Strengths Case Management Fidelity Scale ~ University of Kansas (Draft ) Protocols for Rating Item 1a

Transcription

1 CM responsibilities Item #1. Case Managers Job Responsibilities are fully devoted to case management. 1a) What percentage of time do case spend providing case management and performing related case management responsibilities? Less than 70% Between 70% to 79% Between 80% to 89% Between 90% to 99% % 1b) What percentage of case have mixed responsibilities? 90% or more Between 70% and 89% Between 51% and 69% Between 26% and 50% 25% or less Protocols for Rating Item 1a Find out if case have any responsibilities other than case management. Case management responsibilities would include providing direct services to clients, plus all the indirect activities required of the case management position (e.g. documentation, group supervision, staff meetings, training, etc.). Other responsibilities would be those activities that are outside the scope of the Strengths Model case management position. This could include, but is not limited to, leading psychosocial groups, providing attendant care services, supported employment, screenings for Nursing Facilities for Mental Health (NFMH), therapy, and providing Target Case Management (TCM) to clients on another case manager s caseload. Facilitating Integrated Dual Diagnosis Treatment (IDDT) groups or Dialectical Behavioral Therapy groups (DBT) are counted within the case responsibilities if the case manager is part of an IDDT or DBT team. These groups are allowed because they are part of an integrated model, based on research evidence, that is designed to enhance the effectiveness of case management with the person. Determine the number of hours that case spend providing non-case management activities per week. If this person leads a group, also count the time required to prepare for the group. If the person provides an activity that is not done on a weekly basis (e.g. leads a group two hours twice a month, etc.), determine how many hours are spent doing this activity per month and divide by 4.5 to get a weekly average. Deduct the number of hours spent providing these activities from the total number of hours they work per week and divide by the total number of hours they work per week to get a percentage. Example: If they spend 4 hours of a 40 hour week leading groups, this would be (40-4) 40. After determining the percentage of time that each case manager spends doing case management, add each case manager s percentage together and divide by the total number of case for the team. This number will determine the rating. 1

2 Protocols for Rating Item 1b Take the total number of case that have any responsibilities other than case management and divide by the total number of case on the team. Final Scoring for Item 1 Add the final ratings for Item 1a and Item 1b and divide by two. Caseload Ratios Item #2. Case have low caseload ratios (this varies depending on intensity of caseload, but no more than 20:1) a) What is the average weighted caseload size for the CM team? More than to to to or less Protocols for Rating Item 2a Determine weighted average caseload ratio by dividing each case manager s caseload by the percentage of time the person devotes directly to case management each week (Obtained in Item 1a). For example, if a case manager served 20 people on their caseload and spend 80% of their time doing case management related activities then you would take = 25. Therefore 25 is this person s weighted caseload size. Add all weighted caseloads for all case together and divide by the total number of case on the team. Use this number to determine the final rating. 2

3 Additional Information for Item 2 Project Sites Only Find out if any case serve a high number of special populations. This would include, but is not limited to, persons with a chemical dependency, homeless, older adults, people under 21, developmental disabilities, physical disabilities, high rates of hospitalization, etc. Case serving a high number of people with intensive needs may need to have a lower caseload in order to provide effective services. Integrated MH Services (Currently still under review) Item #3: Integrated Supported Employment Services 3a) The employment specialist attends in all group supervision meetings. 3b) The employment specialist participates in the full group supervision meeting The agency doesn t have an SE program. The agency doesn t have an SE program The agency has an employment specialist but doesn t attend group supervision meetings. An employment specialist attends 50% or less of group supervision meetings An employment specialist attends group supervision meetings but does not stay for full meeting An employment specialist attends 51-99% of group supervision meetings An employment specialist attends all group supervision meetings An employment specialist participates in the full group supervision meeting. 3c) The employment specialist accepts referrals exclusively from the team. The agency doesn t have a SE program An employment specialist accepts referrals from more than 2 teams An employment specialist is assigned to two CM teams & accepts referrals exclusively from those teams. An employment specialist is assigned to one CM team, & accepts referrals exclusively from the team. Protocols for Rating Item 3a Find out if the agency has a Supported Employment (SE) program. If so, find out if an SE worker attends the group supervision meetings. If they do attend, find out what percentage of group supervision meetings held per month they attend. 3

4 Protocols for Rating Item 3b Find out how much of each group supervision meeting the SE worker participates in each group supervision meeting. The SE worker would need to attend each group supervision meeting and stay the entire time to rate a five in this item. Protocols for Rating Item 3c Find out how many teams the SE worker accepts referrals from. You can count that the SE worker accepts referrals from only one team, if 90% or more of the people on their SE caseload are from one team. Final Scoring for Item 3 Add the final ratings for Item 3a, Item 3b and Item 3c and divide by three. Additional Information for Item 3 Project Sites Only Find out what other auxiliary services are available to clients at the center. These could include, but are not limited to, IDDT services, Peer Support, Supported Education, Attendant Care-type services, 24/7 crisis services, etc. If these services are available, it is important to find out how they are integrated with case management services. From interviews with clients, you can also find out how aware people are of these services and have they been offered any of them. The intention is that all of these services would integrate with case management services if they are available within the agency. For now, the integration of these other important auxiliary services with case management are not considered an item of the scale, only because there is currently wide diversity in the way many of these services are implemented in practice. Therefore any measurement of integration would be difficult. 4

