Arizona Families F.I.R.S.T. Program Annual Evaluation Report for the Period July 1, 2004 – June 30, 2005 Submitted on: November 7, 2005; Revised December 16, 2005 Submitted to: Arizona Department of Economic Security Division of Children, Youth and Families Phoenix, Arizona Contract #: Submitted by: E4374163 Applied Behavioral Health Policy The University of Arizona 721 N. Fourth Avenue, Suite 107 Tucson, AZ 85705 (520) 917-0841 Fax (520) 917-0845 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 © 2005 by The University of Arizona Applied Behavioral Health Policy 721 N. Fourth Avenue, Suite 107 Tucson, AZ 85705-8445 (520) 917-0841 email: abhp@email.arizona.edu website: http://www.abhp.arizona.edu This document may be copied and transmitted freely. No deletions, additions or alterations of contents are permitted without the expressed, written consent of Applied Behavioral Health Policy. Prepared by Applied Behavioral Health Policy / The University of Arizona 2 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 3 ACKNOWLEDGEMENTS T his report was prepared by Applied Behavioral Health Policy (ABHP), The University of Arizona, under contract number E4374163 with the Arizona Department of Economic Security, Division of Children, Youth and Families (ADES/DCYF), in partnership with the Arizona Department of Health Services, Division of Behavioral Health Services (ADHS/DBHS) through the Joint Substance Abuse Treatment Fund. Brian L. Arthur and Michael S. Shafer, Ph.D., were responsible for the content, analysis, and writing of the report. Thanks is given to George Bentley, Jim Bradley, Linda Crone-Koshel, Ph.D., James Cunningham, Ph.D., Joy Forehand, Irma Gomez, Pat Malchow, Manjula Mellachuruvu, Cyd Mitchell, Megan Multanen, Deborah Pinkney, Arthea Tate, and Erin Rust for contributing to the report’s analyses, review, and production. The authors wish to thank staff of the Arizona Department of Economic Security/Division of Children, Youth and Families, and the Arizona Department of Health Services/Division of Behavioral Health Services for their ongoing cooperation and assistance with the evaluation. In particular, Steve Sparks, Nancy Hansen and Carmen Preciado of ADES, and Christy Dye, Norma Garcia-Torres and Jennie Lagunas of ADHS have been very helpful throughout the course of the evaluation. Thanks are extended as well to Jaimie Leopold of Leopold Consulting for her work in overseeing the AFF provider stakeholder interviews and client focus groups. This report was funded through a contract with the Arizona Department of Economic Security in partnership with the Arizona Department of Health Services, through the Joint Substance Abuse Treatment Fund. Points of view represented in this report are those of the authors, and do not necessarily represent the official position or policies of either the Arizona Department of Economic Security or the Arizona Department of Health Services. Suggested citation: Applied Behavioral Health Policy. (2005). Arizona Families F.I.R.S.T. Program: Annual Evaluation Report for the Period July 1, 2004 – June 30, 2005. Tucson, AZ: The University of Arizona. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 4 TABLE OF CONTENTS Page Acknowledgements ........................................................................................................................3 Table of Contents ...........................................................................................................................4 List of Tables ..................................................................................................................................5 List of Figures.................................................................................................................................6 Executive Summary .......................................................................................................................7 1. Introduction......................................................................................................................12 1.1 Brief Description of the AFF Program and Client Flow........................................12 1.2 Statewide Context of AFF Program Operations ....................................................14 1.3 Overview of the Evaluation Framework and Data Sources...................................15 2. AFF Program Outcomes .................................................................................................17 2.1 Child Welfare Outcomes Among AFF Participating Clients ................................17 2.2 Employment Outcomes Among AFF Participating Clients...................................19 2.3 Recovery from Substance Use ...............................................................................20 3. Arizona Families F.I.R.S.T. Clients and Services Received ...........................................22 3.1 Referrals to the AFF Program................................................................................24 3.2 Client Outreach and Engagement ..........................................................................25 3.3 AFF Provider Assessments and DBHS Enrollments .............................................27 3.4 Characteristics of AFF Participating Clients .........................................................29 3.5 Substance Use Among New Participating Clients at Time of AFF Assessment or RBHA Enrollment .........................................................................30 3.6 Service Use By Participating Clients.....................................................................31 3.7 Service Mix within Service Domain......................................................................33 3.9 Funding Mix by Service Domain...........................................................................34 3.10 Service Termination and Service Duration............................................................37 4. Summary and Conclusions..............................................................................................39 List of Appendices........................................................................................................................45 Prepared by Applied Behavioral Health Policy / The University of Arizona 5 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 TABLES 1.1. 2.1 2.2 2.3 2.4 2.5 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 Page List of DES Districts, Counties, AFF Providers, and RBHAs...........................................14 Days in Out-of-Home Placement Only for Children Achieving Permanency...................19 Employment Status Among Discharged AFF Clients .......................................................19 TANF Status Among Discharged Clients..........................................................................20 Substance Use, AFF Closed Clients Only .........................................................................20 Substance Use, RBHA Closed Clients Only......................................................................21 AFF Program Referrals by Provider and Quarter ..............................................................24 Outreach and Referral Activity by DES District and AFF Provider .................................26 Assessment Activity by DES District and AFF Provider ..................................................28 Substances Used by Participating Clients 30 Days Prior to Enrollment ...........................30 Proportion of Service Provision by Service Domain for Participating AFF Clients .........32 Services Mix with Treatment Services Domain ................................................................33 Services Mix with Support Services Domain ....................................................................33 Fund Source Mix................................................................................................................34 Funding Mix for AFF Participating Clients Receiving Services within Treatment Services Domain...............................................................................................36 Funding Mix for AFF Participating Clients Receiving Services within Support Services Domain ..................................................................................................36 Case Closure and Length of Stay.......................................................................................38 Prepared by Applied Behavioral Health Policy / The University of Arizona 6 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 FIGURES Page 1.1 2.1 2.2 3.1 3.2 3.3 3.4 3.5 Overview of the AFF Program Model ...............................................................................13 Substantiated CPS Reports Among AFF Participating Clients by DES District...............18 Placement Outcomes for Children of AFF Clients ............................................................18 SFY 2005 Referrals and Client Participation.....................................................................23 Total AFF Referrals By Quarters.......................................................................................24 Cumulative Number of Assessments Since Program Inception by Quarter ......................27 AFF Assessment and Evaluation Services by AFF Providers and RBHA Providers........28 AFF Participating Clients ..................................................................................................30 Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 7 EXECUTIVE SUMMARY Arizona Families F.I.R.S.T. Program in Brief A rizona Families F.I.R.S.T. (AFF) was established by Arizona Revised Statute (ARS) 8-881 (Senate Bill 1280, passed in the 2000 legislative session), and is administered jointly by the Arizona Department of Economic Security (ADES) and the Arizona Department of Health Services (ADHS), with DES designated as the lead agency. The legislation established a statewide program for substance-abusing families entering the child welfare system as well as those families receiving cash assistance through Temporary Assistance for Needy Families (TANF). The legislation recognized that substance abuse is a major problem contributing to child abuse and neglect, and is also a significant barrier for those attempting to re-enter the job market or maintain employment. The evaluation of AFF, required by ARS 8-881, focuses on the implementation of the AFF Community Substance Abuse Prevention and Treatment Program within the six DES districts, the factors that contribute to their success, and the extent to which the legislature’s outcome goals are met: • Increases in timeliness, availability and accessibility of services; • Recovery from alcohol and drug problems; • Child safety from abuse and neglect; and • Permanency for children through reunification. This year’s evaluation continues to focus on the documentation of program implementation through the analysis and reporting of client-level service utilization data from AFF providers and the Department of Health Services/Division of Behavioral Health Services, and qualitative data gathered from AFF program directors, RBHA and Child Protective Services (CPS) representatives, AFF clients, and other stakeholders. Analyses also were conducted with respect to child welfare outcomes as of June 30, 2005. Key findings of the report are summarized below. In What Ways Has the AFF Program Increased the Timeliness, Availability, and Accessibility of Services? Throughout the state, individuals experiencing difficulties with substance use and child neglect or abuse were engaged in treatment services at impressive rates. During this past year, nearly 4,000 individuals were referred to the AFF program. Over 80% of these individuals were contacted through outreach and encouraged to seek treatment services; nearly 70% were assessed, and nearly 2,000 received AFF services this year. The process of reaching out to these families and encouraging them to seek help occurs in a rapid fashion, with contact from an AFF staff person occurring in less than three days for most individuals who have been referred to the program. This is a tremendous accomplishment and one of the cornerstones upon which the program is based. One element of an effective substance abuse treatment program is the rapidity with which individuals are engaged and begin receiving treatment services after their initial inquiry or referral. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 8 Individuals engaged in AFF services received a complementary set of services from both DES and DBHS, and for many of these individuals, the AFF program has facilitated access to behavioral health treatment services and supports. Throughout the state, the majority of individuals participating in the AFF program are exposed to a comprehensive and coordinated array of wraparound services that are jointly funded through the state’s Department of Economic Security and Department of Health Services. For many of these individuals, the AFF program serves as a portal for their ability to access not only substance abuse treatment and other behavioral health services, but also medical care for themselves and their children, as they are assessed for and enrolled in Medicaid services. In most communities throughout the state, AFF participating clients are provided with a seamless system of care that ensures timely access to those services needed to make their children safe, to stabilize their families, and to attain permanency in their role as parents to their children. To What Extent Has the AFF Program Assisted Persons in Their Recovery From Alcohol and Drug Problems? Individuals engaged in the AFF program received effective help that has facilitated reduction and/or abstinence of illicit substances and abuse of alcohol. Over 50% of clients who have completed their participation in AFF services demonstrated no drug use at all during their participation in the AFF program, as verified by drug tests. Fifteen percent of clients who reported using drugs or alcohol upon enrollment in the AFF program reported no use at the time of their discharge. Over 20% of clients who were using methamphetamine or marijuana at the time of their enrollment in the AFF program reported no use of these illegal drugs at the time of their discharge. What Do We Know About Drug Use Among AFF Clients? Based upon the initial assessment information collected on 3,090 participating AFF clients, 67% of participants had used alcohol or one or more illegal substance in the 30 days immediately prior to their assessment. Alcohol, marijuana, methamphetamine, and other drugs were the more commonly self-reported substances, each being reported by approximately 24% - 30% of all clients. Among participating AFF clients that reported substance use in the 30 days prior to their AFF assessment, only 685 reported using only one substance. Fifty-four percent reported using two substances, while 13% reported using three or more substances. The more common patterns of self-reported multiple substance use consisted of combinations of alcohol, methamphetamine, and marijuana. To What Extent Are AFF Clients Engaged in Substance Abuse Treatment? While Assessment, Evaluation, and Screening services were provided to 84% of all participating AFF clients, individuals also received a variety of therapeutic and support services. Family (54%), individual (29%), and group (25%) counseling were common treatment services, Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 9 while supportive services (89%), case management (88%), and transportation (28%) were the more common support services reported. Relatively few participating AFF clients were reported to have received personal care, peer services, home care & family training, supported housing, childcare, or aftercare services through the AFF or RBHA networks. It is possible, however, that AFF clients received these services through other DES programs (i.e., child care services from the DES case worker) or local agencies. To What Extent Are AFF Clients Staying in Treatment Services? At the close of the reporting period, approximately 80% of participating AFF clients in SFY 2005 had completed or were discharged from treatment services, while 20% were still actively engaged in AFF services. Among those clients jointly served by AFF and RBHA provider systems, there was a tendency to have their services closed by the AFF provider while continuing to receive services from a RBHA provider. These individuals were provided with services for a period ranging from 140 – 270 days, on average. Clients who were served only by an AFF provider and not a RBHA provider experienced the shortest length of services provision, at 82 days, on average. How Has the AFF Program Promoted Child Safety and the Reduction of Child Abuse and Neglect? Children of AFF parents or caregivers experienced less subsequent neglect and abuse compared to the state averages. During SFY 2005, only 64 out of the 3090 participating AFF clients (representing 2% of participating clients) had a new substantiated CPS report filed subsequent to their enrollment in the AFF program. This rate is a quarter of the rate reported by CPS for the six-month period ending March 31, 2005 for the entire CPS population including AFF clients.1 How Has the AFF Program Promoted Permanency for Children Through Reunification? Children throughout the state whose parents have been engaged in AFF services were reunited with their parents at rates that exceeded state averages. Over 600 children, representing 23% of all of the children of the participating AFF clients, achieved permanency this year. For the vast majority of these children, permanency through reunification with their parents or caregivers was achieved, with the median length of time in out-of-home placement at 29 days. What Has Been the Pattern of Referrals to the AFF Program? A total of 3,851 individuals were referred to the AFF program during State Fiscal Year (SFY) ending June 30, 2005, averaging 963 referrals per quarter. Referrals in DES District I constituted slightly more than half of all referrals (50.6%), followed by DES District II (23.1%) and District III (12.5%). 1 Arizona Department of Economic Security. (2005). Child Welfare Reporting Requirements: Semi Annual Report For the Period October 1, 2004 Through March 31, 2005. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 10 What Are the Characteristics of Participating Clients? Among all participating AFF clients in SFY 2005, 73% were women, with an average age of 31. Persons of Hispanic, African-American, and American Indian heritage comprised 25%, 8%, and 4% of the participating AFF clients, respectively. Nearly 60% of the participants possessed at least a high school diploma or GED, with slightly more than 25% employed either part- or fulltime. Only 13% of the AFF clients listed their marital status as “married.” What Do We Know About Stakeholders’ Experiences with the AFF Program? Site visits, focus groups, and key informant interviews conducted throughout the state at all of the AFF program locations revealed a high degree of stakeholder and client support and value for the AFF program. While community stakeholders in general expressed strong support for the AFF program, participating AFF clients expressed gratitude for the flexibility in the services provided and the focus of the program upon their family. Participating AFF clients expressed a positive regard for their involvement and participation in their treatment planning process and also articulated appreciation for the respect and autonomy afforded them by their AFF staff. Conclusions and Recommendations This reports contains four global observations regarding the current achievements and outcomes of the AFF program, followed by six areas for enhancement. The identified areas of achievement include: 1. Children throughout the state whose parents have been engaged in AFF services were safe and were reunited with their parents at rates that exceeded state averages. 2. Individuals engaged in the AFF program received effective help that has facilitated reduction in use and/or abstinence from illicit substances and abuse of alcohol. 3. Throughout the state, individuals experiencing difficulties with substance use and child neglect or abuse were engaged in treatment services at impressive rates. 4. Individuals engaged in AFF services received a complimentary set of services from both DES and DBHS, and for many of these individuals, the AFF program facilitated access to behavioral health treatment services and supports. With regard to areas for consideration and possible attention by the DES and ADHS partnership, the following six areas were identified as significant and are discussed more fully in the Summary and Conclusions section of the report. The first two recommendations may be considered “evaluation” recommendations, since they address the ability of the evaluation to achieve consistency across DES and ADHS, rather than problems of the two systems in service delivery and reporting. 1. Past reporting requirements and procedures, particularly with regard to substance use and employment, limit the usefulness of the outcome findings for the AFF program. DES Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 11 may want to examine the new AFF provider contracts, effective July 1, 2005, to assess whether these limitations have been adequately addressed. 