Division of Behavioral Health Department of Health & Social Services Clinical Application of the Alaska Screening Tool & Client Status Review of Life Domains (CSR) March, 2014

Division of Behavioral Health Behavioral Health - 2 Objectives: » Overview of the Alaska Screening Tool » Overview of the Client Status Review » Clinical Applications » CSR-2014

Division of Behavioral Health Mission To manage a comprehensive behavioral health system that promotes quality services and improves outcomes for individuals, families, and communities. Behavioral Health - 3

Division of Behavioral Health Behavioral Health - 4 What is the AST? What is the CSR?

Division of Behavioral Health Behavioral Health - 5 Alaska Screening Tool (AST) Mental Health Depression Anxiety Risk: self/others Trauma Symptoms Substance Abuse Co-occurring Disorders Adverse Experiences FASD Traumatic Brain Injury Major Life Change Intimate Partner Violence Client Status Review (CSR – 2014) Health Physical Health Mental Health Substance Use Harm to Self Emergency Services Tobacco* Physical Activity* Nutrition* Safety Legal Involvement Domestic Violence General Safety Productive Activity Employment/School Other Productive Activities Living with Dignity Housing Supports for Recovery Meaning in Life Life in General Service Quality* Service Outcomes*

Division of Behavioral Health Behavioral Health - 6 What does the AST tell us? Alaska Screening Tool (7/1/2013 to 3/4/2014) AgencyASTsScreening Outcomes Substance Abuse Mental HealthDual Diagnosis TBIFASDAdverse Experience Major Life Change Intimate Partner Violence DepressionAnxietyRisk Self/Others Trauma Total Percentages 9,05264%56%65%33%69%58%40%8%78%65%21%

Division of Behavioral Health Behavioral Health - 7 What does the AST tell us? AST Adverse Experience by Population Types 7/1/2013 and 3/4/2014 # Adverse Experiences SUD%GMH%SMI%SED%COD%OTHER%Total # clients % of Total % % % % % %2, % 1 to % % % % % %2, % 3 to % % % % % %2, % 5 to % % % % % %1, % 7 to % % %708.27% %969.23% % 3,521 1,695 1, ,040 9,052

Division of Behavioral Health Behavioral Health - 8 What does the CSR tell us? Individual Client Level For Client: M119854AG Chart depicting CSR questions: Mental Bad Days, Suicidal Days, Alcohol/Drunk Days, Housing Situation, Legal Involvement 30 Days, Intimate Partner Abuse, Feelings about Life, Feelings about Service

Division of Behavioral Health Behavioral Health - 9 What does the CSR tell us? Statewide Level RBA Scorecard: Treatment Outcomes Adult Measures Client Improvement in Quality of Life Domains between first and second CSR (percent of clients showing improvement) FY2011FY2012FY2013 FY2014 Q1 FY2014 Q2 FY2014 Q3 FY2014 Q4 FY2014 FYTD SMI (CSR #2)73.1%71.9%75.9%77.2%74.8%70.5%0.0%74.8% SED (CSR #2)69.9%71.3%73.5%74.4%64.3%72.7%0.0%71.9% COD CSR #2,5,6) 75.0%71.4%79.0%83.9%75.6%77.8%0.0%79.9% MH (CSR #2)84.7%76.4%74.0%83.5%77.7%65.0%0.0%76.3% SUD (CSR #5,6)93.9%93.3%91.6%90.8%90.2%91.6%0.0%90.8% CSR #2: # of mentally unhealthy days CSR #5: # of days used alcohol CSR #6: # of days used illegal drugs

Division of Behavioral Health Behavioral Health - 10 What does the CSR tell us? Statewide Level RBA Scorecard: Treatment Outcomes Adult Measures Client Improvement in Quality of Life between first and second CSR (percent of clients showing improvement) CSR #16 FY2011FY2012FY2013FY2014 Q1 FY2014 Q2 FY2014 Q3 FY2014 Q4 FY2014 FYTD SMI57.2%55.9%59.2%60.7%61.1%54.4%0.0%59.4% SED53.0%58.4%57.4%56.4%57.1%54.5%0.0%56.3% COD64.1%65.7%58.4%59.7%68.9%59.3%0.0%62.7% MH62.4%57.0%56.8%62.4%68.1%50.0%0.0%60.8% SUD61.6%62.8%62.9%64.3%66.1%64.3%0.0%65.0% CSR #16: How do you feel about housing/basic needs met, safety, supports, friendships, family, life etc.

