Outcomes measures assess clinical outcomes, such as emotional and behavioral functioning, and non-clinical outcomes, such as cost effectiveness and perception of care. The Minnesota Mental Health Action Group (MMHAG) created the Quality and Performance Work Group to ensure credible information is available to families for choosing mental health providers and evaluating the care and services they and their children receive. The group recommended two major strategies:• Identify standardized outcome measures for statewide use across public and private sectors• Develop a coordinated statewide evaluation system
DHS promotes standardized diagnostic assessments and evidence-based practices to ensure accountability in the mental health system to produce the best possible results with existing resources for children and youth. Outcome measures determine success in meeting the mental health needs of children and their families.
At the direction of MMHAG’s Quality and Performance Work Group, DHS piloted use of the Strengths and Difficulties Questionnaire (SDQ) and Child and Adolescent Service Intensity Instrument (CASII) for two years. In 2009 the Minnesota Department of Human Services commissioner and Minnesota Council of Health Plans recommended adopting the CASII in conjunction with the Strengths and Difficulties Questionnaire (SDQ) as the statewide outcome measures for children and youth receiving public and private mental health services.
The SDQ is a brief behavioral screening questionnaire for 3- to 16-year-olds to detect their general symptoms and developmental assets. The first section examines emotional symptoms, conduct problems, inattention-hyperactivity, peer problems and prosocial behavior. The second section assesses the impact of these symptoms on the child and the family or school environment. There is also a follow-up section that asks whether the intervention has reduced problems and helped in other ways. Children, parents and teachers can complete separate versions of the SDQ.
The CASII is an instrument designed to objectively determine the service needs of children and adolescents (ages 6 through 17). Mental health providers rate children and youth on eight dimensions in terms of the strengths and problems. In addition to these ratings, the CASII provides a composite score and level of care recommendation.
The Early Childhood Service Intensity Instrument (ECSII) focuses on the service needs of infants, toddlers and children from ages 0 to 5 years in the context of their families and communities. These young children and their families may need services from a variety of providers and natural supports to meet behavioral, emotional or developmental needs. Based on a developmental and systems perspective, the ECSII recognizes the changing capacities and needs of children over this rapid period of development as well as the range of individual variations among children in normal development. The ECSII considers the relationship of risk and protective factors embedded in the children’s communities and families to children’s temperaments and abilities.
The American Academy of Child and Adolescent Psychiatry developed the CASII and ECSII as tools to objectively determine the service needs of children and adolescents and evaluate their overall functioning across various settings regardless of the diagnosis or system. Both the CASII and ECSII consider child development and the importance of family and community. They apply to a wide variety of treatment environments as well as child and adolescent needs. These tools are similar in origin and format to the Level of Care Utilization System (LOCUS), the instrument for determining the appropriate level of service intensity for adults with mental illness.
With funding from the Centers for Medicare and Medicaid, the Department of Human Services began to develop an outcome measurement system in 2007. This system will later become part of a larger performance management system for all children’s mental health services.
The first phase of the system allows for scoring and reporting on the Child and Adolescent Service Intensity Instrument (CASII) and the Strengths and Difficulties Questionnaire (SDQ). Mental health providers access this system through MN-ITS, the DHS billing system for Minnesota Health Care Programs (MHCP). Statewide training and implementation began the summer of 2009.
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