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The Lighthouse Ohio Consumer Outcomes Protocol

1. DG uoissiupy uuig jo ajoa p sn jueuunjjsu 1DN SISOVW Bunos pupu uayM esn 10j 340doa su3Buoa13S SOWODINO Jeuunsuo OIYO 43 podas Su uo sway Ajuoud lu GO ul 104 X JOW sD d SJUSWWOD LILILILILIJLILI LI EI LILILI LI LI LT LI AJOL SJJeuinsuo suu l BuiMoj oJ ul o AJ AIIDB N pepuodsay 1euunsuo DG uoipujsiumupwy a1 3 s n SAT 9UIDN JU9I 2 DG uoissiupy upig JO lbq pesf Iu uuniisuj ON SISOVW Buuo2s pupu ueu asn 1oJ Faoday sBej J pay seuio2jno 1euinsuo OYO 44 What Do the Scores Tell Us About the Individual Consumer Item and subscale scores provide critical perceptions of the responding consumer or the provider s critical clinical evaluative judgments primarily about the level of functioning of the consumer that directly or through deduction or inference can be used as a barometer of the recovery process The scores indicate the relative strength of these perceptions but they do NOT indicate the relative importance or priority of these perceptions to the provider or consumer That is why thorough discussion is required with the consumer before deriving implications or devising recommendations Not all consumers are equally ready to participate in discussions about Outcomes and treatment planning For those consumers who may want or need some training about how to use the Outcomes information a program exists called Climbing into the Drivers Seat The hand
2. Black African American IB Hispanic Latino e Ej Asian i B Other i H Unknown BH First Name The first name of the client Last Name The last name of the client Date of Birth Ihe date the client was born Date The date that the instrument was completed by the respondent client family member or Agency worker Child s Grade Choose one Child s Sex Choose one Race Specify race of client by selecting from the drop down menu Note You must fill in all of the boxes with either a Yes or No response For public records if you enter a UCI that already exists in the database the individual s personal information Date of Admission Name and Date of Birth from the previous record is automatically filled in on the Header page This information can be modified in your new record but should only be changed if absolutely necessary 29 Header amp Demographics Tabs Adult Consumer Outcomes Tracking Date UPIL Administration Part 4 Empowerment I Quality of Life Part Date The date that the instrument was completed by the respondent client family member or Agency worker First Name The first name of the client Last Name The last name of the client Date of Birth The date the client was born Gender Choose one 30 UCI Tracking Date UPID Administration Part 1 Quality of Life Part 2 Health Stigma Part 3 Symptoms Part 4 Empowerment Part 5 Demographics Adult Consumer A _
3. ConsumerA Part 5 62 Last school grade completed 63 Race 1 no 2 yes J White H Native American Pacific Islander BH Black African American Hispanic Latino Asian BH ther Unknown BH 64 What is your current marital status BH 65 What is your current living situation BH 66 What is your current employment status 67 Are you in treatment because you want to be H Next Last school grade completed Specify race of client by selecting from the menu Race Specify race of client by selecting from the drop down menu Note You must fill in all of the boxes with either a Yes or No response Items 64 67 Select from the drop down menus G Searching and Modifying Outcomes Data he third and fourth options on the Main Switchboard allow Template users to search for a particular record that was entered previously and add and or change the record Like data entry there is a separate search modify function for public and private records The difference is that when searching for a Public record you can search by UCI or by the client s name and date of birth When searching for a Private record you can only search by name and date of birth since Private records are not assigned a UCI Note that searching by the UCI currently reveals no records that is an error with the software search instead by Name and Date of Birth instead When you select one of these functions a dialog box
4. Similarly the youth may lack hope about the future Because of this the Ohio Scales incorporates a four item scale to track hopefulness over time Clinicians may find useful information about the parent s or youth s level of hopefulness over time by tracking changes in the Hopefulness total scale score Use of the Adult Consumer Provider Outcomes Care management opportunities at the agency level exist 1 within the consumer direct care provider interface and 2 at the organizational agency level The consumer and direct care provider would typically use the responses to individual items subscale scores and total scale scores on each instrument This information could be used to develop and or revise individual treatment plans or discuss a specific or immediate concern and strengths of a consumer Aggregate data can be used by program managers within an agency to look at program effectiveness or to suggest areas in which more emphasis is needed If aggregate subscale scores or total scale scores indicate gaps in services or community resources then the agency could develop new programming or encourage consumers along with advocacy organizations to develop community resources The following are some suggestions about how data from the Adult Consumer Outcomes can be used Quality of Life A clinician should closely examine items 1 12 to identify areas in a consumer s life that are particularly problematic or should be the focus of treatment pl
5. consumer has attained stability but is not employed the supervisor and clinician may brainstorm about ways to help the consumer obtain employment if the consumer desires this This may require a modification in services Staff Development e All Lighthouse clinical staff benefit from ongoing review and continuous improvement of client outcome data and data use practices Using both individual and aggregate data the clinical supervisor can begin to identify staff developmental needs to ensure competence with the diversity of client populations and mental health issues served by the program e Comparison of outcome data with ISPs allows assessment of staff clinical formulation and service planning skills including staff competence with collaborative person centered planning selecting appropriate and effective interventions and evaluating client progress and the impact of services e Aggregate problem and functioning data can be used to illuminate the most common and problematic presenting needs of clients to focus on in developing staff assessment planning and intervention skills e Aggregate satisfaction data can be used to help staff identify strategies to most acceptably and effectively provide services Transitional Planning e Transitional Planning By reviewing client progress and changes in client needs as evidenced by the Ohio Consumer Outcomes Clinical Supervisors can assist staff in identifying clients readiness to transition from
6. Autonomy Divide by 6 do not compute activism autonomy Empowerment 34 35 46 60 Sum responses If one or more responses are missing 1 00 4 00 Higher scores indicate Optimism amp Control Divide by 4 do not compute higher levels of Over the Future optimism control over future Empowerment 37 40 43 48 Reverse score the If one or more responses are missing 1 00 4 00 Higher scores indicate Righteous Anger bolded items do not compute higher levels of oum responses righteous anger Divide by 4 Empowerment Reverse score If less than five responses are missing 1 00 4 00 Higher scores indicate Overall appropriate items compute the score using the higher levels of Sum responses completed items empowerment lower Divide by 28 If five or more responses are missing scores indicate lower do not compute levels of empowerment symptom Distress Sum responses If less than five responses are missing Higher scores indicate Overall compute the mean score using the higher levels of completed items insert the mean for distress lower scores missing responses and sum indicate lower levels of If five or more responses are missing distress do not compute Quality of Life Sum responses e If one response is missing compute Higher scores indicate Overall Divide by 12 the score using the completed items more positive feelings e If more than one response is missing do not compute 35
7. Instrument Type C Adult C Adult A C Adult B hio Scales Ohio Scales C Ohio Scales C CARAS C PECFAS Consumer Provider Consumer Youth Agency Worker Parent Form Form Form Farm Form Form Administration C nitial C 3Manth C E Month g Manth Annual C Termination MACSIS LICHE 3101010 Date of admission ot 01 2004 Agency ID UPID fi 0126 Diagnosis Type B oJ LYS User ID more cuoco E Board ID Company Cade HAMIB _ Secondary dx County of residence Group HAM deem ipe iain Program Discharge Date 8 172004 Proqram Hame TFC 2 Tracking Sheet Tab Tracking Date The date that an Outcomes record is entered into the Template This field is completed automatically and defaults to the current date Transaction Type Check New Record for all but records called up for edit Refusal Type Most times check Person Completed Instrument Type Indicates the specific instrument for which data are being entered This field is completed automatically based on the instrument selected on the Instrument Menu and cannot be changed Administration The survey administration number Initial 3 Month 6 Month 9 Month Annual Termination MACSIS UCI This is the client s UCIID Agency ID UPID The Universal Provider ID number UPID assigned to your Agency by ODADAS The UPID number for all Hamilton County Lighthouse programs is 10128 For Dayton Day Treatment it is 11166 LYS User ID This is the
8. Outcomes template If this is your first time accessing the template skip to page 29 2 Log in using your LYS user name The password is HARMONY 3 Select the desired activity you will be entering new data on clients modifying previously entered data or accessing reports t is very important that you select the correct type of record for your client If we are billing Medicaid for the client then you must select Public Record If we are not receiving Medicaid monies for the client select Private Record 4 Select your assessment type 5 Enter data from the Tracking Sheet Make sure to enter your user name and your program name and admission date where indicated 6 Select the Header tab Complete all sections Select the Scales tabs and enter all data found on the assessment 8 When finished click on the Next button at the bottom right of the page This will bring up a dialogue box that will ask if you want to save the record Say Yes A Introduction Welcome to the Data Entry and Reports Template User s Guide This User s Guide is intended to provide helpful information regarding the use of the Template It is divided into several sections starting with an overview of the Template and an explanation of how to navigate through the Template The next section of the guide explains how to enter Outcomes data how to search and modify existing records in the Template how to generate reports and how to export Outco
9. Problem Severity score after treatment that is more similar to the scores for the general population than to other clinical samples e Second the change for a consumer must be reliable the pre to post treatment change must be large enough that differences can be attributed to real change and not to measurement error Jacobson and Truax 1991 provide a method to calculate a Reliable Change Index RCI The change is considered reliable or unlikely to be the product of measurement error if the change index RCI is greater than 1 96 If the consumer meets both criteria movement from one distribution to the other and an RCI greater than 1 96 then the change is considered clinically significant 58 A number of other issues must be considered when using the Jacobson method but a thorough discussion of the difficulties and issues is beyond the scope of this manual Similarly the technical description of RCI calculations is beyond the scope of this protocol Interested readers can refer to the Technical Manual Ogles Melendez Davis amp Lunnen 2000 or other sources for a more detailed review e g Ogles Lambert amp Masters 1996 Consumer Meaningful Change Clinical Significance Using the Jacobson method and the averages for our samples we can identify cutoff and change scores that are necessary for calculating meaningful change The Ohio Scales User s Manual presents examples of cutoff scores and change scores for the Problem Sever
10. are missing do not compute How to handle missing items If less than five responses are missing compute the mean score using the completed items insert the mean for missing responses and sum If five or more responses are missing do not compute If less than five responses are missing insert a score of 3 for the missing responses and sum If five or more responses are missing do not compute If one or more responses are missing do not compute If one or more responses are missing do not compute 000 100 00 80 04 24 Higher scores indicate more severe problems lower scores indicate less severe problems Higher scores indicate higher functioning level lower scores indicate lower functioning level Higher scores indicate less hopefulness lower scores indicate more hopefulness Higher scores indicate less satisfaction lower scores indicate more satisfaction How to interpret scores score 000 100 00 80 04 24 Higher scores indicate more severe problems lower scores indicate less severe problems Higher scores indicate higher functioning level lower scores indicate lower functioning level Higher scores indicate less hopefulness lower scores indicate Higher scores indicate less satisfaction lower scores indicate more satisfaction Ohio Scales Worker Version Scale 1 20 on first page Problem Severity Functioning
11. following values should get written into your database Item or Subscale Form A Score Form B Score Self Esteem Self Efficacy Power Powerlessness Now What If your system computed the correct values involving reverse scored items you re finished everything appears to be fine However if you ended up with values that are different than those shown in the tables other than insignificant rounding differences on a second decimal there appears to be a problem with the way your system computes reverse scores and you ll need to find out what s wrong 4 Section 5 OCO Interpretation amp Use Once the Ohio Consumer Outcomes have been administered and scored the data is available for interpretation The type of scoring used will determine how data is interpreted This section will look at the various ways that information derived from the administrations of the Ohio Consumer Outcomes may be used in Service Planning and Progress Reviews It will also look at the reporting tools that are available through the ODMH Outcomes Data Template and how to access them The next two pages contain blank Strengths and Red Flags reports for use when hand scoring the assessments 42 jodaiJ Su UO SWS Ajuoud S8JU GO ul 104 X MOW sD d SJU9UJUJ02 LILILILILILI LI LI LI LTELI ELI LI LIE TE 4 AJUOld SJJeuinsuo2 sui9j BuiMoj oJ eui ol AJaAuisod pepuodseay uinsuoS 9JDq uoinpJjsiumupyv G1 1e5f SAT SWDN 4934
12. her own understanding of the question is what counts If the consumer does not understand a word give them the dictionary definition of the word Do not script or re interpret questions for the consumer e Providing Focus As a way of helping the respondent focus read the question and each response choice aloud using a pencil to focus the person s eye on each word as you read it Use a sheet of paper to cover extraneous sections e Probing Probing is a set of interviewing skills designed to help a respondent choose a response when they are unclear about which response best suits what they feel think or believe The art of probing is to lead the person to choosing what he she ends up feeling or believing is the best fitting choice for him her without unduly leading or biasing the respondent in the process When a respondent isn t sure about an answer the first principle is to break a multiple choice response format down into a series of choices between two responses If the person has no idea which of multiple choices makes the most sense start at the extremes of the response format with the first and the last choices Ask the respondent which end feels more right More typically respondents have difficulty choosing amongst choices in the middles of scales Rephrasing works well in many cases Real world examples to which the particular respondent can relate are often helpful in assisting him her to choose a response e Issues to Avoid When
