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GOVERNMENT OF THE DISTRICT OF COLUMBIA

DEPARTMENT OF MENTAL HEALTH


Table of Contents:

I. CFSA – Office of Clinical Practice Referrals…….……….……..…………3

Requested Services..………….………………………………...……………..4

Referring Agency........................................................................................6

II. Provider Reported Diagnostic Assessment Data……..….………….……7

Service Delivery…………………….……………….………….……………….9

CALOCUS Administration……………..…………….……………………….13

III. Choice Provider Claims Data……………………………...……………...…13

Services Provided………………………….....……………………………….16

IV. Co-located Staff Referrals……………………………………………………22

V. Wraparound Services……………………………………………….………...25

VI. ChAMPS………………………………………………………………………….26

VII. Conclusion………………………………...…………………………...............33

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FY2009 Amended Implementation Plan Report
District of Columbia Department of Mental Health

I. CFSA – Office of Clinical Practice Referrals:

Referrals from CFSA, within the public mental health system, are screened by a co-
located DMH staff person in collaboration with the CFSA – Office of Clinical Practice,
Behavioral Studies Unit, and routed to Choice Providers via the Access Helpline. In
FY2009, a total of 350 children and youth were referred through this process. As shown
below, the majority of referrals were directed to Progressive Life, First Home Care and
Universal Healthcare, receiving 104 (30%), 88 (25%) and 82 (23%) referrals
respectively. Family Matters received 46 (13%), and Community Connections received
30 (9%) referrals.

FY 2009 Total Number of Youth Referred


CFSA - OCP/BSU
Community
Universal Connections, 30,
Healthcare, 82, 23% 9% Family Matters, 46,
13%

Progressive Life,
104, 30% First Home Care,
88, 25%
(Total Children/Youth = 350)

The following chart shows multiple variables. First, it illustrates with bars, the number of
referral in quarters one and two combined. Then the bars show the number of referrals
in quarters three and four respectively. In addition to the number of referrals sent to
each Choice Provider quarterly, it shows the percentage increase/decrease. The line
with the square labels shows the percentage increase/decrease from quarters one and
two combined, to quarter three for each provider. The line with circular labels shows the
percentage increase/decrease from the first three quarters of FY 2009 to the fourth.
Last, the chart gives the total number of referrals for quarters one and two combined
(192), quarter three (310), and quarter four (350). This chart also shows the percentage
increase/decrease from the combined first and second quarters to the third quarter
(61% increase), and from the first three quarters to the last (11% increase).

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FY 2009 Referrals - CFSA OCP/BSU
400 160%
150%
350 140%

Percentage Increase
300 120%
Number Referred

250 100%

200 80%
74%
68%
150 61% 60%
57%

100 40%
30%
22% 24%
50 20%
11%
5% 5%
0 0% 0%
CC FM FHC PLC UHMS Total
Qs1&2 12 23 40 57 60 192
Q3 30 36 67 99 78 310
Q4 30 46 88 104 82 350
% Increase(Qs1&2 - Q3) 150% 57% 68% 74% 30% 61%
% Increase (Qs 1,2&3 - Q4) 0% 22% 24% 5% 5% 11%

Requested Services:

The referral instrument documents the services a referring social worker would like
his/her client to receive. The following illustrates by provider, the frequency of those
requested services.

Community Connections:
FY 2009 Frequency of Requested Services
There were no
children/youth referred
10
9
to Community
Connections in Quarter
Number of Requests

8
7
6
four. In total for FY
5 2009, there were 18
4 requests for Individual
3
2 Therapy, one for
1 Family Therapy, 12 for
0
Q1 Q2 Q3 Q4 Medication
Ind. Therapy
Fam. Therapy
9
0
9
1
Management, and
Med. Som. 1 6 5 there were eight total
DCCSA Transfers 0 8
DC CSA transfers.

4
Family Matters:
FY 2009 Frequency of Requested Services
In FY 2009, Family
Matters received
16
14
referrals containing
29 requests for
Number of Requests

12
10 Individual Therapy,
8
three for Family
6
4
Therapy, 17 requests
2 for Medication
0
Q1 Q2 Q3 Q4
Management, and
Ind. Therapy 2 15 3 9 accepted nine DC
2 1
Fam. Therapy
Med Som 8 3 6
CSA transfer
DCCSA Transfers 9 children/youth.

First Home Care:


FY 2009 Frequency of Requested Services
Of the referrals
distributed to First
25 Home Care in FY
2009, there were 70
Number of Requests

20
requests for
15 Individual Therapy,
10
12 requests for
Family Therapy, 21
5
requests for
0 Medication
Q1 Q2 Q3 Q4
Ind. Therapy 23 15 23 9
Management, four
Fam. Therapy 4 3 3 2 for CBI, and there
Med Som 5 8 1 7 were four DC CSA
DCCSA Transfers 4
CBI 1 3
transfers
children/youth.

Progressive Life:
In FY2009, there
FY 2009 Frequency of Requested Services were 87 requests for
35 Individual Therapy.
30 There were 12
requests for Family
Number of Requests

25

20 Therapy. There were


15 21 requests for
10 Medication
5 Management and
0 one request for Play
Q1 Q2 Q3 Q4
Ind. Therapy 27 26 31 3
Therapy. There were
Fam. Therapy 6 3 3 10 children/youth
Med Som 5 9 6 1
involved with the DC
Play Therapy 1
DCCSA Transfers 10 CSA transition.