2. Differences in the services reporting requirements of DES and DBHS impede adequate monitoring of the consistency of AFF service provision statewide. 3. Methods for streamlining multiple services, such as assessment and case management, should be reviewed in both partner agency systems, thereby enhancing the efficiency, design, and collaboration of the program. 4. Regional variations in AFF service delivery suggest critical areas for enhanced program monitoring and technical assistance, with particular attention to recent changes in contract requirements. 5. Methods and procedures should be reviewed for reducing the timeframe between referral, engagement, assessment, treatment plan and service initiation, particularly for clients referred from AFF to the RBHA system. 6. Greater coordination among AFF programs, CPS staff and case plans, and RBHA personnel is needed. Summary In summary, it is apparent that the Arizona Families F.I.R.S.T. program is maturing into a robust and well-coordinated program of services, fulfilling the intent of the enabling legislation that led to its development. During the course of the past state fiscal year, 3,090 individuals under supervision by the Child Protective Services for neglect or abuse of their children, and known to have ongoing issues related to the use of alcohol and drugs, have been served by this innovative program. Based upon the programmatic efforts this year: • • • • • • More than 400 children have been returned to the custody of their parents without a recurrence of suspected neglect or abuse. Parents have experienced success in addressing their substance use problems. More than 50% of clients who completed their participation in AFF services demonstrated no drug use at all during their participation in the program, as verified by drug tests. Fifteen percent of clients who reported using drugs or alcohol at the time of their enrollment in the AFF program reported no use at the time of their discharge. Over 20% of clients who were using methamphetamine or marijuana at the time of their enrollment in the AFF program reported no use of these illegal drugs at the time of their discharge. Families have been able to access a seamless network of treatment services and supports designed to promote ongoing recovery and family stability. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 1. 12 INTRODUCTION A rizona Families F.I.R.S.T. (Families in Recovery Succeeding Together) was established as a community substance use disorder prevention and treatment program by ARS 8-881 (Senate Bill 1280, which passed in the 2000 legislative session). Under the requirements of the Joint Substance Abuse Treatment fund that was established under the legislation, Section 8-884 requires an annual evaluation of the Arizona Families F.I.R.S.T. program (AFF). The evaluation of AFF examines the implementation and outcomes of community substance use disorder prevention and treatment services delivered by AFF contracted providers and the Regional Behavioral Health Authorities (RBHA) network. Background information on the development of the Arizona Families F.I.R.S.T. Program is provided in Appendix A. 1.1 Brief Description of the AFF Program and Client Flow The AFF enabling legislation recognized that substance use disorder in families is a major problem contributing to child abuse and neglect, and that substance use can present significant barriers for those attempting to reenter the job market or maintain employment. In addition, federal priorities under the Adoption and Safe Families Act (ASFA) that address child welfare outcomes, such as permanency and shorter time frames for reunification, coupled with time limits established under the TANF block grant, also were factors behind the legislation. AFF is a program that provides contracted family-centered, substance abuse treatment and recovery support services to parents or caregivers whose substance abuse is a significant barrier to maintaining or reunifying the family. The program is a public-private partnership that provides an array of structured interventions to reduce or eliminate abuse of and dependence on alcohol and other drugs, and to address other adverse conditions related to substance abuse. Interventions are provided through the Department of Economic Security, Division of Children, Youth and Families (DES/DCYF) contracted community providers in outpatient and residential settings or through the RBHA provider network. In addition to the traditional services, AFF includes an emphasis on face-to-face outreach and engagement at the beginning of treatment; concrete supportive services, transportation and housing; and an aftercare phase to manage relapse occurrences. Essential elements based on family and community needs, such as culturally responsive services, gender specific treatment, services for children, and motivational enhancement strategies to assist the entire family in its recovery, are incorporated into the service delivery. The diagram on the following page shows the flow of clients through various stages of the AFF program. Prepared by Applied Behavioral Health Policy / The University of Arizona 13 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Figure 1.1 Overview of the AFF Program Model CPS Case workers JOBS Case workers Referred to AFF Provider Conduct outreach & personal contact with client Engage client in services No Current AHCCCS enrolled? Yes DES/DCYF AFF Network Providers • • • • Continue with AFF provider Conduct core assessment Develop service plan Begin services SA education Outpatient Intensive outpatient Residential treatment ADHS/DBHS RBHA Network Providers • • • • • AFF Funded Supportive Services Child care Transportation Housing Job training, etc. Connect to RBHA id enrollment Conduct Conduct core assessment Develop Service plan Begin services Covered Services Guide Access AFF Aftercare Services (optional) Close Case Prepared by Applied Behavioral Health Policy / The University of Arizona Close Case 14 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Table 1.1 summarizes the county, AFF provider agency and associated RBHA within each of six regional DES districts. AFF contracted agencies in bold italics also participate in the RBHA network as either a RBHA or a RBHA network provider. DES District Table 1.1 List of DES Districts, Counties, AFF Providers, and RBHAs Regional Behavioral County AFF Provider Agency Health Authority I Maricopa TERROS ValueOptions II Pima Community Partnership of Southern Arizona (CPSA) La Paz Community Partnership of Southern Arizona (CPSA) Arizona Partnership for Children (AZPAC-Coconino) Arizona Partnership for Children (AZPAC-Yavapai) Old Concho Community Assistance Center Arizona Partnership for Children (AZPAC-Yuma) WestCare Arizona Mohave WestCare Arizona Gila and Pinal Horizon Human Services Cochise, Graham, Greenlee, and Santa Cruz Southern Arizona Behavioral Health Services (SEABHS) Coconino III Yavapai Apache and Navajo Yuma IV V VI 1.2 Northern Regional Behavioral Health Authority (NARBHA) The Excel Group2 Northern Regional Behavioral Health Authority (NARBHA) Pinal Gila Behavioral Health Authority1 Community Partnership of Southern Arizona (CPSA) Statewide Context of AFF Program Operations The most recent data available on past-month illicit drug use in Arizona3 indicate that 16% of Arizonans 18-25 years of age and 4% of Arizonans 26 years of age or older used illicit drugs during the previous 30 days. Further, among these two age groups, 36% and 20%, respectively, reported past month binge alcohol use. Abuse and neglect of children is generally believed to be associated with substance use. In a report to Congress on this issue4, data was presented showing that parents who abuse drugs and alcohol generally do not attend to children’s emotional cues, are poor role models, and discipline their children less effectively than other parents. It is within this context that the AFF program is meant to intervene and break the cycle of substance use and neglect and abuse of children. In September 2005, the Arizona Department of Economic Security, Division of Children, Youth and Families released Strengthening Families – A Blueprint for Realigning Arizona’s Child Welfare System. The Blueprint identifies five key objectives to be achieved by Summer 2006: 2 RBHAs replaced by Cenpatico Behavioral Health of Arizona, Inc., effective July 1, 2005 SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 2000 and 2001. 4 U.S. Department of Health and Human Services (1999). Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection. Washington, DC: US Department of Health and Human Services. 3 Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 • • • • • 15 Develop safe alternatives that result in 5% fewer children being placed in out-ofhome care; Reduce by 10% the number of children in congregate care settings; Serve all children ages birth to six years in their homes, kinship care or foster care without using group homes; Stop the placement of children ages birth to three years in shelter placements; and Reduce the length of stay of children in shelters to no more than 21 days. Additional strategies focusing on families and youth, detailed in the Blueprint, include continuing efforts to improve behavioral health services to meet the unique behavioral health needs of children and families involved with child welfare, in order to enable children to remain in their homes, or to better ensure successful placement in the least restrictive setting in out-ofhome care. The AFF program was singled out as a particularly successful strategy in providing family-centered substance abuse treatment and recovery support services to parents whose substance abuse is a significant barrier to maintaining or reunifying the family. The Blueprint acknowledges the growing problem of methamphetamine use in Arizona and its impact on child safety and well-being. DCYF has formed a multi-disciplinary task force to identify treatment models specific to methamphetamine, identify best practices for ensuring child safety, and develop recommendations to the Division for program improvement. 1.3 Overview of the Evaluation Framework and Data Sources The evaluation design developed for the AFF program focuses on program implementation to determine whether AFF provider agencies implemented the service model as intended by the legislation and program administrators. The design also addresses whether the AFF outcome goals and performance measures, as well as other outcomes in the areas of recovery, family stability, safety, permanency, self-sufficiency, and systems change, were in fact achieved. This year’s report draws upon data from multiple sources. Four core principles guided the use of data sources for the AFF program evaluation: • Minimize the data collection burden to a level that satisfactorily meets the legislatively mandated evaluation requirements; • Avoid duplicative data collection efforts; • Use existing administrative data and formats whenever possible; and • Respect the differing management information systems capabilities among the nine providers. Data sets included: • Service utilization data obtained directly from the nine AFF providers; • Enrollment and encounter data provided by ADHS/DBHS for services provided through the local RBHA network; • DES CHILDS information system, which provides child welfare information, and the DES JAZ/AZTEC information system, providing employment services information; and • Qualitative information obtained from AFF stakeholders and clients. Comments or findings from the stakeholders and clients are provided throughout the report in “text Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 16 box” format. These comments are from a qualitative report on site visits conducted during the summer of 2005 and provided to the AFF program office. Site visit reports are available from Applied Behavioral Health Policy at The University of Arizona. Additional detail regarding information on the data sources used for the annual report is provided in Appendix B. The evaluation framework guiding this year’s evaluation report is in Appendix C. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 2. 17 AFF PROGRAM OUTCOMES T he mission of DES is to promote the safety, well-being, and self-sufficiency of children, adults, and families. Further, the Department envisions a future where every child, adult, and family in the state of Arizona is safe and economically secure. Under the requirements of the Joint Substance Abuse Treatment fund that established the Arizona Families F.I.R.S.T. program (AFF), three priority outcome areas are identified: 1. Increase the availability, timeliness and accessibility of substance abuse treatment to improve child safety, family stability and permanency for children in foster care or other out-of-home placement, with a preference for reunification with a child's birth family. 2. Increase the availability, timeliness and accessibility of substance abuse treatment to persons receiving temporary assistance for needy families to achieve self-sufficiency through employment. 3. Increase the availability, timeliness and accessibility of substance abuse treatment to promote recovery from alcohol and drug problems. This chapter presents AFF outcome data that address the issues of child safety, family stability and permanency, self-sufficiency as reflected in employment, and recovery from alcohol and drug problems as demonstrated by decreased substance use among AFF program participants who received treatment services. Findings are reported under major evaluation questions developed to address the legislative outcome goals and outcomes related to the DES strategic plan. 2.1 Child Welfare Outcomes Among AFF Participating Clients Recurrence of Child Abuse and/or Neglect Among CPS Families Participating in AFF This section examines the extent to which the AFF program promotes and contributes to the Department’s mission of ensuring that children are safe from child neglect and abuse. Specifically, the evaluation question examines whether AFF-participating clients5 identified in the CHILDS data system experienced a substantiated report of child abuse or neglect after their enrollment in the AFF program. The percentage of substantiated CPS child abuse/neglect reports for AFF clients in each of the six districts is presented in Figure 2.1 on the following page. During this period of time, there were a total of 3,090 clients participating in the AFF program; only 2% (n = 64) of these participants had a substantiated new report filed subsequent to their enrollment in the AFF program. Substantiated reports of AFF participants were higher in DES Districts II and VI compared to statewide averages. In contrast, 8% of all investigated child abuse, neglect, and abandonment reports filed with CPS during a six-month period (October 1, 2004 – March 31, 5 Participating clients are defined for the purposes of this report as any clients who received any form of service from an AFF provider and/or a RBHA provider during the period of July 1, 2005 – June 30, 2005. Participating clients include clients who were referred, assessed, and received treatment in SFY2005, along with clients who had been referred and assessed in SFY2004, but continued to receive services in SFY2005. Prepared by Applied Behavioral Health Policy / The University of Arizona 18 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 2005) resulted in a substantiated finding. 6 These data also include AFF participants in examining the substantiation rate. Figure 2.1 Substantiated CPS Reports Among AFF Participating Clients by DES District July 1, 2004 – June 30, 2005 6.8% 5.8% Percent The data indicate that the vast majority of substantiated reports were for neglect (94%), and the remainder (6%) for physical or sexual abuse. These findings are consistent with other studies that showed that substance-abusing caregivers tend to be 8.0% linked with neglect referrals rather than with 6.0% sexual or physical abuse 4.0% referrals.7 Among the AFF clients in this 1.6% 2.0% evaluation with substantiated neglect 0.0% reports, 59% had I reported drug usage at intake to the AFF program. 2.3% II 0.7% 0.5% III IV V VI District Children in CPS Care Whose Caregivers Enroll in AFF Achieve Permanency A total of 2,697 children whose parents Figure 2.2 were participating AFF clients in SFY Placement Outcomes for Children of AFF Clients 2005 were in CPS care at some point SFY 2005 n = 2,697 children during the reporting period. As depicted 2% - Other Discharge in Figure 2.2, the overwhelming majority 1% - Relatives of these children were still in out of home 8 2% - Adoption placements . Approximately one-fourth (23%) of these children achieved 5% - Guardianship permanency through reunification (15%) with their parents or caregivers. An 23% - Permanency additional 2% were discharged from care 15% - Reunification for other reasons (e.g. emancipation, discharge to another agency). Rates of 75% - Still in reunification were similar across the six districts, with Districts V and VI having care significantly higher reunification percentages (27% and 26%, respectively) compared to the statewide average (15%). 6 Arizona Department of Economic Security. (2005). Child Welfare Reporting Requirements: Semi Annual Report For the Period October 1, 2004 Through March 31, 2005. 7 Sun, A., Shillington, A.M., Hohman, M., & Jones, L. (2001). Caregiver AOD Use, Case Substantiation, and AOD Treatment: Studies Based on Two Southwestern Counties. Child Welfare, 80(2), 151-177. 8 Included in this group are children who are participating in trial visits with relatives, guardians, or potential adoptive families. Prepared by Applied Behavioral Health Policy / The University of Arizona 19 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Comments from Stakeholders Among the 626 children who achieved permanency (Table 2.1), Clarity of roles, responsibilities and the median number of days9 in out-of-home care for children functions for ensuring family subsequently living with relatives was 26 days, followed by 29 reunification were frequently cited as areas in need of improvement days for children reunified with parents/caregivers, and 45 days for children where guardianship was arranged. It should be noted that the median number of days in care for reunified children in Districts IV and V were significantly Table 2.1 higher (61 and 71 days, respectively) than the Days in Out-of-Home Placement statewide median average. Additional details on days Only for Children Achieving Permanency n = 626 in care by DES District are summarized in Appendix n Median Average D. 2.2 Employment Outcomes Among AFF Participating Clients Relatives Reunification Guardianship Adoption 30 396 133 67 26 29 45 329 74 103 189 373 This section examines the extent to which the AFF program promotes and contributes to the Department’s mission of promoting economic security for families. As stated in the enabling legislation for the AFF program, AFF program services are provided to recipients of temporary assistance for needy families (TANF) whose substance use is a significant barrier to maintaining or obtaining employment. These individuals are referred to the AFF providers through the Department’s JOBS program. Employment outcome data at the time of discharge were available for 302 AFF participating clients who received services from the RBHA network during the period. A summary of the proportion of discharged clients and their employment status at intake and discharge is shown in Table 2.2. While there was little Table 2.2 change in employment status from the Employment Status Among Discharged AFF Clients At Intake time of client intake to the time of At Employed Unemployed Other discharge, 5% of AFF client Discharge unemployed at intake were reported # of Clients 90 198 14 Employed 91.1% 5.5% employed at discharge. Among those Unemployed 7.8% 92.9% 14.3% employed at intake, 91% were reported Other 1.1% 1.5% 85.7% as employed at discharge. Other data that have a bearing on maintaining employment comes from DES JOBS data. Among AFF clients who were discharged during SFY 2005 (1,097 individuals), 100 clients received JOBS services during the year. Of these discharged “AFF-JOBS” clients: • 63% maintained employment for 30 consecutive days • 52% maintained employment for 60 consecutive days • 38% maintained employment for 90 consecutive days 9 The mid-point wherein half the children spent less time in care and half spent more time in care. Prepared by Applied Behavioral Health Policy / The University of Arizona 20 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 The final piece of data related to client selfsufficiency comes from DES TANF data. Among AFF clients who were discharged during SFY 2005 (1,097 individuals), 17% (188 clients) had received TANF benefits during the year. A summary of the number of months discharged clients received TANF benefits is shown in Table 2.3. In general, the average number of benefit months was 20% lower among clients with closed TANF cases at the time of AFF discharge (average 8.7 months) compared to clients with open TANF cases at time of AFF discharge (11.0 months). 