OUTCOMES IN CARE FY 2015 PRIMARY & BEHAVIORAL HEALTH EDUCATION EARLY CHILDHOOD PREVENTION & WELLNESS

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1 OUTCOMES IN CARE FY 2015 PRIMARY & BEHAVIORAL HEALTH EDUCATION EARLY CHILDHOOD PREVENTION & WELLNESS

2 OUR VISION All people will have the opportunity to grow, change and live healthier, productive lives. OUR MISSION Wheeler provides equitable access to innovative care that improves health, recovery and growth at all stages of life. OUR VALUES We deliver and recognize exceptional service every day in every way All employees will strive to provide culturally and linguistically sensitive and responsive services We will work together to ensure access to care for every individual who needs it We are responsive at the time our clients need us We create a welcoming, comfortable and safe environment for all people that we serve and our employees We build open, honest communication in all that we do We are kind We pursue growth, learning and health for the people we serve and our employees We will always be original, imaginative and inventive We foster collaboration and partnership We promote employee balance and self-care We build positive team and family spirit

3 TABLE OF CONTENTS EXECUTIVE SUMMARY 5 CHILD WELFARE Caregiver Support Team 7 Community Support for Families 8 Foster Care: Family and Community Ties 9 Foster Care: Therapeutic Foster Care 10 Intensive Family Preservation 11 COMMUNITY JUSTICE Alternative in the Community 13 Explore 15 Family Violence Education Program 16 Intermediate Evaluation 17 COMMUNITY-BASED CARE Birth to Three 19 Emergency Mobile Psychiatric Services 21 Intensive In-Home Behavioral Health Services 23 Latino Outreach Program 25 Multidimensional Family Therapy 26 Multisystemic Therapy 28 Multisystemic Therapy-Family Integrated Transitions 29 Multisystemic Therapy-Problem Sexual Behavior 30 Promising Starts/Project LAUNCH Program 31 Wheeler Health & Wellness Center 33 EDUCATION SERVICES Northwest Village School 36 OUTPATIENT CARE Adult Outpatient Services 39 Bettor Choice 40 Children s Outpatient Services 41 OUTCOMES REPORT - FY 15 3 Wheeler Clinic

4 EXECUTIVE SUMMARY OUTCOMES REPORT - FY 15 4 Wheeler Clinic

5 EXECUTIVE SUMMARY WHEELER S COMMITMENT Wheeler Clinic is committed to outcome driven, cost effective solutions and results based accountability in the delivery of integrated primary and behavioral health services. Integral to this commitment is the continuous analysis of data to inform clinical service delivery, ensuring positive outcomes for individuals and families. Wheeler s 100+ programs and services are research-based and provided across the state at Wheeler locations, community settings and in homes. This report demonstrates our capacity to deliver high quality, cost effective solutions for individuals with primary and behavioral health issues, children and families involved with child welfare services and youth and adults involved with community justice systems. This report also demonstrates the degree of rigor reflected in our commitment to quality. The data reflects a sample from across our lifespan continuum of the data, outcomes and benchmarks we utilize to maintain accountability and ensure quality care. Data are drawn from normed and validated assessment tools utilized across clinic programs, as well as from data maintained by state agencies and model developers. Consumer feedback and testimonials are obtained through Wheeler consumer satisfaction surveys. We extend our thanks to our colleagues and partners who share access to external data systems that support these analyses. WHAT THE DATA SHOW The analysis of data demonstrates a positive impact on the health, recovery and growth of those we serve. Effectively administered primary and behavioral health, child welfare and community justice services: Enhance individual and family health and functioning Maintain youth with serious emotional and behavioral problems safely in the community Reduce recidivism among court involved youth and adults Reduce youth and adult alcohol and drug use/abuse Improve academic attendance and performance Enhance employment outcomes Divert emergency department and hospital utilization for behavioral health concerns Help patients effectively manage and reduce effects of chronic disease Strengthen families and reduce incidence of child abuse and neglect Provide effective, cost efficient solutions to some of Connecticut s most pressing health care challenges OUTCOMES REPORT - FY 15 5 Wheeler Clinic

6 CHILD WELFARE OUTCOMES REPORT - FY 15 6 Wheeler Clinic

7 CAREGIVER SUPPORT TEAM Wheeler s Caregiver Support Team supports DCF-licensed foster homes, with a focus on kinship families. The program is designed to prevent or minimize disruption of a child s placement with a foster family by providing intensive in-home interventions to the child and family. The goals of the program are to foster stable placements; assess and respond to family needs; identify and cultivate strengths and supports within the family; and enhance parenting skills of both the kinship and biological family. Families served: In FY15, the first full year of program operations, 56 families with 91 children and youth agreed to participate in Caregiver Support Team services. Support Plans: A support plan was created for 100% of families served. 100% of these plans addressed all priority areas of needs identified in the assessment. Discharge and Transition Plans: 100% of children and youth served by the Caregiver Support Team were connected to a sustainable, positive hobby or interest and normative community-based activity in FY15. Children Maintained in Their Foster or Adoptive Settings (FY15) Client Outcomes: 88% (80 out of 91) of children and youth served by the Caregiver Support Team were maintained in their foster or adoptive settings in FY15. HOPEFUL TOMORROWS Wheeler has done a fantastic job in helping our family through both difficult and rewarding times. They were a very valuable part of this process and their role in all of our lives is very much appreciated. The work Wheeler does is vital to both children in the foster care system and to the families who care for them families with Funded by: Connecticut Department of Children and Families youth DCF Region 6 OUTCOMES REPORT - FY 15 7 Wheeler Clinic