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Universal Healthcare:
FY 2009 Frequency of Requested Services Of the referrals directed
to Universal Healthcare
30 in FY 2009, there were
25 61 requests for
Number of Requests

20
Individual Therapy and
15
15 requests for Family
Therapy. There were
10
three requests for Sex
5
Abuse Therapy and two
0
Q1 Q2 Q3 Q4 for Play Therapy. There
Ind. Therapy 28 19 12 2 were 19 requests for
Fam. Therapy 3 8 2 2 Medication
Sex Abuse Therapy 3
Play Therapy 1 1
Management, and there
Med Som 4 14 1 were six DC CSA
DCCSA Transfers 6 transfers.

Referring Agency:

In addition to those children/youth who were referred by CFSA, and those being
transitioned away from the DC CSA, a total of 17 private foster care agencies made
referrals through the Office of Clinical Practice’s Behavioral Studies Unit at CFSA. The
majority of referrals to Choice Provider Network were from CFSA social workers, 58%
(204 of 350 total referrals). The following chart shows the originating agency
distribution of OCP-routed referrals. Consumers transitioning from the DC CSA
comprised nine percent (31 referrals). Of the remaining referring agencies,
Foundations had the next highest referral rate at eight percent (28 referrals) during
FY2009.
FY 2009 Total Number of Referrals by Source
Seraaj 9
PSI 5
Progressive Life 2
Pressley 3
NCCF 7
MPPI 6
LSS 7
LAYC 1
Kidspeace 5
HCG 6
Foundations 28
First Home Care 1
Family Matters 3
DCCSA Transfers 31
Child Choice 7
CFSA 204
Catholic Charities 10
Boystown 1
Board of Children 1

0 50 100 150 200 250

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II. Provider Reported Diagnostic Assessment Data:

This section reflects data submitted to the Mental Health Authority in FY2009 by four of
the five Choice Providers. Community Connections is excluded from this report as a
result. In FY 2009, a total of 413 children and youth received services through one of
the reporting Choice Provider agencies: Family Matters, First Home Care, Progressive
Life and Universal Healthcare Management Services. Family Matters reported
receiving 49 (12%) referrals; First Home Care reported 132 (32%) referrals; Progressive
Life reported 144 (35%); and Universal Healthcare reported 88 (21%) referrals.
Total Diagnostic Assessments Completed by Agency (FY 2009)

Universal Family Matters,


Healthcare, 88, 49, 12%
21%

First Home
Progressive Care, 132, 32%
Life, 144, 35%

(Total Youth Served = 413)

Similar to the chart above, the chart below further disaggregates the total number of
Diagnostic Assessments each Choice Provider reported having completed, by each
quarter of FY2009.
Total D/As by Agency and FY2009 Quarter
160

140
Number Served

120

100
Total , 144
Total , 132

80
Total , 88

60
Total , 49

40

20

0
Family Matters First Home Care Progressive Life Universal Healthcare
Q1 2 15 29 22
Q2 15 34 4 31
Q3 19 54 57 28
Q4 13 29 54 7
Total 49 132 144 88

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This chart shows the total number of Diagnostic Assessments completed by all
reporting Choice Providers in FY2009 by month.

FY2009 - Total Monthly Diagnostic Assessments


80

70 71

60
Number of D/As

57
52
50

40 41
35 AVG=34 35 36
32
30

20 20
17
10 10
7
0
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul-09 Aug- Sep-
08 08 08 09 09 09 09 09 09 09 09

(Total Diagnostic Assessments = 413)

As represented on the following chart, the majority children/youth receiving Diagnostic


Assessments as part of the Choice Provider intake process were CFSA youth at 284
(76%). Eighteen were TFC children/youth and four were from DYRS. Thirty were
referred by Private Placement Agencies, and agency affiliations were not reported for
27 children/youth.

Affiliated Agency
300
Number of Children/Youth

250

200

150

100

50

0
Private
CFSA DYRS TFC CSS Placement Not Identified
Agency
Q1 62 1 2 3
Q2 55 16 13
Q3 113 3 1 30 11
Q4 54
Total 284 4 18 1 30 27

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Service Delivery:

The service delivery timeframe is derived from the difference between a child/youth’s
date of enrollment with a provider, and the date of the child/youth’s diagnostic interview.
The following chart illustrates the average elapsed time for service delivery, each
month, by provider for FY2009. Among reporting Choice Providers, the average
number of days between a consumer’s enrollment with a provider and the
administration of his/her diagnostic interview was 23 days.
FY 2009 - Average Days Between Enrollment and
Diagnostic Interview
30
AVG=23 Days
25

24
23 23
# Days

20 22

15

10

0
Family Matters First Home Care Progressive Life Universal

Choice Provider

This is further disaggregated by provider and by quarter in the chart displayed below.

Days Between Referral & Diagnostic Interview by FY2009 Quarter


45

40

35
Number of Days

30
AVG=23 Days
25

20

15

10

0
Family Matters First Home Care Progressive Life Universal
Q1 24 42 30 14
Q2 20 15 19 25
Q3 32 22 24 29
Q4 17 13 7 15

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The FY2009 Service Delivery Timeframe chart below shows the number of days
between consumers’ enrollment and diagnostic interview for each reporting provider for
each month of FY2009. It also includes an average line for each month in the fiscal
year. There were four months in FY2009 in which the average number of days for
service delivery exceeded the overall FY2009 average. They include October 2008 (48
days), January 2009 (26 days), April 2009 (25 days), and May 2009 (32 days). In
October 2008, each reporting provider with the exception of Universal Healthcare (17
days), The months in FY2009 in which service delivery occurred fastest were December
2008 (14 days), March 2009 (15 days), and particularly noteworthy were August and
September 2009 which averaged 10 and 12 days respectively.
FY2009 Service Delivery Timeframe
Number of Days Between Enrollment and Diagnostic Interview
80