2.3 Table 2.3 TANF Status Among Discharged AFF Clients Open Closed TANF TANF # of cases 69 119 Average # months 11.0 8.7 Std. Deviation 7.8 6.7 Minimum # months 1 1 Maximum # months 34 32 Median # months 10.0 6.0 Recovery from Substance Use Information regarding reductions in substance usage among participating AFF clients is available Table 2.4 from two sources. For a sample of Substance Use, AFF Closed Clients only clients that received their AFF services SFY 2005 either completely or partially from an DES District Statewide AFF provider, information is available Averages on the frequency and results of # closed clients 1097 physiological screening (urinalysis10) # (%) clients UA results 131(11.9) Mean (sd) UAs per client 5.9(6.3) of their substance use during their # (%) w/ all positive UAs 22(16.8%) course of program participation. # (%) closed clients w/ all negative UAs 75(57.3%) During the SFY 2005, a total of 1,097 # (%) closed clients w/ mixed UAs 34(26%) clients were closed from AFF services, either because they successfully completed the program, dropped out, or otherwise were no longer actively engaged in AFF-related services11. For 12% (n = 131) of these clients, usable results from urinalysis tests were available. These results are summarized in Table 2.4. AFF provider contracts beginning July 1, 2005 require that “Therapeutic random screening shall be performed a minimum of two times per month based on client therapeutic needs.” It is anticipated that there will be ample data next year from which to draw conclusions about substance use recovery among AFF participants. 10 Information provided by AFF providers does not allow for a determination of the substances that were assessed by the urinalysis. 11 Current data collection procedures do not allow for a clear delineation of the reasons or methods of AFF program termination. Prepared by Applied Behavioral Health Policy / The University of Arizona 21 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 The second source of information regarding reductions of substance use patterns among participating AFF clients is examination of the self-reports of alcohol and drug use completed by clients as part of the uniform assessment, at intake and at discharge. A total of 511 clients were discharged from the RBHAs, resulting in 503 usable intake-discharge comparisons. Table 2.5 provides a summary of these data. Key highlights from the previous two tables include: • • • • • Table 2.5 Substance Use, RBHA Closed Clients only SFY 2005 DES District Statewide totals/averages # closed clients # (%) clients reporting no drug use at intake and discharge # (%) clients reporting any substance use at intake and no substance use at discharge # (%) clients reporting methamphetamine use at intake and no substance use at discharge # (%) clients reporting marijuana use at intake and no substance use at discharge # (%) clients reporting alcohol use at intake and no substance use at discharge 511 192 (38%) 45 (14.5%) 29 (21.5%) 12 (21%) 9 (11.5%) 38% AFF clients reported no substance use at both intake and at discharge based on the uniform assessment; 15% of AFF clients reporting substance use at intake reported no substance use at discharge based on the uniform assessment; 21% AFF clients reporting methamphetamine or marijuana use at intake reported no substance use at discharge based on the uniform assessment; 58% AFF clients for whom usable urinalysis results were available demonstrated no substance use throughout the course of their AFF participation; and 17% AFF clients for whom usable urinalysis results were available tested positive for substance use throughout the course of their AFF participation; More detailed information on substance use reduction patterns by DES district are provided in Appendix E. An AFF Success Story Martha V. successfully beat an eight-year addiction to methamphetamine as a result of the AFF program. After Child Protective Services got involved with Martha while she was spending 45 days in the Maricopa County jail, she came to realize, “My kids were more important than anything, especially drugs.” Because of the AFF program, Martha has completed outpatient treatment, chosen a career as a victim’s advocate, and is currently attending community college. Prepared by Applied Behavioral Health Policy / The University of Arizona 22 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 3. ARIZONA FAMILIES F.I.R.S.T. CLIENTS AND SERVICES RECEIVED T his section provides descriptive information about individuals referred to the AFF program for the State Fiscal Year beginning July 1, 2004 and ending June 30, 2005. Topics addressed include: • • • Referrals & outreach Assessments Substance use • • • Engagement in treatment Services received Demographic characteristics A diagram showing client flow through the AFF program is shown in Figure 3.1 on the following page. The flow diagram provides an organizing schema that will be followed throughout the subsequent sections of this report. The diagram shows the number of individuals referred and assessed during the reporting period, the number of clients receiving services, and the partition of clients by RBHA or AFF funding source. Prepared by Applied Behavioral Health Policy / The University of Arizona 23 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Figure 3.1 SFY 2005 Referrals and Client Participation New AFF Referrals n=3,851 Referrals Outreached n =3,132 (81.3% of new referrals) Referrals Accepting Services n =3,178 (82.5% of new referrals) Clients Assessed n =2,296 (59.6% of new referrals) SFY 2005 New Participating AFF Clients n = 1,870 (60% of total participating) 734 (23.8%) clients received services from AFF only 586 clients 148 clients closed continuing from to receive services services + SFY 2004 Continuing Participating AFF Clients n = 1,220 (40% of total participating) Total Participating AFF Clients, SFY 2005 N = 3,090 1,417 (45.6%) clients received services from AFF & RBHA both 37 clients 635 clients 123 clients 622 clients closed closed closed continuing from both from AFF, from to receive systems continuing RBHA, services to receive continuing from both services to receive systems from RBHA services from AFF Prepared by Applied Behavioral Health Policy / The University of Arizona 939 (30.4%) clients received services from RBHA only 474 clients 465 clients closed continuing from to receive services services 24 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 3.1 Referrals to the AFF Program A total of 3,851 individuals were referred to the AFF program during State Fiscal Year (SFY) 2005, averaging 963 referrals per quarter. Referrals in DES District I constituted slightly more than half of all referrals (50.6%), followed by DES District II (23.1%) and District III (12.5%) as shown in Table 3.1. Table 3.1 AFF Program Referrals by Provider and Quarter DES District AFF Provider Quarter 1 Jul-Sep 2004 Quarter 2 Oct-Dec 2004 Quarter 3 Jan-Mar 2005 Quarter 4 Apr-Jun 2005 Statewide Total I II III IV AZPACYavapai Old Concho AZPACYuma V VI Westcare Horizon SEABHS Quarterly Totals TERROS CPSA AZPACCoconino 460 192 20 55 37 10 44 37 71 926 (24.0%) 469 207 20 64 38 15 40 16 50 919 (23.9%) 503 244 11 70 39 27 29 7 52 982 (25.5%) 517 248 17 58 51 17 32 39 45 1024 (26.6%) 1949 (50.6%) 891 (23.1%) 68 (1.8%) 247 (6.4%) 165 (4.3%) 69 (1.8%) 145 (3.8%) 99 (2.6%) 218 (5.7%) 3851 More than 11,700 individuals have been referred to the AFF program since its inception in the spring of 2001. There was a steady increase in the number of referrals through the spring of 2003, followed by a slight decline, and steady growth through the current state fiscal year. Figure 3.2 provides a historical summary of referrals to the AFF program since the inception of the program, by quarter. Figure 3.2 Total AFF Referrals by Quarter March 1, 2001 – June 30, 2005 1200 1000 # of Referrals 800 600 400 200 01 Ju l- S ep 01 O ct -D ec 01 Ja nM ar 02 Ap r-J un 02 Ju l- S ep 02 O ct -D ec 02 Ja nM ar 03 Ap r-J un 03 Ju l- S ep 03 O ct -D ec 03 Ja nM ar 04 Ap r-J un 04 Ju l- S ep 04 O ct -D ec 04 Ja nM ar 05 Ap r-J un 05 M ar -J un ar 0 M < U nk no w n 1 0 Quarters Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 25 Nearly all (98%) referrals to the AFF program are provided by CPS caseworkers, a trend that has been consistent since the inception of the program. Relatively few referrals to AFF are initiated from the JOBS program, with DES Districts V (6%), III (4%), and II (2%) displaying the highest rates of AFF referrals from this program. However, even though there were few referrals from the JOBS program, 319 AFF clients were also receiving services from the JOBS program at some point during the year. Stakeholder Comments on Program Enhancements During the past state fiscal year, a number of programmatic enhancements occurred that have facilitated the referral process. These enhancements, reported by AFF stakeholders during site visits conducted in the preparation of this report, include: • Modifications to the referral form that accommodates additional data needs and collateral information; • Transferring the AFF Program into the Child and Family Services treatment team in District V; • Consolidating outreach agencies from three to one in District II; • Single point of contact; • Post-referral phone call by CPS staff to provide additional information; • Enhanced tracking of clients; and • Clarification of the AFF process with CPS and RBHA staff. 3.2 Client Outreach and Engagement AFF providers are expected to actively outreach and engage into treatment all individuals who are referred to the program. These outreach services are expected to occur within 24 hours (excluding weekends and holidays) of receipt of the referral. Typical activities that providers deliver as part of the outreach and engagement process consist of informing the referred individual of the services available, identifying significant issues related to the referred individual’s needs in accessing services or potential barriers to service use, and providing information to the referred individual about the expected benefits and outcomes of the services. It is generally at this point that an individual referred to the AFF program will either accept or decline enrollment in the AFF program. If accepting enrollment, they will engage in active treatment and support services. Table 3.2 on the following page provides a summary of the referral, outreach and engagement indicators for the current state fiscal year. Data collections issues identified in the 2004 evaluation report, while improved in 2005, were still evident this year as well. For example, AFF providers did not report outreach documentation to the evaluators this year on 19% of referrals. However, case reviews conducted by DES program staff indicated outreach occurred. Therefore, it appears this is a data reporting issue rather than a program implementation issue. The evaluation team, along with DES program staff, have added procedures and reporting mechanisms to monitor missing data elements on a monthly basis rather than a quarterly basis in order to alert providers earlier in the data reporting cycle about the quality of their data. Prepared by Applied Behavioral Health Policy / The University of Arizona 26 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Table 3.2 Outreach and Referral Activity by DES District and AFF Provider DES District AFF Provider # referrals # outreached % outreached Avg. days referral to outreach (standard deviation) # of referred clients accepting services % of referred clients accepting services I II III IV AZPACYavapai Old Concho AZPACYuma V VI Westcare Horizon SEABHS Statewide Averages TERROS CPSA AZPACCoconino 1949 891 68 247 165 69 145 99 218 3851 1845 586 66 233 165 68 105 22 42 3132 94.7% 65.8% 97.1% 94.3% 100% 98.6% 72.4% 22.2% 19.3% 81.3% 1.57 (7.43) 6.26 (19.14) .6 (1.16) 1.58 (6.87) 2.04 (4.82) 9.08 (44.01) 5.93 (8.31) 2.36 (4.79) 17.16 (31.37) 2.98 (13.04) 1943 655 43 128 117 48 129 44 71 3178 99.7% 73.5% 63.2% 51.8% 70.9% 69.6% 89% 44.4% 32.6% 82.5% Key highlights of these data reveal: • • • • • Across the state, over 80% of all individuals referred to the AFF program were provided outreach services. On average, these outreach services occur in less than three days of the receipt of a referral. On average, 83% of individuals that were referred to the AFF program indicated a willingness to accept services from the AFF program. Regional variations existed in the proportion of referred individuals that received outreach services; four AFF providers reported providing outreach services to 90% or more of the referrals they received (AZPAC-Yavapai, AZPAC-Yuma, Old Concho and TERROS) while two AFF providers reported providing outreach services to less than 25% of the referrals they received (Horizon and SEABHS). There was regional variation in the speed with which outreach services were reported: Three AFF providers provided Innovations in Outreach Outreach visitation Utilizing multiple to client’s homes, and repeated efforts often in tandem with at contact, including CPS staff letters, phone calls, and home visits Using motivational Providing advocacy engagement support to clients to strategies meet their more (motivational primary needs interviewing) before engaging in treatment An AFF Success Story It took the AFF provider over two months of persistent outreach and contact to get Ramona to agree to check into a residential treatment program. Following her successful completion in residential treatment, Ramona has transitioned to outpatient treatment and was able to access housing services. Ramona remains clean and sober, has been reunified with her daughter and is employed part time as a peer support specialist in a human services agency. Prepared by Applied Behavioral Health Policy / The University of Arizona 27 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 • • outreach services, on average, in less than 2 Outreach Services Present Special Challenges days following the receipt of a referral to Rural Providers (TERROS, AZPAC-Coconino, AZPACOutreach is by its very nature much more Yavapai), while two providers provided challenging to providers in rural communities, who have to travel long distances to make faceoutreach services, on average, more than a to-face contact with a referred client. week after receiving a referral (AZPAC-Yuma Sometimes clients are ill-informed about the and SEABHS). AFF program, are openly hostile to the outreach Finally, regional variation was noted in the worker, or are distressed by other issues and not yet ready to contemplate engaging in a proportion of referred individuals who treatment program. accepted receipt of services from the AFF program. Two providers reported acceptance rates of less than 65% (AZPAC-Coconino and AZPAC-Yavapai), two other providers reported acceptance rates of less than 50% (Horizon and SEABHS), and the statewide average of referred individuals accepted AFF services was 82.5%. Additional outreach details by AFF provider are provided in Appendix F. 3.3 AFF Provider Assessments and DBHS Enrollments < M ar M ar 0 -J 1 Ju un l-S 01 O ep ct 0 -D 1 Ja e c n- 01 M Ap ar r-J 02 Ju un l-S 02 O ep ct 0 -D 2 Ja e c n- 02 M Ap ar r-J 03 Ju un l-S 03 O ep ct 0 -D 3 Ja e c n- 03 M Ap ar r-J 04 Ju un l-S 04 O ep ct 0 -D 4 Ja e c n- 04 M Ap ar r-J 05 un 05 A total of 2,29612 individuals (representing 60% of all individuals referred to the AFF program) received assessment and evaluation services for substance abuse treatment during the 2005 state fiscal year. The rate of assessments conducted in state fiscal year 2005 is consistent with the historical trends of the AFF program. Since Figure 3.3 the inception of the program in the spring of Cumulative Number of Assessments Since 2001, more than 8,400 individuals, or about Program Inception by Quarter March 1, 2001 – June 30, 2005 two-thirds of all individuals referred to the AFF program, have received assessments for 1200 substance abuse treatment either through 1000 AFF providers or local RBHAs. Even 800 though there has been significant 600 improvement in the reporting of assessments 400 during the past year, due in part to consistent 200 use of the DBHS core assessment tool by all providers, and enhanced monitoring of 0 monthly data from the AFF providers, not all referrals to the program resulted in assessments. Part of the “drop off” from referral to assessment may be due to data collection and reporting issues on the part of providers, and part may be due to lack of client follow-through. This is an area for increased attention by the evaluation team during the coming program year. 12 Note. This figure includes individuals that had been referred to the AFF program in SFY 2004, but not assessed until SFY 2005, along with clients who were referred and assessed during SFY 2005. Prepared by Applied Behavioral Health Policy / The University of Arizona 28 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Assessments are conducted by a contracted AFF provider and/or a DBHS-RBHA contracted provider, depending on the referred individual’s eligibility status for Title XIX Medicaid funding. Forty-two percent of the clients in this report had an assessment in both the AFF provider database and the DBHS-RBHA database (Figure 3.4). For these individuals, most (854) had an assessment completed by the AFF provider prior to being referred to the RBHA provider, where they were re-assessed. A smaller percentage (representing 258 individuals or 10% of all AFF clients with assessments) had been enrolled with the RBHA prior to their AFF referral and subsequent assessment. Figure 3.4 AFF Assessment and Evaluation Services by AFF Providers and RBHA Providers, State Fiscal Year 2005 Total Assessments Conducted = 2,296 A summary of key performance indicators associated with the assessments from providers within each of the DES districts is shown in Table 3.3. Table 3.3 Assessment Activity by DES District DES District Total Assessments RBHA only AFF & RBHA AFF only Average days from referral to assessment (sd) I II III IV V VI Statewide 1239 161 724 354 492 337 55 100 278 122 80 76 141 55 30 56 25 17 4 4 121 34 52 35 2296 726 945 625 27.8 (27.0) 29.6 (28.5) 28.0 (29.4) 17.5 (17.7) 5.5 (4.9) 32.9 (46.4) 28.4 (29.9) Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 29 Key highlights include: • • • • • • Over half (54%) of the total assessments for the past year were conducted for individuals within District I (Maricopa County), and an additional 21% of the assessments for individuals within District II (Pima County). There were a significant number of assessments conducted first by AFF providers in Districts I and VI that later resulted in an enrollment into the RBHA provider system. The median and average number of days from the AFF assessment to the RBHA enrollment was 21 days and 35 days respectively for District I, and 12 days and 27 days respectively for District IV. Four out of ten AFF referrals (40%) did not result in an assessment either through an AFF provider data record or a RBHA enrollment record. Over two-thirds of the non-assessed referrals came from the District I and II AFF providers. AFF providers reported that services delivered to 18% of referred individuals did not result in an assessment. These services primarily were case management and transportation services. On average, the length in time between an individual Comments from Stakeholders being referred to the AFF program and that same The structure for ensuring linkages between AFF and CPS planning individual receiving an assessment for substance abuse processes is insufficient. Previously, was 28.4 days (standard deviation of 29.9 days). there has been little consistency Providers in District V had the shortest period between across AFF providers to integrate referral and assessment at 5.5 days. In contrast, District VI case and treatment planning had the longest duration between referral and assessment, between CPS and AFF providers. The process has been strengthened at 32.9 days. with the new AFF contracts. 