5 Supervision Group Supervision Item #4: Strengths-Based Group Supervision a) The group supervision focuses primary on discussion of clients rather than administrative tasks 40% or less of the meeting is focused on discussion of clients 41-50% of the meeting is focused on discussion of clients 51-69% of the meeting is focused on discussion of clients 70-79% of the meeting is focused on discussion of clients 80% or more of the meeting is focused on discussion of clients 4b) Number of case that attend each group supervision meeting. 9 or more case 8 case 7 case 6 case 5 or fewer case 4c) A specific set of clients are presented using the formal group supervision process 4d) Group supervision presentation quality: Team does not use the formal group supervision process One client is presented using the formal group supervision process Two clients are presented using the formal group supervision process Three or more clients are presented using the formal group supervision process Sub-item 1:Strengths assessments are handed out to each team member for all. No SA s were given to team members in any of the SAs were given to team members in 25% or less of the SAs were given to team members in 26-50% of the SAs were given to team members in 51-99% of the SAs were given to team members in all of the. Sub-item 2: The case manager clearly states what they want help with from the group during the presentation. What the CM wants help with is not clearly stated in any of the What the CM wants help with is clearly stated in less than 25% of the What the CM wants help with is clearly stated in 26-50% of the What the CM wants help with is clearly stated in 51-99% of the What the CM wants help with is clearly stated in all of the Sub-item 3: The case manager clearly states what the client s goal(s) are The client s goals are not clearly stated in any of the The client s goals are clearly stated in less than 25% of the The client s goals are clearly stated in 26-50% of the The client s goals are clearly stated in 51-99% of the The clients goals are clearly stated in all of the 5

6 Sub-item 4: The team asks questions based on the strengths assessment (SA) None of the questions pertaining to the SA are asked.. A few questions based on the SA are asked.. Team asks a majority of questions based on the SA. Sub-item 5: The team brainstorms suggestions to help the client achieve their goal or help the CM engage with person or develop goal. An average of 10 suggestions is generated per review. Brainstorming results in 3 or less ideas per review.. Brainstorming results in 4 to 9 ideas per review -- Brainstorming results in 10 or more ideas per review Sub-item 6: An clear plan/strategy is stated for each presentation. The CM states the next steps. No clear plan or next steps are stated in any of the A clear plan or next steps are stated in less than 25% of the A clear plan or next steps are stated in 26-50% of the A clear plan or next steps are stated in 51-99% of the A clear plan or next steps are clearly stated in all of the. Protocols for Rating Item 4a Rating this item will involving recording the amount of time that specific clients are discussed versus other discussions (e.g. program announcements, policy changes, general program discussion, etc.). Take the total amount of time that specific clients were discussed and divide that by the total time of the meeting. Discussion of resources can count as part of discussion of clients if the discussion is tied to obtaining a resource for a particular client. A general announcement of a resource would count as administrative time. For the purposes of this item, only count the actual time of the meeting, not the scheduled time. For example, it the meeting is regularly schedule for 120 minutes per week, but at this particular meeting they end 10 minutes early, count the total time of the meeting as 110 minutes. Protocols for Rating Item 4b Find out the number of case that regularly attend the group supervision. If someone is absent on the review date, still count the number of the full case management team. If the team has a vacant case management position open on the team, count this position if the agency has the intention of hiring for this position. Do not count other staff that attend the meeting (e.g. the supervisor, SE worker, substance abuse specialist, psychiatrist, nurse, etc.). 6