70
Family Matters
60
Number of Days

First Home Care


50
Average
40

30

20

10

0
Universal Progressive Life
-10 Healthcare

Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep-
08 08 08 09 09 09 09 09 09 09 09 09
Family Matters 72 0 0 34 28 -2 17 47 33 25 19 8
First Home Care 45 56 25 19 14 11 22 23 21 15 13 11
Progressive Life 57 12 22 29 4 23 33 23 15 9 7 6
Universal 17 12 11 23 22 29 28 37 24 21 0 23
Average 48 20 14 26 17 15 25 32 23 18 10 12

Family Matters:
The average number of days between enrollment and diagnostic interview at Family
Matters for FY2009 was 23 days, equal to the overall FY2009 average. In October
2008, Family Matters had outliers that skewed the overall average of that month at 72
days. January 2009, May 2009 and June 2009 also had monthly averages that far
exceeded the Family Matters agency average and the overall FY2009 average, at 34,
47, and 33 average days respectively. Also noteworthy in March 2009, there were
instances where diagnostic interviews were conducted prior to receipt of the referring
documentation, resulting in negative two average days for March.

10
Family Matters
Average Days Between Enrollment and Diagnostic Interview
80

70
Number of Days 60

50

40

30

20

10

-10
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep-
AVG
08 08 08 09 09 09 09 09 09 09 09 09
Family Matters 72 0 0 34 28 -2 17 47 33 25 19 8 23

FY 2009

First Home Care:


First home care also reported an average of 23 days between enrollment and diagnostic
interview, equal to the FY2009 overall average. October and November 2008 saw more
lengthy periods on average (45 and 56 days respectively); however, the following
months were reported to have far more reasonable intervals between referral receipt
and Diagnostic Interview. With the exception of December 2008 (25 days), the
remainder of FY2009 service delivery was equal to or fell below the First Home Care
agency and FY2009 overall averages.
First Home Care
Average Days Between Enrollment and Diagnostic Interview
60

50
Number of Days

40

30

20

10

0
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep-
AVG
08 08 08 09 09 09 09 09 09 09 09 09
First Home Care 45 56 25 19 14 11 22 23 21 15 13 11 23

FY 2009

Progressive Life Center:


Progressive Life reported an average of 24 days between enrollment and diagnostic
interview, only one day higher than the FY2009 average, but also the highest of

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reporting providers by one day. In October 2008, Progressive Life enrolled two
children/youth who did not participate in a diagnostic interview until the end of
December 2008 resulting in 57 days average shown below. Outside of October 2008,
there were only two months, January and April 2009 that exceed the FY2009 average of
23 days and the agency average of 24 days at 29 and 33 days respectively.
Progressive Life
Average Days Between Enrollment and Diagnostic Interview
60

50
Number of Days

40

30

20

10

0
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep-
AVG
08 08 08 09 09 09 09 09 09 09 09 09
Progressive Life 57 12 22 29 4 23 33 23 15 9 7 6 24

FY 2009

Universal Healthcare Management Services:


Universal Healthcare reported the lowest overall average of 22 days between
enrollment and diagnostic interview, one day less than the FY2009 average and the
lowest reporting agency average. There were four months in FY2009 where service
delivery exceeded the FY2009 average. They include March 2009 (29 days), April 2009
(28 days), May (37 days), and June 2009 (24 days).

Universal Healthcare
Average Days Between Enrollment and Diagnostic Interview

40

35
Number of Days

30

25

20

15

10

0
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep-
AVG
08 08 08 09 09 09 09 09 09 09 09 09
Universal 17 12 11 23 22 29 28 37 24 21 0 23 22

FY 2009

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CALOCUS Administration:

The Child and Adolescent Level of Care System (CALOCUS) instrument was
administered by three of the reporting Choice Providers: Family Matters, First Home
Care and Universal Healthcare Management Services. The overall FY2009 average
CALOCUS score was 17. No scores were reported for children/youth enrolled with
Progressive Life. Family Matters had the highest Calocus administration percentage at
78%, followed by First Home Care at 68% and Universal Healthcare 49%. Family
Matters also reported the lowest average Calocus score of 15, followed by Universal
Healthcare and First Home Care (18 and 19 days, respectively). The following chart
shows each reporting provider’s average Calocus score (in bars) and the each agency’s
average administration rate (in lines) for each quarter and also the FY2009 overall
averages in aggregate and by provider.

FY2009 Overall CALOCUS Administration


20 120%
18

% C a lo c u s S c o re R e p o rte d
100%
A v e ra g e S c o re

16
14
80%
12
10 60%
8
40%
6
4
20%
2
FY2009 AVG Calocus = 17 0 0%
Q1 Q2 Q3 Q4 FY2009 AVG
AVG FM Calocus Score 14 19 15 12 15
AVG FHC Calocus Score 19 19 19 19 19
AVG PLC Calocus Score
AVG UHMS Calocus Score 18 18 17 18
% FM w/Calocus 100% 92% 44% 77% 78%
% FHC w/Calocus 83% 92% 76% 21% 68%
% PLC w/Calocus
% UHMS w/Calocus 62% 64% 68% 0% 49%

III. Choice Provider eCura Claims Data:

For FY 2009, Choice Providers submitted claims for services for 4,216 total
children/youth. Serving the largest number and half of the total number served, was
First Home Care, whose eCura Claims data showed services billed for 2,126
children/youth in FY2009. Second was Community Connections at 1,317 (31%)

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children/youth served, followed by Universal Healthcare at 527 (13%). Progressive Life
and Family Matters each served three percent at 126 and 120 children/youth
respectively as shown below.