3.4 Characteristics of AFF Participating Clients During the SFY 2005 reporting period, a total of 3,090 individuals statewide were participating clients in the AFF program. Participating clients are defined for the purposes of this report as any client who received any form of service from an AFF provider and/or a RBHA provider during the period of July 1, 2005 – June 30, 2005. Participating clients include clients who were referred, assessed, and received treatment in SFY2005, along with clients who were referred and assessed in SFY2004, but continued to receive services in SFY2005. More than half of all participating clients were located in District 1, while District III Comments from accounted for an additional 14% of all participating clients. The Stakeholders remaining balance of participating clients (22%) was distributed All clients interviewed reported throughout the other four DES districts. Sixty percent of feeling at ease with and participating clients were enrolled during the current reporting respected by treatment staff, and all agreed that they period and considered new participating clients, while the experienced little wait time to remainder were continuing clients, enrolled during the preceding enter treatment. year but continuing to receive services during the current reporting period. Prepared by Applied Behavioral Health Policy / The University of Arizona 30 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Figure 3.5 provides a districtby-district comparison of new and continuing clients. District II had the highest percentage of new clients and the lowest percentage of continuing clients (74% and 25% respectively) while District V had the lowest percentage of new clients and the highest percentage of continuing clients (23% and 77% respectively). Figure 3.5 AFF Participating Clients July 1, 2004 – June 30, 2005 100% 80% 60% 40% 20% 0% I II III IV V VI DES Districts New Continuing Key findings of the demographic profiles of AFF participating clients include: • 73% of participating clients were women. • Average age was 31 years. • One quarter of all participating AFF clients were of Hispanic or Latina descent, 8% African Americans, and 4% American Indians. • 59% had at least a high school diploma or GED. • 27% were either employed full or part-time. • Marital status was not known or recorded for 45% of the clients and employment status was not known or recorded for 13% of the clients. Regional comparisons of the demographic profiles of AFF participating clients may be found in Appendix G. 3.5 Substance Use Among New Participating Clients at Time of AFF Assessment or RBHA Enrollment Table 3.4 provides a summary of the substances used by participating AFF clients at the time of their initial assessment. Caution should be taken in interpretation of these data, as they are reliant entirely upon self-report, with no physiological assessment (e.g., urinalysis) conducted for verification. These data reflect information derived from the AFF provider database (for those clients who were initially assessed by AFF providers) as well as the ADHS-RBHA MIS for those clients who were initially assessed by the RBHA provider. Significant variation in the rates of self- Table 3.4 Substances Used by Participating Clients 30 Days Prior to Enrollment Total Participating Clients: 3090 # % 1563 50.6% Clients Reporting Use Alcohol Benzodiazepines Cocaine/crack Hallucinogens Heroin/Morphine Inhalants Marijuana Methamphetamine Other drugs Other Narcotics Other sedatives Other Stimulants Prepared by Applied Behavioral Health Policy / The University of Arizona 758 24 262 54 49 13 739 922 167 32 19 28 24.5% 0.8% 8.5% 1.7% 1.6% 0.4% 23.9% 29.8% 5.4% 1.0% 0.6% 0.9% Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 31 reported substance use was observed in the data provided by these two systems, indicating the need for some caution in the interpretation of the resulting information. These limitations notwithstanding, based upon the initial assessment information collected on 3,090 participating AFF clients, 51%% of individuals had used alcohol or one or more illegal substance in the 30 days immediately prior to their assessment. Alcohol, marijuana, methamphetamine, and other drugs13 were the more commonly reported substances, each being reported by approximately 24% - 30% of all clients. Among the 2,064 participating AFF clients that reported substance use in the 30 days prior to their AFF assessment, only 685 reported using only one substance. Fifty-four percent reported using two substances, while 13% reported using three or more substances. The more common patterns of self-reported multiple substance use consisted of combinations of alcohol, methamphetamine, and marijuana. Appendix H provides detailed information on self-reported substance use patterns by DES District. These data continue to document the elevated rates of methamphetamine use, particularly among clients located in DES Districts III, IV, and V, all of which are rural districts with rates of methamphetamine use exceeding 50% of all participating AFF clients. 3.6 Service Use By Participating Clients AFF clients should receive a comprehensive continuum of treatment and support services that facilitate their recovery from substance use and facilitate reunification and stabilization of their families. These services may be funded and provided exclusively by the Department of Economic Security, the Division of Behavioral Health Services (for those clients meeting DBHS and/or Title XIX eligibility criteria), or by both DES and DBHS. During SFY 2005, 1,417 clients (representing 45.9% of all participating clients) received all of their services jointly through AFF and DBHS/RBHA funding; 939 (30.4%) from DBHS/RBHA funding only, and 734 23.8% from AFF funding only. Appendix I provides a taxonomy of the services identified by DES and DBHS. This taxonomy includes services within eight broad service domains that are sub-divided into 35 discrete service categories. Information about the services that clients received is derived from encounter or data files from AFF providers and DBHS. These two data files allow for an analysis of DES-funded and/or DBHS-funded services at the level of the individual. Unfortunately, these data do not allow for a clear determination of the amount or dose of service that an individual received (i.e., number of days of service), but do allow for a comprehensive portrayal of the mix of services received by an individual and the source of funds that were used to pay for the services. Information contained in this section of the report highlights statewide trends in the types of services that participating AFF clients received across the eight service domains, the types of 13 Note. Data provided to the evaluation team does not allow for a delineation of the drugs referenced in the response category, “Other Drugs” Prepared by Applied Behavioral Health Policy / The University of Arizona 32 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 discrete services that clients received within the two major service domains (Treatment Services and Support Services), and the funding mix of these services. Service Access and Service Mix Table 3.5 As noted previously, 3,090 clients Proportion of Service Provision by Service Domain for participated in the AFF program Participating AFF Clients during this report. Table 3.5 Total Participating AFF Clients = 3,09014 provides a summary of the number # clients % participating and proportion of participating Treatment Services 2772 89.7% clients that received one or more Rehabilitation Services 416 13.5% discrete services within each of the Medical Services 1173 38% eight service domains. Support Services 3022 97.8% Crisis Intervention Services 233 7.5% Additionally, Appendix J provides Inpatient Services 148 4.8% district comparisons of the Residential Services 209 6.8% proportion of participating AFF Behavioral Health Day Programs 171 5.5% clients receiving services within each of the eight service domains. Key highlights of these data include: • • • • Support services were provided to 98% of all AFF clients statewide, while treatment services were provided to 90% of all AFF clients statewide. Medical services were provided to slightly more than one-third of all AFF clients. Other services (rehabilitation, crisis intervention, inpatient and residential treatment, and behavioral health day programs) were provided to a relatively small proportion of the AFF clients statewide. Variations in the rates of service provision were observed across DES districts; most notably, DES District II had a significantly lower rate of treatment services (54%) compared to the statewide average of 90%; DES District III had a significantly higher rate of inpatient services (9%) compared to the statewide average (5%), and DES District V had significantly lower rates of rehabilitation services (7%) and medical services (14%) than the statewide averages for the services (13% and 38%, respectively). It is not clear from the data whether these difference reflect real differences in the mix of services these clients received, or reflect variations in the reporting and billing behavior of the contracted AFF and RBHA network providers within these districts. Comments from Stakeholders Clients identified a number of barriers to accessing treatment. More commonly identified barriers included the lack of transportation, the distance between the treatment location and the client’s residence, the availability of treatment services only during normal working hours, and the lack of child care. 14 Because clients received services in multiple domains, the number of clients reported across all service domains exceeds the total number of participating clients. Prepared by Applied Behavioral Health Policy / The University of Arizona 33 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 3.7 Services Mix within Service Domains As just noted, the service domains of Support Services and Treatment Services dominated the mix of services accessed by participating AFF clients. Within each of these domains, a number of discrete service categories are captured, based upon the reporting and billing requirements of DES and DBHS. Within the Treatment Services domain, for example, there are seven discrete service categories, while there are 12 discrete service categories within the Support Services domain. A statewide summary of the services mix within the Treatment Services Domain is shown in Table 3.6. Table 3.6 Likewise, a Services Mix within Treatment Services Domain statewide summary Total Participating AFF Clients = 3,090 % all of the types of # clients participating 14 support services is AFF Clients Receiving Treatment Services = 2772 clients shown in Table 3.7. Individual Counseling 895 29.0% (Appendix K Family Counseling 1617 52.3% contains a summary Group Counseling 755 24.4% of the service Assessment, Evaluation and Screening Services 2595 84.0% Other Treatment Services by Professionals 156 5.0% categories for each Intensive Outpatient Services 146 4.7% DES district.) Key Outpatient Services 419 13.6% findings from Tables 3.6 and 3.7 include: • Assessment, Evaluation, and Screening services were provided to nearly 84% of all participating AFF clients. • Participating AFF clients received a variety of clinical interventions, including family (54%), individual (29%), and group (24%) counseling. • Supportive services (88%), case management (88%), and transportation (28%) were the more common support services provided to those participating AFF clients that received Support Services. • Relatively few participating AFF clients received Support Services that included personal care, peer services, home care & family training, supported housing, childcare, or aftercare services. 15 Table 3.7 Services Mix within Support Services Domain Total Participating AFF Clients = 3,090 % all AFF Clients Receiving Support Services # clients participating 14 clients = 3022 Case Management Personal Care Services Home Care Training Family Self-Help/Peer Services Unskilled Respite Care Supported Housing Sign Language Services Supportive Services15 Transportation Child Care Services After Care Other Services May include items such as utility payments, car repairs, etc. Prepared by Applied Behavioral Health Policy / The University of Arizona 2707 27 51 113 1 69 3 2734 855 3 86 543 87.6% 0.9% 1.7% 3.7% <0.5% 2.2% 0.1% 88.5% 27.7% 0.1% 2.8% 17.6% 34 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 • • 3.8 Regional variation between DES districts was noted in the mix of Treatment Services that participating AFF clients received. In comparison to statewide averages, fewer participating clients in DES District II received family counseling (23% District vs. 60% statewide), while fewer clients in DES District V received assessment and evaluation services (68% district vs. 94% statewide). Regional variations between DES districts were noted in the mix of Support Services that participating AFF clients received. In comparison to statewide averages, fewer clients in District II received case management (53% vs. 90% statewide) or transportation services (<1% district vs. 28% statewide), fewer participating clients in District V received supportive services (26% vs. 91% statewide), and fewer clients in District VI received transportation services (8% district vs. 28% statewide). Funding Mix by Service Domain A goal of AFF is to facilitate wrap-around services, drawing upon a mixture of fund sources available through the DES, Title XIX – Medicaid, and SAPT funding. Since Medicaid eligibility is a fluid and dynamic process, a participating AFF client may move in and out of Medicaid eligibility throughout the course of their participation in the AFF program. Likewise, the comprehensive continuum of services mandated by the AFF program includes services that may be Medicaid reimbursable, other services that are not Medicaid reimbursable but reimbursable through DES funds, and other services that may be reimbursable through both Medicaid and DES-AFF funds. The proportion of AFF clients receiving services within a service domain by funding source is shown in Table 3.9. Note that 46% of the clients receiving treatment services and 60% of those receiving support services were funded by both DES and DBHS. For example, a client could begin receiving substance abuse outpatient treatment from an AFF provider immediately upon completion of their intake and assessment, and 30 days later, become eligible for Title XIX services, subsequently receiving their treatment services through the local RBHA. In this example, the client’s treatment services would be counted under the column heading “DES and DBHS funds” in Table 3.8. Table 3.8 Fund Source Mix Proportion of Participating AFF Clients Receiving Services Within a Service Domain by Fund Source DES and # of Clients DES funds DBHS Receiving only funds Services 2772 Treatment Services 30.92% 46.10% 416 Rehabilitation Services 40.38% 1.44% 1173 Medical Services 34.19% 15.77% 3022 Support Services 30.34% 60.39% 233 Crisis Intervention Services 0.00% 0.43% 148 Inpatient Services 0.00% 0.00% 209 Residential Services 16.27% 9.57% 171 Behavioral Health Day Programs 0.00% 0.00% Prepared by Applied Behavioral Health Policy / The University of Arizona DBHS funds only 22.98% 58.17% 50.04% 9.27% 99.57% 100.00% 74.16% 100.00% Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 35 Other key findings include: • Among all clients receiving Treatment Services, DES funds16 were utilized by 77%, while DBHS funds17 were utilized by 69%. • Among all clients receiving Support Services, DES funds were utilized by 91%, while DBHS funds were utilized by 70%. • It is worth noting that services within the crisis intervention and inpatient services domains are reported exclusively by the local RBHA system. One would think these are needed services by at least a few AFF clients. It is worth exploring how AFF contractors are providing and/or reporting these services to the DES/AFF office and the evaluation team. • With the exception of Treatment Services and Support Services, more than half of the clients accessing services in any of the remaining six service domains did so with funds provided through DBHS. • Regional variations in funding mix for Treatment and Support Services were observed across DES Districts. For an example, District II had a significantly lower rate of DBHS funding for Treatment Services (38%, compared to a statewide average of 69%), while Districts IV and V had significantly lower rates of DES funding for Treatment Services (48% and 19%, respectively, compared to a statewide average of 77%). District II had a significantly lower rate of DBHS funding for Support Services (40% compared to a statewide average of 70%) and District V had a significantly higher rate of DBHS funding for Support Services (98% compared to a statewide average of 70%). A statewide summary of the proportion of clients that received Treatment Services, and a statewide summary of the proportion of clients that received Support Services, delineated by service category (paid for through DES funds only, DBHS funds only; or a combination of DES funds and DBHS funds), are provided in Tables 3.9 and 3.10, respectively, on the following page. Participating AFF clients could appear in different columns for different service categories. For example, if a client received individual counseling services that were paid exclusively by DES, the client would be represented in the DES column. However, the same client may have also received Assessment and Evaluation services that were paid by both DES and DBHS, in which case the client would also be included in the “DES & DBHS Funds” column for this service. Accordingly, data presented in Tables 3.9 and 3.10 reflect the fund sources of individual clients at the level of the discrete service category, whereas the data previously presented in Table 3.9 reflected the fund sources for clients who received all of their services within a service domain (i.e., “Treatment Services”) by fund source. 16 Includes those clients receiving services with DES funds only and those clients receiving services with DES & DBHS funds. 17 Includes those clients receiving services with DBHS funds only and those clients receiving services with DES & DBHS funds. Prepared by Applied Behavioral Health Policy / The University of Arizona 36 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Table 3.9 Funding Mix for AFF Participating Clients Receiving Services within the Treatment Services Domain 95.64% 0.66% 99.21% 0.78% 1.38% 0.13% 3.58% 97.97% 0.66% Total Clients Receiving Service 895 1671 755 41.12% 39.00% 19.88% 2595 0.00% 100.00% 100.00% 0.00% 0.00% 0.00% 100.00% 0.00% 0.00% 156 146 419 DES Funds only Individual Counseling Family Counseling Group Counseling Assessment, Evaluation and Screening Services Other Treatment Services by Professionals Intensive Outpatient Services Outpatient Services DES & DBHS DBHS Funds Funds only Table 3.10 Funding Mix for AFF Participating Clients Receiving Services within the Support Services Domain DES Funds only Case Management Personal Care Services Home Care Training Family Self-Help/Peer Services Unskilled Respite Care Supported Housing Sign Language Services Supportive Services Transportation Child Care Services After Care Other Services 23.20% 0.00% 23.53% 0.00% 0.00% 79.71% 0.00% 100.00% 16.73% 100.00% 100.00% 100.00% DES & DBHS DBHS Funds Funds only 53.75% 0.00% 0.00% 0.00% 0.00% 1.45% 0.00% 0.00% 6.43% 0.00% 0.00% 0.00% 23.05% 100.00% 76.47% 100.00% 100.00% 18.84% 100.00% 0.00% 76.84% 0.00% 0.00% 0.00% Total Clients Receiving Service 2707 27 51 113 1 69 3 2734 855 3 86 543 These data reflect both actual organizational behavior in terms of expenditure patterns, as well as organizational policies and billing structures. As an example, the fact that 100% of all Intensive and Non-Intensive Outpatient Services were funded by DES funds is reflective of the fact that DBHS does not recognize that service category within its covered services matrix; the same service may be captured within the DBHS system as Individual, Group, or Family Counseling. Similarly, the fact that Personal Care Services were funded exclusively from DBHS funds is due in part to the fact that this service is not recognized by the DES system; this same service may be captured by the service category of Other Services within the DES system. As such, caution must be exercised in interpreting these data. They provide a perspective of the overall “braiding” or mixing of fund sources used to provide a comprehensive continuum of services to participating AFF clients, but do not provide a full or complete assessment of either the funding policies of the participating agencies or their relative economic contributions to the provision of services to these participating AFF clients. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 37 Notwithstanding these limitations, these data do provide compelling Comments from documentation that the intent of the AFF program is being realized: Stakeholders Individuals are being provided with a flexible and integrated system CPS staff reported very of care from both the Department of Economic Security and the little contact from the RBHA Division of Behavioral Health Services’ network of regional about TXIX clients. behavioral health providers and community based agencies. It should be noted that service descriptions, i.e., “family counseling”, “intensive outpatient” may be unique to DES or DBHS. Consider that: • • • • • • • Over 80% of all participating AFF clients are being assessed and evaluated using DES funds exclusively or a combination of DES and DBHS fund sources; relatively few clients (19.88%) were evaluated solely with DBHS funds. For those clients that received Family Counseling services, nearly all (97.97%) were provided this service with funds provided by DBHS. Family Counseling services is not a service category defined within the AFF contract scope of work. For those clients receiving individual counseling services, nearly all (95.64%) were provided this service with funds provided by DES. Both DES and DBHS provided Case Management Services to 2,707 participating AFF clients. While equivalent numbers of participating AFF clients received case management services that were funded only by DES (23.2%) or only by DBHS (23.0%), the majority (53.7%) received their case management services jointly from DES and DBHS. All participating AFF clients that received Supportive Services (n = 2,734) received these services funded exclusively by DES. DBHS funds were utilized to pay for transportation services for 83.3% of the participating AFF clients that utilized this service, compared to 23.2% of the participating AFF clients whose transportation services were funded in part by DES funds. Regional variations in the fund source patterns for discrete service category expenditures were evident for all service domains. Detailed summaries of the mix of fund sources by discrete service category by DES District are in Appendix L. 3.9 Service Closure and Service Duration Review of the data files provided by DBHS and the AFF providers identified a total of 1,265 (41%) unique AFF participating clients whose cases had been closed, as indicated by closure notes in their case files. Closer inspection of these data revealed multiple permutations in closure activity, wherein individuals might be officially closed in one system (AFF) and either closed or not receiving any services in the other system (e.g., DBHS). Alternatively, an individual could be closed in one system (e.g., DBHS) while continuing to receive services in another. These individuals were arranged into four sub-groups. First, an individual was defined as a “true closure” if s/he had a closure note in one or both of the data systems and received no additional Prepared by Applied Behavioral Health Policy / The University of Arizona 38 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 services from either system after the date of the closure. Second, we defined AFF “partial closures” as individuals for whom a closure note was found in the AFF provider database and continuing services for the individual were noted in the DBHS database subsequent to the date of the closure. Third, we defined DBHS partial closures as individuals for whom a closure note was found in the AFF provider database and continuing services for the individual were noted in the DBHS database subsequent to the date of the closure. Finally, we defined continuing clients as individuals for whom no case closure was noted in either system and continuing services may or may not have been noted in the services information provided. These various closure patterns for the state as a whole are summarized in Table 3.11. Clients Served by AFF Only n = 734 (23.8%) # (%) clients # (%) clients served and continuing closed by AFF AFF only only 586 (19.0%) 148 (4.8%) Table 3.11 Case Closure and Length of Stay # Total Participating Clients = 3090 Clients Served by Both Systems n = 1417 (45.9%) # (%) clients # (%) clients # (%) clients served by AFF served by AFF served by AFF and RBHA and and RBHA, but and RBHA, but closed by both closed only by closed only by systems AFF RBHA Clients Served by RHBA Only n = 939 (30.4%) # (%) clients continuing with both systems # (%) clients served and closed by RBHA only # (%) clients continuing RBHA only 622 (20.1%) 474 (15.3%) 465 (15.0%) 37 (1.2%) 635 (20.5%) 123 (4.0%) Mean (sd) length of service Mean (sd) length of service Mean (sd) length of service Mean (sd) length of service Mean (sd) length of service 81.6 (85.3) 147.3 (238.7) 270.4 (396.7) 131.7 (211.0) 195.6 (221.8) Key highlights of these data are as follow: • • • The majority of clients served jointly by AFF and RBHA providers are closed first by their AFF provider while continuing to access services through the RBHA. The majority of clients served jointly by AFF and/or RBHA providers experience lengths of service ranging from 147 – 270 days, on average. Clients who were served exclusively and then closed by an AFF provider experienced the shortest length of service, at 82 days on average. In contrast, individuals served exclusively and then closed by a RBHA provider experienced an average length of service of 196 days. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 4. 39 SUMMARY AND CONCLUSIONS A s the AFF program completes its fourth year of operations, information is accumulating that indicates that this program is achieving the outcomes and impacts for which it was designed. Further, as shown in this report, there is now a longitudinal body of information that can aid in the identification of best practices throughout our state, and by extension, identification of localized programmatic practices that may warrant additional attention during the upcoming period. Among the achievements and accomplishments of the AFF program during the SFY 2005 period, four critical outcomes and achievements stand out. Children throughout the state whose parents have been engaged in AFF services were reunited with their parents at rates that exceed state averages. Children of AFF parents experienced less subsequent neglect and abuse compared to the state average. Data contained in this report document that of the 2,697 children whose parents were enrolled in the AFF program, 23% experienced permanency placements this year, with the overwhelming majority being safely reunited with their parents. Furthermore, children are being returned to family environments that are safe and free of neglect or abuse, as demonstrated by the fact that there were only 64 cases of substantiated CPS reports filed among the nearly 3,100 participating clients of the AFF program this year. The rate of substantiated cases of neglect and abuse among AFF participating families is one-fourth the all CPS state average. Individuals engaged in the AFF program received effective help that has facilitated reduction and/or abstinence of illicit substances and abuse of alcohol. Over 50% of clients who have completed their participation in AFF services demonstrated no drug use at all during their participation in the AFF program, as verified by drug tests. Fifteen percent of clients who reported using drugs or alcohol upon enrollment in the AFF program reported no use at the time of their discharge. Over 20% of clients who were using methamphetamine or marijuana at the time of their enrollment in the AFF program reported no use of these illegal drugs at the time of their discharge. Throughout the state, individuals experiencing difficulties with substance use and child neglect or abuse were engaged in treatment services at impressive rates. During this past year, nearly 4,000 individuals were referred to the AFF program. Over 80% of these individuals were contacted through outreach and encouraged to seek treatment services; nearly 70% were assessed, and nearly 2,000 received AFF services this year. The process of reaching out to these families and encouraging them to seek help occurs in a rapid fashion, with contact from an AFF staff person occurring in less than three days for most individuals who have been referred to the program. This is a Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 40 tremendous accomplishment and one of the cornerstones upon which the program is based. One element of an effective substance abuse treatment program is the rapidity with which individuals are engaged and begin receiving treatment services after their initial inquiry or referral. Individuals engaged in AFF services received a complimentary set of services from both DES and DBHS, and for many of these individuals, the AFF program has facilitated access to behavioral health treatment services and supports. Throughout the state, the majority of individuals participating in the AFF program are exposed to a comprehensive and coordinated array of wraparound services that are jointly funded through the state’s Department of Economic Security and Department of Health Services. For many of these individuals, the AFF program serves as a portal for their ability to access not only substance abuse treatment and other behavioral health services, but also medical care for themselves and their children, as they are assessed for and enrolled in Medicaid services. In most communities throughout the state, AFF participating clients are provided with a seamless system of care that ensures timely access to those services needed to make their children safe, to stabilize their families, and to attain permanency in their role as parents to their children. In addition to these key outcomes and achievements of the AFF program, there exist six areas wherein programmatic or reporting enhancements should be considered: Differences in the services reporting requirements of DES and DBHS impede adequate monitoring of the consistency of AFF service provision statewide. While DES and DBHS are to be complimented for their cooperation in the implementation and management of the AFF program, the separate policies and procedures of these systems with regard to provider reporting requirements present challenges and limitations to evaluating the AFF program with validity. As an example, while most AFF participating clients were found to receive treatment services that were provided by their AFF provider and the RBHA, one system (RBHA) tracks three forms of counseling services (individual, group, family), while the other system (AFF) tracks outpatient and intensive outpatient services. Consequently, data contained in this report could be inappropriately interpreted to assume that the AFF provider in District II provided individual and group counseling at rates significantly lower than the state averages, when in fact it appears that the provider in this region simply reported these services within the DES recognized code of “outpatient services.” As the AFF program continues to serve as a critical component of the state’s effort at addressing the issues of substance use among Arizona families, DES and DBHS should consider a variety of alternatives that could enhance the consistency and complementariness of their reporting requirements for providers. As an example, this past year, DES adopted the DBHS Uniform Assessment for all AFF providers, dropping other assessment tools that had been previously required. An alternative that these two systems might consider is the Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 41 adoption of common service matrix that provides consistency across systems in the definitional qualities of service elements. At a minimum, it is apparent that increased attention to provider training and monitoring with regard to reporting requirements and expectations would be appropriate. Past reporting requirements, particularly with regard to substance use and employment, limit the usefulness of the outcome findings from the AFF program. DES may want to examine the new AFF provider contracts, effective July 1, 2005, to assess whether these limitations have been adequately addressed. In this report, the ability to report on reductions in substance-using behavior and improvements in employment activity of participating AFF clients, both of which are key outcomes articulated in the enabling legislation of the AFF program, is hampered by existent reporting requirements and expectations. As an example, while both DES and DBHS require their providers to submit information on the use of urinalysis tests, DBHS fails to require their providers to submit the results of the test. As such, while the evaluation team had information provided by the RBHAs which confirmed that a drug test had been conducted, the information failed to contain the results of the test, rendering these data useless in evaluating reductions in drug usage. Similarly, while 586 clients were closed from AFF only services this year, only 131 of these clients, representing just 22%, had usable drug test data. The new AFF provider contract, effective July 1, 2005, requires that drug screening be conducted and reported to the evaluation team a minimum of twice monthly. The same limitations in available information regarding employment outcomes were also evident in the conduct of this evaluation during the past year. Under the previous reporting requirements, there was limited information that addressed directly the impact of the AFF program on increasing or maintaining employment. Further, it could be argued that the AFF program is a substance abuse treatment program with indirect linkages to employment outcomes. These limitations leave the state with limited information regarding the relative effectiveness of this program in achieving meaningful outcomes in two out of the three domains specifically identified by the enabling legislation. During the current program year, AFF providers will be asked to supply employment information at the time of case closure. A number of recommended alternatives are suggested that may necessitate a revision to the four core principles guiding the use of data sources for the AFF evaluation. • First, linking provider payment to timely and consistent submission of required information would enhance the reporting on key outcome indicators. • Second, DES and DBHS could consider more frequent re-assessments of clients than is currently required. Currently, clients are required to be re-assessed (after their intake) only when a significant change in their situation occurs, at the time that their case is closed, or every 12 months. As a result, very few client Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 42 records include re-assessments. Closure assessment information often looks very similar to intake assessment information, leading to some suspicion that the assessment information is simply reported after the fact of case termination, particularly for those individuals who have simply stopped coming to treatment. One alternative might involve a required reassessment every 3-months, inasmuch as the average length of treatment for AFF clients who were served and closed jointly by AFF and the RBHA was 147 days. • Third, DES and DBHS could consider conducting a randomized follow-up study of a sample of former AFF participants to assess the longer-term impacts of the AFF program upon these families. Currently, the only information available to evaluate the outcomes of the AFF program are indicators of in-program outcomes, and begs the question of longer term impacts after the client is no longer receiving AFF services. Review methods for streamlining multiple services, such as assessment and case management, conducted in both partner agency systems, thereby enhancing the efficiency, design, and collaboration of the program. In the services section of the report, data was presented that showed AFF clients were receiving case management and assessment services from both partner agency systems. While the services are not duplicative in the sense that an instance of case management or an assessment on a particular day are “double counted” in both systems, there is indication that both systems are providing a duplicative services, possibly at different time periods or concurrently. It is an area for examination and possible streamlining that DES/DCYF and ADHS/DBHS may want to examine in the coming year. Regional variations in AFF service delivery suggest critical areas for enhanced program monitoring and technical assistance. Throughout this report, numerous instances have been noted wherein the program performance, the characteristics of the clients being served, or the outcomes being achieved by clients and their families have varied substantially in a particular district or region, as compared to other districts, or in comparison to statewide programmatic averages. These variances provide opportunities to identify and better understand exemplary performance as well as identify performance areas in need of improvement and remediation. Most notably, throughout this report there were multiple instances in which the performance indicators in various districts were observed to be at significant variance to statewide indicators. It is not clear from the information available whether the observed regional variations are the result of variations in provider data collection and reporting behavior, whether they reflect true regional differences in the local population, Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 43 or whether they demonstrate variance in policy interpretation and/or procedural implementation within these communities, such as the use of family or drug courts, CPS programs or initiatives that may be unique to districts, or changes in historical trends. Examples of regional variations that may merit further analyses include: • • • Only 22% of referrals in District V and 19% of referrals in District VI received outreach services, while the statewide average was 81% of all referrals. While 83% of referred clients statewide accepted AFF services, only 52%, 44% and 33% accepted services in Districts III (AZPAC-Yavapai), V, and VI, respectively. In contrast, 99% of all referred clients in District I accepted services. While 90% of all participating clients were reported to receive Treatment Services, only 54% of the clients in District II received Treatment Services. The use of comparative contrast methods to identify and then examine the reasons for such regional variations is recommended as a focal point for enhancing the formative evaluation value of this report. Such variations may help to ensure consistency in policy interpretation, procedural implementation, or reporting behavior by AFF providers across the state. It should be noted that coordinated efforts are underway by the AFF program office and the evaluation team to provide AFF contractors with tools and technical assistance that will enable them to better monitor the quality of their data collection and reporting efforts. These tools include reports on “missing data,” outlier data (data outside an expected range), and logical inconsistencies (an assessment date prior to a referral date). Explore methods and procedures to reduce days between referral, engagement, assessment, treatment plan and service initiation, particularly for clients referred from AFF to the RBHA system. There is no clear standard for how long it should take for a referral to get from an AFF provider to the local RBHA, nor who is responsible for monitoring this process. The two systems have independent timeframe standards for referral-to-intake/assessment, intake/assessment-to-next service, and intake/assessment-to-service plan completion. For DES/DCYF the timeframe is expressed in “business” days, while ADHS/DBHS uses calendar days. Some of the data summarizing the referral-to-first service timeframe are way beyond acceptable ranges for both ADHS/DBHS and DES/DCYF. Some of the issues may be related to data reporting versus program operations. Both DES/DCYF and ADHS/DBHS, in collaboration with service providers and the evaluation team, may want to explore methods and procedures for reducing service timeframes and/or enhancing reporting capabilities. Greater coordination between AFF programs, CPS staff and case plans, and RBHA personnel is an area of immediate need. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 44 Perhaps the greatest strength of the AFF program is also its greatest challenge. As stated previously, the AFF program is exemplified best by the cooperative and collaborative manner in which the majority of AFF clients are exposed to a seamless array of services and supports under auspices of both DES and DBHS. In spite of the interagency nature of the program, a common theme that emerged from site visits, key informant interviews, and focus groups conducted throughout the state was the continuing need for greater coordination, communication, and collaboration between Child Protective Services, Regional Behavioral Health Authorities, and AFF providers. While representatives throughout the state spoke positively about the coordination between CPS and AFF providers at the point of referral, they also expressed frustration at the lack of coordination and communication for continuing cases, and at unevenness in the responsiveness of the RBHAs. Most notably, references made in site visit interviews and focus groups attended by CPS workers hinted at a lack of RBHA involvement (especially for the non-XIX eligible AFF client) in some regions of the state. Participants also noted a lack of coordination between the case plan for a child under CPS protective care and the case plan for the parental AFF client, and limited knowledge of and coordination with the AFF program. Key informants also expressed concern at the limited availability of “family-friendly” services, including limited accessibility to family-focused counseling (such as multi-dimensional family therapy, brief strategic family therapy) and the limited availability of residential treatment options that allow for children to stay with their parents. Summary In summary, it is apparent that the Arizona Families F.I.R.S.T. program is maturing into a robust and well-coordinated program of services, fulfilling the intent of the enabling legislation that led to its development. During the course of the past state fiscal year, 3,090 individuals under supervision by the Child Protective Services for neglect or abuse of their children, and known to have ongoing issues related to the use of alcohol and drugs, have been served by this innovative program. Based upon the programmatic efforts this year: • • • • • • More than 400 children have been returned to the custody of their parents without a recurrence of suspected neglect or abuse, Parents have experienced success in addressing their substance use problems. More than 50% of clients who completed their participation in AFF services demonstrated no drug use at all during their participation in the program, as verified by drug tests. Fifteen percent of clients who reported using drugs or alcohols at their enrollment in the AFF program reported no use at the time of their discharge. Over 20% of clients who were using methamphetamine or marijuana at the time of their enrollment in the AFF program reported no use of these illegal drugs at the time of their discharge. Families have been able to access a seamless network of treatment services and supports designed to promote ongoing recovery and family stability. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 APPENDICES Appendix A: Appendix B: Appendix C: Appendix D: Appendix E: Appendix F: Appendix G: Appendix H: Appendix I: Appendix J: Appendix K: Appendix L: Appendix M: Background Information on the Arizona Families F.I.R.S.T. Program Data Sources Used in the Annual Report Evaluation Plan Days in Care by DES District Substance Use Reduction Patterns by DES District Outreach and Engagement by AFF Provider AFF Client Demographic Characteristics by DES District Substance Use Patterns by DES District Taxonomy of DES and DBHS Services Service Access and Service Mix by DES Districts Service Utilization by DES Districts Mix of Funding Sources by Service Categories by DES Districts Case Closure and Length of Stay by DES Districts Prepared by Applied Behavioral Health Policy / The University of Arizona 45 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 46 Appendix A: Background Information on the Arizona Families F.I.R.S.T. Program The AFF program is administered jointly by the Arizona Department of Economic Security/Division of Children, Youth and Families (ADES/DCYF) and the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS), with DES designated as the lead agency. The legislation established a statewide program for substance disordered families entering the child welfare system, as well as those families receiving cash assistance through Temporary Assistance for Needy Families (TANF). The legislation recognized that substance disorder in families is a major problem contributing to child abuse and neglect, and that substance abuse can present significant barriers for those attempting to reenter the job market or maintain employment. Federal priorities under the Adoption and Safe Families Act (ASFA) that address child welfare outcomes, such as permanency and shorter time frames for reunification, coupled with lime limits established under the TANF block grant were also factors behind the legislation. The purpose of AFF is to develop community partnerships and programs for families whose substance disorder is a barrier to maintaining, preserving, or reunifying the family, or is a barrier to maintaining self-sufficiency in the workplace. The joint Substance Abuse Treatment Fund was established to coordinate efforts in providing a continuum of services that are family-centered, child-focused, comprehensive, coordinated, flexible, community based, accessible, and culturally responsive. These services were to be developed through government and community partnerships with service providers (including subcontractors and the RBHAs) and other entities such as faith-based organizations, domestic violence agencies, and social service agencies. The Arizona Legislature mandated in ARS 8-884 that the following outcome goals be evaluated: • Increase the availability, timeliness, and accessibility of substance abuse treatment to improve child safety, family stability, and permanency for children in foster care or other out-of-home placement, with a preference for reunification with the child’s birth family. • Increase the availability, timeliness and accessibility of substance abuse treatment to achieve self-sufficiency through employment. • Increase the availability, timeliness and accessibility of substance abuse treatment to promote recovery from alcohol and drug problems. The initial AFF program Steering Committee18 required that the following performance measures be used to evaluate the effectiveness of the program: • Reduction in the recurrence of child abuse and/or neglect. • Increase in the number of families either obtaining or maintaining employment. • Decrease in the frequency of alcohol and/or drug use. • Decrease in the number of days in foster care per child. • Increase in the number of children in out-of-home care who achieve permanency. 18 The initial AFF program Steering Committee was a policy committee chaired by the Governor’s Office that provided guidance and oversight to the program during the start-up phase of the program. The committee disbanded after the initial start-up year of program operations. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 47 In the spring of 2001, nine provider agencies received contracts through DES to implement a community substance abuse prevention and treatment program under Arizona Families F.I.R.S.T. Contract providers across the State of Arizona were funded so that AFF services were available in every county. The DES district geographic service areas, AFF provider agencies and Regional Behavioral Health Authorities (RBHA) during the report period are summarized in the following table. Table 1.1 List of DES Districts, Counties, AFF Providers, and RBHAs DES Regional Behavioral County AFF Provider Agency District Health Authority I Maricopa TERROS ValueOptions II Pima Community Partnership of Community Partnership of Southern Arizona (CPSA) Southern Arizona (CPSA) III Coconino Arizona Partnership for Northern Regional Children (AZPAC-Coconino) Behavioral Health Authority (NARBHA) III Yavapai Arizona Partnership for Northern Regional Children (AZPAC-Yavapai) Behavioral Health Authority (NARBHA) III Apache and Navajo Old Concho Community Northern Regional Assistance Center Behavioral Health Authority (NARBHA) IV Yuma Arizona Partnership for The Excel Group Children (AZPAC-Yuma) IV La Paz WestCare Arizona The Excel Group IV Mohave WestCare Arizona Northern Regional Behavioral Health Authority (NARBHA) V Gila and Pinal Horizon Human Services Pinal Gila Behavioral Health Authority VI Cochise, Graham, Southern Arizona Community Partnership of Greenlee, and Behavioral Health Services Southern Arizona (CPSA) Santa Cruz (SEABHS) Among the nine AFF providers, three are Title XIX providers (Horizon, SEABHS, and TERROS) and provide treatment services for both Title XIX and non-Title XIX AFF clients. CPSA, an AFF contractor and RBHA, does not provide direct client services, but instead, contracts with other providers for actual service delivery. The remaining five providers are nonTitle XIX providers (AZPAC-Coconino, AZPAC-Yavapai, AZPAC-Yuma, Old Concho, and WestCare) and must refer Title XIX AFF clients to the local RBHA or a Title XIX provider for treatment services. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 48 Appendix B: Data Sources for the Annual Report This year’s annual report draws upon data from multiple sources. Four core principles guided the use of data sources for the AFF program evaluation: • Collect the least amount of data necessary in order to satisfactorily meet the legislatively mandated evaluation requirements; • Avoid duplicative data collection efforts; • Use existing administrative data and formats whenever possible; and • Respect the differing management information systems capabilities among the nine providers. AFF providers use a common data-reporting format, revised by the AFF evaluation contractor, for the reporting period beginning July 1, 2004. The primary information used for the analysis of AFF program services was service utilization data obtained directly from the nine AFF providers. These data were collected by the AFF providers and sent to the evaluation team in a variety of electronic formats, and imported into a client-level database developed and maintained by the evaluation contractor. Service utilization data are reported for the annual reporting period that covers July 1, 2004 through June 30, 2005. For some service activities, data are also presented from program inception (March 2001) through June 30, 2005. Another data set used for the analysis of the AFF program was enrollment and encounter data provided by ADHS/DBHS for services utilized by Title XIX AFF clients. ADHS/DBHS service utilization data are reported for the annual reporting period that covers July 1, 2004 through June 30, 2005. It should be noted that ADHS/DBHS service utilization data is constantly updated and added to by the RBHAs and their providers, and there may be a reporting lag from service delivery to appearance in the ADHS/DBHS information system, of anywhere from 30 to 90 days. The service utilization data for Title XIX AFF clients is moderately complete through June 30, 2005 since ADHS/DBHS provided the data set in early September 2005. Two additional data sets used for this evaluation include the ADES CHILDS information system, which provides child welfare information, and the ADES JAZ/AZTEC information system, providing employment services information. These data are reported for the annual reporting period that covers July 1, 2004 through June 30, 2005. The third major source of data used for the analysis of the AFF program is AFF stakeholders. These stakeholders include AFF program managers, RBHA liaisons, CPS managers and caseworkers, AFF provider collaborators, and clients of the program. A variety of data collection methodologies were used with these stakeholders, including individual interviews, focus groups, and document reviews. The purpose for using this third data source was to document and assess programmatic successes, changes in program implementation, updates on collaborative partnerships, perceived barriers and facilitators to program implementation, changes in contextual issues, and other events that may have positively influenced service delivery. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 49 Appendix C Arizona Family F.I.R.S.T. Program Evaluation Plan for Fiscal Year July 1, 2004 through June 30, 2005 Outcome Goals – ARS 8-884 1. Increase the availability, timeliness and accessibility of substance abuse treatment to improve child safety, family stability and permanency for children in foster care or other out of home placement, with a preference for reunification with the child’s birth family. 2. Increase the availability, timeliness and accessibility of substance abuse treatment to achieve self-sufficiency through employment. 3. Increase the availability, timeliness and accessibility of substance abuse treatment to promote recovery from alcohol and drug problems Research Variable Data Sources Method of Data Timeframe Proposed Questions Collection Analysis Descriptive Monthly AFF provider Provider electronic Did the AFF • Number of days between referral & statistics data files service data program improve screening; the timeliness of • Number of days between screening and drug treatment assessment; Annually ADHS/DBHS CIS ADHS/DBHS services in each • Number of days between assessment & data for RBHA electronic data files catchment area? service plan completion providers How? • Number of days between service plan and first treatment service • Engagement rate: # receiving at least one treatment service / # of referrals x 100% • Retention Rates: 30 Days: 2+ treatment services within first 30 days; 60 Days: 2+ treatment services each 30 day period 90 Days: 2+ treatment services each 30 day period 180 Days: To be defined Prepared by Applied Behavioral Health Policy / The University of Arizona 50 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Research Questions Variable • • • • • • • • • Did the AFF program improve the availability of drug treatment services in each catchment area? How? • • • • • • • Number of days between referral & screening Number of days between screening and assessment Number of days between assessment & service delivery plan Average wait time for appointments Timing of scheduled transportation Staff perception of time frames in which clients receive services Barriers to receiving services Role of collaborative partnerships Clients’ perceptions of time frames within which they receive services Program capacity Service gaps Service additions or deletions Perception of sufficiency of community’s services Clients’ perceptions of services offered by the program Clients’ perception of whether service needs are met Client contact with case manager Data Sources Method of Data Collection Interviews Annually AFF participants Focus groups Annually AFF program managers Interviews Annually Focus groups Annually AFF program managers Timeframe Proposed Analysis Qualitative analyses Key stakeholders Qualitative analyses Key stakeholders AFF participants Prepared by Applied Behavioral Health Policy / The University of Arizona Qualitative analyses 51 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Research Questions Did the AFF program improve the accessibility of drug treatment services in each catchment area? How? Variable • • • • • • • • • • How did improvements result in the reunification with birth families for Method of Data Collection Interviews Timeframe Proposed Analysis Qualitative analyses Annually AFF participants Focus groups Annually Qualitative analyses Available slots Service utilization Wait time Hours of operation Transportation Perception of clients’ access to services Barriers to receiving services Role of collaborative partnerships Role of referral system Clients’ perceptions of whether they actually receive services they need Clients’ perceptions of how well they understand how service delivery stem operations Proximity of services Contact with case managers Subsequent allegations of abuse & neglect Subsequent birth with prenatal drug exposure AFF program managers DES CHILDS data set DES electronic data file Annually Descriptive statistics DES CHILDS data set DES electronic data file Annually Descriptive statistics • Adoption Family reunification Guardianship Long-term foster care Child(ren) remaining at home while caregiver receives treatment Client perceptions of family stability AFF participants Focus groups Annually • Family reunification DES CHILDS data set DES electronic data file Annually Qualitative analyses Qualitative analyses • How did improvements in timeliness, availability, and accessibility affect child safety? How did improvements affect family stability and permanency for children in foster care or other out-ofhome placement? Data Sources • • • • • • • • • Key stakeholders Prepared by Applied Behavioral Health Policy / The University of Arizona 52 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Research Questions children who had been placed in out of home care? How did improvements affect TANF participants’ ability to achieve self-sufficiency through employment? Variable • • • • • How did improvements promote recovery from drug and alcohol problems? • Receipt of TANF Secured employment Maintain employment status for 90 days Lose employment status and regain TANF benefits Client perceptions of ability to achieve self-sufficiency Drug and alcohol use past 30 days Data Sources Method of Data Collection Drug screens Proposed Analysis JAS DES electronic data file Annually Descriptive statistics AZTEC Annually AFF participants DES electronic data file Focus groups ADHS/DBHS core assessment AFF Provider service data At initial assessment Change in status Every 12 months At closure Monthly Descriptive statistics Qualitative analyses Longitudinal analysis ADHS/DBHS CIS data for RBHA providers • Timeframe AFF client drug screens Prepared by Applied Behavioral Health Policy / The University of Arizona Date file submitted by providers Annually Descriptive statistics 53 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Performance Measures – Scope of Work, III-1: Required Performance Measures: 1. Reduction in the recurrence of child abuse and/or neglect; 2. Decrease in the frequency of alcohol and/or drug use 3. Decrease in the number of days in foster care per child 4. Increase in the number of children in out-of-home care who achieve permanency Research Variable Data Sources Questions DES CHILDS Was there a • Reports of suspected child data set reduction in the abuse/neglect recurrence of child abuse and/or neglect? For those who had DES CHILDS • Reports of suspected child abuse/neglect data set abuse/neglect allegations at • Foster care entry program entry, what percent subsequently had children placed in foster care? DES JAS data Was there an • Length of time receiving TANF increase in the • Average monthly amount received from set DES AZTEC number of families TANF data set either obtaining or • Secured employment maintaining • Maintained employment at 90 day employment? follow-up Was there a ADHS/DBHS • Drug and alcohol use past 30 days decrease in the core assessment • Drug screens frequency of alcohol AFF participant and/or drug use? drug screens Was there a decrease in the number of days in foster care per child? • Days in foster care DES CHILDS data set Prepared by Applied Behavioral Health Policy / The University of Arizona Method of Data Collection DES electronic data file Timeframe Annually Proposed Analysis Descriptive statistics DES electronic data file Annually Descriptive statistics DES electronic data file Annually Descriptive statistics Date file submitted by providers At initial assessment Change in status Every 12 months At closure Annually Descriptive statistics DES electronic data file Descriptive statistics 54 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Research Questions Was there an increase in the number of children in out-of-home care that achieved permanency? What percentage of clients successfully completed their treatment service plans? Variable Data Sources • • Reunification Adoption DES CHILDS data set • Service plan completion AFF Provider service data ADHS/DBHS CIS data for RBHA providers Prepared by Applied Behavioral Health Policy / The University of Arizona Method of Data Collection DES electronic data file Timeframe Annually AFF Provider service data Monthly ADHS/DBHS CIS data for RBHA providers Annually Proposed Analysis Descriptive statistics Descriptive statistics 55 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Scope of Work, III-4: DES Strategic Plan Key Indicators Research Variable Questions Goal 1: To promote • Number of referrals for substance recovery from abuse treatment alcohol and drug • Participants who have engaged in at abuse for AFF least one therapeutic service program • Participants who have engaged in AFF participants treatment for 3 months • Participants who have engaged in AFF treatment for 6 months Goal #2: To reduce • Individuals referred who have engaged the recurrence of in substance abuse treatment program child abuse and and do not have a subsequent neglect of AFF substantiated CPS report after 6 program months of enrollment. participants’ children Goal #3: To • # of children of referred individuals who establish participate in substance abuse permanency for the treatment that achieve permanency children of AFF through reunification, adoption or program guardianship following at least 6participants months parental participation in the substance abuse treatment program. Data Sources AFF Provider service data Method of Data Collection AFF Provider electronic data files Timeframe Monthly ADHS/DBHS CIS data for RBHA providers ADHS/DBHS electronic data files Annually AFF provider service data AFF Provider electronic data files Monthly DES/CPS data set DES/CPS electronic data files Annually AFF provider service data AFF Provider electronic data files Monthly DES/CPS data set DES/CPS electronic data files Annually Prepared by Applied Behavioral Health Policy / The University of Arizona Proposed Analysis Descriptive statistics Descriptive statistics Descriptive statistics 56 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix D Days in Care by DES District: Appendix D Days in Care for Children Discharged SFY 2005 DES District Discharged Reunified Minimum Days in care Maximum Days in care Median Days in Care Average Days in Care Still in Care Minimum Days in care Maximum Days in care Median Days in Care Average Days in Care Relatives Minimum Days in care Maximum Days in care Median Days in Care Average Days in Care Adoption Minimum Days in care Maximum Days in care Median Days in Care Average Days in Care Emancipation Minimum Days in care Maximum Days in care Median Days in Care Average Days in Care Guardianship Minimum Days in care Maximum Days in care Median Days in Care Average Days in Care Transfers to Agencies Minimum Days in care Maximum Days in care Median Days in Care Average Days in Care I II Statewide Total 213 41 65 24 11 42 396 0 0 0 1 32 1 0 813 679 938 209 763 346 938 28 15 30 61 