8 COMMUNITY SUPPORT FOR FAMILIES Community Support for Families (CSF) is a voluntary, family-driven program that assists families in strengthening natural and community support systems to maintain safe and healthy home environments. The program helps families identify their unique strengths and needs and assists them in overcoming barriers to meeting those needs by: establishing links to community supports and services for food, clothing, shelter, mental health and/or substance abuse treatment and other services; working with families to identify and mobilize natural supports; providing information on parenting and child development or other interventions to increase safety for children; and supporting parents connections with their child s school community. Wheeler and partner Family Life Education, Inc. provide CSF services in DCF Region 4 and Wheeler and partner Human Resources Agency of New Britain (HRA) provide CSF services in DCF Region 6. Engagement: Over 80% of families referred to Wheeler for CSF services in Regions 4 and 6 completed a treatment plan. Wheeler exceeded the DCF goal in Region 6 (84% were engaged compared with the goal of 80%) and met the goal in Region 4. Percentage of Families Referred Who Completed a Treatment Plan (FY15) Successful Discharge/Families Who Met Their Treatment Goals (FY15) Successful Discharge: Over 82% of families in Wheeler s Region 4 and 6 CSF program met their treatment goals. Wheeler exceeded the DCF goal of 80% in both regions. POSITIVE OUTCOMES Over 99% of Wheeler s CSF clients indicated that they were satisfied with services. 585 Funded by: Connecticut Department of Children and Families families served DCF Region 4: 248 families served DCF Region 6: 337 families served Wheeler Clinic 8 OUTCOMES REPORT - FY 15

9 FOSTER CARE: FAMILY AND COMMUNITY TIES Family and Community Ties Foster Care (FACT Foster Care) provides enhanced in-home support to foster families, serving children ages 6-17 with complex behavioral needs coming from residential settings. Wheeler s staff provides 24-hour-a-day support, intensive training and in-home support to help families create a positive setting in which children can grow and thrive. Families Served: During FY15, Wheeler s FACT Foster Care program achieved 12 successful placements, four for the year and two children were adopted. The program also licensed three full-time families to provide FACT foster care services. Placement Stability: 94% of children were stable in their FACT Foster Care placements in FY15. Placement Stability and Behavioral Health Outcomes Behavioral Health Outcomes: 90% of youth had no emergency room visits or inpatient hospitalizations in FY15. Safety of Homes: 100% of foster homes met physical safety and compliance standards in FY15. Client Satisfaction: 100% of foster parents were satisfied with the services they received from the FACT Foster Care program in FY15 and 74% of clients (youth) were satisfied with the care they received from the program. 94% 90% of children were stable in their FACT Foster Care placements of youth had no emergency room visits or inpatient hospitalizations Funded by: Connecticut Department of Children and Families DCF Region 5 OUTCOMES REPORT - FY 15 9 Wheeler Clinic

10 FOSTER CARE: THERAPEUTIC FOSTER CARE Therapeutic Foster Care (TFC) provides 24-hour supported homes to children and adolescents, primarily ages 6 through 17, needing the therapeutic level of foster care. The program also serves younger children as part of a sibling group and works with children over 18 years of age. The TFC program offers foster families training and ongoing support to help them provide a structured and nurturing environment for children who have been removed from their home due to abuse and/or neglect and who may be experiencing symptoms related to trauma, loss and other behavioral health concerns. Stability of Foster Home Placement: Over 92% of children were maintained in their TFC placement over the last three fiscal years, exceeding the DCF benchmark of 90% in each year. Children Maintained in Therapeutic Foster Care Placements Youth Adjustment: Wheeler exceeded DCF benchmarks for each of the three key measures of adjustment for youth in the TFC program from FY13 through FY15: visits to the emergency room for behavioral health reasons, behavioral health hospitalizations and involvement in the juvenile justice system. Higher percentages indicate better adjustment. Measures of Youth Adjustment (FY13-FY15) 55 Funded by: Connecticut Department of Children and Families families served DCF Region 5, DCF Region 4 - Hartford Area Office and DCF Region 6 - New Britain Area Office Wheeler Clinic 10 OUTCOMES REPORT - FY 15

11 INTENSIVE FAMILY PRESERVATION Intensive Family Preservation (IFP) supports families involved with DCF, due to concerns about abuse and neglect, to maintain their children safely in their homes. The intensive in-home intervention helps families develop skills and connect to a network of community resources and supports to improve the family environment. Wheeler provides five hours of direct service per week for 12 weeks including skill development and assistance in developing a cohesive and safe family environment. The team develops an individualized intervention plan to meet the unique needs of each family member. Family Functioning: Families participating in IFP services demonstrated improved family functioning as measured by the North Carolina Family Assessment Scales (NCFAS). In FY15, 100% of families served showed improvement in one area and 86% showed improvement in two areas. Children Remained in their Homes: Wheeler s IFP program helped maintain children safely in their homes. The children in 100% of families in FY13, 94% in FY14 and 97% in FY15 were able to remain safely in their homes. Percentage of Children Maintained in Their Home (FY13-15) New Reports of Abuse/Neglect: New reports of abuse and/or neglect decreased for families during IFP program involvement. Over 85% of families served each year during FY13, FY14 and FY15 had no new DCF referrals during program participation. Higher percentages are better, as they indicate no further DCF involvement. Percentage of Families with No DCF Referrals During Program (FY13-15) 34 Funded by: Connecticut Department of Children and Families families served DCF Region 6 - New Britain Area Office OUTCOMES REPORT - FY Wheeler Clinic

12 COMMUNITY JUSTICE OUTCOMES REPORT - FY Wheeler Clinic

13 ALTERNATIVE IN THE COMMUNITY Wheeler s Alternative in the Community (AIC) programs offer community-based intervention services for adults involved with the court or probation. The AICs use a curriculum-driven, evidence-based model designed to assess the needs of each individual and reduce their involvement in the criminal justice system. Services include substance abuse intervention, skill-building, community service opportunities, job development and placement, case management, educational, basic needs and vocational supports, and gender-responsive programming. Wheeler AICs serve the Bristol, Meriden, Middletown, New Britain and Enfield Geographical Area Courts. Wheeler s Enfield program opened in late 2015 and outcome data are not yet available. Client Engagement: Wheeler has successfully engaged clients throughout its AIC programs as measured by the percentage of clients with intakes, timely enrollment in services, the positive bond created between staff and clients (i.e., therapeutic alliance), and group completion rates, as described below. Percent of Clients with Intakes (2015) Clients with Intakes: Each of Wheeler s four AIC programs exceeded the AIC goal for clients with intakes in Wheeler s AICs ranged from 92-97% compared with the goal of 90%. Timely Service Enrollment (2015) Timely Enrollment: Each of Wheeler s four AIC programs exceeded the AIC goal for timely enrollment in Wheeler s AICs ranged from 80-93%, compared with the goal of 80%. 1,704 clients served Funded by: State of Connecticut Judicial Branch, Court Support Services Division Bristol, Enfield, Meriden, Middletown and New Britain Geographical Area Courts OUTCOMES REPORT - FY Wheeler Clinic