13. information regarding specific programs These numbers may be very useful in reporting to regulatory bodies or in attempts to gain agency funding It should be noted that average change scores reported in this fashion do not include information regarding the causes of change Unless control groups or some other form of control has been used in an experimental fashion consumer improvement could be due to other factors than treatment As a result administrators should be careful how they make attributions about Outcomes data collected from a single group tracked over time e Satisfaction with Service The clinician may also examine the Satisfaction Scale to see if the consumer is satisfied with behavioral health services In addition the Satisfaction Scales may be aggregated to give an overall picture of consumer satistaction with services Reports of high consumer satisfaction with services can be helpful in communicating overall agency 55 effectiveness Conversely if consumer satisfaction ratings are less favorable this would provide important feedback to the administrator regarding specific programs e Change in Hopefulness One key ingredient for family involvement in behavioral health services is the parent s hopefulness about being able to parent and care for their child When families seek services they are often physically tired and emotionally discouraged by the challenges of raising a child with serious emotional and behavioral problems
14. is designed to help you ask meaningful questions about overall Lighthouse county or state wide Consumer Outcomes and get them answered How Does the ODM Work he ODM accomplishes guides the user to the desired information through two sets of simple easily understood questions supported by on screen lists and instructions Some prompts require an entry others are optional As the user responds to each prompt the ODM will present the next appropriate options based upon the prior selection e Using Outcomes Data for Program Planning A Note of Caution The Ohio Mental Health Consumer Outcomes System provides valuable information to users and purchasers of services However there are two key cautions and qualifications that must be taken into account before using the Consumer Outcomes information for funding and selective contracting with agencies provider organizations 1 there are very few empirically established causal links between specific mental health system services specific agencies or specific workers clinicians and consumer outcomes and 2 comparisons of Outcomes across mental health boards or agencies provider organizations or workers clinicians should be viewed with extreme caution i Outcomes findings should be used as indicators of areas requiring further exploration and subsequent treatment program and system planning ii It is not appropriate to assume the cause of a given finding can be attributed only to the mental heal
15. may be able to offer additional information to encourage participation Instructions to the Consumer Once you are as sure as you can be that the consumer understands his her rights agrees to proceed and appears capable of participating move on to showing him her how to complete the survey You should address the following points e Understanding the Items Emphasize that the respondent should never proceed with a survey question if he she is unsure of either its meaning or how to respond but that it is his or her own understanding of the question that should be used in answering If the consumer does not understand a word let him or her know that you or some other person will provide a definition e How to Select a Response Make sure the respondent knows how to select choose his her survey answers i e how to use the response formats e Changing Responses Tell the respondent that he she can change the answers by erasing and putting a new check mark or X in the better response choice e Completing All Items Ask the respondent to please answer all the questions unless of course there are ones that they would rather not as explained in their rights as a participant Providing Assistance to the Consumer It you apply these guidelines you will have a fairly good idea whether or not the consumer will need assistance to complete the survey Suggestions for assistance include e Providing Limited Guidance Tell the consumer that his or
16. not sent to the Board or ODMH Entering private records into the Template allows an Agency to track Outcomes for all clients not just those that receive public funds More information on entering Outcomes data is provided in Section E of this document NOTE All records exported to the Board must be entered as public records and have a valid UCI A note about clients who may start out as Private and move into Public There is no way to move a client s information from the Private part of the database to the Public part of the database by using the Template interface If you have a client who needs to move from one to the other the data will need to be moved at the Table level Please email Tina Bowen and she will see that the appropriate records are moved 2 The third and fourth options allow Template users to search for records and to add and or change records that were entered previously Like data entry there is a separate search modify function for public and private records Section F contains additional information about the search modify function The next options allow Template users to generate individual level reports for use in treatment planning with clients Again there is a separate reporting function for public and private records Section H of this document contains additional information about the reporting function To close and exit the Template click the last option Exit Program A dialog box will appear to confirm that you
17. of a diagnostic measure such as the Child Behavior Checklist Achenbach amp Edelbrock 1983 Nevertheless much useful information is available upon initial administration of the Ohio Scales While the consumer is responsible for participating in recovery oriented activities the clinician s job is to facilitate the recovery process To this end clinicians can use the Ohio Consumer Outcomes survey results in the following ways As a means to engage the consumer in their treatment as well as provide structure to the therapeutic relationship To identify needs that require immediate attention To identify consumer issues concerns as well as strengths that the clinician might not otherwise be aware of Also by reviewing the highest and lowest consumer ratings on the survey the clinician can identify the consumers strengths and needs This information can then be used to develop the treatment plan with the consumer To empower the consumer family member by incorporating his her self assessment into treatment planning Use individual scores over time to identify strengths and weaknesses may display in run charts bar charts To support Treatment Planning that is individualized and Recovery focused and to support agency Care Management activities s Compare and contrast high and low individual Outcomes scores May trend changes in domain scores over time Generate a Care Management Report that includes the total scale subscale and single question scor
18. past 90 days the youth was residing in that setting The total of all the days will therefore add to 90 Although the authors of the Ohio Scales did not develop this scale it was felt that tracking this information could be helpful to the agency worker the agency and the overall system The worker should identify the categories that most closely resemble the settings in which the youth stayed Scoring for this scale is not included on the form but it is possible to compute a score if the worker thinks it would be a meaningful measure of the child s treatment progress Each setting is given a statistical weight as listed in the table below To get the ROLES total score each weight is multiplied by the number of days in the blank next to the setting The sum of these products is then calculated to get a total The total is then divided by 90 to get the average Restrictiveness for the previous 90 days compute score score missing items Scores score If less than five responses are missing g s the mean score using the completed items insert the mean for missing responses and sum If five or more responses are missing do not compute If less than five responses are missing insert a score of 3 for the missing responses and sum Example If during the last 90 days a child was placed in a juvenile detention facility for 2 days a group home for 12 days and with the biological father for 76 days the ROLES score wo
19. percentage of your eligible clients is incorporated into the Outcomes System at this point How are clients and appropriate family members being approached and or trained about the Outcomes System Describe the method s you are using for data collection e g manual data entry and use of the ODMH Data Entry and Reports Template How are staff keeping track of being reminded about when initial and subsequent Outcomes administrations are due How are you handling both critical error reports and informational error reports from the board about Outcomes data transmitted 2 Outcomes Data Use in Treatment Planning Describe the ways in which Outcomes data are being used in treatment planning How are clients and appropriate family members involved What is the process What is the process by which the agency gets Outcomes data to the clinician and the client to enable the data to be used in a timely fashion in treatment planning Where are Outcomes instruments and or data subsequently maintained 3 Outcomes Data Use in Lighthouse Quality Improvement Performance Improvement Describe how Outcomes data are being used in agency performance improvement activities How are data being aggregated Are they being combined with other data What kinds of reports are being produced Which agency staff are involved in developing and reviewing these reports What kinds of actions have been taken in the agency due to the performance improvement process In addition t
20. really want to exit the Template 22 F Entering Outcomes Data 1 The Instrument Menu When you select one of the two data entry options on the Main Switchboard the menu of Outcomes instruments appears These are the instruments for which data can be entered into the Template The title bar at the top of the menu indicates whether you have chosen to enter a public or a private record Click the button next to the name of the instrument you would like to enter To return to the Main Switchboard click the Return to Main Menu option Adult Consumer A _ Adult Provider A _ Adult Consumer B mJ Ohio Scales Youth m Ohio Scales Parent mu Ohio Scales Agency Worker __ CAFAS Option __ PECFAS Option gu Return to Mam Menu 2 Types of data entry fields There are several types of fields you will encounter when entering data Descriptions of these different field types are provided below Text boxes Text boxes allow you to manually type in values Typically you are restricted in the type and amount of data you can enter in these fields For example the UCI field allows you to only enter numbers no letters and you cannot enter more than 12 digits Example MACSIS UCI MACSIS UCIH 23 Option boxes These boxes contain a set of options from which you can choose You select only one option out of the set by clicking on the circle next to the desired option Example Gender Child s Sex Male Fema
21. use of aggregate Outcomes data at various stages of the project Exhibit 9 amp 12 In the past year have you prepared any agency performance improvement reports that contain Outcomes data analyses and interpretation Exhibit 14 In the past year do you have any agency executive team and or agency board of trustees minutes that reflect discussion demonstrating use of Outcomes data Exhibit 11 an ue Planning Total if the total is 6 or more no action is necessary If the Preparation amp Implementation Total if the total is 6 or more no action Performance Total A B If the total is 6 and neither section A or B total is less than 6 the agency should submit a Plan of Correction indicating is necessary If the total is less than 6 the agency should submit a Plan of Correction equals zero no Performance Plan of Correction is necessary If the total is less than the steps it intends to create the ability to lay the groundwork for use of indicating how it intends to prepare staff and consumers family members regarding the use 6 or if section A or B equals zero the agency should submit a Plan of Correction Outcomes data of Outcomes data Exhibit 5 indicating how it intends to address actual use of Outcomes data for Treatment Planning and or Performance Improvement 5 The Ohio Youth Scales Focus and Intent The Ohio Youth Problem Functioning and Satisfaction Scales Short Form Ohio Scales are designed to assess behavi
22. youth may need to be assessed for serious risk of harm to self or others or for disturbed thinking It may also be helpful to check whether the parent and youth give different information on these critical items Target Problems In developing a treatment plan the next section to check would be the Problem Severity Scale on the front of the instrument A quick scan will tell the clinician the problems that are endorsed as occurring most frequently These problems are likely to be the most relevant to the treatment and can be included as target problems in the treatment plan Again any differences in the ratings by the parent and youth may prove helpful in dealing with both the youth and the family e Functional Strengths The next section to check would be specific responses to the Functioning Scale on the back of the page Any functioning items that are rated highly may be noted as strengths A rating of 3 or 4 on a functioning item identifies specific attributes or activities that can be included in the treatment plan as personal strengths The clinician may also take note of any specific functioning questions that might improve rapidly and then be helpful in working on problems For example improvement in hobby participation or appropriate recreational activities might quickly aid improvement in self concept or relationships with peers or family e Compare Total Scores In addition to initial use of individual item responses to aid with the s
23. 5 Item Scale Aggressive Behavior 1 Item Community Functioning Computed Score Safety and Health 9 Independent Items What is Measured e Intake complete prior to Narrative Summary and ISP Every 3 months as part of the ISP review with the exception of TLP whose ISP updates are completed every 6 months therefore administrations will occur with greater frequency than ISP updates Completion time It typically takes higher functioning consumers between 10 and 20 minutes to complete the Adult Consumer Form and lower functioning consumers between 30 and 40 minutes to complete the Adult Consumer Form Some consumers particularly those who are unable to read or those whose functioning level is low may take longer or may require assistance When Administered Items are worded to reflect ability level or self management skills independently of services received The reference group for making ratings on this instrument should be all the adult consumers the clinician has ever known not just the consumers on the current caseload The clinician s observation of the consumer s behavior self reporting of behavior reports from significant others and clinical judgment should all be used as sources of information on which to base the ratings Please note that the ratings are based on the consumer s highest level of functioning during the past six months Section 2 Administration The Outcomes process is about making evidence ba
24. Adult Consumer Form the worker might be able to spot combinations of items like a low sense of empowerment coupled with an indication that the person can t get their concerns about medication answered that would be even more meaningful For example it could lead to a plan that would help the consumer in being more assertive with his her doctor e Clinicians and other direct care providers could compare a person s scores over time and pick out the one or two areas where there has been the most improvement These results could then be shared with the consumer since it is meaningful for consumers to have feedback about areas in which they are doing well The Overall Instrument Looking carefully at the whole instrument even without scoring into subscales is a very valuable aid for clinicians and other direct care providers Sometimes individual questions have more nuance for a treatment plan than would a subscale This is clearly critical for the Symptom Distress component This whole section of the instrument sums to just one score and that will be useful at all three levels of the system However clinicians and other direct care providers would likely be more interested in which symptom areas were causing the most distress e The instrument can help clinicians and other direct care providers know where to advocate for the consumer For example if consumers are having housing problems can t get medication questions answered and or are havi