FY 2009 Total Children/Youth Served

Universal, 527, Community


13% Connections,
Progressive Life, 1317, 31%
126, 3%

First Home Care, Family Matters,


2126, 50% (N = 4,216) 120, 3%

The total number of children/youth served is based on


eCura claims submitted October 2008 - September 2009.

The chart below shows the total served by the entire Choice Provider Network by
FY2009 quarter. It also displays the percentage increase in the number of
children/youth served from quarter to quarter. From the first to second quarter, and also
from the second to the third quarter, the number of children/youth served increased by
16%. From the third to the fourth quarter, the number of children/youth served
increased by 2%.

FY2009 Total Served by Quarter: eCura Claims Data


1400

1200
Number of Children/Youth

1000

800
16% 16% 2%
600 Increa

400 1 1
8 9 1 2
200 3 9 8 0
2 2 3 9
0
Q1 Q2 Q3 Q4
FY09 Quarter

14
The chart below further disaggregates the total number of children/youth served by the
Choice Provider Network, within the MHRS structure by FY2009 quarter.
FY 2009 Number Children/Youth Served
2500
2126

2000
Number Served

1500 1317

1000

527
500
120 126

0
Community First Home Progressive
Family Matters Universal
Connections Care Life
Q1 352 13 422 18 27
Q2 320 19 500 21 132
Q3 301 46 596 58 182
Q4 344 42 608 29 186
TTL 1317 120 2126 126 527

As shown on the following chart, the number of children/youth served by Community


Connections decreased by 10% from the first to the second quarter of FY2009, and 6%
from the second to the third quarter of FY2009. However, the number of children/youth
served from the third to the fourth quarter at Community Connections increased by
13%. The number of children/youth served by Family Matters increased by 32% from
the first to the second quarter of FY2009, and increased by 59% from the second
quarter to the third. However, Family Matters showed a 10% decrease in the number of
children/youth served from the third to the fourth quarter. The number of children/youth
served by First Home Care increased by 16% from both the first to the second quarter
and also from the second to the third quarter. There was a two percent increase in the
number of children/youth served from the third to the fourth quarter. Progressive Life
experienced a 14% increase from the first to the second quarter, a 64% increase from
the second to the third quarter. There were no claims for services in eCura from
Progressive Life for the fourth quarter, representing a 100% decrease from the third to
the fourth quarters of FY2009. Universal Healthcare Management Services saw an
84% increase in the number of children/youth served from the first to the second
quarter, a 27% increase from the second to the third quarter, and a two percent
increase from the third to the fourth quarter of FY2009. As previously mentioned, the
overall number of children/youth served increased 16% from the first to the second
quarter and from the second to the third quarter. A two percent increase was
experienced from the third to the fourth quarter of FY2009.

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Percentage Quarterly Claims Increase/Decrease - FY 2009

Q1-Q2 Q2-Q3 Q3-Q4

100% 80%
80% 59% 64%
60%
32% 27%
40% 14% 16%16%
13% 16% 16%
20% 2% 2% 2%
0%
-20% -6% -10%
-10%
-40%
-60%
-80%
-100%
-120% -100%

Community Family First Home Progressive Universal Overall


Connections Matters Care Life Quarterly
Increase
Represents the percent increase or decrease in the total number of children/youth for which
claims were submitted from the first to the second quarter, from the second to the third
quarter, and from the third to the fourth quarter.

Services Provided:

4000
Total Number of Children/Youth Receiving Each Service
3596
3500
Number of Children/Youth

3000

2500

2000

1500

848 923
1000
596
500 271
157
61
0
DA Community Counseling CBI Med Som Team Mtg CTV
Support Tx
Service Types: FY 2009

The chart above represents the total number of children/youth for which each type of
service claims were submitted in FY2009 by the five choice providers in aggregate.
This includes each child/youth for which a claim for a particular service was submitted,
by service category. The most utilized service across Choice Providers was Community

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Support, as 3,596 children/youth received Community Support services, particularly
noteworthy as the overwhelmingly most requested service by referring social workers
through the OCP/BSU process has consistently been Individual Therapy; however, only
21% of children/youth actually received Therapy/Counseling, while 91% of
children/youth received Community Support, which was not a service requested by any
social workers referring through the OCP/BSU process. Medication Management was
second highest utilized service, 923 children/youth, and more aligned with referral data
reported by the CFSA OCP/BSU. Counseling was actually the third most utilized
service at 848 children/youth. A total of 596 children/youth received Community Based
Intervention. There were a total of 271 claims submitted for Diagnostic Assessments
completed as part of the Choice Provider Network. Last, providers submitted claims for
Team Meetings and CTV services for 117 and 39 children/youth respectively. The chart
below further separates this service utilization information by FY2009 quarter.
FY 2009 Overall Number of Children/Youth Receiving
Each Service by Quarterly eCura Billing Claims
1200

1000
Number Served

800

600

400

200

0
Community
DA Counseling CBI Med Som Tx Team Mtg CTV
Support
Q1 60 736 146 113 205 26 0
Q2 62 871 209 136 222 45 9
Q3 105 944 225 167 217 46 30
Q4 44 1045 268 180 279 40 22