14 Therapeutic Alliance: The therapeutic alliance is a measure of the strength of the bond between clients and program staff. Each of Wheeler s four AIC programs exceeded the goal on the Working Alliance Inventory (WAI) during 2014 and the first three quarters of 2015, the most recent data available. Working Alliance Inventory (2015 Q1-Q3) Group Completion: Wheeler s success in achieving group completion rates is evidenced throughout its AIC continuum. All four Wheeler AIC programs have achieved group completion goals in Reasoning and Rehabilitation (R&R) and Treating Alcohol Dependence (TAD) groups and the Middletown and New Britain AICs achieved Employment Skills Group (ESG) group completion goals in Group Service Completion (2015) Employment: Wheeler s Meriden, Middletown and New Britain AICs surpassed employment goals in Over 50% of the clients who were unemployed at intake gained employment during program participation in Meriden (52%), Middletown (52%) and New Britain (53%). Clients Gaining Employment (2015) 50%+ of the clients who were unemployed at intake gained employment during program participation in Meriden, Middletown and New Britain, surpassing the goal. Wheeler Clinic 14 OUTCOMES REPORT - FY 15

15 EXPLORE PROGRAM The Explore program is a 26-session psycho-educational group intervention for men charged with domestic violence offenses. The program provides information and skills men need to change their behaviors and improve their current and future relationships. The goal is to increase offender accountability and victim safety. Recidivism: Wheeler s re-arrest rate for Explore clients following group completion was at or below the state benchmark of 20% for each of the program locations in 2014 and Lower rates are better than higher rates. They indicate fewer clients were arrested following service completion. Timely Enrollment: All Wheeler Explore programs surpassed the CSSD benchmark of 94% enrolled within 60 days over the last two years. In 2015, Wheeler enrolled 100% of Explore clients in Hartford and New Britain within 60 days of referral. Higher rates are better than lower rates. No-Show Rate: Three of Wheeler s four Explore programs, including the larger Hartford and New Britain sites, were below the CSSD benchmark of 15% in Lower rates are better than higher rates. They indicate that fewer clients missed services. 12-Month Re-Arrest Rate for Domestic Violence Enrolled in 60 or Fewer Days No-Show Rates 655 Funded by: State of Connecticut Judicial Branch, Court Support Services Division clients served Bristol, Hartford, Meriden and New Britain Geographical Area Courts OUTCOMES REPORT - FY Wheeler Clinic

16 FAMILY VIOLENCE EDUCATION PROGRAM Wheeler s Family Violence Education Program (FVEP) provides specialized intervention and education to individuals arrested for family violence crimes. Each group cycle meets for nine weekly group sessions, with separate groups for males and females in each location and Spanish language groups in Hartford and Waterbury. FVEP services are designed to increase offender accountability and victim safety. Recidivism: Wheeler s re-arrest rate for FVEP clients within one year of group completion was below the state goal in 2014 in each of its program locations and three of four programs were below the goal in Lower rates are desired. They indicate fewer individuals are being re-arrested. 12-Month Re-Arrest Rate for Domestic Violence Timely Enrollment: In 2015, Wheeler surpassed the CSSD goal for timely enrollment in each of its program locations. Over 97% of all clients were enrolled within 60 days of referral. Wheeler added groups as needed to meet demand and ensure client access to FVEP services. Clients Enrolled in 60 or Fewer Days No-Show Rate: Wheeler s FVEP programs have consistently had fewer no-shows than the CSSD goal for the last two calendar years. Lower rates are better than higher rates. They indicate that clients are attending services. No-Show Rate 1,859 Funded by: State of Connecticut Judicial Branch, Court Support Services Division clients served Bristol, Hartford, Middletown, New Britain and Waterbury Geographical Area Courts Wheeler Clinic 16 OUTCOMES REPORT - FY 15

17 INTERMEDIATE EVALUATION Wheeler s Intermediate Evaluation (IE) program provides comprehensive, multi-disciplinary evaluations for youth ages referred by the courts or DCF. Intermediate Evaluations are conducted by an interdisciplinary team and includes a psychologist interviewing the child; a home study with the family completed by a clinician; and a comprehensive review of past and current clinical and educational assessment and intervention. If the need for formal psychological testing or psychiatric evaluation is identified, these supplemental evaluations are provided by IE staff or by one of the program s subcontracted providers. The findings of all evaluation components are integrated into a single report and summary, with comprehensive and detailed recommendations. Families Served: Wheeler completed 37 Intermediate Evaluations during FY15, 13 for DCF and 24 for the courts. Demographic characteristics of the population served are below. Client Gender Client Race/Ethnicity Quality of Evaluations: Wheeler s IE team completed individualized evaluations to address each client s unique needs and produced high-quality reports that included clear service recommendations and incorporated feedback from families. 100% of evaluations included recommendations that addressed all of the referral questions. 97% of evaluations contained at least one recommendation generated by the family and/or child/youth. 89% of evaluations contained at least one community-based intervention recommendation. IE Recommendations for Clients Number and Type of Recommendations Community-based Services 33 Residential 2 Therapeutic Foster Care 2 Family Arrangement 1 37 Funded by: Connecticut Department of Children and Families DCF Regions 3, 4 and 6 clients served

18 COMMUNITY-BASED CARE OUTCOMES REPORT - FY Wheeler Clinic

19 BIRTH TO THREE Wheeler s Birth to Three program, part of the Connecticut Birth to Three System, is a family-centered, strengths-based program that serves families with children under 3 years of age who have (or are at risk for) significant developmental delays or disabilities. The program works directly with young children to address these challenges using a team of highly trained specialists and strengthens the capacity of families to meet the developmental and health-related needs of their infants and toddlers. Social-Emotional Skills: Children participating in Wheeler s Birth to Three Program caught up to their sameage peers in demonstrating positive social-emotional skills including social relationships. Wheeler s Birth to Three program exceeded the state goal by 18.8% and the state average by 17.3% in the percent of children who caught up to their same-aged peers on positive social-emotional skills. Percent of Infants & Toddlers who Demonstrate Improved Positive Social-Emotional Skills (FY15) Acquisition and Use of Knowledge and Skills: Children participating in Wheeler s Birth to Three Program outperformed the state goal by 10.7% and the state average by 10.8% in the percent of children who improved acquisition and use of knowledge and skills including early language/communication to the level of same-aged peers. Percent of Infants & Toddlers who Demonstrate Improved Acquisition and Use of Knowledge and Skills (FY15) 474 Funded by: Connecticut Department of Developmental Services families served 13 communities in Greater New Britain, Farmington Valley and West Hartford Area OUTCOMES REPORT - FY Wheeler Clinic