Division of Behavioral Health Behavioral Health - 11 What does the CSR tell us? Statewide Level RBA Scorecard: Treatment Outcomes Adult Measures Client Perception of Treatment Services on their second CSR (Percent of clients indicating satisfaction of services). (CSR #18a & 18b) FY2011FY2012FY2013 FY2014 Q1 FY2014 Q2 FY2014 Q3 FY2014 Q4 FY2014 FYTD SMI77.0%78.0%77.0%79.0%80.0%84.0%0.0%80.0% SED79.0%65.0%66.0%80.0%43.0%88.0%0.0%79.0% COD82.0%86.0%85.0%87.0%85.0%89.0%0.0%87.0% MH82.0%74.0%81.0%90.0%87.0%89.0%0.0%89.0% SUD79.0%77.0%83.0%85.0%87.0%85.0%0.0%86.0% CSR #18a: I was treated with respect. CSR # 18b: I was able to get all the services I needed.

Division of Behavioral Health Behavioral Health - 12 What does the CSR tell us? Statewide Level RBA Scorecard: Treatment Outcomes Adult Measures Client Perceptions of Treatment on their second CSR (percent of clients satisfied that services have improved the quality of their life) (CSR #18c) FY2011FY2012FY2013 FY2014 Q1 FY2014 Q2 FY2014 Q3 FY2014 Q4 FY2014 FYTD SMI77.0%76.0%73.0%76.0%79.0% 0.0%78.0% SED74.0%63.0%60.0%75.0%43.0%76.0%0.0%71.0% COD81.0%83.0%79.0% 78.0%85.0%0.0%80.0% MH79.0%73.0%80.0%86.0%84.0%83.0%0.0%85.0% SUD77.0%80.0%82.0%85.0%86.0%84.0%0.0%85.0% CSR #18c: The services improved the quality of my life.

Division of Behavioral Health Behavioral Health - 13 Alaska Screening Tool (AST) Mental Health Depression Anxiety Risk: self/others Trauma Symptoms Substance Abuse Co-occurring Disorders Adverse Experiences FASD Traumatic Brain Injury Major Life Change Intimate Partner Violence Depression Scale (5 Levels): 56% of all clients The level of accumulated Adverse Experiences: While the most reported adverse experience for any age group is “having lived with an addicted person” (44% children – 57% adults), a significant proportion have lived with someone who is physically abused, or been physically abused themselves. Rates are highest for clients in treatment for Mental Health or Co- occurring Disorders. 38% of children have lived with an abused person, and 25% have been abused 31% of youth have lived with an abused person, and 27% have been abused. 35% of adults have lived with an abused person, and 46% have been abused

Division of Behavioral Health Behavioral Health - 14 Alaska Screening Tool Levels of Depression Volume/Type of Adverse Experiences -- necessitate active inclusion of other household members. --potential impact for all life domains Tobacco abstinence at the end of the 1 st yr. of treatment may be the most robust predictor of abstinence from illicit drug use at a 9 year follow up Comorbid Medical Conditions and the related “Modifiable Risk Behaviors” Client Status Review (CSR – 2014) Health Physical Health Mental Health Substance Use Harm to Self Emergency Services Tobacco* Physical Activity* Nutrition* Safety Legal Involvement Domestic Violence General Safety Productive Activity Employment/School Other Productive Activities Living with Dignity Housing Supports for Recovery Meaning in Life Life in General Service Quality* Service Outcomes*

Behavioral Health - 15 Moving Forward CSR – 2014 » Coercion and motivation to seek services » Changes in Federal reporting requirements ◆ Modifications to “Legal Involvement” questions ◆ Modifications to “Housing” questions ◆ Modifications to “School” related questions ◆ Modifications to “Employment” questions » Substance Use Disorder ◆ Addition of “binge” drinking » Co-Morbid Medical Conditions ◆ Addition of “Health Risk Behavior” questions » Client Feedback: Expansion of “Quality of Services” questions

Behavioral Health - 16 Moving Forward CSR – 2014 » Target Date for Full Implementation: April 1, 2014 » AKAIMS has been programmed to allow CSR-2011 and CSR-2014 to be entered, until April 15. » The CSR will be sent to providers March 13, 2014 » EDI Agencies: ◆ Coordinate programming with your EHR vendor to accommodate the new CSR ◆ Change data submission transactions to accommodate the new CSR-2014.

Thank you. Questions? Behavioral Health - 17