The chart below illustrates the percentage increase or decrease in service utilization
from the first to second quarter, from the second to the third quarter, and from the third
to the fourth quarter. There was a three percent increase in the number of Diagnostic
Assessments billed for from the first to the second quarter, a 69% increase from the
second quarter to the third, but a 58% decrease from the third to the fourth quarter.
Community Support experienced an 18% increase from the first to the second quarter,
an eight percent increase from the second to the third quarter, and an 11% increase
from the third to the fourth quarter of FY2009. There was a 43% increase in the number
of children/youth who received Counseling from the first to the second quarter, an eight
percent increase from the second to the third quarter, and a 19% increase from the
third to the fourth quarter. CBI saw a 20% increase from the first to the second quarter,
followed by a 23% increase from the second to the third quarter, and an eight percent

17
increase from the third to the fourth quarter of FY2009. There was also an eight
percent increase in the number of children/youth who received Medication
Management services from the first to the second quarter, which was followed by a two
percent decrease from the second to the third quarters. Medication Management saw
a 29% increase from the third to the fourth quarter of FY2009. For Team Meetings and
CTV services, the comparatively low number of children/youth receiving these services
impacts the percentage increase/decrease. Team Meetings increased by 73% from the
first to the second quarters, from 26 to 45 Team Meetings. In the third quarter, there
was a two percent increase, and a 13% decrease from the third to the fourth quarter.
There were no CTV services billed for in the first quarter. There was a 233% increase
in CTV services from the second quarter to the third, representing an increase of nine
children/youth in the second quarter to 30 in the third. This was followed by a 27%
decrease from the third to the fourth quarter, dropping 30 in the third to 22 in the fourth
quarter of FY2009.

FY2009 Percentage Quarterly Increase/Decrease


by Service Type (Per eCura)

Q1-Q2 Q2-Q3 Q3-Q4


250% 233%

200%
Percentage Change

150%

100%
69% 73%
43%
50% 29%
18% 19% 20% 23%
3% 8%11% 8% 8% 8% 2%
0%
-2%
-13%
-27%
-50%
-58%
-100%
Diagnostic Community Counseling CBI Med Som Tx Team Mtg CTV
Assessment Support
Service Type

The 271 total Diagnostic Assessments billed for in eCura appears to be discordant as
the provider reported monthly data shows a total of 413 completed Diagnostic
Assessments. This difference is attributable to the unavailability of claims data in eCura
for Diagnostic Assessments that were invoiced and counted as a part providers’
monthly data submissions, but were not included in the overall total of Diagnostic
Assessments billed for in eCura. This is because providers have up to 90 days in which
a claim for a service can be submitted for payment after it is rendered. As a result,
there are claims that were submitted after September 30, 2009 and are consequently
not reflected in the totals of this report. The following chart shows the distribution of
Diagnostic Assessments across the Choice Provider Network by provider and FY2009
quarter.

18
Diagnostic Assessments
80

70

60
Number Completed

50

40

30

20

10

0
Community First Home Progressive Universal
Family Matters Total
Connections Care Life Healthcare
Q1 2 39 17 2 60
Q2 39 10 17 66
Q3 1 22 15 36 74
Q4 0 4 21 1 18 44

The chart below represents the number of children/youth who received counseling
services by provider and FY2009 quarter.

Counseling

180
160

140
Number Served

120
100

80
60
40

20
0
Community Universal
Family Matters First Home Care Progressive Life
Connections Healthcare
Q1 3 10 128 0 5
Q2 4 5 146 7 47
Q3 3 150 9 63
Q4 16 27 156 20 49

19
This chart represents the number of children/youth who received Community Based
Intervention by provider and FY2009 quarter.

CBI
160

140

120
Number Served

100

80

60

40

20

0
Community Universal
Family Matters First Home Care Progressive Life
Connections Healthcare
Q1 25 88
Q2 28 108
Q3 29 138
Q4 34 146

The chart below displays the number of children/youth who received Medication
Management services for each provider by FY2009 quarter.

Med Som Tx

160

140
Number Served

120

100

80

60

40

20

0
Community Universal
Family Matters First Home Care Progressive Life
Connections Healthcare
Q1 71 7 117 5 5
Q2 63 2 130 6 21
Q3 39 130 5 43
Q4 74 12 150 43

20
The following chart shows the number of children/youth who had Team Meetings by
provider and FY2009 quarter.

Team Meetings

45
40
35
Number Served

30

25
20
15

10
5

0
Community Universal
Family Matters First Home Care Progressive Life
Connections Healthcare
Q1 6 20
Q2 8 35 2
Q3 1 42 3
Q4 37 3

The following chart illustrates the number of children/youth who received DCCSA
Consumer Transition Vouchers (CTV services) by Choice Provider and FY2009 quarter.

DCCSA Consumer Transition Vouchers


12

10
Number of Vouchers

0
Community Universal
Family Matters First Home Care Progressive Life
Connections Healthcare
Q1
Q2 5 4
Q3 8 5 6 11
Q4 11 7 4

CTV payments are billable in three parts. CTVs facilitate infrastructure building for
Choice Providers enrolling transitioning children/youth from the DCCSA. The first CTV

21
payment is billable at time of enrollment (no service required). The second CTV
payment is billable after face-to-face contact with the consumer. The third is billable
after 30 days, with an additional face-to-face contact.