20 Use of Appropriate Behaviors to Meet Needs: Wheeler s Birth to Three Program far exceeded the state goal in the percent of children who caught up to sameaged peers in their use of appropriate behaviors to meet their needs. Wheeler exceeded the state goal by 16.9% and the state average by 9.1%. Percent of Infants & Toddlers who Demonstrate Improved Use of Appropriate Behaviors to Meet Their Needs (FY15) Timely Services and Transition Planning: Wheeler s Birth to Three program provided an evaluation and assessment and an Individualized Family Service Plan (IFSP) meeting within 45 days of referral for 100% of eligible infants and toddlers. 100% of children exiting Wheeler s Birth to Three program received timely transition planning to support their transition to preschool and other appropriate community services. POSITIVE OUTCOMES Satisfaction Survey: Birth to Three families completed satisfaction surveys for both DDS and Wheeler. As can be seen below, families reported that Wheeler s Birth to Three program helped them know their rights, effectively communicate their children s needs and helped them help their children develop and learn. Families also reported that staff treated them in a respectful manner and provided needed and effective services. DDS Client Satisfaction Survey 94% of families in Birth to Three for at least 6 months reported that early intervention services helped their family know their rights 94% of families in Birth to Three for at least 6 months reported that early intervention services helped their family effectively communicate their children s needs 94% of families in Birth to Three for at least 6 months reported that early intervention services helped their family help their children develop and learn Wheeler Client Satisfaction Survey 100% of families reported that the Birth to Three program provided services that their child needed 96% of families reported that the Birth to Three services their child received were effective 96% of families reported that the Birth to Three program staff treated their family in a sensitive and respectful manner Wheeler Clinic 20 OUTCOMES REPORT - FY 15

21 EMERGENCY MOBILE PSYCHIATRIC SERVICES Wheeler s Emergency Mobile Psychiatric Services (EMPS) provides multidisciplinary community responses to children and youth experiencing behavioral health emergencies in the community, home, school and hospital emergency departments. The goal is to provide services that will assist families and children at a time of crisis. Number Served and Response Volume: Wheeler s Hartford Regional EMPS team provided 28% of all EMPS services in Connecticut in FY15, responding to 3,489 calls, including 262 after-hours calls. Wheeler served children per 1,000 in the region, eclipsing all other providers. EMPS Response Episodes by Service Area (FY15) Mobile Response Rate: Wheeler s mobile response rate, 92.5%, surpassed the DCF goal of 90%. Of Wheeler s mobile responses, 87% were under 45 minutes, exceeding the goal of 80%. Population Served and Trauma Exposure: 96% of clients served by Wheeler s EMPS program in FY15 met the criteria for serious emotional disturbance (SED). This was considerably higher than the EMPS statewide rate of 78%. Additionally, 64% of children served by Wheeler reported trauma exposure at intake. Trauma exposure included witnessing violence (29%), being the victim of violence (18%), disrupted attachment/multiple placements (16%), sexual victimization (13%) and other (24%). 3,029 Funded by: Connecticut Department of Children and Families Number Served per 1,000 Children (FY15) clients served 18 communities in Greater Hartford, Greater New Britain and Meriden/ Wallingford OUTCOMES REPORT - FY Wheeler Clinic

22 Top Referral Sources Other 12% Emergency Department 11% Self/family 41% School 36% POSITIVE OUTCOMES Behavioral Health Outcomes: Children in Wheeler s EMPS program decreased their emergency department usage and hospital admission during treatment compared to the six months prior to program entry. School suspensions/expulsions and arrests were also lower during program participation than in the six months prior to program entry. EMPS: Suspensions/Expulsions and Arrests (FY15) Clients Evaluated in an ED in the 6 Months Prior and During an Episode of Care (FY15) Clients Admitted to a Hospital (Inpatient) for Psychiatric or Behavioral Health Reasons (FY15) HOPEFUL TOMORROWS The Wheeler staff were a lifeline, providing us with guidance and support until appropriate long-term services could be secured for our daughter. They worked tirelessly, making calls to providers and programs and helped us locate a psychiatrist who was a good fit. They were always there in times of crisis and helped us assess and maintain her safety and helped her find coping strategies. Wheeler Clinic 22 OUTCOMES REPORT - FY 15

23 INTENSIVE IN-HOME BEHAVIORAL HEALTH SERVICES Wheeler s Intensive In-home Behavioral Health Services (IIBHS) program is an innovative, strengths-based, in-home program designed to serve children, adolescents and young adults, ages 3-24, with acute psychiatric and/or co-occurring challenges. Youth and young adults referred to IIBHS are at risk or have histories of emergency department, inpatient and/or residential treatment admissions. The program provides on-site, rapid response to emergency departments, inpatient units or home to facilitate immediate access to treatment; strength-based, intensive in-home individual and/or family therapy delivered at flexible, convenient times; 24/7 crisis support; and integration with primary care, schools and other treatment providers. IIBHS serves individuals covered by Anthem Blue Cross Blue Shield of Connecticut. The program has expanded to serve ConnectiCare, Harvard Pilgrim and United Healthcare/Oxford (administered by United Behavioral Health operating under the brand Optum) insured youth and young adults. Reduction in Higher Levels of Care Following Services: Wheeler s IIBHS program has reduced the number of inpatient/residential treatment center admissions; days clients are in inpatient/residential treatment centers; emergency department admissions; days clients are in partial hospitalization programs; and days clients are in Intensive Outpatient (IOP) care. The following outcomes are based on Anthem insurance claim data. Inpatient/Residential Treatment Center Admissions Program Discharge September 2013 September % reduction of inpatient/ residential treatment center admissions 180 Funded by: Anthem Blue Cross Blue Shield of Connecticut as well as ConnectiCare, Harvard Pilgrim and United Healthcare/Oxford (administered by United Behavioral Health operating under the brand Optum) Statewide clients served OUTCOMES REPORT - FY Wheeler Clinic