71 16.5 29 104.04 74.73 131.55 67.5 236.36 71.33 103.51 1371 193 253 87 22 98 2024 0 0 1 1 9 0 0 3559 666 1079 760 418 905 3559 45 16 48 43 90 48 44 152.42 79.51 129.49 87.67 156.55 151.57 139.82 20 1 3 6 0 0 30 1 12 70 18 N/A N/A 1 387 12 70 203 N/A N/A 387 12.5 12 70 29.5 N/A N/A 26.5 82.45 12 70 56.5 N/A N/A 73.67 41 6 7 5 2 6 67 0 200 7 42 78 4 0 1383 857 1076 678 78 900 1383 203 533 117 547 78 470.5 329 355.78 523.17 288.9 468 78 458.33 373.06 6 1 1 1 0 2 11 16 449 473 553 N/A 68 16 2458 449 473 553 N/A 113 2458 403.5 449 473 553 N/A 90.5 449 681 449 473 553 N/A 90.5 522 99 5 11 2 5 11 133 1 15 1 45 14 1 1 1586 19 938 160 14 497 1586 66 15 181 102.5 14 70 45 209.55 16.6 228.36 102.5 14 137.82 188.96 25 5 1 3 1 0 35 0 8 556 7 102 N/A 0 533 179 556 462 102 N/A 556 69 17 556 20 102 N/A 62 113.84 48.6 556 163 102 N/A 121.03 Prepared by Applied Behavioral Health Policy / The University of Arizona III IV V VI 57 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix E Substance Use Indicators, By District SFY 2005 DES District I II III IV V VI # participating clients # (%) participating clients UA results Mean (sd) UAs per participating client # (%) participating clients w/ all clean UAs # (%) participating clients w/ mixed UAs # closed clients # (%) closed clients UA results Mean (sd) UAs per closed client # (%) closed clients w/ all clean UAs # (%) closed clients w/ mixed UAs 1972 334(64.5) 263 3(0.6) 445 87(16.8) 195 93(18.0) 43 0(0) 172 1(0.2) Statewide Averages 3090 518 2.7(3.0) 5(5.2) 15.4(16.8) 11.6(9.7) N/A 1(N/A) 6.4(9.8) 279(72.1) 3(0.8) 61(15.8) 43(11.1) 0(0) 1(0.3) 387 55(42.0) 0(0) 26(19.8) 50(38.2) 0(0) 0(0) 131 664 69(52.7) 107 1(0.8) 139 19(14.5) 91 41(31.3) 34 0(0) 62 1(0.8) 1097 131 2.6(3.3) 11(N/A) 10.1(7.8) 9.5(6.6) N/A 1(N/A) 5.9(6.3) 61(62.9) 1(1.0) 12(12.4) 22(22.7) 0(0) 1(1.0) 97 8(23.5) 0(0) 7(20.6) 19(55.9) 0(0) 0(0) 34 Prepared by Applied Behavioral Health Policy / The University of Arizona 58 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix F Year to Date Average Number of Days From Referral to Services State Fiscal Year 2005 DES Districts I AFF Provider TERROS Days from Referral to Outreach n=1845 Minimum 0 Median 1 Maximum 173 Mean 1.57 Standard Deviation 7.43 Days from Referral to Service n=1943 Acceptance Minimum 0 Median 0 Maximum 359 Mean 2.59 Standard Deviation 23.67 Days from Referral to Client n=3 Refusal Minimum 22 Median 22 Maximum 87 Mean 43.67 Standard Deviation 37.52 Days from Referral to RBHA n=0 Referral Minimum N/A Median N/A Maximum N/A Mean N/A Standard Deviation N/A Days from Service Acceptance n=1052 to Assessment Minimum 0 Median 20 Maximum 268 II CPSA III III AZPAC AZPAC Coconino Yavapai III Old Concho III Total IV AZPAC Yuma IV West Care IV Total V VI SEABH Horizon Total S n=586 0 1 304 6.26 19.14 n=66 0 0 5 0.6 1.16 1 n=233 0 0 85 1.58 6.87 1 n=165 0 0 40 2.04 4.82 n=464 0 0 85 1.6 5.6 n=68 0 0 351 9.08 44.01 n=105 0 4 53 5.93 8.31 n=173 0 2 351 7.17 28.26 n=22 0 0.5 17 2.36 4.79 n=42 n=3132 0 0 1.5 1 112 351 17.16 2.98 31.37 13.04 n=655 0 6 309 14.89 33.84 n=43 0 0 32 2.97 7.08 n=128 0 2 41 5.23 7.53 n=117 0 0 0 0 0 n=288 0 0 41 2.77 6.18 n=48 0 0 31 0.93 4.81 n=129 0 0 0 0 0 n=177 0 0 31 0.25 2.52 n=44 0 0 19 1 3.25 n=71 n=3178 0 0 13 0 210 359 29.38 5.6 41.92 25.68 n=10 7 25.5 82 36.5 24.72 n=5 6 14 49 26 20.35 n=12 6 27 98 32.83 23.75 n=9 3 8 40 18.77 14.65 n=26 3 24 98 26.65 20.59 n=0 N/A N/A N/A N/A N/A n=0 N/A N/A N/A N/A N/A n=0 N/A N/A N/A N/A N/A n=1 0 0 0 0 N/A n=1 2 2 2 2 N/A n=41 0 24 98 29.04 23.36 n=0 N/A N/A N/A N/A N/A n=16 1 7.5 49 11.5 11.92 n=82 1 8.5 109 18.9 22.64 n=39 1 5 43 7.3 8.23 n=137 1 7 109 14.73 19.17 n=21 2 7 21 8.61 5.38 n=14 1 6.5 32 9.92 9.84 n=35 1 6 32 9.14 7.38 n=1 0 0 0 0 N/A n=0 N/A N/A N/A N/A N/A n=173 0 7 109 13.52 17.53 n=146 0 10 148 n=13 1 14 43 n=121 0 23 772 n=13 0 6 32 n=147 0 21 772 n=34 2 19 155 n=50 0 8.5 62 n=84 0 11.5 155 n=5 0 10 49 n=62 n=1496 0 0 0 17 210 772 Prepared by Applied Behavioral Health Policy / The University of Arizona 59 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 DES Districts I AFF Provider TERROS Mean 26.83 Standard Deviation 27.03 Days from Referral to n=1063 Assessment Minimum 0 Median 20 Maximum 228 Mean 27.8 Standard Deviation 27 Days from Assessment to Service Plan n=10902 Minimum 0 Median 0 Maximum 336 Mean 8.75 Standard Deviation 38.26 Days from Service Plan to 1st Service n=875 Minimum 0 Median 0 Maximum 251 Mean 2.98 Standard Deviation 14.23 Days from Referral to 1st Service n=897 Minimum 0 Median 21 Maximum 256 Mean 29.44 Standard Deviation 27.96 II CPSA 18.4 24.08 III III AZPAC AZPAC Coconino Yavapai 21.69 42.87 15.92 83.62 III Old Concho 10 10.14 III Total 38.08 76.74 IV AZPAC Yuma 27.97 30.56 IV West Care 12.52 12.52 IV Total 18.77 22.85 V VI SEABH Horizon S Total 13.8 4.15 25.68 20.3 26.71 35.32 n=154 2 21 153 29.6 28.46 n=14 1 15.5 44 22.36 15.81 n=125 0 27 317 39.38 43.09 n=13 0 6 32 10 10.14 n=152 0 25.5 317 35.3 40.48 n=34 4 21.5 155 29.29 29.97 n=50 0 8.5 62 12.48 12.55 n=84 0 13 155 19.28 22.78 n=8 0 5.5 12 5.5 4.9 n=79 n=1541 0 0 15 20 232 317 32.88 28.4 46.37 29.92 n=33 0 9 48 12.39 9.67 n=7 0 8 39 14.71 16.26 n=86 0 9.5 281 27.5 44.99 n=8 0 0 7 0.88 2.47 n=101 0 8 281 24.5 42.38 n=17 0 0 33 4.29 8.86 n=45 0 0 0 0 0 n=62 0 0 33 1.17 4.93 n=6 0 0 0 0 0 n=25 n=1317 0 0 31 0 236 336 55.32 10.54 69.3 38.72 n=29 0 0 10 0.34 1.85 n=0 N/A N/A N/A N/A N/A n=40 0 7 279 25.43 52.35 n=4 11 11.5 12 11.5 0.57 n=44 0 9.5 279 24.15 50.02 n=11 0 6 51 12.73 18.35 n=28 0 7 28 8.89 8.17 n=39 0 7 51 9.97 11.79 n=5 2 3 4 3 1 n=5 4 26 78 28.8 30.06 n=68 13 33 183 42.51 31.79 n=0 N/A N/A N/A N/A N/A n=52 9 44.5 314 67.13 58.39 n=4 15 16 26 18.25 5.25 n=56 9 41 314 63.64 57.66 n=13 8 40 108 38.46 29.21 n=28 0 16 34 16.86 9.62 n=41 0 20 108 23.7 20.54 n=5 5 7 12 8.6 3.2 n=18 n=1085 10 0 62 22 234 314 72.17 32.41 54.78 32.19 Note: 1 For 2 clients in Coconino and 11 clients in Yavapai there is no referral acceptance/refusal RBHA date, but have an outreach Note: 2 For 38 clients in TERROS the service plan was done before assessment Prepared by Applied Behavioral Health Policy / The University of Arizona n=997 0 0 279 4.23 17.85 60 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix G AFF Participating Clients Demographic Characteristics State Fiscal Year 2005, N - 3090 DES Districts AFF Providers I II III III III IV IV V VI AZPAC AZPAC Old AZPAC All Sites TERROS CPSA Coconino Yavapai Concho Yuma West Care Horizon SEABHS Total % Female Male Unknown 1468 494 10 181 81 1 46 13 0 168 77 1 104 36 0 53 20 0 79 42 1 33 10 0 125 47 0 Average Age 30.63 31.84 29.31 32.72 31.06 30.72 31.02 29.86 31.55 American Indian/Alaska Native Asian Black/African American Caucasian/White Native Hawaiian/Pacific Islander Multiple Races Other 79 4 181 1615 5 54 3 9 0 62 239 0 1 0 8 0 2 41 0 0 7 5 0 5 226 0 3 3 13 0 1 119 0 1 7 5 0 3 39 0 0 27 2 1 0 109 1 3 5 2 0 1 36 0 0 4 1 1 2 148 1 1 16 124 4.0% 6 0.2% 257 8.3% 2572 83.2% 7 0.2% 63 2.0% 72 2.3% Hispanic/Latino Not Hispanic/Latino Unknown 484 1489 1 70 161 32 9 47 0 28 210 1 33 107 0 45 26 0 13 108 0 19 24 0 60 112 0 761 24.6% 2284 73.9% 34 1.1% Gender 2257 73.0% 820 26.5% 13 0.4% Average Age 30.95 Race/Ethnicity Ethnicity Prepared by Applied Behavioral Health Policy / The University of Arizona 61 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix G AFF Participating Clients Demographic Characteristics State Fiscal Year 2005, N - 3090 DES Districts AFF Providers I II III AZPAC TERROS CPSA Coconino III III IV AZPAC Old AZPAC Yavapai Concho Yuma IV West Care V VI All Sites Horizon SEABHS Total % Marital Status Married Registered Domestic Partner Divorced Single, never married Separated Legally Separated Widowed Unknown Educational Attainment Less than 1 year Grades 1 to 11 High School Graduate or GED Vocational/Technical School Some College, no degree College – AA/BA degree Graduate/Post Grad degree Unknown Employment Status Employed Not Employed Unknown 216 0 127 663 84 2 9 871 8 0 6 27 8 0 0 214 14 0 7 21 4 0 0 13 73 3 31 78 15 0 3 43 19 0 4 27 3 0 0 87 17 0 4 20 2 0 0 30 24 4 9 52 12 0 3 18 0 0 1 3 1 0 0 38 30 0 10 56 6 0 3 67 401 13.0% 7 0.2% 199 6.4% 947 30.6% 135 4.4% 2 0.1% 18 0.6% 1381 44.7% 3 800 582 22 293 15 3 254 3 75 72 4 21 7 4 77 0 17 24 1 9 2 0 6 0 102 75 11 31 10 3 14 1 42 54 4 13 4 0 22 4 44 14 1 6 1 1 2 0 63 44 0 10 2 0 3 0 22 12 0 5 0 0 4 3 79 43 6 25 3 0 13 14 1244 920 49 413 44 11 395 486 1233 253 71 107 85 22 31 6 114 124 8 36 81 23 18 54 1 41 76 5 9 26 8 50 108 14 847 27.4% 1840 59.5% 403 13.0% Prepared by Applied Behavioral Health Policy / The University of Arizona 0.5% 40.3% 29.8% 1.6% 13.4% 1.4% 0.4% 12.8% 62 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix H Substance Use Patterns Reported at Intake New Participating AFF Clients, SFY 2005 DES Districts Total Participating Clients I II III IV V VI Total 1191 196 266 134 10 73 1870 Clients reporting use 706 132 222 121 7 47 1235 66.0% 286 11 139 20 9 6 322 409 17 19 13 11 85 0 45 8 13 1 74 53 74 0 0 2 146 8 21 16 18 4 122 135 8 10 2 11 58 0 3 0 2 1 45 68 0 0 0 1 3 0 1 0 0 0 3 6 3 0 0 0 25 0 6 1 1 0 21 28 22 0 0 0 603 19 215 45 43 12 587 699 124 29 15 25 Alcohol Benzodiazepines Cocaine/crack Hallucinogens Heroin/Morphine Inhalants Marijuana Methamphetamine Other drugs Other Narcotics Other sedatives Other Stimulants Prepared by Applied Behavioral Health Policy / The University of Arizona % 32.2% 1.0% 11.5% 2.4% 2.3% 0.6% 31.4% 37.4% 6.6% 1.6% 0.8% 1.3% Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 63 Appendix I AFF Services Taxonomy Service Labels and Definitions Recognized by the Department of Economic Security Substance Abuse Education: These services are short-term in duration and are appropriate for clients who are unwilling to commit to more intensive services. Attendance at substance abuse awareness groups and individual counseling to consider the effect of substance abuse in one’s life would be included under substance abuse education. Outpatient Treatment Services: Outpatient treatment services are intended for clients who can benefit from therapy, are highly motivated, and have a strong support system. These clients need a minimum level of intervention and other supports. Service providers are required to provide a minimum of three hours per week of individual or group treatment (or a combination of both). Intensive Outpatient Treatment Services: Intensive outpatient services are intended for clients who can benefit from structured therapeutic interventions, are motivated, and have some social supports. This continuum of services is appropriate for clients who need a moderate amount of therapy and supports. At a minimum, service providers are expected to provide nine hours per week of therapy for a minimum of eight weeks. This therapeutic involvement can include individual, group, and family therapy; substance abuse awareness; and social skills training. Residential Treatment: Residential treatment services are intended for clients who need an intensive amount of therapeutic and other supports to gain sobriety. These services include 24-hour care and supervision. Similar to intensive outpatient treatment, residential treatment can include individual counseling, group therapy, family therapy, substance abuse awareness, and social skills training. Residential treatment may include children residing with parents while the parents are in treatment. Aftercare Services: Aftercare services are provided for clients at the end of their treatment plan through the AFF provider. It should be noted that aftercare service is not a recognized service category within the ADHS/DBHS system. At a minimum, the aftercare plan includes a relapse prevention program, identification and linkage with supports in the community that encourage sobriety, and available interventions to assist clients in the event that relapse occurs. Development of the aftercare plan is expected to begin while the client is in treatment. It should be noted that while aftercare is not a billable service under the ADHS/DBHS covered services guide, there is an expectation that RBHA service plans will address recovery management and relapse management. Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 64 Service Domains/Definitions Recognized by the Division of Behavioral Health Services.19 Treatment Services: Services provided by or under the supervision of behavioral health professionals to reduce symptoms and improve or maintain functioning. These services have been further grouped into three subcategories: Behavioral Health Counseling and Therapy; Assessment, Evaluation and Screening Services; and Other Professional. Rehabilitation Services: These services include the provision of education, coaching, training, demonstration and other services, including securing and maintaining employment to remediate residual or prevent anticipated functional deficits. Four subgroups of services are defined. Medical Services: Medical services are provided by or ordered by a licensed physician, nurse practitioner, physician assistant, or nurse to reduce a person’s symptoms and improve or maintain functioning. These services are further grouped into the following subcategories: Medication; Laboratory; Medical Management; and Electro-Convulsive Therapy. Support Services: Support services are provided to facilitate the delivery of or enhance the benefit received from other behavioral health services. These services are further grouped into the following categories: case management; personal care services; family support; self-help/peer services; therapeutic foster care services, unskilled respite care; supported housing; sign language or oral interpretive services; supportive services; and transportation. Crisis Intervention Services: Crisis intervention services are provided to a person for the purpose of stabilizing or preventing a sudden, unanticipated, or potentially deleterious behavioral health condition, episode or behavior. Crisis intervention services are provided in a variety of settings. Inpatient Services: Inpatient services (including room and board) are provided by an OBHL licensed Level I behavioral health agency and include hospitals, sub-acute facilities, and residential treatment centers. These facilities provide a structured treatment setting with daily 24-hour supervision and an intensive treatment program, including medical support services. Residential Services: Residential services are provided on a 24-hour basis and are divided into the following subcategories based on the type of facility providing the services: Level II behavioral health residential facilities and Level III behavioral health residential facilities. Behavioral Health Day Programs: Day program services are scheduled on a regular basis either on an hourly, half day or full day basis and may include services such as therapeutic nursery, in-home stabilization, after school programs, and specialized 19 See http://www.azdhs.gov/bhs/covserv.htm Prepared by Applied Behavioral Health Policy / The University of Arizona Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 65 outpatient substance abuse programs. These programs can be provided to a person, group of person, and/or families in a variety of settings. Day programs are further grouped into the following three subcategories: supervised; therapeutic; and psychiatric/medical. Prepared by Applied Behavioral Health Policy / The University of Arizona 66 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix J Frequency and Proportion of Participating AFF Clients Receiving Discrete Services, by DES District III IV V VI II I N = 445 N = 195 N = 43 N = 172 DES Districts n = 1972 n = 263 Services Treatment Services # % # 1844 220 681 1935 187 86 137 93.5 .11 3.45 98.1 9.4 4.36 6.94 142 33 110 249 1 11 17 % # % # % 53.99 415 93.03 180 92.3 12.54 91 20.44 34 17.4 41.82 210 47.19 109 55.9 94.67 441 99.10 193 98.97 .38 35 7.86 5 2.56 4.18 40 8.99 6 3.07 6.46 37 8.31 9 4.61 # 37 3 6 42 1 1 2 % # % Statewide N = 3090 # 86.04 154 89.53 2772 89.7 6.97 35 20.34 416 13.5 13.95 57 33.13 1173 38 97.67 162 94.18 3022 97.8 2.32 4 2.32 233 7.5 2.32 4 2.32 148 4.8 4.64 7 4.92 209 6.8 Rehabilitation Services Medical Services Support Services Crisis Intervention Services Inpatient Services Residential Services Behavioral Health Day 146 7.4 0 0 20 4.49 4 2.05 1 2.32 0 0 171 Programs Note. Percentage of clients receiving a service domain (i.e., "Treatment Services") expressed as a function of all participating clients within a District Prepared by Applied Behavioral Health Policy / The University of Arizona % 5.5 67 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix K Frequency and Proportion of Participating AFF Clients Receiving Discrete Services, by DES District DES Districts Services I # Treatment Services II % 1844 Individual Counseling # III % 142 867 47.02% 1 # IV % 415 0.70% # % 180 14 3.37% 11 V # % 37 6.11% 1 VI # % 154 2.70% 1 Statewide # % 2772 0.65% 895 32.29% Family Counseling 1168 63.34% 33 23.24% 267 64.34% 93 51.67% 33 89.19% 77 50.00% 1671 60.28% Group Counseling 748 40.56% 3 Assessment, Evaluation and Screening Services Other Treatment Services by Professionals Intensive Outpatient Services Outpatient Services Rehabilitation Services Behavioral Health Prevention/Promotion Education 0 0.00% 3 2.11% 29 6.99% 8 4.44% 0 0.00% 4 2.60% 156 5.63% 69 16.63% 0 0.00% 1 2.70% 8 5.19% 146 5.27% 262 14.21% 49 34.51% 41 9.88% 44 24.44% 3 8.11% 33 91 3 34 20 12.99% 419 15.12% 35 416 68 30.91% 23 69.70% 24 26.37% 9 26.47% 3 100.00% 28 80.00% 155 37.26% 1 5.88% 0.45% 11 33.33% 0.00% 110 Medication Services 34 Laboratory Services 423 62.11% 4 4.99% 0 0.00% 2 0 0.00% 2 5.71% 14.71% 0 0.00% 8 22.86% 160 38.46% 32 35.16% 24 70.59% 0 0.00% 3 8.57% 4 210 3.64% 1 6 109 0.48% 3 2.75% 57 16 3.85% 169 40.63% 1173 0 0.00% 1 1.75% 43 3.64% 110 52.38% 97 88.99% 0 0.00% 1 1.75% 635 54.13% 3.67% 353 51.84% 15 13.64% 125 59.52% 22 20.18% 4 66.67% 25 43.86% 544 46.38% 374 54.92% 101 91.82% 90 42.86% 23 21.10% 4 66.67% 51 89.47% 643 54.82% 1935 Personal Care Services 755 27.24% 1.41% 681 Case Management 0.00% 3 83 37.73% 21 63.64% 43 47.25% 5 Pharmacy Services 0 2 3.58% 110 50.00% 0 Support Services 2.70% 66 Psychoeducational Services Medical Management 1 112 6.07% Substance Abuse Education Medical Services 1.67% 1761 95.50% 122 85.92% 378 91.08% 166 92.22% 25 67.57% 143 92.86% 2595 93.61% 220 Skills Training and Development 2.11% 249 441 42 193 162 3022 1785 92.25% 131 52.61% 435 98.64% 187 96.89% 42 100.00% 127 78.40% 2707 89.58% 5 0.26% 6 2.41% 3 0.68% 5 2.59% 4 9.52% 4 2.47% 27 0.89% 1.69% Home Care Training Family 2 0.10% 2 0.80% 36 8.16% 8 4.15% 0 0.00% 3 1.85% 51 Self-Help/Peer Services 87 4.50% 16 6.43% 2 0.45% 5 2.59% 0 0.00% 3 1.85% 113 3.74% Unskilled Respite Care 0 0.00% 0.00% 1 0.23% 0 0.00% 0 0.00% 0 0.00% 1 Supported Housing 20 1.03% 0 0.00% 48 10.88% 1 0.52% 0 0.00% 0 0.00% 69 2.28% Sign Language Services 2 0.10% 0 0.00% 1 0.00% 0 0.00% 0 0.00% 3 0.10% Supportive Services Transportation 0 0.23% 0 0.03% 1813 93.70% 234 93.98% 378 85.71% 160 82.90% 11 26.19% 138 85.19% 2734 90.47% 0.40% 161 36.51% 31 16.06% 8 19.05% 13 8.02% Child Care Services 0 0.00% 0 0.00% 3 0 0.00% 0 0.00% 0 0.00% 3 0.10% After Care 16 0.83% 14 5.62% 38 8.62% 18 9.33% 0 0.00% 0 0.00% 86 2.85% 0.80% 125 28.34% 90 46.63% 0 0.00% 16 9.88% 543 17.97% Other Services Crisis Intervention Services Crisis Intervention Services Mobile Crisis Intervention Services Stabilization Inpatient Services Residential Services Behavioral Health Short-Term Residential Level II 641 33.13% 1 310 16.02% 2 187 1 0.68% 35 5 1 4 855 28.29% 233 64 34.22% 1 100.00% 21 60.00% 5 100.00% 1 100.00% 4 100.00% 96 41.20% 167 89.30% 0 86 137 0.00% 11 17 15 42.86% 0 40 37 0.00% 6 9 0 0.00% 1 2 0 0.00% 4 7 136 99.27% 17 100.00% 36 97.30% 9 100.00% 1 50.00% 182 78.11% 148 209 7 100.00% 206 98.56% Behavioral Health Long-Term Residential Level III 1 0.73% 0 0.00% 1 2.70% 0 0.00% 0 0.00% 0 0.00% 2 0.96% Child Residential Services w/Parent 3 2.19% 0 0.00% 0 0.00% 0 0.00% 1 50.00% 0 0.00% 4 1.91% 1 0 Behavioral Health Day Programs Supervised Behavioral Health Treatment and Day Programs Therapeutic Behavioral Health Services and Day Programs 146 4 0 2.74% 20 4 0.00% 0 0.00% 171 0 0.00% 2 10.00% 0 0 0.00% 144 98.63% 0 0.00% 18 90.00% 4 100.00% 1 100.00% 0 0.00% 6 3.51% 167 97.66% Note. Percentage of clients receiving a discrete service (i.e., "Individual Counseling") expressed as a function of all clients receiving a service category (i.e., "Treatment Services") Prepared by Applied Behavioral Health Policy / The University of Arizona 68 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix L Service Funding Mix DES District I v. Statewide Averages DES District I Statewide Averages DES & DBHS Funds DES & DBHS Funds DES Funds only # % # % DBHS Funds DES Funds only only # % # % # % DBHS Funds only # % Treatment Services Individual Counseling Family Counseling Group Counseling Assessment, Evaluation and Screening Services Other Treatment Services by Professionals 841 97.00% 4 0.34% 744 99.47% 856 95.64% 7 19 1.63% 1145 98.03% 7 0.81% 19 11 23 1.38% 1637 98.14% 1 749 99.21% 0.13% 3 2.19% 0.40% 0.66% 1 0.78% 32 0.13% 5 3.58% 0.66% 716 40.66% 823 46.73% 222 12.61% 1067 41.12% 101239.00% 516 19.88% 0 0.00% 0 0.00% 112 100.00% 0 0.00% 0 0.00% 156 100.00% Intensive Outpatient Services 66 100.00% 0 0.00% 0 0.00% 146 100.00% 0 0.00% 0 0.00% Outpatient Services 262 100.00% 0 0.00% 0 0.00% 419 100.00% 0 0.00% 0 0.00% Rehabilitation Services Skills Training and Development 0 0.00% 0 0.00% 68 100.00% 6 3.87% 0 0.00% 149 96.13% Behavioral Health Prevention/Promotion Education 0 0.00% 0 0.00% 0 0.00% 0 0.00% 16 0 0.00% 0 0 0.00% 0 Psychoeducational Services Substance Abuse Education 110 100.00% 0 1 0.90% 0.00% 83 100.00% 0.00% 0 0.00% 169 100.00% 0 8.65% 0.00% 160 100.00% 0.00% 0 0.00% Medical Services Medication Services Laboratory Services 0 0.00% 0 0.00% 34 100.00% 0 0.00% 0 0.00% 43 100.00% 316 74.70% 18 4.26% 89 21.04% 501 78.90% 29 4.57% 105 16.54% Medical Management 0 0.00% 0 0.00% 353 100.00% 3 0.55% 0 Pharmacy Services 22 5.88% 83 22.19% 269 71.93% 23 3.58% 84 13.06% 536 83.36% 0.00% 541 99.45% Case Management 426 23.87% 1098 61.51% 261 14.62% 628 23.20% 145553.75% 624 23.05% Support Services Personal Care Services 0 0.00% 0 0.00% 5 100.00% 0 0.00% 2 100.00% 12 23.53% 0 0.00% 27 100.00% Home Care Training Family 0 0.00% 0 0.00% Self-Help/Peer Services 0 0.00% 0 0.00% 87 100.00% Unskilled Respite Care 0 0.00% 0 0.00% Supported Housing 6 30.00% 1 5.00% 13 65.00% Sign Language Services 0 0.00% 0 0.00% 2 100.00% 0 0 0.00% 3 100.00% Supportive Services 1813 100.00% 0 0.00% 0 0.00% 2734 100.00% 0 0.00% 0 Transportation Child Care Services 0 0.00% 0 0.00% 39 76.47% 0 0.00% 113 100.00% 0 0.00% 0 0.00% 0 0.00% 55 79.71% 1 1.45% 13 18.84% 0.00% 1 100.00% 0.00% 46 7.18% 34 5.30% 561 87.52% 143 16.73% 55 6.43% 657 76.84% 0 0.00% 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 After Care 16 100.00% 0 0.00% 0 0.00% 86 100.00% 0 0.00% 0 0.00% 0.00% Other Services 310 100.00% 0 0.00% 0 0.00% 543 100.00% 0 0.00% 0 0.00% Crisis Intervention Services Crisis Intervention Services Mobile 0 0.00% 0 0.00% 64 100.00% 0 0.00% 0 0.00% 96 100.00% Crisis Intervention Services Stabilization 0 0.00% 0 0.00% 167 100.00% 0 0.00% 1 0.55% 181 99.45% Inpatient Services Residential Services Behavioral Health Short-Term Residential Level II 23 16.91% 13 9.56% 100 73.53% 32 15.53% 20 9.71% 154 74.76% Behavioral Health Long-Term Residential Level III 0 Child Residential Services w/Parent 0.00% 0 0.00% 1 100.00% 1 0 0.00% 1 50.00% 3 100.00% 0 0.00% 0 4 100.