IV. Co-Located DMH Staff:


Under provisions set forth by LaShawn V. Fenty, additional staffing at DMH to support
enhanced children's mental health services to include one psychologist and one clinical
the social worker assigned to CFSA's child protective services unit (CPS) under the
direct supervision of the DC CFSA's Behavioral Studies Unit. These staff persons are
located at 400 Sixth Street in southwest Washington, and began seeing consumers
from CFSA October 27, 2008. They primarily provide mental status assessments
(screenings) and case consultations. However, they may also participate in unit
meetings, family team meetings and conduct trauma symptom assessments. Referrals
are placed in a designated box in the CPS Division, which is checked periodically
several times per day. The co-located DMH staff provides mental health services on-
site; however, they do not have access to agency transportation, and as a result, are
limited to client visits that are coordinated and facilitated by the CPS social worker or
investigator. The chart below represents the referral-based activity of the co-located
DMH staff for FY 2009. There were 179 total families referred in FY2009. Eighty
actual mental health screenings were conducted, and Co-located staff consulted on 100
cases.

Program Activity FY 2009


200
180
179
160
140
120
100
100
80
80
60
40
20
0
Total Referrals Screenings Consultations

DMH Staff Co-located at CFSA

22
The chart below shows the distribution of referral activity for each month of FY2009.
Co-located DMH staff responded to an overall average of 15 referrals per month in
FY2009.

Total Monthly Referrals


35

32
30

25
24

20
AVG=15 19
18
15 16
14
13 13
10
10 10
8
5

2
0
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

FY 2009 Total = 179 Referrals

There has been a gradual increase in the number of families referred. Also, particular
effort is being made currently to deepen the general understanding of CPS social
workers of the co-located DMH staff resource, i.e. access and appropriate utilization.
As shown below, CPS social workers request services for families is divided among
children and adults at the overall FY 2009 monthly average of seven children/youth
versus nine adults served.

FY 2009 Population Served


30

25 26

20

Youth AVG=7 Adult AVG=9


15 16

13 13
12
10 11 10

8 8 7 8 7 8
5 6 6 6
5
4
3 3 3
0 2 2
0
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

Total Youth Served = 82 Month Total Adults Served = 105

# Youth Served # Adults Served

23
The chart below further illustrates the proportion of children/youth to adults receiving
services through the co-located DMH staff persons in FY2009.

FY 2009 Percentage of Youth Versus Adults Served


100% 100%

90%
81% 80% 81%
85%
80% 75%
68% 70%
67% 67%
70%
62% 67%
57%
60%

50%
43% 40%
38% 39%
40%
32% 30% 33%
25% 31% 33%
30% 23%
19%
20%

10%
0%
0%
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 AVG

% Youth Served % Adults Served

The vast majority of service requests from CFSA CPS social workers were for mental
status assessments, also referred to as mental health screenings, and case
consultations. As shown in the following chart, mental health screenings accounted for
36% of the service requests received, while case consultations accounted for 63%. The
outstanding one percent is attributed to inappropriate requests for service. Co-located
staff averaged seven screenings and eight case consultations per month in FY2009.
FY 2009 Mental Health Screenings and Case Consultations
30 120%

25 100%

20 80%

15 60%

10 40%

5 20%

0 0%
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep-
AVG
08 08 08 09 09 09 09 09 09 09 09 09
Screenings 0 3 2 7 1 8 7 3 4 9 12 24 7
Consultations 2 10 11 6 7 8 10 7 5 9 13 12 8
% Screenings 0% 23% 14% 54% 13% 50% 37% 30% 40% 50% 50% 75% 36%
% Consultations 100 77% 79% 46% 88% 50% 53% 70% 50% 50% 54% 38% 63%

24
V. DC City-wide Pilot and School-based Wraparound Services:

Total FY2009 Youth Served The DC Citywide Pilot


and School-based
35
Wraparound Initiative
30 32 expanded from the
25
original 24 slots in July
26
2009, bringing the total
20
available slots to 34
15 through funding from
10 the State Mental
Health Community
5
6 Block Grant. The
0 additional 10 slots are
Wrap Pilot DCPS-RTC Return Total
dedicated to 10 DCPS
children/youth
returning from residential treatment centers. At the end of FY2009, six of the 10 slots
were filled. Referrals
for two additional two
FY2009 City-wide Pilot Status at Referral
children/youth were in
process at the end of
this reporting period. Returning, 11,
34%
There were 32 Diverted, 21,
66%
children/youth enrolled
in the Wrap Pilot
program in FY2009. Of
those enrolled in the
Citywide Pilot, 11 (N=32)
(34%) were returning to
the community and 21
(66%) were diverted
from RTC or PRTF placements for the aforementioned FY2009 total of 32. Of the 26
children/youth enrolled in city-
FY2009 City-wide Wraparound Serivces wide pilot wraparound
Placement Types services in FY 2009. In
12 45%
FY2009, eleven (42%)
40%
children/youth remained in
Percentage in Placement

10
Number in Placement

35%
8 30% their respective biological or
25% adoptive homes, five (19%)
6
20% were placed in foster care,
4 15% four (15%) were placed in
2
10% both group homes and
5%
residential treatment centers,
0 0%
Biological/
Group Hospital/
and the last two (8%) were
Adoptive Foster Care Residential
Home
Home Detention either hospital or detention-
# Youth 11 5 4 4 2 oriented placements.
% Youth 42% 19% 15% 15% 8%

