Comprehensive Child Crisis Services and the CAT

Comprehensive Child Crisis Services and the CAT 1/20/2011 N. Israel, Ph.D. OQM for CYF-SOC

Context • CAT in use for over two years • Clinical ‘slippage’: the form vs tool problem • Learning from your Numbers: Initial Pilot validation of use for CCCS effectiveness and decision support • Talking through your Numbers: Finer-grained uses of the CAT • FutureCAT

The Tool Issue • What class of object is a hammer? • Do you need to know what you’re doing with a hammer? • Does how you use it matter? • Can a hammer be used for good? For evil? • Does it matter if you have a hammer if you don’t use it?

SF CAT • Basic Decision Support Algorithm: • What does “Decision Support” Mean?

PastCAT • Dr. Chen supervised this work with Ms. Booker • Initial look at: • Disposition based on CAT scores • Effectiveness of Crisis Case Management • To reduce acuity of Needs • To reduce likelihood of re-entry to CCCS

PastCAT • Disposition: • Looked at disposition for 278 consecutive clients

Summary of Current Use • The vast majority of decisions made (>90%) are consistent with recommendation of the CAT • For decisions in which either intensive community support or hospitalization would be appropriate, we see a gradient: higher severity leads to increased likelihood of hospitalization • This pattern is consistent with good clinical practice

Current Use: Following Up • Clinical Implications: • Want to see why 2 very-low-risk clients were hospitalized • Want to better understand why 1/3 of Moderate Risk clients were hospitalized • Want to understand why 5 high-risk clients were not hospitalized

Clinical Discussion • Decision Support: • What does a score of 2-4 generally mean? • What would indicate to you that a person with a score in the 2-4 range would need hospitalization? • So, what would Good use look like? • What would Bad use look like?

CCM Effectiveness • How effective is CCM in reducing acuity and re-entry? • Characteristics on Entry (92 clients): • Average CAT score of 2 • About 20% with score of 4 or higher

CCM Effectiveness • Effectiveness: • On average, CAT Score cut in half • Statistically significant (reliable difference) • What is the clinical meaning of this? • Recidivism: • Percent returning to CCCS within 3 months: • CCM: 9% (9/96) Non-CCM: 7% (3/45) • Original Intake CAT Characteristics of returners: • CCM Avg: 3.1 Non-CCM Avg: 3.3

CCM Effectiveness • Recidivism Patterns: Days to recidivism

CAT for CCM • What is the goal of CCM? • How does the CANS inform communication around that goal? • What would you work on with a client who has one ‘3’? • What would you work on with a client who has two ‘2’s?

CAT for CCM: Good Use • What currently happens when people deny a problem (such as the reason for referral) exists? • What are the chances the referring event didn’t happen? • What are the chances it will come up again? • What is language you can use to make it non-threatening to work on this problem?

FutureCAT • What are ways the CAT can be used at the initial assessment to help clinical decision-making and clinical communication? • What are ways the CAT can be used in CCM to communicate with families and assess recidivism risk?

FutureCAT • What else can we provide centrally to make the CAT more useful to your work? • Assessment • Case Management • Supervision

We’re Done! • Thanks! Feel free to contact me at: nathaniel.israel@sfdph.org

Comprehensive Child Crisis Services and the CAT