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Step by Step: Comprehensive Culture and Practice Change and the CANS-MH

Step by Step: Comprehensive Culture and Practice Change and the CANS-MH. Suzanne Button, Ph.D. Assistant Executive Director, Quality & Clinical Outcomes. At the start of our initiative, Astor services had been delivering nationally-acclaimed behavioral health services for over 50 years.

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Step by Step: Comprehensive Culture and Practice Change and the CANS-MH

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  1. Step by Step: Comprehensive Culture and Practice Change and the CANS-MH Suzanne Button, Ph.D. Assistant Executive Director, Quality & Clinical Outcomes

  2. At the start of our initiative, Astor services had been delivering nationally-acclaimed behavioral health services for over 50 years. Programs included a broad array of inpatient, educational, and community based programs at 23 sites in the Hudson Valley Region and New York City area of New York State (we now have 28 sites). Serving over 6,500 children, adolescents, and their families each year.

  3. To change the culture from one of “we do what we like/know/prefer” to “we do what we know is likely to be effective for our clients” To increase the number of evidence based and best practices in application across the agency To meaningfully measure outcomes in diverse contexts at the program and aggregate levels Goals in 2002

  4. Culture change is critical…. those variables that create organizational culture combine to become the single most predictive factor in the success or failure of innovation.

  5. Creating a System of Outcomes Management using the CANS-MH Use CANS-MH as a message of expectations Use CANS-MH data as a meaning-making tool Incorporate clinician and managerial experience, consumer input Use data to focus and inform the discussion “Measurement as Communication”

  6. Agency Impact 2003-2010

  7. Significant changes in clinical practice

  8. 2002 Five evidence-based practices in use 2003 Agency--wide use of Child Adolescent Needs & Strengths-Mental Health Version (Lyons, 2001) (CANS-MH) as standard treatment planning and outcomes tool Barkley model for ADHD assessment and treatment Goldstein social skills training in residential programs 2004 Collaborative Problem Solving in select day treatment programs CBT for Youth Sex Offenders 2005 CBT for externalizing disorders General CBT intensive training for all clinical staff UCLA PTSD Reaction Inventory for all clinical clients

  9. 2006 PCIT in 0-5 programs TF-CBT in all clinics Sanctuary in residential programs Tool box skills training in foster care programs Expansion of CPS to all day treatments 2007 School based CBT for depression Norcross “tickler” questions in all clinics RET in all clinics 2008 EBP for sexually reactive use FFT in juvenile justice and adolescent day treatments March OCD protocol in clinics 2009 CFIT pilot approved and applied for Coping Cat in clinics

  10. Opportunities for advocacy and public relations

  11. 2002 Use of CANS-MH data led to increased rates in residential programs. 2007 The Joint Commission invited CEO to address membership on EBP at its national conference. First publication of aggregate data (describing populations) in annual report. 2008 Short listed for TJC’s Codman Award, featured in national publication of TJC. 2009 First aggregate clinical outcomes published in annual report, on website, and in press releases. Substantial increases in county contracts for community based programs linked, in part, to demonstrable outcomes. 2010 Residential programs shifted to 100% “hard to place” rates. Co-sponsoring PCIT training conference with NYU Child Study Center. Invited to apply for EBP award from NYS OMH.

  12. And, most importantly, demonstrable improvements in clinical outcomes.

  13. Visible shifts in outcomes began to emerge in 2007 (CANS-MH indicates client improvement in most areas across agency). Parent/caregiver satisfaction survey results suggest a shift from overall satisfaction with Astor staff to satisfaction with specific services and the reduction of specific symptoms. Dimensions showing statistical improvement on the CANS-MH have steadily increased across the agency. We are now routinely planning next steps of the initiative based on evidence, including our CANS-MH data.

  14. Analyzed over 3,500 CANS collected across programs over eight years. Dimensions improve, with the exception of Caregiver dimension. We are doing better, overall, with younger children, Clear links emerge in the data between practices adopted and outcomes (anxiety, depression, attention deficit disorder, and oppositional behavior groups show improved outcomes). Slow improvements in risk reduction for youth who cause sexual harm are emerging, further focus is needed. Presenting problems only moderately impacted by new practices include attachment, trauma, and antisocial/criminal behavior – across age groups and program types. 2010 Aggregate Results

  15. Sustaining interest and effort…..

  16. “.. the integration of best researched evidence and clinical expertise with patient values.” Institute of Medicine, 2001 Practice-based evidence

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