25. ID Imarey Consumer responded positively to the following items Functioning i1 Ta what degree da you have troubles getting along with friends 412 To what degree do you have troubles attending school and getting passing grade Eg Adult Consumer Form A Red Flag Report MACSIS UCI 0202020 Date of Birth 08 0871 388 Client Name Wey Stead Admission Date 01 01 2004 Administration Date 03 71 0 2004 Provider ID morey Consumer responded most negatively to the following items Quality of Life 1 Haw do vou feel about the amount of friendship in your lite a2 Haw do vou feel about the amount of money in your lire G3 Haw do you feel about how comfortable and well off vau are financially a4 Haw do you feel about how much money you have to spend for fun 5 Haw do you feel about the amount of meaningful activity in your life such as work school volunteer activity leisure activity QB Haw do you feel about the amount of freedom you have 47 Ohio Scales Version Comparison Report This report consists of line graphs that compare Youth Parent and Worker responses on the Functioning and Problem Severity subscales across three previous administrations A table containing the actual subscale scores for each respondent is located at the bottom of each graph Ohio Scales Version Comparison MACHBIB UA 0101010 Cllant Name OCelin guint DabnfElrh G3 se Adminiciradinn Parod DHTHCETE tb DU70U47TKI o
26. Outcomes information for adult consumers or child amp adolescent consumers GO Source of Data Required Source Child and Adolescent Consumers Measurement Source Required Consumer Outcomes scores come from multiple sources Whose measurements of the consumer would you like to see O Consumer Characteristics Optional Ger All Genders Combined Race All Races Combined Age All Ages Combined Diagnostic GrouAll Diagnoses Combined Education Range All Education Ranges Combined Consumer Characteristics Optional List any special characteristics of the consumers for whom you d like to see Outcomes scores If you re not interested in making a specific selection for a given characteristic select the All Combined response i e the first selection in each section Time the Consumers Have Been in Treatment Required Time in Treatmen All Time in Treatment Values Combined Time the Consumers Have Been in Treatment Required Outcomes are measured at various points during a consumer s treatment Indicate the approximate time in treatment as measured in time since last admission that best describes the consumers for whom you d like to see Outcomes scores 76 Reporting Period Optional Reporting Y ear 7 Fiscal Y ear Calender Y ear 2006 Reporting Period All Quarters Combined cS Include Results f Reporting Period Optional Outcomes can be examined according to the
27. Probing Don t try to sum up the respondent s response in your own words stick to the choices in the response format Don t define the respondent s answer for him or her get him her to do it Don t over probe If the respondent becomes irritated annoyed or very frustrated stop and go on to the next question Completing the Survey Process After the person has completed the survey thank him her and provide assurance that the information will be very helpful in treatment For a respondent who has low self esteem is timid or otherwise doesn t express much self confidence you may want to make him her aware that in just a few minutes he she made dozens of decisions Ask the person to review his her responses and make sure each is answered the way he she intended Collect the survey packet and quickly review the person s response pattern If for instance the person consistently selected the first response choice for every question you need to ask the person if that s how he she truly meant to answer In other words did he she understand the questions and the response format Section 3 Data Entry Once the Ohio Consumer Outcomes have been administered the data needs to be entered into a database Lighthouse Youth Services uses the ODMH Data Entry amp Reports Template to enter the data trom the Ohio Scales and the Adult Consumer Outcomes measures Each program is responsible for their data entry This section will guide the user in how t
28. Provider Adult Form Scale Items used to How to compute How to handle How to interpret compute score score missing items scores score Overall Activities of 6A 6H e Sum responses e f one response is missing compute 1 00 5 00 Higher scores indicate Daily Living e Divide by 8 the score using the completed items higher functioning If more than one response is missing level with regard to do not compute daily living activities Overall Community 1 11 See instructions on If less than four responses are 11 55 Higher scores indicate Functioning page 6 of this missing compute the mean score higher level of document using the completed items insert the community mean for missing responses and sum functioning e f four or more responses are missing do not compute Computation of the Community Functioning Scale from Provider Adult Form The first 11 items from the Provider Adult Form A can be combined to compute a Community Functioning score The process has several steps as follows 1 Recode all items marked Unsure or Not Applicable to Missing 2 Because of the different nature of the various questions some standardization is required before the responses can be combined into a single Community Functioning score Item 1 Social Contact should be recoded as follows e 1 Withdrawn Isolated e 2 Minimal Contact e 3 Moderate Contact e 5 Optimal Contact Items 5 Forced Moves and 11 Aggressive Be
29. The Lighthouse Youth Services Ohio Consumer Outcomes Protocol A Lighthouse Youth Services d Performance Improvement Project Table of Contents Section 1 Overview Lighthouse amp the Ohio Consumer NEUE Outcomes zl fy nee The ODMH Outcomes Rule A NNNM Assessment Description o s o section 2 Administration NR Frequency amp Administration Tracking ds Guidelines for Administering the Ohio Consumer s QUT OM ES es Io s ZUSCtioen 3 CcoO f U aaa 15 Section 4 Data Entry 55 24 HERE Data Entry Section Table of Contents J _ re Data Entry Quick Start DT section 5 OCO Interpretation amp Use 5 42 a Blank Strengths Report for Hand Scoring A eee Blank Red Flags Report for Hand Scoring AA Individual Client Reports Using the Outcomes Data PECES Template iii A Using the OCO in Service Planning U 99 _ re Determining Clinically Significant Change SB s ee How to Engage the Client in Using OCO Data CHENT WY USING A IC Oo am Section 6 Using the OCO in Supervision 64 LIGHTHOUSE YOUTH SERVICES Section 7 Using the OCO in Performance Improvement 67 x C E Section 1 Consumer Outcomes Overview Lighthouse amp the Ohio Consumer Outcomes The purpose of this protocol is to educate Lighthouse staff members on the Ohio Consumer Outcomes Rule the instruments used in assessment and their administration and scoring as well as interpretation use i
30. al your computer s C drive Open the folder and drag the file Copy of ODMHoutComeslocal mdb to your desktop Double click on the icon the template will open and the logon screen will appear D Logging On to the Template When the Template is opened the first screen that appears is the Logon screen When the Template is being opened for the first time the Agency and Password boxes will be blank In the Agency box enter your Agency s assigned Universal Provider ID number UPID The UPID number for all Hamilton County Lighthouse programs is 10128 For Dayton Day Treatment it is 11166 After entering the UPID enter a password The password is Harmony it is not case sensitive When opening the Template in the future the Agency box will be filled automatically with the previously entered UPID Just enter the appropriate password and click OK to proceed to the Main Switchboard Export Reminder Since all of the data will be housed in one location it will not be necessary for users to use the export feature contained in the software Even though you will not be exporting files there is a reminder that may pop up atlog on Ignore the reminder and click OK to proceed to the Main Switchboard Export Reminder x The Following instrument types contain records that hawe been entered within the past two weeks but have not been exported Ignore this Please remember to export them message and Adult Consumer Form A Click OK Adult Provi
31. anning e g Meaningful Activity Family Relationships and Housing Physical Health and Medication Issues Items 13 and 14 should be closely monitored to ascertain whether a referral to a physical health care provider is indicated or whether the agency s medical statf needs to address the consumer s concerns about medication Symptom Distress Identification of specific symptoms with lowest ratings as well as other areas in the questionnaire having ratings that indicate lesser levels of problems to identify strengths e Comparison of symptoms with highest distress ratings with other areas in the questionnaire having high ratings to explore possible relationships between items for setting goals 56 e Comparison of consumer s global symptom distress scores over time Making Decisions Empowerment Scale Comparison of items with the best empowerment ratings as well as items in other areas having high ratings to identify strengths e Comparison of items with the worst empowerment ratings with items in other areas having low ratings to explore possible relationships between items for setting goals e Comparison of the consumer s global empowerment scores over time e A major use of the Making Decisions Empowerment Scale for clinicians direct care providers is to identify areas that they need to work on with the consumer This can be a single item or pattern of items in the instrument Once the worker gets all the information that is in the
32. appears asking you to enter search criteria that will be used to find the particular record for which you are searching The search criteria vary slightly from instrument to instrument For example the Form Completed by field is visible only if the Ohio Scales Parent or Ohio Scales Worker instrument is selected 3l The criteria should be entered from top to bottom since choices for each field are dependent on previously selected criteria For example once you have selected an instrument to find your choices of UCIs are limited to those that have been entered previously for that particular instrument All items must be completed for the search to reveal the data Va HOP mod UE Please enter the following riteria for your search record eee See Y mee Tenn ticum iF Instrument Search Records Dy a T nedha uc Last Hame First Hame Date of Birth m Administration Date et a TI E rr tert Cancel pee piste After setting the search criteria click the OK button The specified record is displayed on the appropriate data entry form Any changes you make to any of the fields in this record will affect the original record i e the changes will overwrite any old values contained in this record when the record is saved After modifying the record a dialog box will appear asking if you want to save the record A second dialog box will ask if you want to mark this record f
33. ared sense of where the client might be in terms of their recovery e he Lighthouse worker should see what view the client has of their longer term future Together they identify how present status supports or presents challenges to the client s hopes e Together they would review the components of the Ohio Recovery Model and try to determine which components might be most relevant to the person at this point in time Similarities and differences in perspectives should be noted and discussed NOR Power amp Clinical Care Peer Support Family Support Meaningful ys Control Activity Community Access to Education Involvement Resources 62 STEP 4 Shared Service Recovery Plan Based on the joint assessment and integration of information that has occurred in Steps 2 amp 3 the Lighthouse worker and Client should identify a limited number of activities to be undertaken to address the recovery goals General Guidelines Use findings as indicators for further exploration Do not assume causes are attributed to the mental health system or specific provider Use caution in interpretation of all data Do not use data for sanctions until it has been proven valid reliable and useful Do not compare providers and board areas based on too little information Recognize your responsibility to monitor inappropriate uses of data Outcomes provides Clients with an opportunity to become proactive strengths based and involved in their treatment decisi
34. ata for Quality Improvement or Performance Improvement activities Percentage of members of a Quality Improvement team who are consumers who have received training in using aggregate Outcomes data for Quality Improvement Percentage of agency executive team minutes that contain aggregate Outcomes data and discussions of possible improvement strategies Date 4 02 07 Performance A Treatment Planning Submit an example of supporting documentation for all items with a response of 1 or 2 0 lt x Under 50 1 amp 50 75 2 lt X Over 75 In the past year what percentage of active cases show evidence that Outcomes data were used in Diagnostic Assessments the treatment planning process and or Progress Notes Exhibit 9 In the past year what percentage of clinicians was actively using Outcomes data in treatment planning Exhibit 9 amp 13 In the past year what percentage of consumers family members report both that they reviewed the Outcomes data with their Clinicians and that the data were used actively in their treatment planning Exhibit 9 In the past year what percentage of clinical supervisors was actively using Outcomes data in their clinical supervision activities per clinical supervision reports Performance B Performance Improvement Submit an example of supporting documentation for all items with a response of 2 In the past year have you conducted any quality improvement projects that demonstrate
35. below 13 How often does your physical condition interfere with your day to day functioning D Never C Seldomrarely Sometimes Often Always Now enter the sample instruments into whatever electronic system you are using to score and store the Outcomes data Then check to see what scores actually ended up in your system In Scenario 1 the following values should get written into your database Item or Subscale Form A Score Form B Score Self Esteem Self Efficacy 2 Both scenarios are based upon the traditional paper and pencil versions of the Adult Consumer Forms A and B printed in the Outcomes System Procedural Manual The Procedural Manual and the individual forms can be downloaded from the Outcomes Initiative Web Site referenced above 40 Scenario 2 Complete sample copies of Adult Consumer Form A and Adult Consumer Form B with the last box checked for all questions on the instruments as in the example below 13 How often does your physical condition interfere with your day to day functioning If you use the ODMH O Never Outcomes Data C Seldom arely Sometimes Template Often Dd Always If you use the ODMH Outcomes Data Template to Now as before enter the sample instruments into whatever electronic system you are run reports for you client using to score and store the Outcomes data Then check to see what scores actually please see the next section ended up in your system In Scenario 2 the
36. book for this program is available in the training section of the Outcomes Web Site Identifying a Client s Strengths and Red Flags A scale score is the combination of individual questions on the survey that together are a measure of an outcome The scores obtained on each scale can be compared to each other to see where there are areas of strength or need However the instrument does not determine the importance of each area only the consumer can determine what s important to them after carefully comparing the results to their own priorities Scores can also be compared over time to see if there has been progress on goals and objectives on the recovery plan and to see if any other needs arise The client may choose to work with individual questions rather than scale scores because the individual question may be more important to them than the scale score 45 The Individual Client Reports Available in the ODMH Outcomes Data Template There are two Create Reports options on the Main Switchboard one for public records and one for private records These options allow Template users to generate individual level reports for use with clients 1 Types of Reports Several individual level reports can be generated using the Template A description and example of each report is included below At this time the Template does not have a built in aggregate reporting function Change Over Time Report This report consists of a series of line graphs ea