24 48% Days in Inpatient or Residential Treatment Center Settings Program Discharge September 2013 September 2014 reduction of the number of days clients spent in inpatient/residential treatment centers Emergency Department Admissions Program Discharge September 2013 September % reduction of emergency department admissions Partial Hospitalization Program Days Program Discharge September 2013 September % reduction of the number of days clients spent in partial hospitalization programs Intensive Outpatient Days Program Discharge September 2013 September % reduction of the number of days clients spent in intensive outpatient services Wheeler Clinic 24 OUTCOMES REPORT - FY 15

25 LATINO OUTREACH PROGRAM Wheeler s Latino Outreach Program ensures Latino individuals have access to supportive substance abuse and/or mental health services. The program identifies and refers individuals who would benefit from substance abuse and mental health treatment to local services. In addition, the program provides a combination of case management, information campaigns, home and hospital visits and education through communitybased, in-service training. The program also assists clients with the health insurance application process and coordinates transportation for treatment appointments. Wheeler s Latino Outreach Program serves adults in Bristol, New Britain and Plainville. Clients Engaged in at Least One Service Within 180 Days (FY15) Engagement: Wheeler s Latino Outreach Program successfully engaged 100% of clients in at least one service within 180 days, doubling the goal of 50%. HOPEFUL TOMORROWS Yo estoy muy satifecha del programa. 66 Funded by: Connecticut Department of Mental Health and Addiction Services Bristol, New Britain and Plainville clients served OUTCOMES REPORT - FY Wheeler Clinic

26 MULTIDIMENSIONAL FAMILY THERAPY Multidimensional Family Therapy (MDFT) is an innovative and evidence-based intensive in-home program for youth ages 9-18 presenting with substance abuse issues, oppositional behaviors and family conflict. The MDFT team provides clinical interventions and strategies coupled with connecting the youth to services in the community, collaborating with internal and external providers, as well as addressing educational needs. Across Wheeler s DCF MDFT teams, youth achieved their treatment goals, remained in their homes, remained in schools and had no new arrests. Achieving Treatment Goals: 75% of youth met their treatment goals, compared with the goal of 70%. Wheeler s Hartford, New Britain and Waterbury teams exceeded the goal. Remaining in the Home/Community: 94% of youth were able to remain in their homes and in the community at discharge, far exceeding the goal of 80%. All Wheeler DCF MDFT teams exceeded the goal. Remaining in School: 89% of youth were in school at program discharge. No New Arrests: 74% of clients had no new arrests, compared with the goal of 75%. Wheeler s New Britain and Waterbury teams exceeded the goal. Client Outcomes (FY15) 253 clients served Funded by: Connecticut Department of Children and Families and the State of Connecticut Judicial Branch, Court Support Services Division DCF Region 2 - New Haven Area Office, DCF Region 4 - Hartford Area Office, DCF Region 5 - Waterbury Area Office, DCF Region 6 - New Britain Area Office and Superior Court for Juvenile Matters - Waterford Wheeler Clinic 26 OUTCOMES REPORT - FY 15

27 Parent Satisfaction Parent Satisfaction: Parents participating in MDFT services with their adolescent indicated that they trusted their service provider s judgment, liked the services they received and the services met their needs. POSITIVE OUTCOMES Three of Wheeler s MDFT teams, MDFT New Britain, MDFT Waterbury and MDFT Hartford, were recognized by the MDFT model developer for being in the Top Five for data outcomes in the state on the MDFT fidelity reports for the first half of Program Outcomes 94% 89% 74% of youth were able to remain in their homes and in the community at discharge HOPEFUL TOMORROWS of youth were in school at program discharge of youth had no new arrests Wheeler is amazing. They continue to go above and beyond for my entire family. We love them and would recommend them to anyone. OUTCOMES REPORT - FY Wheeler Clinic

28 MULTISYSTEMIC THERAPY Multisystemic Therapy (MST) is an evidence-based intensive family- and community-based treatment program serving youth ages with complex emotional, social and academic needs, court-involved youth and other high-risk families. The model blends cognitive behavioral therapy, behavioral management training, family therapies and community psychology. Wheeler has provided MST services for youth and families in Connecticut since Completion Rates: Wheeler s DCF New Britain Substance Abuse (96%) and CSSD Waterbury (93%) MST teams significantly exceeded the completion rate goal and Wheeler s DCF Manchester/Hartford (83%) and CSSD New Britain (84%) MST teams were just below the 85% goal for treatment completion. Model Adherence: Wheeler s MST teams consistently exceed the goal for model adherence as measured by the Therapist Adherence Measures. Each team exceeded the goal in FY15. A higher score indicates greater fidelity to the model. Completion Rates (FY15) Therapist Adherence Measures (TAMs) (FY15) Ultimate Outcomes: Wheeler s MST teams were very successful in achieving model goals for the three key outcome indicators: youth living at home at discharge, youth in Ultimate Outcomes (FY15) school or working at discharge and youth with no new arrests during treatment. All four of Wheeler s MST teams exceeded the goals of youth living at home at discharge and no new arrests during treatment and three of Wheeler s four MST teams exceeded the goal of youth in school or working at discharge. 179 clients served Funded by: Connecticut Department of Children and Families and the State of Connecticut Judicial Branch, Court Support Services Division DCF Region 4 and Superior Court for Juvenile Matters - New Britain & Waterbury Wheeler Clinic 28 OUTCOMES REPORT - FY 15