25
VI. Children and Adolescents Mobile Psychiatric Services (ChAMPS)

Children and
FY2009 ChAMPS Summary Adolescents Mobile
800 Psychiatric
700 Services
(ChAMPS) is a
600 crisis emergency
500 service operated by
Anchor Mental
400
Health of Catholic
687
300 Charities, providing
onsite mobile
200
338 396 response and crisis
100 beds for children,
adolescents and
0
their families in
Unduplicated Total Calls Received Total Deployments
Children
crisis. Mental
health crisis
intervention is
provided in the community, at school or home to help manage extreme emotional
behaviors and to avoid unnecessary visits to the emergency room, police intervention
and placement
disruption. The
ChAMPS team
officially launched FY2009 Total ChAMPS Calls By Quarter
th 300
on the 28 of
October 2008 and
has experienced 250 262
a steady increase
in overall monthly 200
195
call volume. 175
150
There were 338
total unduplicated
100
children served
by ChAMPS in
50
FY2009. The 55
overall total 0
number of calls
Q1 Q2 Q3 Q4
received in
FY2009 was 687. 687 Total Calls Received
There were 396
(58%) calls resulting in ChAMPS mobile crisis response team deployment in FY2009.

26
In the first
Percent Change in Quarterly ChAMPS Call Volume quarter, 55 calls
300%
were received,
followed by 195
250% calls in the
255%
200% second quarter,
resulting in a
150%
255% increase in
100% calls received
from the first to
50%
34%
the second
0% quarter. There
-32%
-50%
were 262 calls
1st to 2nd Quarter 2nd to 3rd Quarter 3rd Qtr to 4th Qtr received in the
third quarter
resulting in a 34% increase in calls received from the second to the third quarter. In the
fourth quarter, ChAMPS received 175 calls, down from 262 in the previous quarter,
leading to a 32% decrease in calls from the third to the fourth quarter. The chart below
shows the total number of calls to ChAMPS received each month. The average number
of calls received by ChAMPS each month was 57 calls. The pattern shows a general
upward trend in calls received, spiking in April 2009 at 109 calls. The pattern trends
downward through August 2009, elevating to near peak levels in September 2009.

ChAMPS - FY2009 Total Calls Received


120

108
100

93 92
Number of Calls

80
81
AVG=57 Calls 77

60
61

48
40
37 35
27
20
22

6
0
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

(687 Total Calls Received)

27
The ChAMPS Crisis Team
FY2009 Total Deployments By Quarter
does not deploy a unit for
140 91% 100% every call received. Calls
90% are screened to determine
120
80% whether ChAMPS

P ercen tage D ep lo yed


N um b er D eployed

100 61% 70%


60% services are appropriate,
80 60% and if the criteria is met, a
47%
50% unit will be deployed.
60
40% Moreover, there may be
40 30% situations where a
20% child/youth in crisis has a
20
50 117 123 106 10% CBI worker or a
0 0% Community Support
Q1 Q2 Q3 Q4 worker, and one of those
worker(s) responds to the
# Deployed Calls % Deployed Calls
crisis instead of the
ChAMPS team. The bars
on the chart above
illustrate the number of calls resulting in the deployment of a crisis team, while the line
plot shows the percentage of total calls received resulting in deployment, on the
secondary Y axis in
each quarter of FY2009 Change (%) in Quarterly ChAMPS Deployments
FY2009. In the first
quarter of FY2009, 140%

there were 50 120% 134%


ChAMPS 100%
deployments
80%
resulting in a 91%
deployment rate for 60%
that quarter, 40%
deploying of 50 of 55 20%
calls received. In the 5%
0%
second quarter, there
were 117 ChAMPS -20%
-14%
deployments out of -40%
195 total calls 1st to 2nd Quarter 2nd to 3rd Quarter 3rd Qtr to 4th Qtr
received, resulting in
a deployment rate of
60%, and representing a 134% increase in the number of ChAMPS deployments from
the first to the second quarter. In the third quarter, there were 123 deployments out of
a total of 262 calls resulting in a deployment rate of 47%. The number of deployments
increased from the second to the third quarter by five percent. In the fourth quarter,
there were 106 deployments out of 175 total calls received, resulting in a deployment
rate of 61%. Dropping from 123 to 106 deployed calls, there was a 14% decrease from
the third to the fourth quarter in the number of deployments. There was an average of

28
33 deployed calls each month. The chart that follows shows the number of actual
deployments for each month in FY2009 represented by the bars. The line plot shows
the percentage of deployments for each FY2009 month, with an overall deployment rate
for FY2009 of 58%.

FY2009 Total Calls Resulting in Deployment


60 100%
100% 100%
90%
50 77%

Percentage of Deployments
80%
Number of Deployments

69%
66%
63% 70%
40
# Deployments AVG = 33 59% 54%
57%
60%

30 44% 52% 50%


47% 40%
20
30%

20%
10
10%
6 27 17 22 51 44 28 44 32 30 24 52
0 0%
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

396 Total Deployments


687 Calls Received = 58% Overall Deployment Rate

Total Calls Deployed % Calls Deployed

The ChAMPS mobile


teams’ response time FY2009 Average Response Times By Quarter
is within one hour.
ChAMPS average
27.0
response time in
minutes for FY2009 26.5
was 25 minutes – 42% 26.0 26
M in u te s E la p sed

of the maximum 25.5


allowable response
25.0
time. ChAMPS’
25.0
average response time 24.5
in the first quarter was 24.0 24.3
24.3 minutes. In the 23.5
24
second quarter, it
23.0
increased to 25
minutes, and 26 in the 22.5
third quarter. In the Q1 Q2 Q3 Q4
fourth quarter, the
average response time
dropped to 24 minutes.