37. ces child parent and agency worker can be charted on the forms e Change in Items It may also be useful in some cases to selectively track specific problem areas that were identified for clinical work In this case the consumer may complete specific relevant questions items more frequently than the scheduled administration of the entire Ohio Scales The Ohio Scales offer great flexibility for individual customization in order to provide the greatest usefulness possible Compare Change in Scales In constructing case conceptualizations the clinician may also find it useful to use scale totals or even specific item responses to better understand theoretically how a consumer is improving Specifically the clinician may look at the improvement over time in the Problem Severity Scale versus the Functioning Scale Does it seem with a particular youth that problems have been disrupting functioning and an improvement in the Problem Severity Scale precedes an improvement in the Functioning Scale On the other hand does it seem with a particular case that functioning improvement provides help with problems The Ohio Scales provides specific information on an individual s changes to help address issues such as these Aggregate Change Tracking results over time also provides useful information to administrators as well as clinicians Administrators may aggregate or average the improvement numbers for all consumers or groups of consumers to obtain
38. ch representing an individual s scores on a particular subscale across administration periods The report is available for the following instruments Adult Consumer Form A Adult Consumer Form B Ohio Scales Youth Form Parent Form and Worker Form See the example below Ohio Scales Youth Form MACSIS UCI 0101010 Client Hame Dd in Quint Date of Birth 0808 1988 Administration Period 01 01 2004 to O7 01 2004 Admission Date 0101 2004 Provider ID Imorey 46 Red Flag and Strengths Reports These reports list items that an individual responded to negatively or positively for a particular administration On the Red Flag Report the results are grouped by most negative and negative responses while results on the Strengths Report are grouped by most positive and positive responses The results on each report are also grouped by the section of the instrument in which they appear e g Quality of Life Symptom Distress etc Both reports are available for Adult Consumer Form A Adult Provider Form A Adult Consumer Form B and the Ohio Scales Youth Parent and Worker forms Both reports also include a Consumer s Priority column in which priority items can be identified by the client and clinician working together in a treatment session Eg Ohio Scales Youth Strengths Report MACSIS UCE 0505050 m Date of Birth 05 0871 388 Client Hame Cally Cowe Admission Date 01 01 2004 Administration Date 01 01 2004 Provider
39. d quality of the service delivery system Trends or patterns of negative or marginal perceptions can indicate disconnects between consumers and providers that have implications for training gaps in services or community resources requiring program planning advocacy collaboration or funding Along with other confirmatory data sources these trends can assist agencies in development of new programs services or resource shifting or elimination of services that are not effective Data from the Ohio Consumer Outcomes should be reported in the quarterly annual Program Summary MIS Reports Program staff will have quarterly discussions of the aggregate Outcomes data and will record all findings in their program CQI workbook Minutes section If the data warrants performance improvement plans will be enacted and updated quarterly in the program CQI Action Planning section Quarterly Outcomes Performance Reviews conducted by agency executive management will regularly review outcomes information Minutes from those meetings will reflect the data discussed and any findings actionable items or performance improvement projects suggested by the data Quality Improvement and Identifying Best Practices One of the most important uses of consumer outcomes is for quality improvement of the service delivery system Using Outcomes data to develop benchmarks reliability and validity estimates and confidence intervals with statewide outcomes data we can determine i
40. der Form 4 Ohio Scales Agency Worker Version Ohio Scales Parent version Ohia Scales Youth version 20 E The Main Switchboard The Main Switchboard presents the functions available in the Template including entering data searching and moditying existing data and creating individual level care management reports The different options can be selected by clicking the appropriate button to the left of the text or by tabbing to the desired option and pressing the Enter key Medicaid clients with a UCI ID Enter a New Public Hecord Enter a New Private Record E S earch Modify an Existing Public Record Non Medicaid clients Bi Search Modify an Existing Private Record E Create Reports Public Records gy Create Reports Private Records E Import Previous Template Utility Ey Exit Program The first two options are both for data entry one for public records and one for private records Public records are Outcomes data that have been collected for clients whose mental health services are paid for in full or in part by the public mental health system These clients have a Universal Client Identifier UCI in the Department s claims system MACSIS Private records are Outcomes data that have been collected for clients whose mental health services are paid by private insurance or other non public funds These clients do not have a MACSIS UCI Private records are NOT included in the export process and therefore are
41. dministration Date 07 01 2004 i dus mm re r J 2s dt Tr 5 hiyi CENE I Pr E ta ie at pai tu L it BI OK L Cancel E m n e un Pd ETE E hy oc L s T t eet ee eae ei pages ll Wi uq n Ke ie E LET ED aer Mee EUER a T 50 Report Criteria Menu for Administration Tracking Report ER i vem dude ns F Starting Date 01 01 2004 7 87 Ending Date 05 0 2004 2 Ts p This EN ETETE both reir p OTT records E E EM the selected ese r ant 05 HE ipid T iter gm Tu DE Pere Le TI iur ut 3t oa PR pora act nl E ale 4 PF i ete GET met ee T rA Lnd t 4 Navigating report display screens If only one report option is selected the requested report will appear in a full screen display If multiple report options are selected the resulting reports will be generated and displayed as different tiles on your screen rather than appearing in a full screen display like single reports To navigate between different pages of a report use the arrows located in the lower left corner of the report screen These arrows will allow you to move to the first page the previous page the next page or the last page of the report Page u 1 rn 4 Read C 5l You can highlight the different report tiles fo make a certain report active When active a report can be printed or its zoom level can be changed for viewing To adjust the zoom level of a report click the magnifyin
42. e returned to the Instrument Menu UPID Administration Part 5 Demographics Part 2 Health Stigma werrment Quality of Life For a public record if you select Yes the required fields are checked to ensure that they contain complete and valid data If data in any of these fields are missing or invalid a brief message about the error appears and the screen advances to the first field that needs to be corrected Records that have incomplete or invalid data in required fields cannot be saved If all of the required fields are complete and valid the record is saved and you are returned to the Instrument Menu Private records do not contain any required fields If you select Yes the record is saved and you are returned to the Instrument Menu 4 Tracking Sheet amp Header screens The Tracking Sheet and Header screens deserve special attention because they contain fields that are critical to the successful entry and use of Outcomes data at the Agency level as well as successful transmission of public Outcomes records to the Board and ODMH The Tracking Sheet is the first screen you see when entering a new record and is the same for every instrument The Header screen is the second tab section of each screen and varies slightly from instrument to instrument Key fields e g UCI Tracking Date UPID and administration are always located at the top of the screen above the tabs These fields are filled in automatically once the corr
43. eceive behavioral health services Each item is rated for severity frequency on a six point scale A total score is calculated by summing the ratings for all 20 items The Functioning Scale is comprised of 20 items designed to rate the youth s level of functioning in a variety of areas of daily activity e g interpersonal relationships recreation self direction and motivation Each item is rated on a five point scale Although the Problem Severity Scale is similar to many other existing symptom rating scales that focus on the severity of behavioral problems the Functioning Scale provides a broader range of ratings This provides an opportunity for raters to identify areas of functional strength A total functioning score is calculated by summing the ratings for all 20 items Higher scores are indicative of better functioning In addition to the Problem Severity and Functioning Scales two brief four item scales on the parent and youth forms assess satistaction and hopefulness Four items assess satisfaction with and inclusion in behavioral health services on a sixpoint scale The total satisfaction score is calculated by summing the four items Four additional items on the parent and youth forms tap levels of hopefulness and well being either about parenting or self future respectively Each of these is also rated on a six point scale The total hopefulness score is calculated by summing the four items Finally the agency worker version of the Oh
44. ers benefit from treatment The statistical tests that researchers offer however do not always provide the most relevant information Statistical tests may be difficult for many outcomes consumers to understand In addition statistical tests do not provide information regarding the effectiveness of treatment for any one individual Similarly the clinical relevance of consumer change is not considered in many research designs Hence methods for determining and displaying the clinical meaningfulness of consumer change may facilitate the description and dissemination of outcomes data Jacobson and colleagues Jacobson Follete amp Revenstorf 1984 Jacobson amp Revenstorf 1988 Jacobson amp Truax 1991 proposed a standardized method for determining clinical significance This method is based on the assumption that clinically significant change involves a return fo normal functioning Jacobson and Truax 1991 propose two criteria for assessing clinical significance e First consumers receiving psychological interventions should move from a theoretical dysfunctional population to a functional population as a result of treatment In other words if the distributions of individuals in need of treatment and healthy individuals are represented graphically the consumer who has completed treatment should be more likely to be identified as a member of the healthy population distribution For example a youth receiving outpatient counseling should have a
45. es for the consumer Compare scale item scores with normative scores or local benchmarks to help identify the consumer s strengths and weaknesses Chart the scale item scores at each administration and compare Outcomes scores over time to statewide data showing scores over time A clinician can collaborate with a consumer to use his her self assessment Outcomes information along with the clinician s Outcomes information to develop an individualized recovery focused treatment plan 53 Outcomes results for a specific consumer can be used to monitor the consumers change over time Graphing the results for each administration of the survey provides a clear picture of the consumer s change or lack of change The outcomes information may also suggest areas in which the clinician needs to serve as an advocate for the consumer Development of the Treatment Plan Administration of the Ohio Scales at admission provides an index of a youth s current problems and level of functioning Answers to a standardized list of questions help ensure that the typical problems and areas of functioning encountered by youth who receive behavioral health services will be covered Critical Items Specific responses to critical items should be checked first Positive responses to items such as hurting self cutting or scratching self taking pills talking or thinking about death or using drugs or alcohol will require the immediate attention of the clinician The
46. esponding data are entered on the Tracking Sheet You do not need to enter data in these fields Required fields labeled in blue in the Template are found only on the Tracking Sheet and Header screens of public records Private records do not contain any required fields Required fields must contain complete and valid data If data in any of these 26 fields are missing or invalid the existing record cannot be saved and the Template will not allow you to advance to a new record Although MACSIS UCI is not labeled in blue in the Template it is also a required field for public records Each record must have a complete and valid Universal Client Identifier UCI in order for the record to be submitted to the statewide Outcomes database successfully If the UCI submitted with an Outcomes record is incomplete or does not match the client s UCI in the Claims MACSIS Member System the Outcomes record will be rejected Required fields in the Template include the Tracking Date Instrument Type Administration MACSIS UCI Agency ID UPID Date of admission Date Instrument Completed First Name Last Name and Date of Birth Tracking Date UPID Administration UCI 101010 8 12 2004 10128 Tracking Header Problem Severity Hope Satistaction Functioning TRACKING SHEET Tracking Date 0932 2004 Transaction C New Revised Refusal Type Person C Person unable Person Type Record Record Refused to complete Completed
47. etween fields and sections The fields on the data entry screens generally go in order from top to bottom left to right Use the Tab key to advance to the next field or press the Tab key while pressing the Shift key to go back to the previous field Tracking Date UPID Administration Part 3 Symptoms Part 4 Empowerment Part 5 Demographics Tracking Header Part 1 Quality of Life Part 2 Health Stigma Since the instruments contain more fields than can fit on one screen the items are divided among multiple tabs for each record you enter Each tab represents a different section of the Outcomes instrument you are entering You can move between tabs in several ways Click the left and right arrow keys in the upper left corner of the screen to move forward and back between sections Click the section title tabs near the top of the screen e g Tracking Header etc to jump to a different section of the instrument Press the Tab key after entering a value in the last field on a page The screen automatically advances to the next section of the instrument unless you are in the last section Advancing to a new record There are two Next buttons on each data entry screen One button is displayed at all times in the upper right corner of the screen and the other button is in the lower right corner of the last tab section of the current instrument For a public record when either of these buttons is clicked the required field
48. examine the scoring rules provided below and build these rules into the software that they use to collect and store Outcomes data It is the responsibility of Providers to compute the correct subscale scores at the local level When a production Outcomes record is received at ODMH subscale scores are computed again in order to verify that they have been scored accurately Subscale scores submitted by Providers that differ more than one tenth or 1 for whole number scales from the state generated scores will be replaced with the state generated score in the statewide database A Note About Reverse Scoring Some items on the adult instruments are worded such that a given response e g never represents a desirable or positive response for one question but a less desirable response for another In order to compare items or combine items into a numeric subscale certain items may need to be reverse scored for consistency When reverse scoring an item the highest and lowest numerical values are substituted for each other the next highest and next lowest values are substituted for each other and so on Keep in mind that items that represent non scaled values e g missing not applicable should not be included in either reverse scoring or computation of subscales When reviewing the guidelines an asterisk indicates that a scale contains one or more reverse scored items and the actual items that should be reverse scored are bolded Example Four Po
