 611 facilities that completed the 2008 SAMHSA Survey of Mental Health Treatment Facilities (SMHTF) Facilities that reported in the SMHTF to provide 24-hour out-of-home residential treatment for children and youth age 17 and under invitation with 4 reminder s and 2 phone calls in spring 2009 Respondents were not compensated Received responses from 293 facilities, or 53.8% Respondents Representative of SMHTF Respondents to our survey were representative of SMHTF in terms of: Licensure Accreditation Payment Number of children/youth served Region 9 10 Facility Characteristics Facility Characteristics Accreditation 1% 10% 32% 35% NCQA CARF COA Joint Commission 11 12

Facility Characteristics To what extent do family

Planning Treatment Team Typically Includes 80 70

Team 67% 65% 63% Contribute to Treatment Plan

Decision Maker in Treatment Planning 15 16

with other agencies Most facilities reported that

and/or youth are not primary decision makers in

3 Facility Characteristics To what extent do family members and youth participate in decision-making in treatment planning? Youth and Family Member Roles in Treatment Planning Treatment Team Typically Includes % 60% 53% Select Treatment Team 67% 65% 63% Contribute to Treatment Plan Youth Family Members Both 17% 12% 6% Primary Decision Maker in Treatment Planning Treatment Plans Conclusions: Treatment Planning Nearly all facilities reported using strength-based treatment planning and working with other agencies Most facilities reported that they incorporate youth and family input Parents and/or youth are not primary decision makers in treatment planning Half of facilities include family liaisons or natural helpers on the treatment team 17 18

Staff Knowledge Do residential treatment staff understand and apply

60% 50% 40% 30% 20% 10% 0% Knowledge of Family-Driven Youth-Guided

Care Principles 43% 38% 19% Youth-Guided Care Principles Not heard

need additional training Regularly apply principles 19 20

regularly apply family-driven principles 19 percent of facilities

that staff have not heard of or need training to apply these

support practices of residential treatment facilities?

4 Staff Knowledge Do residential treatment staff understand and apply the principles of family-driven, youthguided care? 60% 50% 40% 30% 20% 10% 0% Knowledge of Family-Driven Youth-Guided Care Among Residential Treatment Staff 45% 43% 12% Family-Driven Care Principles 43% 38% 19% Youth-Guided Care Principles Not heard of or not received training in principles Understand principles but need additional training Regularly apply principles Conclusions: Staff Training 12 percent of facilities have staff that regularly apply family-driven principles 19 percent of facilities have staff that regularly apply youth-driven principles Most report that staff have not heard of or need training to apply these principles What are the family visitation policies and family support practices of residential treatment facilities? Family Visitation Practices 99.6% of residential treatment providers allow family visitation Family Support Practices 23 24

Peer Support Conclusions: Family Support Facilities

visitation Some facilities restrict visitation Few

Involvement in Oversight and Operations* To what

oversight and operations of residential treatment?

staff training or quality assessor 27 28 Conclusions:

family members or youth in management, training, or

adopted some practices that are consistent with

5 Peer Support Conclusions: Family Support Facilities engage in several family support activities and allow visitation Some facilities restrict visitation Few facilities offer peer support Family Involvement in Oversight and Operations* To what extent are family members and youth involved in the oversight and operations of residential treatment? *Includes serving as a board member, family liaison, staff training or quality assessor Conclusions: Oversight and Operations Few facilities include family members or youth in management, training, or quality assurance Final Conclusions Facilities have adopted some practices that are consistent with family-driven, youth-guided care Family members and youth should be placed at the center of decision-making There is a need for staff training Family members and youth should be included in oversight 29 30

6 Mathematica is a registered trademark of Mathematica Policy Research. 23rd Annual Children's Mental Health Research & Policy Conference March 7-10, 2010 Project Sponsors and Advisors Kamala Allen, Center for Health Care Strategies Abel Ortiz, Annie E. Casey Foundation Gary Blau, SAMHSA Sheila Pires, Human Services Collaborative For More Information Please contact: Jonathan Brown Mathematica Policy Research or jbrown@mathematica-mpr.com Advisory panel and survey reviewers 31 32

Overview/Goals. Moving New York City Community Residential Programs to the Familydriven. Program Evaluation and Survey Analysis

Overview/Goals. Moving New York City Community Residential Programs to the Familydriven. Program Evaluation and Survey Analysis 2rd Annual Children's Mental Health Research & Policy Conference March -, Moving New York City Community Residential Programs to the Familydriven and Youth guided Care Arena: Program Evaluation and Survey