29
The chart below shows the average response time in minutes for each FY2009 month.

ChAMPS - Average Response Time (Minutes) - FY 2009


35

30 31
AVG=25 Minutes

27 27
25
26
Minutes Elapsed

25 25 25
24
23 23
22
20 21

15

10

0
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

FY2009 Hospitalizations and F12s


By Quarter
25 40%

35%
20
30%

Percentage
Number

15 25%

20%
10 15%

10%
5
5%

0 0%
Q1 Q2 Q3 Q4
Total Calls Resulting in 14 21 12 20
Hospitalization
Total Cases Requiring FD12 1 12 11 15
% Calls Resulting in 28% 18% 10% 37%
Hospitalization
% FD12 Cases 2% 10% 9% 28%

Total Hospitalizations = 67 Total FD12s = 39

Of all deployed calls in FY2009, 17% (67 calls) resulted in hospitalization. Ten percent
(39 calls) of deployed calls during this period required FD12 status designation. The
bars on the chart below represent the number of calls resulting in hospitalization or
FD12 status designation for each month. The line plot illustrates the corresponding
percentages of calls resulting in hospitalization or FD12 status designation, on the
secondary Y axis for each FY2009 month.

30
FD12s and Hospitalizations on Deployed Calls - FY 2009
14 45%

40%
12

Percentage of Incidents
35%

Number of Incidents
10
30%

8 25%

6 20%

15%
4
10%
2
5%

0 0%
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep-
AVG
08 08 08 09 09 09 09 09 09 09 09 09
Total Calls Resulting in 1 4 9 1 8 12 4 3 5 6 3 11 6
Hospitalization
Total Cases Requiring FD12 0 1 0 0 7 5 5 3 3 3 3 9 3
% Calls Resulting in 17% 15% 41% 3% 10% 15% 4% 3% 8% 13% 9% 12% 8%
Hospitalization
% FD12 Cases 0% 4% 0% 0% 14% 11% 11% 7% 9% 10% 13% 17% 8%

Total Hospitalizations = 67 Total FD12s = 39

Of the total calls resulting in


Children/Youth (%) Maintaining Placement by Quarter deployment, an average of
100% 75% (296 out of 396 calls)
90% resulted in a continuation of
80% 88%
on-going placements during
70% 76%
60% 68%
this reporting period.
50% Percentages of calls in
54%
40% which placements were
30% maintained by FY2009
20% quarter is shown left, while
10% the chart below shows the
0%
Q1 Q2 Q3 Q4
percentage of maintained
FY2009
placements each month in
FY2009.

Percentage of Children Maintaining


Pre-Existing Placement on Deployed Calls - FY 2009

100%
93%
90% 89%
82% 83%
80% 78% 78%

70% 70%
67% AVG=75%
63% 63%
60% 58%
Percent

50%

40%
35%
30%

20%

10%

0%
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

Month

31
There are also four crisis
FY2009 Quarterly Placement Patterns
beds available to provide
140 Number of Children/Youth respite for youth and families
120 as an alternative to placement
100 disruption for children who do
80 not meet the threshold for
60 acute care. However,
40 utilization was very low
20 throughout FY2009, since
0
Q1 Q2 Q3 Q4
alternative respite options
28 82 127 45
with family members,
Biological Parents
Kinship Care 3 18 25 13
established foster care
Foster Care 6 11 29 36 emergency respite is often
Treatment Foster Care 0 10 2 1 the first choice of families in
Homeless 0 2 0 0 crisis. ChAMPS is
restructuring the crisis beds
operation to increase utilization of the available crisis beds to further impact the number
of children/youth in crisis able to remain in their current placements. The chart on the
left shows quarterly placement patterns for FY2009. The total number of children/youth
served in FY2009 by ChAMPS having CFSA association is 150. The monthly average
CFSA ChAMPS children/youth each month was 13.

FY2009 ChAMPS Cases with CFSA Association


35
Number of Children/Youth

30
29

25

22
20 20
AVG=13
17
15
13
11 11
10 10

7
6
5
4

0 0
Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09

Total ChAMPS CFSA Children/Youth = 150

32
VII. Conclusion

In conclusion, the table


shown at right represents
the impact of the FY2009 Utilization Summary
programs reported on
Total Number of
here-to-fore in terms of Program
the number of Children/Youth
children/youth who
received services from OCP-BSU Referrals 350
October 2008 through Choice Provider Diagnostic
September 2009. 350 Assessment Data 413
referrals were routed to Choice Provider Billing Data 4,216
Choice Providers through Referrals to Co-Located DMH
the OCP-BSU referral Staff 179
process. Choice
Providers (except ChAMPS (Unduplicated Total) 338
Community Connections) City-wide Wraparound
reportedly completed 413 Program 32
Diagnostic Assessments as part of their intake process. Data from DMH’s eCura
electronic claims database indicates Choice Providers provided one or more services to
4,216 children/youth in FY2009. The clinicians co-located at CFSA conducted a total of
179 mental health screenings and case consultations. ChAMPS deployed crisis teams
on 396 of 687 calls received for an overall deployment rate for FY2009 of 58% - serving
an unduplicated total of 338 children/youth, and a total of 32 children/youth were
enrolled in the DC Choices City-wide Pilot Wraparound program. The last chart shows
the number of actual CFSA children/youth that utilized the above programs.

FY2009 CFSA Children/Youth Program Utilization


450
413
400
Number of Children/Youth

350
350

300

250

200
150
150

100

50
15
0
OCP-BSU Referrals Provider Diagnostic ChAMPS City-wide Wraparound
Assessment/Intake Program
Data

Program

33

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