49. f a program is working as anticipated e f consumers receiving services from a particular program at an agency routinely display poor outcomes results it may be necessary to review the program operations and goals to identify potential reasons for poor outcomes and make the necessary modifications e likewise if a particular program routinely leads to positive consumer outcomes the program can be reviewed to determine what aspects of the program contribute to consumer success to use in other programs Therefore the Outcomes are used to assist in identifying best practices that result in improved outcomes for consumers and families 69 Using Outcomes to Inform and Guide Lighthouse Leadership e Agency board administrators can use consumer outcomes results to assure that they are meeting the requirements of certifying accrediting or payor organizations e Agencies boards can also use consumer outcomes results to provide educational information to their Board members e Agencies can use outcomes results for strategic planning e Finally outcomes results can be used as a means to improve an agency s board s marketing fund raising and grant writing capabilities 70 Ohio Consumer Outcomes Aggregate Data Available Lighthouse programs and management look at aggregate data and uses it in performance improvement activities Data from the Ohio Consumer Outcomes should be reported in the quarterly annual Program Summary MIS Reports and analysis of t
50. f three or fewer items are missing the individual s mean score on all the other items should be substituted for each missing item before the total score is 36 calculated If four or more items are missing the total score should not be calculated Ohio Scales Youth Version Problem Severity Functioning Hopefulness Satisfaction Items used to compute score 1 20 on first page 1 20 on second page 1 4 on second page left upper corner 1 4 on second page right upper corner Ohio Scales Parent Version kas Items used to How to compute compute score score Problem Severity Functioning Hopefulness Satisfaction 1 20 on first page 1 20 on second page 1 4 on second page left upper corner 1 4 on second page right upper corner How to compute How to handle How to interpret score missing items scores score e oum responses e oum responses e Sum responses e Sum responses e Sum responses Sum responses e Sum responses e Sum responses If less than five responses are missing compute the mean score using the completed items insert the mean for missing responses and sum If five or more responses are missing do not compute If less than five responses are missing insert a score of 3 for the missing responses and sum If five or more responses are missing do not compute If one or more responses are missing do not compute If one or more responses
51. fferent OS Seo diagnoses This is a companion to the Diagnosis By Staff Adult Consumer and Diagnosis Adult Consumer and Provider Provider Aggregate report but can be used alone to compare how U l Cross sectional Aggregate people with different primary diagnoses are doing on average over time Reports the mean scores on the Adult Consumer instrument scales at two user selected time points as well as calculating the number and percentage of cases reliably improved staying the same and reliably deteriorating Reports the mean scores on the Adult Provider Community Functioning scale at two user selected time points as well as calculating the number and percentage of cases reliably improved staying the same and reliably deteriorating 72 Aggregate Youth Reports Agency Wide Aggregate Report for Youth Parent and Worker Ohio Scales Agency forms Summarizes the subscale scores for all three Ohio Scales Cross sectional instruments for all youth clients in the database Program Wide Aggregate Report for Agency Youth Parent and Ohio Scales by Program Worker forms Summarizes the subscale scores for all three Ohio Cross sectional Scales instruments for all youth clients in the database Compares average scores on the Ohio Scales by diagnosis and by Ohio Scales By Diagnosis By Staff staff member It shows how different staff members are doing in Cross sectional treating consumers with different diagnoses This is a companion
52. fiscal or calendar year in which they were obtained Within any particular year you also have the option of specifying a particular calender quarter For what period would you like to see information Outcomes to be Reported Required Outcome Cate Functioning Outcomes to be Reported Required Outcomes are measured for several areas of a consumer s life From which area would you like to see information Note After selecting the Outcomes area for reporting you may be given the opportunity to further specify if you wish to see information for the entire area or for one particular Outcomes question that contributed to the overall score for the area being reported Report Format Required Please Select Graph or Table Graph cS Table Select area and s io The Entire State r7 One Service Boa None 7 One Residency E None One Provider Age LIGHTHOUSE HAMI 10128 Report Format Required Outcomes can be displayed as bar graphs or tables How would you like to display the Outcomes you have selected Contact Information For more information on this protocol contact Tina Bowen 513 487 7172 tbowen lys org For OCO administration Data entry questions Supervision Using the Strengths and Red Flags Reports Joyce Cooper 513 487 7188 cooper lys org For Data Reports using the Reports Template Generator Reporting data in the Program Summary Reports Laura Morey 513 487 7180 Imorey lys or
53. formation about how particular consumers are doing rather it provides objective information about reported consumer Outcomes The basic unit of the ODM is a single administration of an Outcomes instrument with no reference to the individual consumer other than some basic HIPAA compliant demographic information In addition no implicit value judgments about consumers getting better or worse are included in the design One can only speak about change for similar groups at different times Therefore it is inappropriate to attach simple explanations to why some score changes do or do not occur without having other supporting data How Up to Date Is the ODM Information The ODM data base is updated by the ODMH Office of Information Services OIS every three months Each time the ODM data base is refreshed it is completely replaced with a new data base prepared from the Outcomes System production data base That way any corrections or changes that get made to the production data base automatically flow to the ODM the next time it is refreshed 75 lin d kc Ohio Mental Health Consumer Outcomes Data Mart Step By Step Instructions note the section below are screen shots that have been copied from the website and are a little bit mashed together when you look at the actual website it will make sense O consumer Population Required Consume Please Select One Consumer Population Required Do you want to look at
54. g For using data in performance improvement activities Use of the Outcomes Data Mart How to report data analysis in the CQI Workbook 78
55. g glass icon on the report menu bar in the upper left corner of the screen and then click on the report You can also adjust the appearance of the report for viewing by adjusting the zoom percentage Reports can be printed by clicking the printer icon on the report menu bar or by selecting the Print option from the File menu also located in the upper left corner of the screen E fo 100 Close Window i File Edit View Tools Window Help When you are finished viewing and or printing your reports you can close the report by clicking the X in the upper right corner of the report or by clicking the Close button on the report menu bar J2 Using the Ohio Consumer Outcomes in Service Planning Clinical Use of the Ohio Scales The Ohio Scales give the clinician a wealth of useful and easily understandable information Perhaps most obvious is the ability to track a consumer s progress over time with repeated administrations of the instrument Ongoing ratings of overall functioning and problem severity can be useful to clinicians and program administrators alike Additionally however the initial administration of the Ohio Scales provides excellent information to aid in development of the consumer s treatment plan It should be noted that the Ohio Scales were developed primarily to aid in the tracking of service effectiveness As a result they do not provide the degree of comprehensive information that might be associated with the administration
56. havior should be recoded as follows e 1 7 Yes e 5 No Item 10 Criminal Justice should be recoded as follows e 5 Yes e 1 No 3 Compute the Overall Activities of Daily Living Subscale Score The Activities of Daily Living subscale score is an arithmetic average To compute the subscale score sum the responses to questions 6A through 6H that have values of 1 2 3 4 or 5 and divide the sum by the number of questions the provider has answered If one item is missing or marked Unsure the subscale score should be calculated based on the remaining seven items If more than one item is missing or marked Unsure the subscale should not be calculated 4 Compute the Meaningful Activities Composite Score The Meaningful Activities composite score is an arithmetic average To compute the score sum the responses to questions 7A through 7F that have values of 1 2 3 4 or 5 and divide the sum by the number of questions the provider has answered The Meaningful Activities composite score can be computed with up to five missing items 5 Compute the Community Functioning Score The Community Functioning score is a total To compute the score sum the responses to the following Community Functioning 7 Question 1 Recoded Question 2 Question 3 Question 4 Question 5 Recoded Overall Activities of Daily Living Subscale Meaningful Activities Composite Score Question 8 Question 9 Question 10 Recoded Question 11 Recoded I
57. he data from these reports should be discussed in the quarterly program CQI meetings The following section provides an overview of the reports available to the programs and how to access them For more detailed explanations and instructions see Appendix 1 Reports Template Generator and Appendix 5 ODMH Data Mart Available Individual Reports in the Reports Template Generator The following reports may be accessed using the Reports Template Generator The Reports Template Generator is available for anyone to use It is more likely that the reports found in this section will be used as part of your program s summary data process and created and reported by Lighthouse s Business Analyst Joyce Cooper jcooper lys org 513 487 7188 Individual Reports Summarizes scores on Adult Consumer Form over multiple administrations Contains all of the scale scores and many individual items from the Adult Consumer measure combined with the Functioning Adult Combined Report Assessment Scale and a summary of information about the negative events that may have happened to the consumer from the Adult Provider instrument ARROW Achieving Recovery and Resiliency Designed to be used in treatment planning and suggests potential the Outcomes Way Report activities for consumers treatment and or recovery plan Youth Parent Worker Combined Report summarizes the subscale scores on all three Ohio Scales instruments 3 Month over multiple administrations Summarize
58. ial and exude confidence have the lowest refusal rates generally three to six percent Inexperienced administrators tend to invite more refusals by unintentionally Confusing the potential respondent Contributing to the person s suspiciousness or paranoia by not acting in a forthright manner Not being able to answer questions clearly and easily Not conveying confidence in the importance of the survey information Subtly or overtly giving the person multiple opportunities to say no What the person offers as a refusal may be a screen for the real reason An example would be an illiterate person who states he she doesn t have time to do the survey We suggest that your first response should be a literal one responding directly to the issue that the person raises Many people will reconsider and participate at this juncture The remainder will usually either reiterate their first concern or give you another reason for refusing You should politely acknowledge what the respondent says briefly and clearly state that the information will prove important to treatment and then give him her a chance fo respond If the person still refuses then you have two new objectives The first objective is to determine if the refusal is permanent or temporary The easiest way to determine this is to ask the person if he she would be willing to do the survey at another time Your second objective is to learn as much as you can about why he she is refusing so you
59. ingful Change In addition to determining if the consumer made a clinically significant change or not we could use these data to describe the child s pre and post treatment status For example Sigmund entered treatment with a Problem Severity score of 40 This is typical of youth who receive community support services After nine months of service he had a Problem Severity score of 12 which is more similar to other youth living in his community within one standard deviation of the community sample mean The magnitude or size of change 28 points also indicates that he made a reliable change for the better 59 Reliability Change Index for Outcomes Instruments Instrument Adult Consumer ACA Adult Provider APA Ohio Scales Agency Worker Ohio Scales Parent Ohio Scales Youth Findings adopted from Healy 2005 Respondents Adult Consumers who are thought to have severe mental illnesses Providers of those consumers who complete the Adult Consumer A Form Providers of Youth 5 to 17 years Parents of Youth 5 to 17 years Youth 12 to 17 years Collection Scales Range Positive Reliable Clinical Times Direction Change Cutting Score Initial Symptom Distress 15 75 Lower 119 Six months Annually Empowerment 1 4 Higher 0 4 At Termination Overall Quality of 1 5 Higher 0 8 Life Financial QOL 1 5 Higher 1 0 Initial Community 11 55 Higher 4 0 Six months Functioning Annuall
60. int Four Point Five Point Five Point Scale Scale Scale Scale Original Score Reverse Score Original Score Reverse Score 1 4 1 5 2 3 2 4 3 2 3 3 4 1 a 2 5 1 34 Adult Consumer Form Scale Items used to How to compute How to handle How to interpret compute score score missing items scores score Quality of Life 2 4 Sum responses e f one or more responses are missing 1 00 5 00 Higher scores indicate Financial Status e Divide by 3 do not compute more positive feelings about financial status Empowerment 38 39 42 45 Reverse score the lf one response is missing compute 1 00 4 00 Higher scores indicate Self esteem 47 51 52 57 bolded items the score using the completed items higher self esteem self Self Efficacy 59 Sum responses If two or more responses are missing efficacy Divide by 9 do not compute Empowerment 40 41 43 49 Sum responses If one response is missing compute 1 00 4 00 Higher scores indicate Power 50 54 55 56 Divide by 8 the score using the completed items higher sense of power Powerlessness If two or more responses are missing lower scores indicate do not compute sense of powerlessness Empowerment 36 44 53 58 Reverse score the If one response is missing compute 1 00 4 00 Higher scores indicate Community 60 61 bolded items the score using the completed items higher levels of Activism amp oum responses If two or more responses are missing community