29 MULTISYSTEMIC THERAPY- FAMILY INTEGRATED TRANSITIONS Multisystemic Therapy-Family Integrated Transitions (MST-FIT), an adaptation of MST, combines three evidence-based treatment models: MST, Dialectical Behavior therapy (DBT) and Motivational Interviewing (MI). Developed to help transition incarcerated youth back into the community, the program provides youth ages 12 to 17.5 and their families the tools to successfully navigate the critical transition period following their incarceration. Ultimate Outcomes: Youth participating in MST-FIT at least 6-8 weeks prior to release from their facility, as dictated by the MST-FIT model, had positive outcomes on the three key measures of program success: youth living at home at program discharge, youth in school or working at program discharge and youth with no new arrests during treatment. Living at Home: 75% of youth were living at home at program discharge. Youth in School or Working: 88% of youth were in school or working at program discharge. Youth with No New Arrests: 75% of youth had no new arrests during MST-FIT treatment. 75% 88% 75% of youth were able to remain in their homes and in the community at discharge POSITIVE OUTCOMES of youth were in school at program discharge of youth had no new arrests 87.5% of youth participating in MST-FIT at least 6-8 weeks prior to release reduced their substance use during treatment. Funded by: Connecticut Department of Children and Families DCF Regions 2, 4, 5 & 6 and DCF Region 3 - Middletown Area Office OUTCOMES REPORT - FY Wheeler Clinic

30 MULTISYSTEMIC THERAPY- PROBLEM SEXUAL BEHAVIOR Multisystemic Therapy-Problem Sexual Behavior (MST-PSB), an MST adaptation, supports youth returning to the community from incarceration or residential placement and families maintaining youth with problem sexual behaviors in their homes and the community instead of residential placement. Wheeler s MST-PSB program serves youth ages 10 to 17.5 and their families in 61 communities in central and western Connecticut. Ultimate Outcomes: Wheeler s MST-PSB program has been extremely successful in achieving goals for the three key MST- PSB outcome indicators. 100% of youth in Wheeler s initial team (Wheeler 1) were living at home at discharge, in school or working at discharge and had no new arrests during treatment in FY15. Wheeler s new MST-PSB team (Wheeler 2) surpassed goals on youth in school or working at discharge and youth with no new arrests during treatment. Completion Rate: Wheeler s initial MST- PSB team (Wheeler 1) surpassed the goal for completion rate in both FY14 and FY15. Over 90% of the youth served by Wheeler s initial MST-PSB team completed treatment compared with the goal of 85%. Ultimate Outcomes (FY15) Completion Rate (FY15) Model Adherence: Both Wheeler MST-PSB teams achieved the goal for model adherence in FY15 as measured by the Therapist Adherence Measures. Wheeler s initial team far exceeded the goal and Wheeler s second team achieved it, a significant achievement for the new team. Higher scores means greater adherence to the model. Therapist Adherence Measures (TAMs) (FY15) 46 Funded by: Connecticut Department of Children and Families DCF Regions 5 & 6 and DCF Region 4 - Hartford Area Office clients served Wheeler Clinic 30 OUTCOMES REPORT - FY 15

31 PROMISING STARTS/PROJECT LAUNCH PROGRAM Wheeler s SAMHSA-funded Promising Starts/Project LAUNCH program was designed to address the mental health needs of children, birth through age 8 and their families in New Britain. The initiative supports parents, early learning programs and the community to address the needs of vulnerable children and their families and ensure a coordinated level of care that begins at the earliest stages of a child s development. Two evidence-based direct service programs are included in the project s scope of services: Child First and Circle of Security. Child First is an intensive, therapeutic home visiting-program that works with parents and families to help address emotional, behavioral or developmental challenges, as well as learning problems in young children, birth to 6 years of age. This program aims to decrease family stressors, promote relational health and connect families to much-needed supports and services. The Circle of Security Parenting Program is a six-to-eight session group intervention for parents of young children, birth to 8 years of age. The program is designed to help parents better understand and respond to their child s emotional needs; help their child manage their emotions and behaviors; and increase parent s understanding of the importance of secure attachment for healthy child growth and development. Child First Program Impact: Wheeler has provided Child First services to 143 families since program implementation. Parents and children involved in the Child First program demonstrated significant treatment gains. Through September 2015: The quality of parent-caregiver interactions improved as measured by the Child Caregiver Interaction Scale (CCIS). This finding is statistically significant with a medium effect size. Child problems decreased as measured by the Brief Infant Toddler Social Emotional Assessment (BITSEA). This finding is statistically significant with a medium effect size. Child social competence increased as measured by the Brief Infant Toddler Social Emotional Assessment (BITSEA). This finding is statistically significant with a small effect size. Caregiver post-traumatic stress symptoms decreased as measured by the Caregiver PTSD Symptoms Scale (PSSI). This finding is statistically significant with a very large effect size. Caregiver depression decreased as measured by the Depression Scale for Caregivers (CESD). This finding is statistically significant with a small effect size. 123 Funded by: U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services as part of SAMHSA s Project LAUNCH Initiative City of Bristol, New Britain and New Haven families served OUTCOMES REPORT - FY Wheeler Clinic

32 Circle of Security Program Impact: Wheeler has provided Circle of Security in both group settings and through home visiting programs. Through September 2015, 318 parents have completed Circle of Security services. Of the 111 parents/caregivers who completed the parent questionnaire: 67% reported that the program helped reduce their level of stress from parenting/caregiving. 71% reported that the program made their relationship with their child better. 83% reported that the program provided them with new skills and abilities as a parent/caregiver. 71% 83% reported that the program made their relationship with their child better POSITIVE OUTCOMES reported that the program provided them with new skills and abilities as a parent/caregiver Wheeler s Promising Starts program received a no-cost extension from SAMHSA to continue providing Child First services in New Britain through April Wheeler has also expanded its Child First programming to serve families in Bristol based on its success in New Britain. Wheeler s Bristol team is funded with federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) funds through Child First and the Office of Early Childhood. Wheeler has a lead role with the SAMHSA-funded CT Elm City Project LAUNCH initiative linking statewide and community-based actions to promote child health and wellness in New Haven. Wheeler was asked to join this initiative due to its success with the New Britain Project LAUNCH initiative. HOPEFUL TOMORROWS Wheeler taught me about my son s emotional development and how to better understand his feelings and what he was trying to express. I became more aware of my parenting style and learned to be more patient. They were kind, compassionate and really understood what I was going through. I feel more calm, level-headed and positive about the future. Wheeler Clinic 32 OUTCOMES REPORT - FY 15

