Albany County System of Care Model Part One Matt Vogel Fall 2009 Independent Study in Propensity Score Analysis and Matching

Historical Background No single serving agency can provide all services and supports needed by families with children who have disabilities and/or or vulnerable to abuse and neglect Complex needs Program limitations Funding limitations In the early 1980s mental health services for children came under scrutiny Children in need of treatment were not getting services they needed Services were often provided in restrictive, out-of-home settings Few community based services were available Families had limited involvement in their child’s care Cultural difference between providers and children were rarely taken into account

Historical Background Child and Adolescent Service System Program (1984) National Institute of Mental Health Created in response to these concerns Provided the initial design of the System of Care model, to provide comprehensive services to address the needs of youth and families with severe emotional disturbances Core goals: Interagency collaboration Individual, strength based care Cultural competence Child and family involvement in service plans Community based services

Historical Background Comprehensive Community Services for Children and Their Families Program Established in 1992 by the Substance Abuse and Mental Health Services Agency (U.S. Department of Health and Human Services) Provides 6-year grants to U.S. communities to develop infrastructure and improve upon existing community based mental health services Communities are given discretion in how to distribute funds To date 136 communities have received SAMHSA funding

Eastern Kentucky North Carolina (10 counties) California 5 (Santa Cruz, San Mateo, Riverside Ventura, & Solano Counties) Vermont 1 (statewide) Lyons, Riverside, & Proviso, IL Bismarck, Fargo, & Minot, ND Northern Arapaho Tribe, WY Sault Ste. Marie Tribe, MI Rhode Island 2 (statewide) Hillsborough County, FL Charleston, SC King County, WA Clark County, WA Clackamas County, OR Vermont 2 (statewide) Passamaquoddy Tribe, ME Rhode Island 1 (statewide) Maine (4 counties) Edgecombe, Nash, & Pitt Counties, NC Alexandria, VA Baltimore, MD South Philadelphia, PA Mott Haven, NY Detroit, MI Northwoods Alliance, WI Milwaukee, WI Navajo Nation Sacred Child Project, ND San Diego County, CA Napa & Sonoma Counties, CA Lane County, OR Santa Barbara County, CA Greenwood, SC West Palm Beach, FL Contra Costa County, CA Birmingham, AL North Carolina (11 counties) Oglalla Sioux Tribe, SD Lancaster County, NE Willmar, MN Pima County, AZ Marion County, IN Charleston, WV Montgomery County, MD Delaware (statewide) Burlington County, NJ Westchester County, NY Worcester, MA New Hampshire (3 regions) Gwinnett & Rockdale Counties, GA System-of-Care Communities of the Comprehensive Community Mental Health Services for Children and Their Families Program United Indian Health Service, CA Nebraska (22 counties) San Francisco, CA Clark County, NV Rural Frontier, UT Denver, CO Las Cruces, NM Wichita, KS Parsons, KS Travis County, TX                    Sacramento County, CA Glenn County, CA Colorado (4 counties) El Paso County, TX  Oklahoma Ft. Worth, TX Choctaw Nation, OK St. Charles County, MO Missouri Broward County, FL Connecticut (statewide) Washington, DC  New York, NY Lake County, IN Illinois (Chicago area) Idaho Wai'anae & Leeward, HI Fairbanks, AK Yukon Kuskokwim Delta Region, AK Guam Puerto Rico Oakland, CA Monterey County, CA Four Counties, OR  Allegheny County, PA Southern Consortium & Stark County, OH Cuyahoga County, OH Jackson, MS St. Louis, MO Nashville, TN Louisiana (5 parishes) 3 counties & Catawba Nation, SC DateNumber   Funded Communities  DateNumber  Erie County, NY Albany County, NY Montana & Crow Nation Kentucky (8 counties)

Albany County received SAMHSA funding in 2003 which established Families Together in Albany County The explicit goals of this system include i mproving child and family functioning and satisfaction with services improving access to services creating fewer hospitalizations and other out-of home placements. providing early identification and intervention for children with developmental, behavioral or emotional concerns improving family engagement and compliance with care plans and services. Families Together in Albany County

Family Resource Centers –Located in Albany, Colonie and Byrne –Staffed and run by parents –Provide training and other support to childcare centers, schools, community-based providers who work with families and children –Provide children and families with information, peer support, recreation, referrals and linkages to services, support items and advocacy Parent Partners –Provide social support and information to families –Have experience raising SED child –Expected to reduce caregiver strain Core Components Families Together in Albany County

Traditionally, when children in Albany County were referred for mental health services they would present at either the Children’s Mental Health Unit on Green Street or through the Albany County Single Point of Access Through coordinated efforts between FTAC and the Albany County Department of Probation, the Department of Child and Family Services and various school districts, beginning in January of 2006, families began to be referred to the family resource centers for mental health services Program Functioning Families Together in Albany County

Intake evaluations are conducted on all children presenting at a family resource centers Families of eligible children are provided with access to various community based and system of care specific services These may include things such as: –Sessions with a behavioral specialist –Circles of Support –Comprehensive planning sessions –Referrals to other agencies –Youth/caregiver empowerment workshops Program Functioning Families Together in Albany County

Federal funding for the Albany System of Care runs out December 31 st, 2009 FTAC is in the process of soliciting funds from New York State to continue providing services to eligible families in Albany County FTAC is looking for analyses to substantiate their claims that the System of Care model is effective in Albany County Are families receiving FTAC services better off than families receiving traditional mental health services in Albany County? Purpose of Analysis

Prior evaluations of the Albany County System of Care suggest that families receiving FTAC services are worse off on an array of outcome measures when compared to families receiving traditional services FTAC stakeholders suggest that families who present and agree to services have greater needs than families entering in through traditional portals and those who do not agree to services In other words, these two groups differ substantially on a number of covariates, rendering most comparisons biased Selection Bias Prior Analyses

Descriptive Study Demographic information on all families presenting for services between January 1, 2006 and October 31 st, 2009 N = 1497 unique families Longitudinal Child and Family Outcome Study Convenience sample of 245 families Caregiver and youth interviews every 6 months Observational Study Evaluation design Data Structure

Is there a causal relationship between receipt of FTAC services and family outcomes in the first 6 months of involvement? –Outcomes: Caregiver Strain –To what extent are caregivers affected by the demands associated with raising a SED child Caregiver involvement in service plan Satisfaction with services –Sample: All families enrolled in the longitudinal evaluation study from intake to six months N=154 Research Questions

Treatments: 1.Utilization of Family Resource Centers Has the family visited one of the three family resource centers in the first six-months of involvement in the program? 2.Utilization of Parent Partners Has the family utilized the services of a parent partner in the first six-months of involvement with the FTAC FTAC Treatments

An ideal comparison would embrace a randomized experimental design, in which families are assigned to receive either traditional services (control) or system of care services (treatment) when a child is initially referred Unfortunately families are NOT randomly assigned to FTAC vs. Traditional services Instead evaluation is based on observational data –Systematic differences may exist between those who agree vs. not agree to services Differences between Families

Caregiver characteristics Baseline strain Interruption of caregiver life Caregiver age Caregiver education Race Differences between Families Family characteristics History of illness Poverty Family resources Health insurance Family Functioning Child characteristics Gender Age Presenting problems Severity of disorder Comorbidity Specific diagnosis Functional impairment School performance Social functioning Referral source