61. io Scales includes the Restrictiveness of Living Environments Scale ROLES Information regarding the initial development of the ROLES can be obtained by reviewing the original article written by Hawkins et al 1992 The ROLES assesses the level of restrictiveness for the youth s placements during the past 90 days A higher score means on average the youth is placed in a more restrictive setting Ohio Mental Health Consumer Outcomes at a Glance Adult Consumers Adult Consumer Form Provider Adult Form Completed by Consumer Completed by Service Provider Focus and Intent The Adult Consumer Overall Empowerment 28 Item Scale Focus and Intent The Provider Adult Form Form gathers perceptions from young ie sob i illedey gathers the primary worker s observations consumers in the Lighthouse Independent 8 Item Subscale Living and Transitional Living Programs of Community Activism and Functional Status Autonomy 6 Item Scale Social Contact 1 Item Optimism and Control Over Social Interaction 1 Item Overall Quality of Life 12 Item Scale the Future 4 Item Subscale Social Support 1 Item ne ee jems Righteous Anger e Housing Stability 1 Item 4 Item Subscale Forced Moves 1 Item Financial Status Activities of Daily Living 8 Item Subscale S Item Subscale Meaningful Activities 6 Item Subscale Safety and Health 7 Independent Items ade A Item Criminal Justice 1 Item Symptom Distress 1
62. ity and Functioning Scales for all three raters of Outcomes For example if the parent ratings indicated that the total Problem Severity score decreased by 10 points and the most recent rating fell below 25 then the youth could be said to have made clinically meaningful changes Three methods to assess Clinical Significance A There is at least a 2 standard deviation SD distance from the mean of the original dysfunctional group B The subsequent result should fall within 2 standard deviations from the mean of the non clinical population C There is a greater likelihood that the post treatment score falls closer to the mean of the non clinical population than the mean of the clinical group Jacobson Follette amp Revenstorf 1984 proposed a statistical way to calculate the cutting score for the variable of interest How to calculate Clinical Significance Adopting method C above as recommended by Jacobson and Truax 1991 we calculate the clinical significance with the means and standard deviations from both the clinical group and the non clinical population to establish a cutting score for this purpose Cutting score Mainciai X SDnorm Mnorm X SDeiinical SDnorm SE SDaiinicai Where Mainical and Mnom are the mean scores of the clinical group and the non clinical population respectively SDainica and SDnorm are the standard deviations of the clinical group and the non clinical population respectively Description of Mean
63. le Combo boxes The majority of the fields in the Template are combo boxes You can either manually type in appropriate values or click the down arrow to view and select a valid value on the pull down menu Values placed in these fields must be listed on the pull down menu otherwise an error message will appear and you will be asked to enter a new value Example Parts 1 5 on Adult Consumer Form A Adult Consumer KEY 1 Terrible 2 Mostly dissatisfied 3 Equally Satistied Dissatisfied Ey 4 Mostly satished 5 Very Pleased g Does not Apply question 7 anly Aloe et pou fees about 1 The amount of friendship in your life Terrible The amount of money in your life Mostly dissatisfied How comfortable and well off are you financially Equally satisfied dissatisfied Mostly satisfied How much money you have tn spend Very pleased The amount of meaningful activity in your life The amount of freedom you have umm mm The way you and your family act toward each other 3 Navigating data entry screens 24 Resizing data entry screens If you cannot see the entire screen i e you need to scroll horizontally to move around the screen you can resize the screen by moving your cursor to the lower right corner When the cursor turns to an arrow you can drag the arrow to the right to resize the screen You may need to move the screen to the upper left corner first to allow more room for this resize operation Moving b
64. lect a report option a Report Criteria Menu will appear Each Report Criteria Menu differs based on the type of report you want to generate and how you want the Template to search for report data by UCI or by Name and Date of Birth Since private records do not contain a UCI Name and Date of Birth criteria must be specified to generate a report based on these records Because the selection criteria fields are all combo boxes you can avoid typing errors by choosing from the pull down menu for each field The fields are updated in order from top to bottom For example after you select an instrument the UCI combo box displays UCIs in the database for that particular instrument After a UCI is selected only that client s administration dates are listed in the administration date combo box Examples of the different Report Criteria Menus are shown below Report Criteria Menu for Change Over Time Ohio Scales Version Comparisons Report Strengths and Red Flags Reports and for Generating Multiple Reports SELERITUEIADUI Rr De ee Ln ee ee i Euer eed An M I ul MU Bie 20 rigs ae Br al ed a i Please enter the following z information for your report A ET Seay oT oe Lr Instrument EZ Search Records by C Uc Name and Date of Birth uc Ber Dr LastName Quint dues First Hame DeLin Date of Birth josmenses ae Starting Administration Date 01012004 i 5r ie Sd Ending A
65. mes files You may refer to the different sections of this guide as needed However new users are encouraged to read each section in order B Template Overview Data Entry and Editing The Template allows provider agencies to enter and edit data contained in the Outcomes instruments It has built in data validation checks to reduce data entry errors and to help to ensure overall data quality Data entered using the Template are automatically formatted to comply with the specifications required by ODMH Outcomes Reporting The Template can also be used to produce several basic consumer based care management reports for all Outcomes System instruments except the CAFAS and PECFAS It extracts information from the database and prepares an individualized report of a consumer s responses to items on each instrument C Accessing the Template the First Time For Programs Not Located at 1501 Madison Road Use tsweb to access the data entry template Once in the tsweb environment go to My Computer and double click on the DATA F hard disk drive Open folder ODMH Outcomes Local New For Hamilton County based programs drag the file Copy of ODMH outComesLocal mdb to your tsweb desktop For Dayton Day Treatment open the folder DaytonTX and drag the file Shortcut to DaytonOhioOutcomes mdb to your tsweb desktop For Programs Located at 1501 Madison Road Access the folder ODMH Outcomes on the share drive Drag the folder ODMH Outcomes Loc
66. n service planning and reviews supervision and performance improvement activities of the data collected by the assessments The Ohio Consumer Outcomes is the umbrella term for the Adult Consumer Outcomes and the Ohio Youth Scales your program and the age of your clients determines which instrument is used All programs who receive mental health dollars are required to use the Ohio Consumer Outcomes with their clients About Ohio Consumer Outcomes The overall intent of the Ohio Mental Health Consumer Outcomes System is to measure how people change in treatment and determine if the services they receive have an impact To achieve that end the Outcomes System is designed to capture information at the beginning and the end of treatment and if there is long enough in between to capture information at additional intervals between the beginning and the end The Outcomes process is about making evidence based informed decisions regarding the care and treatment of people Therefore in order to be an effective tool for treatment planning and quality improvement each Outcomes administration should be timely reviewed with the consumer integrated into the treatment planning process and aggregated for the purposes of agency quality improvement Those administrations should then be submitted to ODMH to meet Administrative Rule and Certification requirements Consumer outcomes have three main purposes e to manage consumer care e foimprove the se
67. ng physical health problems this might point to additional services that are needed It will also help the clinicians and other direct care providers get a better overall picture of the consumer and may highlight areas that the provider hadn t thought about as needing attention The following are some suggestions about how data from the Adult Provider Outcomes can be used e Low individual functioning scores may indicate specific treatment needs Some items may indicate more immediate needs in areas related to health and safety e g housing stability recent victimization suicide attempt or attempt to harm someone else A e Particularly low scores on some questions e g Question 3 regarding the consumer s social support network will indicate that more information should be sought from the consumer and that work needs to take place to develop more adequate resources to support the consumer in improving his her functioning e Data may be able to be used by provider agencies for making level of care assignments e Aggregate data may indicate needed new areas for program expansion e g housing initiatives e On both the individual and aggregate levels scores from the first and the second administrations of the instrument should be compared to illuminate improvement or decreases in functioning Determining Clinically Significant Change In the current behavioral health care market consumers of outcomes data want evidence that consum
68. o locate the database and enter the OCO data into the database template Information found in this section corresponds with the Lighthouse User s Guide VOS507 A Quick Overview Ohio Consumer Outcomes This is the reference to both the Ohio Youth Scales and the Adult Consumer Outcomes Administration Used to describe an assessment that has been completed Age Requirement for Ohio Consumer Outcomes We may use the Ohio Youth Scales on clients up to age 18 After a child turns 18 ODMH looks for the Adult Consumer Outcomes When entering the Adult Consumer Outcome administration into the database if a child has already been in the system with Youth Scales the Administration Type on the tracking sheet would not be initial rather it would be a continuation of the child s prior testing For older children 16 and up it is appropriate to use the Adult Consumer Outcomes before they reach age 18 What is the Tracking Sheet and where do find if The tracking sheet is a cover sheet for the Ohio Consumer Outcomes The Tracking Sheet is found on Lightworks on the Clinical Forms page There is a sheet for Hamilton County programs and a sheet for Dayton Day Treatment Which children clients will be entered into the system All children clients in participating programs will be entered into the database Clients with a UCIID will be entered as Public Records See Section D for details all others will be entered as Private Records What is
69. o the above questions Lighthouse completed the Consumer Outcomes Rule Data Use Compliance Monitoring Score Sheet see page 5 of this Protocol and submitted it with the necessary documentation with our last application for recertification Monitoring of OCO Data Rule compliance is conducted by the agency s Compliance Manager CQI Manager Peer Review and Evidence based Best Practice CQI Committees and is reported to and reviewed by the Continuous Quality Performance Improvement Committee and the agency s executive leadership Progress on implementation and compliance is reviewed quarterly and where necessary steps taken to achieve compliance The LYS CQI PI Committee is tasked with monitoring compliance and benchmark attainment overall 68 The Compliance Manager regularly monitors the inputting of data into the ODMH Data Template and ensures that data entered is Qs error free as possible Using Outcomes Data to Create Performance Improvement Activities Performance data derived from the Ohio Consumer Outcomes will be aggregated analyzed and reported on an ongoing basis in a manner that facilitates use of the data by program staff Performance improvement tools such as histograms diagrams control and run charts and other tools that allow data to be referenced compared and understood over time will be used as appropriate What Do the Aggregate Scores Tell Us This information represents quantifiable feedback regarding the consumer perceive
70. ocacy Individual Family Level e Families of adults work with consumer e Families of children adolescents contribute to data work with child provider e System Level learn about local implementation attend meetings monitor local use of Outcomes System Four Steps To Outcome Based Service Recovery Planning STEP 1 Getting the Picture e Organize available information about the client s bio psycho social history e Consider their strengths problems life situations and social cultural environments e Consider information about progress you have from previous outcome data e Try to get a mental picture of the person s life STEP 2 Common Understanding of Outcome Status Picture e The goal of this step is for the Lighthouse worker and their client to work together to integrate information share perspectives come to a common understanding of the client s present outcome status in the context of their bio psycho social picture e he client and the Lighthouse worker engage in meaningful discussions regarding Outcome Reports produced by the ODMH Consumer Outcomes System o Lighthouse worker and client both prioritize what issues or situations need changing the most o The best result is a negotiated and shared view of present status in the context of the client s past picture and areas where change is desired STEP 3 Common Understanding of Recovery Process amp Status e Client and Lighthouse worker work jointly to get a sh
71. omicdon Cat Di THEE PruudsriLD gmorey Functioning tal T m Hl qi E mx Ti n 48 Tracking Report This report displays a listing of public and private clients for each clinician that have an upcoming administration within a selected date range TRACKING REPORT Administrations Due Administration Date Interval 0101 2004 to 08 10 2004 Clinician Imorey Instrument Ghio Scales Youth UC 0505060 Hame Cally Come Prev Admin Initial 0 20 520 04 D4 D1 2004 Optional Instrument Ohio Scales Parent Uc 0101010 Hame DeL iri Guint Prev Admin Initial 01 012004 04 01 2004 Instrument Ohio Scales Agency Worker Uci 0101010 Hame DeLin iGuint Prev Admin Initial 0110172004 04901 2004 2 The Reports Menu When you select one of the two reporting options on the Main Switchboard a menu of possible reports appears The title bar at the top of the menu indicates whether you have chosen to generate a public or a private client report Click the button next to the name of the report you would like to generate If you would like to generate more than one report for a particular client click the Generate Multiple Reports option To return to the Main Switchboard click the Return to Main Menu option mj Change Over Time Strengths Report ml Hed Flags Report m Ohio Scales Version Comparison mi Generate Multiple Reports E Tracking mJ Return to Main Menu 49 3 Report Criteria Menus After you se
72. ons Clients with an opportunity to become more involved in the development of their treatment plan and their treatment process This in turn enhances the client s movement toward self determination empowerment From the client perspective the purpose of the Outcomes survey process is to help the client become active in their treatment process identify strengths and weaknesses identify the parts of their life in which they are dissatisfied work with mental health professionals and family friends to achieve goals and participate in the recovery process 63 Section 6 Using the Ohio Consumer Outcomes in Supervision This section describes how to use the OCO in supervision to enhance service planning and clinical outcomes Outcomes data may be integrated into many of the routine tasks of clinical supervisors Three specific time points are especially relevant the initiation of services periodic review of ongoing cases and ending services 64 Clinical Supervisor Use of Ohio Consumer Outcomes e The stages that the Ohio Consumer Outcomes may be used by the clinical supervisor Case Assignment The supervisor can review a consumers outcome reports and data to identify consumer strengths problems and preferences to effectively match the consumer to the most appropriate treatment provider e For example the supervisor may note that the consumer reports periodic thoughts of self harm As a result a clinician who has a record of high