33 WHEELER HEALTH & WELLNESS CENTER Wheeler s Health & Wellness Center, located at 10 North Main Street, Bristol, provides integrated primary care, behavioral health, dental hygiene and support services to individuals across the lifespan in a medicallyunderserved community within the city. The center achieved designation as a federally qualified health center in Close collaborations with Bristol Hospital and other community providers ensure patients have access to specialty care, as well as support for obtaining basic needs. Patient Visits by Service Type During 2015, Wheeler s Health & Wellness Center provided medical, behavioral health, enabling and dental hygiene services. Of the 4,545 visits to the Health & Wellness Center, 2,559 visits were for medical services; 1,900 visits were for behavioral health services; 47 visits were for enabling services; and 39 visits were for dental hygiene. *Of note, Wheeler s dental hygiene services opened in September, Patient Visits by Service Type (2015) Preventive Health Screenings & Services Adult Weight Screening Follow-Up: 77% of adult patients who were over- or under-weight as determined by BMI had a follow-up plan of care documented, exceeding the goal of 50% and exceeding both state and national health center averages. Tobacco Use Screening and Cessation: 100% of adult patients were screened for tobacco use. More than 98% of tobacco users received tobacco cessation counseling intervention and/or pharmacotherapy, exceeding both state and national health center averages. Cervical Cancer Screening: 87% of female patients, ages 21 to 64, received one or more Pap tests, exceeding the goal of 65% and exceeding both state and national health center averages. 1,111 Funded by: Anthem Blue Cross and Blue Shield Foundation, Connecticut Department of Mental Health and Addiction Services, Connecticut Health and Educational Facilities Authority (CHEFA), the Health Resources and Services Administration (HRSA), an operating division of the U.S. Department of Health and Human Services, United Way of West Central Connecticut and public and private insurance Greater Bristol Area clients served OUTCOMES REPORT - FY Wheeler Clinic

34 Chronic Disease Management Asthma Treatment - Pharmacologic Therapy: 100% of patients age 5 to 40 years with a diagnosis of persistent asthma were prescribed either the preferred long term control medication or an acceptable alternative pharmacological therapy, exceeding the goal of 50% and exceeding both state and national health center averages. Quality of Care Measures Chronic Disease Management (2015) Cholesterol Treatment: 100% of patients age 18 years and older with a diagnosis of Coronary Artery Disease were prescribed a lipid lowering therapy, exceeding the goal of 70% and exceeding both state and national health center averages. Heart Attack/Stroke Treatment: 57% of patients who had acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) or who had a diagnosis of Ischemic Vascular Disease (IVD) had documented use of aspirin or other antithrombotic during the measurement year, exceeding the goal of 50%. Blood Pressure Control: 59% of patients, ages 18 to 85, with a diagnosis of hypertension had a most recent blood pressure reading less than 140/90, exceeding the goal of 50%. HIV Linkage to Care: 100% of HIV patients newly diagnosed by the health center had a medical visit for HIV care within 90 days of first-ever diagnosis, exceeding the goal of 85% and exceeding both state and national health center averages. Outreach and Community Health Education: Approximately 50 targeted outreach and health education events reached more than 800 individuals at local community action agencies, soup kitchens, a methadone clinic, probation office, community justice program, library, local grocery stores and at the health center. These activities included information on general health center resources, or focused on specific topics including nutrition, diabetes care, dental hygiene, or HIV testing, as well as enrollment assistance. HOPEFUL TOMORROWS h 48% Increase in the number of patients Wheeler served. I have my medical, primary care doctors with Wheeler Clinic. It s very convenient, everyone is connected together. If I had to go to individual physicians I probably wouldn t make those appointments. It would cause me a lot of anxiety to go from one physician to the next. The support system that I have gotten from Wheeler is tremendous. Wheeler Clinic 34 OUTCOMES REPORT - FY 15

35 EDUCATION SERVICES OUTCOMES REPORT - FY Wheeler Clinic

36 NORTHWEST VILLAGE SCHOOL Wheeler s Northwest Village School is a therapeutic day school designed for students, ages 4-21, with special education needs who exhibit complex social, emotional, learning and/or behavioral challenges that have resulted in a Planning and Placement Team decision to seek placement outside of a traditional public school setting. Located in Plainville, Northwest Village School serves more than 70 school districts throughout the state. Advancement: Over the past three years, over 94% of students in Wheeler s Northwest Village School advanced to the next grade. In the school year, 94% of students advanced. Percent of Students who Advanced to the Next Grade Student Attendance: Students at Wheeler s Northwest Village School had an attendance rate of 89% during the and school years and a rate of 90% during the school year. Student Attendance Rate Academic Gains: Students in grades 3-8 showed substantial gains in reading, math and writing based on Blue Ribbon Testing. The data reflects that the academic rigor of school programming is helping more children to perform at grade level. Preparation for the Future: All 105 of NVS high school students are engaged in pre-vocational training and of our 105 high school students, 25% (26 students) are working on job sites in the local community. Funded by: Tuition-based 225 clients served 70 school districts throughout the state

37 Graduation: 100% of our high school seniors graduated in SY2015 and over the last four school years, 35-40% of our graduating seniors moved on to college or vocational training. Post-Graduation Plans: Wheeler s Northwest Village School and the Academy satellite school graduated 32 students in 2015, the largest graduating class to date. Of graduating students, 11 had plans to attend college; nine had an identified job, signed on for Job Corps or joined the military; and nine planned to attend a transition year in school to further develop vocational skills. Plans Following Graduation for Seniors Who Graduted in June 2015 POSITIVE OUTCOMES Survey of Lead Education Agencies: Wheeler s survey of Lead Education Agencies (LEAs) to date indicates that of those who have worked with Wheeler for one year or more: 97% 97% 97% of LEAs are satisfied with the quality of education services their students receive at our schools HOPEFUL TOMORROWS of LEAs are satisfied with the quality of clinical services their students receive at our schools of LEAs are satisfied with the quality of written evaluations completed by our staff I have learned that I am a hard worker and have changed by seeing my talent and I know what I can do and do great in the real world. The world awaits.