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 6 100.00% 0 0.00% 0 0.00% 144 100.00% 0 0.00% 0 0.00% 167 100.00% 0.00% 50.00% Behavioral Health Day Programs Supervised Behavioral Health Treatment and Day Programs Therapeutic Behavioral Health Services and Day Programs Prepared by Applied Behavioral Health Policy / The University of Arizona 69 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 DES District II Appendix L Service Funding Mix DES District II v. Statewide Averages DES & DBHS Funds DES Funds only # % # % Statewide Averages DBHS Funds only # % 0.00% DES & DBHS Funds DES Funds only # % DBHS Funds only # % # % 32 3.58% Treatment Services Individual Counseling 1 100.00% 0 0.00% 0 856 95.64% 7 0.78% 2 0 0.00% 31 93.94% 11 0.66% 23 1.38% 1637 98.14% Group Counseling 3 100.00% 0 0.00% 0 749 99.21% 1 0.13% Assessment, Evaluation and Screening Services 86 70.49% 2 1.64% 34 27.87% 1067 41.12% 1012 39.00% 516 19.88% Family Counseling Other Treatment Services by Professionals 0 6.06% 0.00% 0.00% 0 0.00% 0 5 0.66% 0 0.00% 3 100.00% Intensive Outpatient Services 2 100.00% 0 0.00% 0 0.00% 146 100.00% 0 0.00% 0.00% 156 100.00% 0 0.00% Outpatient Services 49 100.00% 0 0.00% 0 0.00% 419 100.00% 0 0.00% 0 0.00% Skills Training and Development Behavioral Health Prevention/Promotion Education 3 0.00% 20 86.96% 6 3.87% 0 0.00% 149 96.13% 0 0.00% 0 0.00% 11 100.00% 0 0.00% 0 0.00% Psychoeducational Services 0 0.00% 0 0.00% 21 100.00% 0 0.00% 0 0.00% 160 100.00% Substance Abuse Education 0 0.00% 0 0.00% 0 Medication Services 0 0.00% 0 0.00% 4 100.00% Laboratory Services 4 100.00% 0 0.00% 0 Medical Management 0 0.00% 0 0.00% 15 100.00% 3 0.55% 0 Pharmacy Services 1 0.99% 0 0.00% 100 99.01% 23 3.58% 84 13.06% 536 83.36% Case Management 35 26.72% 2 1.53% 94 71.76% 628 23.20% 1455 53.75% 624 23.05% Rehabilitation Services 13.04% 0 0.00% 169 100.00% 0 16 8.65% 0.00% 0 0.00% 0.00% 43 100.00% Medical Services 0.00% 0 0.00% 0 501 78.90% 29 4.57% 105 16.54% 0.00% 541 99.45% Support Services Personal Care Services 0 0.00% 0 0.00% 6 100.00% 0.00% 0 0.00% 27 100.00% Home Care Training Family 0 0.00% 0 0.00% 2 100.00% 12 23.53% 0 0.00% 39 76.47% Self-Help/Peer Services 0 0.00% 0 0.00% 16 100.00% Unskilled Respite Care 0 0.00% 0 0.00% 0 Supported Housing 0 0.00% 0 0.00% 0 0 0.00% 0 0.00% 234 100.00% 0 0.00% Sign Language Services Supportive Services 0 0 0.00% 0 0.00% 113 100.00% 0.00% 0 0.00% 0 0.00% 1 100.00% 0.00% 55 79.71% 1 1.45% 13 18.84% 0 0.00% 0 0 0.00% 3 100.00% 0 0.00% 2734 100.00% 0 0.00% 0 0.00% 0.00% Transportation 0 0.00% 0 0.00% 1 100.00% 143 16.73% 55 6.43% 657 76.84% Child Care Services 0 0.00% 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 0.00% After Care 14 100.00% 0 0.00% 0 0.00% 86 100.00% 0 0.00% 0 0.00% Other Services 2 100.00% 0 0.00% 0 0.00% 543 100.00% 0 0.00% 0 0.00% Crisis Intervention Services Mobile 0 0.00% 0 0.00% 1 100.00% 0 0.00% 0 0.00% 96 100.00% Crisis Intervention Services Stabilization 0 0.00% 0 0.00% 0 0 0.00% 1 0.55% 181 99.45% Crisis Intervention Services 0.00% Inpatient Services Residential Services Behavioral Health Short-Term Residential Level II Behavioral Health Long-Term Residential Level III 2 11.76% 0 0.00% 15 88.24% 32 15.53% 20 9.71% 154 74.76% 0 0.00% 0 0.00% 0 0.00% 1 0 0.00% 1 50.00% Child Residential Services w/Parent 0 0.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 6 100.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 167 100.00% 50.00% Behavioral Health Day Programs Supervised Behavioral Health Treatment and Day Programs Therapeutic Behavioral Health Services and Day Programs Prepared by Applied Behavioral Health Policy / The University of Arizona 70 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 DES District III Appendix L Service Funding Mix DES District III v. Statewide Averages DES & DBHS Funds DES Funds only # % Statewide Averages DBHS Funds only # % # % 13 92.86% 0 0.00% 1 7.14% 5 1.89% 4 1.51% 258 97.36% 0 0.00% 0 0.00% DES Funds DES & DBHS Funds only DBHS Funds only # % # % # % 856 95.64% 7 0.78% 32 3.58% 11 0.66% 23 1.38% 1637 98.14% 749 99.21% 1 0.13% Treatment Services Individual Counseling Family Counseling Group Counseling Assessment, Evaluation and Screening Services Other Treatment Services by Professionals 0 0.00% 5 0.66% 139 36.77% 101 26.72% 138 36.51% 1067 41.12% 1012 39.00% 516 19.88% 0 0.00% 0 0.00% 29 100.00% 0 0.00% 0 0.00% 156 100.00% Intensive Outpatient Services 69 100.00% 0 0.00% 0 0.00% 146 100.00% 0 0.00% 0 0.00% Outpatient Services 41 100.00% 0 0.00% 0 0.00% 419 100.00% 0 0.00% 0 0.00% Skills Training and Development 1 4.17% 0 0.00% 23 95.83% 6 3.87% 0 0.00% 149 96.13% Behavioral Health Prevention/Promotion Education 0 0.00% 0 0.00% 0 0.00% 0 0.00% Psychoeducational Services 0 0.00% 0 0 0.00% 0 Substance Abuse Education 32 100.00% 0 0.00% 0 Medication Services 0 0.00% 1 100.00% Laboratory Services Rehabilitation Services 0 0.00% 0.00% 43 100.00% 0.00% 169 100.00% 0 16 8.65% 0.00% 160 100.00% 0.00% 0 0.00% 0.00% 43 100.00% Medical Services 0.00% 0 0 0.00% 0 91 82.73% 7 6.36% 12 10.91% 501 78.90% 29 4.57% 105 16.54% Medical Management 3 2.40% 0 0.00% 122 97.60% 3 0.55% 0 0.00% 541 99.45% Pharmacy Services 0 0.00% 1 1.11% 89 98.89% 23 3.58% 84 13.06% 536 83.36% Support Services Case Management Personal Care Services Home Care Training Family Self-Help/Peer Services Unskilled Respite Care Supported Housing Sign Language Services Supportive Services Transportation 100 22.99% 237 54.48% 98 22.53% 628 23.20% 1455 53.75% 624 23.05% 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 0.00% 27 100.00% 39 76.47% 11 30.56% 0 0.00% 25 69.44% 12 23.53% 0 0.00% 0 0.00% 0 0.00% 2 100.00% 0 0.00% 0 0.00% 113 100.00% 0 0.00% 0 0.00% 1 100.00% 0 0.00% 0 0.00% 1 100.00% 48 100.00% 0 0.00% 0 55 79.71% 1 1.45% 13 18.84% 0 0 0.00% 3 100.00% 0.00% 2734 100.00% 0 0.00% 0 0 0.00% 0.00% 0 0.00% 1 100.00% 378 100.00% 0 0.00% 0 0.00% 0.00% 97 60.25% 19 11.80% 45 27.95% 143 16.73% 55 6.43% 657 76.84% Child Care Services 3 100.00% 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 After Care 38 100.00% 0 0.00% 0 0.00% 86 100.00% 0 0.00% 0 0.00% Other Services 125 100.00% 0 0.00% 0 0.00% 543 100.00% 0 0.00% 0 0.00% 96 100.00% 0.00% Crisis Intervention Services Crisis Intervention Services Mobile 0 0.00% 0 0.00% 21 100.00% 0 0.00% 0 0.00% Crisis Intervention Services Stabilization 0 0.00% 1 6.67% 14 93.33% 0 0.00% 1 0.55% 181 99.45% Behavioral Health Short-Term Residential Level II 6 16.67% 7 19.44% 23 63.89% 32 15.53% 20 9.71% 154 74.76% Behavioral Health Long-Term Residential Level III 1 100.00% 0 0.00% 0 0.00% 1 0 0.00% 1 50.00% 0 0.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 2 100.00% 0 0.00% 0 0.00% 6 100.00% 0 0.00% 0 0.00% 18 100.00% 0 0.00% 0 0.00% 167 100.00% Inpatient Services Residential Services Child Residential Services w/Parent 50.00% Behavioral Health Day Programs Supervised Behavioral Health Treatment and Day Programs Therapeutic Behavioral Health Services and Day Programs Prepared by Applied Behavioral Health Policy / The University of Arizona 71 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 DES District IV Appendix L Service Funding Mix DES District IV v. Statewide Averages DES & DBHS Funds DES Funds only # % # % Individual Counseling 1 9.09% 0 Family Counseling 0 0.00% 0 2 66.67% 0 0.00% Statewide Averages DBHS Funds only # % DES Funds DES & DBHS DBHS Funds only Funds only # % # % # % 0.00% 10 90.91% 856 95.64% 7 0.78% 32 3.58% 0.00% 93 100.00% 11 0.66% 23 1.38% 1637 98.14% 33.33% 749 99.21% 1 0.13% Treatment Services Group Counseling Assessment, Evaluation and Screening Services 1 5 0.66% 48 28.92% 32 19.28% 86 51.81% 1067 41.12% 1012 39.00% 516 19.88% Other Treatment Services by Professionals 0 0.00% 0 0.00% 8 100.00% Intensive Outpatient Services 0 0.00% 0 0.00% 0 0.00% 146 100.00% 0 0.00% 0 0.00% 44 100.00% 0 0.00% 0 0.00% 419 100.00% 0 0.00% 0 0.00% Skills Training and Development Behavioral Health Prevention/Promotion Education 2 0.00% 7 77.78% 0 0.00% 0 0.00% 2 7.69% Psychoeducational Services 0 0.00% 0 0.00% 5 100.00% Substance Abuse Education 24 100.00% 0 0.00% 0 Outpatient Services 0 0.00% 0 0.00% 156 100.00% Rehabilitation Services 22.22% 0 0.00% 6 3.87% 0 0.00% 149 96.13% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 160 100.00% 169 100.00% 0 16 8.65% 0.00% 0 0.00% 0.00% 43 100.00% Medical Services Medication Services 0 0.00% 0 0.00% 3 100.00% Laboratory Services 89 91.75% 4 4.12% 4 Medical Management 0 0.00% 0 0.00% 22 100.00% 3 0.55% 0 Pharmacy Services 0 0.00% 0 0.00% 23 100.00% 23 3.58% 84 13.06% 536 83.36% Case Management 49 26.20% 98 52.41% 40 21.39% 628 23.20% 1455 53.75% 624 23.05% 4.12% 0 0.00% 0 501 78.90% 29 4.57% 105 16.54% 0.00% 541 99.45% Support Services Personal Care Services 0 0.00% 0 0.00% 5 100.00% 0 0.00% 0 0.00% 27 100.00% Home Care Training Family 1 12.50% 0 0.00% 7 12 23.53% 0 0.00% 39 76.47% Self-Help/Peer Services 0 0.00% 0 0.00% 5 100.00% 0 0.00% 0 0.00% 113 100.00% Unskilled Respite Care 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 1 100.00% 1 100.00% 0 0.00% 0 0.00% 55 79.71% 1 1.45% 13 18.84% 0 Supported Housing Sign Language Services Supportive Services 0 0.00% 87.50% 0 0.00% 0 0.00% 0 0.00% 3 100.00% 160 100.00% 0 0.00% 0 0.00% 2734 100.00% 0 0.00% 0.00% 0 0.00% Transportation 0 0.00% 2 6.45% 29 93.55% 143 16.73% 55 6.43% 657 76.84% Child Care Services 0 0.00% 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 0.00% After Care 18 100.00% 0 0.00% 0 0.00% 86 100.00% 0 0.00% 0 0.00% Other Services 90 100.00% 0 0.00% 0 0.00% 543 100.00% 0 0.00% 0 0.00% Crisis Intervention Services Mobile 0 0.00% 0 0.00% 5 100.00% 0 0.00% 0 0.00% 96 100.00% Crisis Intervention Services Stabilization 0 0.00% 0 0.00% 0 0.00% 0 0.00% 1 0.55% 181 99.45% Crisis Intervention Services Inpatient Services Residential Services Behavioral Health Short-Term Residential Level II Behavioral Health Long-Term Residential Level III 1 11.11% 0 0.00% 8 88.89% 32 15.53% 20 9.71% 154 74.76% 0 0.00% 0 0.00% 0 0.00% 1 0 0.00% 1 50.00% Child Residential Services w/Parent 0 0.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 6 100.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 167 100.00% 50.00% Behavioral Health Day Programs Supervised Behavioral Health Treatment and Day Programs Therapeutic Behavioral Health Services and Day Programs Prepared by Applied Behavioral Health Policy / The University of Arizona 72 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 DES District V Appendix L Service Funding Mix DES District V v. Statewide Averages DES & DBHS Funds DES Funds only Statewide Averages DBHS Funds only # % DES Funds DES & DBHS DBHS Funds only Funds only # % # % # % # % # % Individual Counseling 0 0.00% 0 0.00% Family Counseling 0 0.00% 0 0.00% 33 100.00% 11 32 3.58% Group Counseling 0 0.00% 0 0.00% Assessment, Evaluation and Screening Services 2 8.00% 3 12.00% 20 80.00% 1067 41.12% 1012 39.00% 516 19.88% 0 0.00% Treatment Services Other Treatment Services by Professionals 1 100.00% 856 95.64% 7 0.78% 0.66% 23 1.38% 1637 98.14% 1 100.00% 749 99.21% 1 0.13% 0 0.00% 0 5 0.66% 0 0.00% 0 0.00% Intensive Outpatient Services 1 100.00% 0 0.00% 0 0.00% 146 100.00% 0 0.00% 0.00% 156 100.00% 0 0.00% Outpatient Services 3 100.00% 0 0.00% 0 0.00% 419 100.00% 0 0.00% 0 0.00% Skills Training and Development 0 0.00% 0 0.00% 3 100.00% 6 3.87% 0 0.00% 149 96.13% Behavioral Health Prevention/Promotion Education 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 Rehabilitation Services Psychoeducational Services 0 0.00% 0 0.00% 0 0.00% Substance Abuse Education 0 0.00% 0 0.00% 0 0.00% Medication Services 0 0.00% 0 0.00% 0 0.00% 0.00% 169 100.00% 0 16 8.65% 0.00% 160 100.00% 0.00% 0 0.00% 0.00% 43 100.00% Medical Services 0 0.00% 0 Laboratory Services 0 0.00% 0 0.00% 0 Medical Management 0 0.00% 0 0.00% 4 100.00% 501 78.90% 29 3 0.55% 0 4.57% 105 16.54% Pharmacy Services 0 0.00% 0 0.00% 4 100.00% 23 3.58% 84 13.06% 536 83.36% 0.00% 541 99.45% Support Services Case Management 1 2.38% 2 4.76% 39 92.86% 628 23.20% 1455 53.75% 624 23.05% Personal Care Services 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 27 100.00% 39 76.47% Home Care Training Family 0 0.00% 0 0.00% 0 0.00% 12 23.53% 0 0.00% Self-Help/Peer Services 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 113 100.00% Unskilled Respite Care 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 1 100.00% Supported Housing 0 0.00% 0 0.00% 0 0.00% 55 79.71% 1 1.45% 13 18.84% 0 0.00% 0 Sign Language Services 0 0.00% 0 0.00% 0 0.00% 3 100.00% 11 100.00% 0 0.00% 0 0.00% 2734 100.00% 0 0.00% 0 Transportation 0 0.00% 0 0.00% 8 100.00% 143 16.73% 55 6.43% 657 76.84% Child Care Services 0 0.00% 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 0.00% After Care 0 0.00% 0 0.00% 0 0.00% 86 100.00% 0 0.00% 0 0.00% Other Services 0 0.00% 0 0.00% 0 0.00% 543 100.00% 0 0.00% 0 0.00% Crisis Intervention Services Mobile 0 0.00% 0 0.00% 1 100.00% 0 0.00% 0 0.00% 96 100.00% Crisis Intervention Services Stabilization 0 0.00% 0 0.00% 0 0 0.00% 1 0.55% 181 99.45% Supportive Services 0.00% 0.00% Crisis Intervention Services 0.00% Inpatient Services Residential Services Behavioral Health Short-Term Residential Level II 0 0.00% 0 0.00% 1 100.00% 32 15.53% 20 9.71% 154 74.76% Behavioral Health Long-Term Residential Level III 0 0.00% 0 0.00% 0 0.00% 1 0 0.00% 1 50.00% 1 100.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 6 100.00% 0 0.00% 0 0.00% 1 100.00% 0 0.00% 0 0.00% 167 100.00% Child Residential Services w/Parent 50.00% Behavioral Health Day Programs Supervised Behavioral Health Treatment and Day Programs Therapeutic Behavioral Health Services and Day Programs Prepared by Applied Behavioral Health Policy / The University of Arizona 73 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 DES District VI Appendix L Service Funding Mix DES District VI v. Statewide Averages DES & DBHS Funds DES Funds only Statewide Averages DBHS Funds only # % DES Funds DES & DBHS DBHS Funds only Funds Only # % # % # Individual Counseling 0 0.00% 0 0.00% Family Counseling 0 0.00% 0 0.00% 77 100.00% 11 Group Counseling 0 0.00% 0 0.00% % # % # % 32 3.58% Treatment Services Assessment, Evaluation and Screening Services Other Treatment Services by Professionals 1 100.00% 856 95.64% 0 0.00% 7 0.78% 0.66% 23 1.38% 1637 98.14% 749 99.21% 1 0.13% 5 0.66% 76 53.15% 51 35.66% 16 11.19% 1067 41.12% 1012 39.00% 516 19.88% 0 0.00% 4 100.00% Intensive Outpatient Services 8 100.00% 0 0 0.00% 0.00% 0 0.00% 146 100.00% 0 0 0.00% 0 0.00% 0.00% 156 100.00% 0 0.00% Outpatient Services 20 100.00% 0 0.00% 0 0.00% 419 100.00% 0 0.00% 0 0.00% Rehabilitation Services Skills Training and Development 0 0.00% 0 0.00% 28 100.00% 6 3.87% 0 0.00% 149 96.13% Behavioral Health Prevention/Promotion Education 0 0.00% 0 0.00% 0 0.00% 0 0.00% Psychoeducational Services 0 0.00% 0 0.00% 8 100.00% 0 0.00% 0 Substance Abuse Education 3 100.00% 0 0.00% 0 Medication Services 0 0 0.00% 1 100.00% Laboratory Services 1 100.00% 0 0.00% 0 Medical Management 0 0.00% 0 0.00% 25 100.00% 3 0.55% 0 Pharmacy Services 0 0.00% 0 0.00% 51 100.00% 23 3.58% 84 13.06% 536 83.36% Case Management 17 13.39% 18 14.17% 92 72.44% 628 23.20% 1455 53.75% 624 23.05% 2 40.00% 0.00% 169 100.00% 0 16 8.65% 0.00% 160 100.00% 0.00% 0 0.00% 0.00% 43 100.00% Medical Services 0.00% 0.00% 0 0.00% 0 501 78.90% 29 4.57% 105 16.54% 0.00% 541 99.45% Support Services Personal Care Services 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 27 100.00% 39 76.47% Home Care Training Family 0 0.00% 0 0.00% 3 100.00% 12 23.53% 0 0.00% Self-Help/Peer Services 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 0.00% 113 100.00% Unskilled Respite Care 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 1 100.00% 13 18.84% Supported Housing 0 0.00% 0 0.00% 0 0.00% 55 79.71% 1 1.45% Sign Language Services 0 0.00% 0 0.00% 0 0.00% 0 0 0.00% 3 100.00% 138 100.00% 0 0.00% 0 0.00% 2734 100.00% 0 0.00% 0 Supportive Services 0.00% 0.00% Transportation 0 0.00% 0 0.00% 13 100.00% 143 16.73% 55 6.43% 657 76.84% Child Care Services 0 0.00% 0 0.00% 0 0.00% 3 100.00% 0 0.00% 0 After Care 0 0.00% 0 0.00% 0 0.00% 86 100.00% 0 0.00% 0 0.00% 16 100.00% 0 0.00% 0 0.00% 543 100.00% 0 0.00% 0 0.00% 96 100.00% Other Services 0.00% Crisis Intervention Services Crisis Intervention Services Mobile 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% Crisis Intervention Services Stabilization 0 0.00% 0 0.00% 0 0 0.00% 1 0.55% 181 99.45% 0.00% Inpatient Services Residential Services Behavioral Health Short-Term Residential Level II 0 0.00% 0 0.00% 7 100.00% 32 15.53% 20 9.71% 154 74.76% Behavioral Health Long-Term Residential Level III 0 0.00% 0 0.00% 0 0.00% 1 0 0.00% 1 50.00% Child Residential Services w/Parent 0 0.00% 0 0.00% 0 0.00% 4 100.00% 0 0.00% 0 0.00% 6 100.00% 50.00% Behavioral Health Day Programs Supervised Behavioral Health Treatment and Day Programs 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% Therapeutic Behavioral Health Services and Day Programs 0 0.00% 0 0.00% 0 0.00% 0 0.00% 0 0.00% 167 100.00% Prepared by Applied Behavioral Health Policy / The University of Arizona 74 Arizona Families F.I.R.S.T. Program Annual Evaluation Report for 2004 – 2005 Appendix M - Case Closure and Length of Stay by DES District Case Closure and Length of Stay, by DES District DES District # total participating clients # (%) clients served and closed by AFF only Mean (sd) length of service for clients served by AFF only # (%) clients continuing AFF only # (%) clients served and closed by RBHA only Mean (sd) length of service for clients served by RBHA only # (%) clients continuing RBHA only # (%) clients served by AFF and RBHA and closed by both systems Mean (sd) length of service for both systems # (%) clients served by AFF and RBHA, but closed only by AFF Mean (sd) length of service for AFF services only # (%) clients served by AFF and RBHA, but closed only by RBHA Mean (sd) length of service for RBHA services only I II III IV V VI Statewide Totals 1972 263 445 195 43 172 3090 448(76.5) 42(7.2) 39(6.7) 23(3.9) 0(0) 34(5.8) 586 N=149 76.2 (72.2) N=14 94.5(120.5) N=32 102.7(123.6) N=17 68.1(72.9) N/A N=13 95.6(83.3) N=225 81.6(85.3) 16(10.8) 37(25.0) 51(34.5) 27(18.2) 1(0.7) 16(10.8) 148 185(39.0) 65(13.7) 95(20.0) 67(14.1) 34(7.2) 28(5.9) 474 N=166 171.3(255.4) N=52 163.9(162.5) N=79 230.7(209.2) N=65 247.6(218.7) N=18 157.3(100.9) N=22 205.7(156.1) N=402 195.6(221.8) 174(37.4) 112(24.1) 39(8.4) 37(8.0) 4(0.9) 28(6.0) 465 31(83.8) 0(0) 5(13.5) 1(2.7) 0(0) 0(0) 37 N=30 159.0(259.2) N/A N=5 75.8(63.5) N=1 154(N/A) N/A N/A N=36 147.3(238.7) 576(90.7) 0(0) 27(4.3) 14(2.2) 0(0) 18(2.8) 635 N=135 283.2(418.5) N/A N=17 249.4(260.8) N=5 79.4(54.1) N/A N=2 78(107.4) N=159 270.4(396.7) 93(75.6) 1(0.8) 23(18.7) 3(2.4) 1(0.8) 2(1.6) 123 N=88 130.9(228.0) N=1 387.0(N/A) N=22 130.5(153.9) N=2 74.0(67.8) N=1 140.0(N/A) N=2 108.0(152.7) N=116 131.7(211.0) Prepared by Applied Behavioral Health Policy / The University of Arizona