73. or re export If you click Yes the changes you made are saved and the record will be included in the next export file that is created If you click No the changes you made will still be saved but the newly revised record will not be included the next time you create an export file for that particular instrument H Exporting Template Data You will not need to export data as it will be handled by the Compliance Manager Tina Bowen 32 Section 4 Scoring Once the Ohio Consumer Outcomes have been administered the data needs to be scored There are two ways to score the administrations by hand or by using the reports found in the ODMH Outcomes Database Template Both methods will be discussed in this section and information for scoring may be found on the Lightworks Ohio Consumer Outcomes page 33 Ohio Mental Health Consumer Outcomes System Scoring Guidelines The purpose of this document is to describe the rules that should be followed when computing scores associated with the Outcomes instruments All of the scales listed in this document are included in the Outcomes data specifications and are computed automatically by the ODMH Data Entry and Reports Template except for the Quality of Life Overall and Overall Community Functioning scales shaded in gray These scales are not currently required but it is anticipated that they will be included in the Outcomes data specifications in the future Providers should
74. oral problems and level of functioning of youth hopefulness and satisfaction with services There are three parallel torms of the Ohio Scales which allows assessment of the consumer s strengths and weaknesses from multiple perspectives Ohio Mental Health Consumer Outcomes at a Glance Youth Consumers All Youth T i Ohio Scales Ohio Scales Ohio Scales E L i Y Form 42 18 B oris WN a std NR c compete By von gas In for Youth Ages 5 18 for Youth Ages 5 18 Problem Severity Problem Severity Problem Severity 20 ltem Scale 20 ltem Scale 20 ltem Scale Functioning Functioning Functioning 20 Item Scale 20 ltem Scale 20 Item Scale Hopefulness About Hopefulness About Restrictiveness of Life or Overall Well Being Caring for the Identified Youth Living Environment ROLES 4 Item Scale 4 Item Scale Computed Score Satisfaction with Satisfaction with Behavioral Health Services Behavioral Health Services 4 ltem Scale 4 Item Scale What is Measured Intake Complete prior to Narrative Summary and ISP subsequent Every 3 months as part of the ISP review with the excepiion of TLP whose ISP updates are compleied every 6 months therefore administrations will occur with greater frequency than ISP updates E Q a 2 E i lt o lt Ohio Youth Scales Item Descriptions The Problem Severity Scale is comprised of 20 items covering common problems reported by youth who r
75. ot act as a pink slip putting a person in the hospital e If does not act as a diagnostic instrument t does not give syndrome names or labels Explain that the Ohio Outcomes Survey is meant only to show how a person is doing in her his recovery The purpose for collecting Outcomes data o For adults the opportunity to let the agency know how the consumer is doing in a number of areas so that this information can be used for discussion with the worker around treatment planning and progress o Forfamilies of child adolescent consumers the opportunity to let the agency know how the child is doing in a number of areas so that the information can be used in treatment planning o For youth age 12 18 the opportunity to let the agency know how the consumer is doing so that the information can be used to help them with their problems The time it will take to complete o Adult Consumer Form 10 40 minutes depending upon consumer functionality o Ohio Scales Parent Form 15 minutes o Ohio Scales Youth Form 15 minutes How Lighthouse protects the confidentiality of the data in accordance with agency policies and HIPAA requirements o Disclosure of information in the performance of professional duties is a necessary feature of the helping professions such disclosure is subject to professional standards and legal restrictions Without the written consent of the client and if a minor his her legal guardian Lighthouse staff may not relea
76. page Restrictiveness of Living Environments Scale residential settings on top of second page 1 20 on second 23 categories of e Sum responses e Sum responses If five or more responses are missing do not compute Total days must add up to 90 See instructions on page of this document Higher scores indicate more severe problems lower scores indicate less severe problems Higher scores indicate higher functioning level lower scores indicate lower functioning level Higher scores indicate more restrictive environments lower scores indicate less restrictive environments 00 5 10 0 Computation of the Restrictiveness of Living Environments Scale ROLES from the Ohio Scales Worker Version Setting Jail Juvenile detention youth corrections Inpatient psychiatric hospital Drug alcohol rehabilitation center Medical hospital Residential treatment Group emergency shelter Vocational center Group home Therapeutic foster care Individual home emergency shelter Specialized foster care Foster care supervised independent living Home of a family friend Adoptive home Home of a relative School dormitory Biological father Biological mother Two biological parents Independent living with friend The ROLES consists of a list of 23 categories of residential settings Next to each specific setting is a blank line on which the agency worker writes the number of days during the
77. pecifics of a treatment plan calculating scale total scores may also be useful Total scores for the youth can be compared to average scores in the ODMH Data Reports series or on the Outcomes Data Mart This gives the clinician an overall indication of how the youth s scores compare to a sample of youth who are in a different program in the agency or in the state as a whole The Ohio Scales User s Manual gives comparative information about a sample of youth who are not receiving services 54 Tracking Changes Over Time Use in Progress Reviews The easy administration of the Ohio Scales allows the instrument to be used as frequently as the clinician would like Over time it is then possible to track any improvement in an objective manner free from the difficulties of relying on memory e Change in Total Scores There are several different ways to use data collected over time Viewing scale total scores it is possible to see the overall amount of improvement In addition total scale scores can be compared to a community sample For example the clinician can examine scale total scores at admission and after three months to see if any changes in overall Problem Severity or Functioning occurred The Ohio Youth Problem Functioning and Satisfaction Scales Short Form User s Manual Ogles et al 1999 contains forms that can be used for tracking change in Problem Severity and Functioning Total Problem Severity and Functioning scores for all three sour
78. quality work with individuals in this circumstance may be assigned Likewise clinicians who are in training or new to the agency may be assigned cases with fewer potential difficulties based on the initial assessment and the standardized outcome data matching clinician level of experience with case difficulty e Treatment Planning The outcome data and reports also provide important assessment information The supervisor can review the outcome results with the clinician to identify potential issues plan an approach for reviewing the issues with the consumer and project the potential treatment issues and services that may be provided Identifying the types of services needed and determining the appropriate intensity of services are especially important factors to consider e Allocation of Services Individuals may report needs problems or strengths in a variety of domains that indicate potential provision of vocational recreational therapeutic medical or other services Clinical supervisors can review the intake outcome ratings to help supplement other assessment data and supervisee reports to determine the types and intensity of services offered to the consumer Reviewing Individualized Service Plans ISPs e Review OCO to increase understanding of client s needs strengths priorities and service preferences e Critical items red flags prioritized in collaboration with client family e Strengths with client family priorities prioritized in collabo
79. ration with client family o Ensure that Clinical Formulation narrative summary summarizes this information o Ensure that safety issues client identified needs and goals and client strengths are reflected in the ISP Periodic Review Reviewing Client Progress e Tracking consumer progress on goals and treatment issues using outcome instruments is the primary function of ongoing outcome assessment The clinical supervisor can use this data to inform the supervisory process e Review OCO including red flags and strengths to determine whether service needs have changed If so changes should be reflected in the ISP e Assess changes in behavioral functioning future orientation and satisfaction with services to determine areas of progress and areas requiring modifications to the ISP A review of outcome tracking data will reveal cases in which the consumers are making progress remaining stable or deteriorating Supervisors can use this information to 65 determine what cases to review during supervision This information can also be used to increase or decrease the intensity of services depending on the situation e Forless than anticipated progress help supervisee explore alternative service strategies to facilitate progress When consumers seem to plateau in their recovery clinical supervisors can review the outcome data reports with the clinician to identify areas in the consumers life that could be addressed to propel growth For example if a
80. rts in separate windows on your computer One of the nice things about that feature is that you can easily jump back and forth between the data selection screen and any reports you have run by simply clicking on the right item in the tray at the bottom of your screen That means you can run multiple reports by clicking on the selection screen tab changing the responses to only those prompts you wish and preparing another report Each new report will open in a separate window One trick you might find useful is to run several reports with slightly different selection criteria and have them open in several separate maximized windows Then by selecting one tab after another you can see how the results differ by watching the bar graphs change each time you click on a different report Click click click Just like in the movies Is the ODM a Powerful Data Base for Research No The ODM is a simple tool to provide limited basic and accurate decision support information about reported consumer Outcomes in Ohio it is not an attempt to be all things to all people The primary uses of ODM information are for clinical and organizational management rather than research Can the ODM Report Individual Consumers Changes No The ODM allows comparisons of consumer groups with given sets of characteristics to similar groups at different points in time even though the individuals in the groups may not be the same So keep in mind that the ODM does not provide in
81. rvice delivery system and e to account for public resources Therefore outcomes data are of use to consumers and their family members workers clinicians agency provider organizations mental health boards the Ohio Department of Mental Health and the general public Lighthouse amp Compliance with the Outcomes Data Rule The ODMH Outcomes Rule 5122 28 04 mandates that Lighthouse Youth Services plan for Outcomes implementation collect Outcomes data on eligible consumers flow those production data to ODMH be able to show evidence of use of Outcomes data in treatment planning and be able to show evidence of use of Outcomes data in agency performance improvement Consumer Outcomes Rule Data Use Compliance Monitoring Score Sheet Agency Name ighthouse Youth Services Inc 1 In Progress Planning No supporting documentation is required The agency has an official agency protocol that specifies how Outcomes data will be used in treatment planning The agency has a data collection technology that can generate timely client specific Outcomes summary reports that can be reviewed with consumers and family members The agency has minutes from QA QI PI meetings that routinely document planned uses of Outcomes data The agency is able to aggregate its own data by programs and compare these scores with statewide averages and averages from similar agencies The agency has an official agency protocol that indicates specific way
82. s are checked to ensure that they contain complete and valid data If data in any of these fields are missing or invalid a brief message about the error appears and the screen advances to the first field that needs to be corrected Records that have incomplete or invalid data in required fields cannot be saved Private records do not contain any required fields Therefore when either Next button is clicked they are automatically saved 25 After the record is saved a dialog box appears asking if you want to enter another record for the same instrument If you select No the current record is saved and the Instrument Menu appears If you select Yes you are then asked whether you want to enter the same type of record public or private If you click Yes a new blank screen appears for the same instrument and type of instrument public or private you just entered If you click No a new blank screen appears for the same instrument but different type of instrument public or private than you just entered The change in type of instrument is noted in the title bar of the new screen that appears Closing a data entry screen To close a data entry screen and return to the Main Switchboard click the X button located in the upper right corner of the screen When you click this button a dialog box will appear asking if you want to save the record you just entered or modified If you select No the current screen record is cleared and you ar
83. s in which Outcomes data will be aggregated and reported on a regular basis The agency has a Performance Improvement Plan for utilizing Outcomes data that has been approved by an accreditation organization listed in ODMH Rule 5122 25 02 The agency has an internal tickler system for reminding staff when Outcomes administrations are due 0 Under 25 1 I 25 75 2 lt X Over 75 UPID 90128 Preparation amp Implementation No supporting documentation is required Percentage of clinicians expected to do Outcomes who have completed training in using the Outcomes data in treatment planning in collaboration with their clients Percentage of clinical supervisors of staff expected to do Outcomes who are knowledgeable in using the Outcomes data in treatment planning Percentage of adult consumers and or parents of child and adolescent consumers who have completed training in using Outcomes data in treatment planning in collaboration with their clinicians Percentage of records reviewed that contain at least one initial and one subsequent Outcomes administration form or report Percentage of clinical team meeting minutes that document discussions about using Outcomes data Percentage of clinical team minutes that contain Outcomes data regarding one or more consumers and discussions of possible improvement strategies Percentage of members of a Quality Improvement team who have received training in using aggregate Outcomes d
84. s the subscale scores on all three Ohio Scales instruments Initial 6 Month Annual over multiple administrations Schedule Designed to help providers complete the initial Ohio Scales worker Worker Treatment Planning Report instrument this reports summarizes the Youth and Parent s initial Ohio Scales data 7 Available Aggregate Reports in the Reports Template Generator The following reports may be accessed using the Reports Template Generator The Reports Template Generator is available for anyone to use It is more likely that the reports found in this section will be used as part of your program s summary data process and created and reported by Lighthouse s Business Analyst Joyce Cooper jcooper lys org 513 487 7188 Aggregate Adult Consumer Reports Hle 0 U 0N Detail 0000 A Type if applicable Summarizes Adult Consumer Form and Adult Provider Form subscale Adult Consumer and Provider for Agency scores for all adult clients in the database over multiple Cross sectional administrations Summarizes Adult Consumer Form and Adult Provider Form subscale Adult Consumer and Provider By Program scores for all adult clients in the database over multiple administrations by program Compares average scores on the Adult Consumer and Provider Diagnosis By Staff Adult Consumer and reports by diagnosis and by staff member It shows how different Provider Aggregate staff members are doing in treating consumers with di