38 OUTPATIENT CARE OUTCOMES REPORT - FY Wheeler Clinic

39 ADULT OUTPATIENT SERVICES Wheeler routinely solicits input from clients regarding their experience with the services they receive via an agency satisfaction survey. The following results include responses from adults in Wheeler s Intensive Outpatient (IOP) and Adult Outpatient services. Clients like the services they receive at Wheeler. 95% of clients indicated they like the services they receive. Clients are engaged in services. 92% of clients indicated that they have participated in choosing their treatment/service goals. They feel comfortable asking questions. 96% of clients indicated that they felt comfortable asking questions about the services they receive. They feel respected: 97% of clients felt their service provider was sensitive to and respected their gender and 97% felt their service provider was sensitive to and respected their ethnic background. Clients would come back to Wheeler and would refer their friends to Wheeler. 91% of clients indicated they would come back to Wheeler if they needed help in the future and 93% indicated that they would refer a friend to Wheeler if the friend needed help. POSITIVE OUTCOMES 95% 96% 97% of clients indicated they like the services they receive 5,347 Funded by: Connecticut Department of Mental Health and Addiction Services, State of Connecticut Judicial Branch, Court Support Services Division and public and private insurance Greater Hartford, New Britain and Plainville Area of clients indicated that they felt comfortable asking questions about the services they receive clients served of clients indicated that they felt their service provider was sensitive to and respected their ethnic background OUTCOMES REPORT - FY Wheeler Clinic

40 BETTOR CHOICE PROBLEM GAMBLING SERVICES Wheeler s Bettor Choice program helps individuals and their families cope with and recover from gambling problems. Treatment may include individual, group, marital and/or family therapy. Financial and peer counseling are also available. Individualized treatment plans are developed for all clients to meet their specific needs. DMHAS re-procured its Bettor Choice and Disordered Gambling Integration (DiGIn) problem gambling services in DMHAS selected Wheeler to continue providing both services due to its success with the models. Treatment Completion: 76% of clients in Wheeler s Bettor Choice program completed treatment successfully, achieving the goal of 75%. Wheeler s performance was considerably higher than the statewide average. Successful Treatment Completion (FY15) Program Engagement: 81% of Wheeler s Bettor Choice clients were engaged in two or more services within 30 days, compared with the DMHAS goal of 75%. Clients Engaged in Two or More Services Within 30 Days (FY15) 52 Funded by: Connecticut Department of Mental Health and Addiction Services DMHAS Region 4 clients served Wheeler Clinic 40 OUTCOMES REPORT - FY 15

41 CHILDREN S OUTPATIENT SERVICES Wheeler s Children s Outpatient Services provides gender-responsive, trauma-informed and person-centered individual, family and group therapy to help children, adolescents and families develop skills and coping strategies they can use for a lifetime. Wheeler s Children s Outpatient Services address behavioral health challenges working with clients and caregivers to establish treatment goals specific to youth and family s needs. Wheeler utilizes evidence-based practices including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Dialectical Behavior Therapy (DBT). Wheeler s Extended Day Treatment (EDT) program is an intensive therapeutic after-school treatment program for children and adolescents who have behavioral and emotional difficulties at home, school or in the community. Child and Parent/Caregiver Satisfaction: Wheeler routinely solicits parent/caregiver input regarding their experience with their child s services. 99% of parents and 97% of children served indicated that they liked the services they/their child has received at Wheeler. Gender-sensitive and Culturally-competent Services 99% of parents and 99% of children served indicated that the child s service provider was sensitive to and respects the child s gender. 99% of parents and 98% of children served indicated that the child s service provider was sensitive to and respects their family s culture/ethnic background. 99% 99% 99% of parents indicated that they liked the services their child has received at Wheeler. 1,816 Funded by: Connecticut Department of Children and Families, State of Connecticut Judicial Branch, Court Support Services Division, public and private insurance and United Way of West Central Connecticut Greater Bristol, Hartford, Middletown and Plainville Area of parents and children served indicated that the child s service provider was sensitive to and respects the child s gender clients served of parents and children served indicated that the child s service provider was sensitive to and respects their family s culture/ ethnic background OUTCOMES REPORT - FY Wheeler Clinic

42 Engagement 99% of parents and 95% of children served indicated that they participated in choosing the child s treatment/service goals. 99% of parents and 95% of children served indicated that they felt comfortable asking questions about the services the child is receiving. Effectiveness 98% of parents indicated that the services their child has received helped their family and 96% of children said the services have met their needs. 98% of parents and 94% of children served indicated that if they need help in the future they will come back to Wheeler. POSITIVE OUTCOMES Problem Severity: Children participating in Wheeler s children s outpatient (COP) services, Extended Day Treatment (EDT) services and Trauma-Focused Cognitive Behavioral therapy (TF-CBT) programs exceeded the goals for reduction in problem severity. Child Functioning: Children participating in Wheeler s COP and EDT services exceeded the goal for increased child functioning. Wheeler s TF-CBT services were just below the goal. This may be associated with an increased volume of court-involved youth with higher levels of complexity and lower levels of engagement in ongoing services. As clients are released from probation, they sometimes withdraw from treatment. Ohio Scales: Children's Outpatient (COP), Extended Day Treatment (EDT) and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) HOPEFUL TOMORROWS Wheeler helped us put the pieces of our lives back together. It s all a work in progress still, but we wouldn t have made it this far without their understanding and advocacy. Wheeler Clinic 42 OUTCOMES REPORT - FY 15

43 SERVING OUR COMMUNITIES ACROSS CONNECTICUT Serving Our Communities Across Connecticut NEW Falls Village Enfield Torrington Hartford Manchester Bristol Plainville Newington New Britain Southington Waterbury Meriden Middletown Danbury New Haven New London Key = Wheeler Location(s) = Wheeler Collaborative Project Site = Wheeler Service Area more than 19,000 received direct care Funded by: Connecticut Department of Children and Families, Department of Mental Health and Addiction Services, Department of Developmental Services, Department of Social Services, State of Connecticut Judicial Branch, Court Support Services Division, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, individuals, corporations, foundations, United Way, client fees and third-party payers Statewide Wheeler Clinic is accredited by The Joint Commission. Our programs and services are licensed or approved by the Connecticut Department of Children and Families, Connecticut State Department of Education and the Connecticut Department of Public Health.

44 91 Northwest Drive, Plainville, CT 06062