85. same as the network login name first initial and last name used by the social worker or case manager NOT the data entry person Board ID Enter as found on the Tracking Sheet Hamilton County enter HAMIM Dayton enter MONTB County of Residence Hamilton County enter HAMI Dayton enter MONT Important If a client is a permanent resident of another county always enter the first four letters of that county i e Clermont County would be CLER Date of Program Admission This date is for when a client first enters your program and does not have to match when the client enters into the Medicaid system This field will auto fill after the initial administration upon entry of the client UCIID Diagnosis Type Use the DSMIV with NO DECIMALS and NO EXTRA ZEROs i e 311 would be entered as 311 don t worry about filling up all the spaces 295 6 would be entered as 2956 Program Name Enter your program initials TFC YDC ILP Program Discharge Date Enter the date that your client discharged from your program 28 Header Tab Youth Scales UCIH Tracking Date UPID Administration 0101010 8 12 2004 10128 Tracking Header Problem Severitu Hope Satisfaction Functioning Youth Header Information Child s First Hame DeLin Date 08 04 2004 Child s grade 03 i Child s Last Hame Quint Child s Date of Birth 087087 398 Child s Sex Male Female Race 1 no 2 yes White e H Native merican Pacific Islander M
86. se any information concerning a youth or family in any program except as otherwise permitted by law for a valid purpose o Information is stored in the case file and in a database located on a secure network Explain the person s rights as a participant o We want them to participate and encourage them to do so but make clear that refusal to participate does not influence the services that they receive A final assurance that the information from or about the consumer is really important to the agency An offer to answer questions about the instrument if the person filing it out doesn t understand something Inability to Complete If a problem exists with the consumer taking the survey e g refuses is too ill then the following pathway guides the admini stration of the survey Maintain the principle with all consumers of do no harm Use clinical judgment to determine the appropriateness of giving the survey to a particular consumer If the person refuses to complete the survey the staff person should attempt to understand why this person refuses If the person continues to refuse to complete the survey even after the staff person has explained the situation to the person then the staff person should record the refusal on the Tracking Sheet If the consumer refuses or is too ill to take the Adult Consumer Form the responsible worker should still complete the Provider Adult Form Survey administrators who appear comfortable with the mater
87. sed informed decisions regarding the care and treatment of people Therefore in order to be an effective tool for treatment planning and quality improvement each Outcomes administration should be Timely Reviewed with the consumer Integrated into the treatment planning process Aggregated with similar administrations for other consumers for the purposes of agency quality improvement Those administrations should then be entered into the database and submitted to ODMH 9 9 9 9 Frequency of Administration e Intake complete prior to Narrative Summary and ISP e Every 3 months as part of the ISP review with the exception of TLP whose ISP updates are completed every months therefore administrations will occur with greater frequency than ISP updates Administration Tracking An Excel based tracking worksheet has been designed to help programs keep track of when their ISP and OCO administrations are due This worksheet automatically calculates the date that an ISP is due The Ohio Consumer Outcomes are expected to be administered quarterly with each ISP update See sample below ISP and Adult Consumer Outcomes Tracking Worksheet Note There is a defaull date thal is currently in the grayed oul cells ignore it The date will automatically be correclly filled once you ve Date Initial Ohio Date Initial Ohlo Date 0 Day Date 0 Day typed the Admission Date and the Initial ISP date Consumer Provider Ohio Consumer Ohio Provider Outcomes O
88. services if applicable Supervisors can help staff use OCO results to document progress identify which issues and service approaches were most acceptoble to the client and effective and identify additional needs that should be addressed in the transition planning process 66 Section 7 Using the Ohio Consumer Outcomes in Performance Improvement This section describes how to use the OCO in performance improvement activities quality improvement and planning activities Includes using the data at the program management upper management and LYS board levels One of the purposes of consumer outcomes is to improve mental health services Aggregated consumer outcomes provide data for the respective ongoing quality improvement processes of agencies boards and ODMH and for developing and monitoring best practices Using our agency s 67 CQI process which includes the Planning Doing Acting Checking quality improvement method our agency with the active participation of consumers and families colects and analyzes its own data to make decisions about changing or maintaining program service treatment processes that affect our consumers outcomes Compliance Lighthouse must answer a majority of the following questions from the Ohio Consumer Outcomes Data Rule and ODMH Certification Attachment 7 to ensure that we keep our ODMH certification 1 Outcomes Data Collection and Submission Which Outcomes System instruments are you using What
89. th system or to a specific provider or practitioner lil Caution must be exercised in interpreting Outcomes data iv Potential data users should resist the temptation to compare providers or board areas based on simple analyses that don t reflect the differences in programs and the consumers they serve v Data users must recognize their responsibility to monitor such inappropriate use of the data Multiple Agency Identifiers I you want to prepare a report for a particular agency you may find several entries for that agency when you go to select it for the report This occurs because some agencies have submitted Outcomes data using several identifiers over time We are taking steps to minimize the problem but for the present you may have to run multiple 74 reports to get all the data for those agencies Currently there is data for Lighthouse MONT 11166 Dayton Day Treatment and Lighthouse HAMI 10128 all Hamilton County residing clients e Duplicate or Confusing Agency Names Which agency is which It often seems like deciphering provider agency names is like trying to find your bag at the airport baggage claim They all seem the same The ODM can t help change the names but there s a link on the Outcomes Data Mart Web Site that will take you to a listing of all Ohio providers and their MACSIS contact information which may help you identify the exact agency you want for a given ODM report Stacking Bar Graphs The ODM opens up repo
90. the Agency ID UPID The UPID number for all Hamilton County Lighthouse programs is 10128 For Dayton Day Treatment itis 11166 What is the password Does it change The password is Harmony No it will not change In preparation for administration data entry what needs to be in the client file Tracking sheet assessments MACSIS screen shots and confirmation sheet Data on Tracking sheet and Header Tabs MUST match with what is in the MACSIS system If the information does not match it will be rejected and we ll have to revise the record and resubmit it Use the screen shot faxed by MHAP to enter DOB UCI ID on the screen shot it is labeled Sub ID and to check that the last name spelling matches up Keeping track of assessments that are entered It will be important to mark the assessments already entered into the database as there is no real search function that would make checking easy Place a checkmark or a hole punch in the same location e g upper right corner every time you enter an assessment Table of Contents NENNEN QUICK Start g rR E A Infroduction ll aa aa aaa B Template Overview 5 0 _ C _ Accessingihe Template for the First Time D Logging On E TheMain witchbooard 1 1 1 Ad Entering Outcomes Dota E G X Searching and Modifying Outcomes Data i H ss Exporting Template Data Quick Start Using the Template at a Glance 1 Access the
91. to Ohio Scales By Diagnosis By Staff report but Ohio Scales By Diagnosis can be used alone to compare how people with different primary Cross sectional diagnoses are doing on average over time Reports the mean scores on the Youth Ohio Scales at two User selected time points as well as calculating the number and percentage of cases reliably improved staying the same and reliably deteriorating Additionally the number of Youth who are at Clinical Level at the starting period and number of Youth that experience Reliable and Significant change are also reported Same as Youth Ohio Scales Longitudinal Report except reports on Parents Same as Youth Ohio Scales Longitudinal Report except reports on Workers perspective Tracking Report for all Consumers Tracking Report This report can be used to see which consumers have an upcoming administration between the start date and end date entered in the parameter field 73 Available Aggregate Data Reports in ODMH Outcomes Data Mart The following reports may be accessed using the ODMH Outcomes Data Mart found on the ODMH website http www mh state oh us oper outcomes data mart index html The Data Mart is available for anyone to use It is more likely that the reports found in this section will be used as part of your program s summary data process and created and reported by Lighthouse s Business Analyst Joyce Cooper jcooper lys org 513 487 7188 What Is the Outcomes Data Mart The ODM
92. trations to that event Guidelines for Administering the Ohio Consumer Outcomes Materials for Administering a Paper and Pencil Version Make sure you have the following materials at hand A blank survey instrument Tracking Sheet Use either the Hamilton County or Montgomery County tracking sheet A copy of the Lighthouse OCO Protocol Responsible Person The person responsible for having the consumer complete the appropriate Outcomes instrument is the designated primary worker Crisis If the person is in severe crisis or in need of hospitalization at the time a survey is due the survey should be postponed until his her condition stabilizes Explaining the Outcomes Instrument The consumer s successful completion of the Outcomes instrument depends in part on his her understanding the purpose and importance of the endeavor Therefore you should explain a number of things to the consumer when introducing the instrument e he name of the instrument e A brief overview of what is in the specific instrument e Explain to the client what a survey does e By definition a survey studies and provides an overview e It answers the basic question How am I doing in my recovery program e The Ohio Outcomes Survey helps identify strength e t is for the consumers to compare themselves to themselves and does not do If does not act as a test e It does not determine changes in financial services or programs e If does n
93. uld be calculated in this way Setting Days Weight Product Detention Center 2 9 0 18 0 Group Home 12 5 5 66 0 152 0 236 0 With Father T6 2 0 Total 90 236 90 2 62 The ROLES score for the past 90 days is 2 62 38 Reverse Scoring Validation Scenarios for Organizations Not Using the Data Entry and Reports Template Note The information presented here is designed to provide a quick validity check of reverse scoring System computation methods should not be based upon this document alone for complete scoring documentation refer to the Outcomes Procedural Manual Outcomes Data Flow Guide and other detailed documents available on the Outcomes Web Site http www mh state oh us initiatives outcomes outcomes html Reverse Scoring Some items on Adult Consumer Form A and Adult Consumer Form B are worded such that a given response e g never represents a desirable or positive response for one question but a less desirable response for another In order to compare items or combine items into a numeric subscale certain items need to be reverse scored for consistency When reverse scoring an item the highest and lowest numerical values are substituted for each other the next highest and next lowest values are substituted for each other and so on The following table illustrates the process Four Point Scale Five Point Scale Original Score Reverse Score Original Score Reverse Score Checked on Form Stored in S
94. utcomes Outcomes Outcomes Completed and Completed and Completed ond Completed and Calculated Entered For Entered For Calculated Entered For Enlered For Medicaid Date DAF Field Date Initial Future Dates Future Dates Field Futura Dates Futura Dates Client First Client Last Client Yes Referral Admission Discharge Completed or Date Inifial ISP ISP Annual Fee Reter o Next ISP Referto Mext Is Date 90 Day Date 90 Day Refer o Next ISP Refer to Mext ISP Name Name LYS Worker No Source Date Date Reviewed Due Completed Agree Date Dote Dole Review Due Review Done Date Date sample Name Tab ithe Y HCJFS 1 1 2005 1 22 2005 1 31 2005 1 30 2005 1 15 2005 1 31 2005 1 29 2005 4 30 2005 4 29 2005 4 30 2005 4 16 2005 Ida Know Other Y Hm Ch 2 7 2006 1 19 2007 2 10 2005 3 9 2006 3 10 2006 2 15 2008 3 15 2006 3 16 2006 4 7 2006 4 6 2006 8 2 2006 4 1 2006 1 30 1900 3 30 1900 It is important to avoid administration creep where late administrations can decrease the frequency with which actual administrations occur In cases where the instruments are administered later than scheduled follow up administrations should be anchored to the consumer s originally scheduled initial administration date even if this means there is a shorter time between some administrations However agencies have the option of shortening the time interval preceding an annual administration to coincide with some other annually occurring event and anchor subsequent annual adminis
95. y At Termination Initial Functioning 0 80 Higher 8 0 50 0 Six months Annually Problem Severity 0 100 Lower 10 00 20 0 At Termination Initial Functioning 0 80 Higher 8 0 50 0 Six months Problem Severity 0 100 Lower 100 20 0 Annually u Satisfaction 4 24 Lower 6 0 At Termination Hopefulness 4 24 Lower 6 0 Initial Functioning 0 80 Higher 8 0 60 0 Six months Problem Severity 0 100 Lower 100 200 Annually Satisfaction 4 24 Lower 6 0 At Termination Hopefulness 4 24 Lower 90 For greater detail on Reliability Change Findings adopted from Ogles Melendez Davis amp Lunnen 1999 see Appendix 4 60 The what why and how of using Outcome information in Recovery planning How to Engage the Client Discuss with your client e What the Red Flag Report and Strengths Report or similar reports are and what they are for e What a Recovery Service Plan is and what it is for e Why she he should participate in the development of a Recovery Service Plan e How both you and your client will participate in the development of the Recovery Service Plan e Explain what your role is in the process and what is expected of her him What Does It Mean For Families For families of Adult Consumers e Educate and encourage participation e Work with consumer and clinician worker e Advocacy For families of Children Adolescents e Opportunity for input e Involvement in treatment planning e Adv
96. ystem Checked on Form Stored in System 02022020 4 3 2 1 Q N Q OQ N L 1 UU NWA Items that represent non scaled values e g missing not applicable should not be included in either reverse scoring or computation of subscales Reverse scored items on the Adult Consumer Form A include items 13 16 34 35 36 38 39 42 44 45 46 47 48 51 52 53 57 58 59 60 and 61 Reverse scored items on the Adult Consumer Form B include items 13 and 16 1 Items 13 and 16 are stand alone measurements of individual outcomes related to Safety and Health no inter item comparisons or relationships e g sums averages are appropriate Even though the individual items should not be combined with each other for consistency purposes you should reverse score items 13 and 16 so that the most positive response carries the highest value 39 Testing Your Reverse Scoring Methodology The Data Entry and Reports Template will automatically reverse score all appropriate items If you re not using the Data Entry and Reports Template you can check to see if your reverse scoring methodology is correct by running some sample instruments through your system and seeing if you get correct subscale scores Two scenarios with expected values are outlined below Scenario 1 Complete sample copies of Adult Consumer Form A and Adult Consumer Form B with the first box checked for all questions on the instruments as in the example

The Lighthouse Ohio Consumer Outcomes Protocol

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