7 Protocols for Rating Item 4c Observe to see if the team is using or attempting to use the formal group supervision process as outlined in the Strengths Model of Case Management. At minimum, this would include a somewhat structured format lasting at least 15 minutes which included the presenting case manager asking for some specific help from the team, the team brainstorming suggestions and a plan is developed. Count the number of clients that are presented using this format. Protocols for Rating Item 4d This item is only used to rate the quality of the formal group supervision. If the team get a rating of 1 on Item 4c, you do not need to rate Item 4d. You can still give the team feedback on elements within their group supervision process that are compatible with the formal group supervision process as outlined by the Strengths Model of Case Management. This item contains six sub-items. To rate Item 4c, you will need to rate each of the individual sub-items and divide by six. Sub-Item 1: Strengths assessments are used throughout the review. Copies of the strengths assessment need to available to each person in the group supervision meeting. Of the formal case, count the number of that used the strengths assessment and divide by the number of total case for that meeting. Sub-Item 2: The review begins with a statement of what the CM wants help with. This should be explicitly stated prior to beginning discussion of the client situation, however as long as the case manager or someone in the group draws attention to this at some point in the presentation, it should be counted as occurring. Count the number of in which the case manager states what they are wanting help with and divide by the number of total case for that meeting. Sub-Item 3: The case manager clearly states what the client s goal(s) are. Ideally this would start at the beginning of the presentation, but as long as the client s goal(s) is (are) stated at some point in the presentation, it should be counted. Often the what the case manager wants help with is also the client s goal, even though it is not explicitly stated as such. For example, case manager might start off a presentation saying he/she needs help with helping a client get an apartment, but not explicitly state this is the client s goal. Unless the discussion clearly indicates that this is not the client s goal, go ahead and count it as being the client s goal. If the case manage states something like they are needing help getting the person to take their medications, stay out of the hospital, stay clean or sober, etc., these goals need to have the client s goal specifically stated to meet the criteria for this item. An exception to this is if the client does not currently have a goal they wish to work on. In this situation count it as occurring, if the case manager makes it known that there is not a goal that has been stated by the client. Sub-Item 4: The team asks questions based on the strengths assessment. Count the number of questions that are asked of the presenting case manager regarding information contained on the strengths assessment versus questions not related to the strengths assessment. To rate a five on this item, a majority of the questions would need to be based on information contained in the Strengths Assessment. Sub-item: 5: The team brainstorms suggestions to help the client achieve their goal or help the CM engage with person or develop goal(s). Count the number of suggestions that result from the brainstorming session. It does not matter whether the suggestions are good or bad ones. The intent is that good 7

8 brainstorming should generate a lot of ideas. Take the number of suggestions that were generated for each presentation and divide by the number of. An average of 10 suggestions per presentation would need to be generated to rate a five on this item. Sub-item 6: A clear plan/strategy is developed for each presentation. After each group supervision presentation, the case manager should explicitly state what next steps he/she will take based on the suggestions that were generated. This should sound more like I like the idea of making a referral to supported employment. I will meet with her (the client) this Thursday and get a little more clarity on her interest in working. I also like the idea of using a 1-10 scale with her to assess any ambivalence she might have about working. I ll try that as well. verses I ll give her a call this week and go from there. To rate this item, take the number of that end with an explicit plan/strategy developed and divide by the total number of for that meeting. Scoring for Item 4d Add the ratings for all the sub-items for 4d and divide by 6. Final Scoring for Item 4 Add the ratings for Item 4a, Item 4b, Item 4c, and Item 4d and divide by 4. Item #5. s duties a) spends at least 2 hours per week providing a quality review of tools related to Strengths Model of Case Management (i.e. Strengths Assessments and Personal Recovery Plans) and integration of these tools into actual practice. spends less than 30 minutes reviewing Strengths Assessments and Personal Recovery Plans spends minutes per week reviewing Strengths Assessments and Personal Recovery Plans spends minutes per week reviewing Strengths Assessments and Personal Recovery Plans spends minutes per week reviewing Strengths Assessments and Personal Recovery Plans spends at least 2 hours per week reviewing Strengths Assessments and Personal Recovery Plans 5b) spends at least 2 hours a week giving case specific feedback on skills/tools related to the Strengths Model of Case Management. spends less than 30 minutes case giving them specific feedback on skills/tools related to the model spends minutes per week giving case specific feedback on skills/tools related to the model spends minutes per week giving case specific feedback on skills/tools related to the model spends minutes per week giving case specific feedback on skills/tools related to the model spends at least 2 hours per week giving case specific feedback on skills/tools related to the model 8

9 5c) spends at least 2 hours per week providing field mentoring for case spends less than 30 minutes per week providing field mentoring for case spends minutes per week providing field mentoring for case spends minutes per week providing field mentoring for case spends minutes per week providing field mentoring for case spends at least 2 hours per week providing field mentoring for case 5d) What is the ratio of case to supervisors? 1 supervisor to 9 or more case 1 supervisor to 8 case 1 supervisor to 7 case 1 supervisor to 6 case 1 supervisor to 5 or less case Protocols for Rating Item 5a Ask the supervisor if he/she reviews Strengths Assessments and/or Personal Recovery Plans. Ask when this occurs and if this they have a set time devoted to this. Ask him/her to describe the process he/she goes through when reviewing Strengths Assessments and/or Personal Recovery Plans. Listen for differences between reviewing these tools for document compliance purposes (e.g. present in the chart, signed and dated by client and case manager, up-to-date, etc.) versus reviewing for quality. For example when reviewing the Strengths Assessment, they would be looking to make sure the information was detailed and specific, uses client language throughout, captures the interests and aspirations of the client, has specific priorities generated by the client, etc. The supervisor might also be looking to see if information generated from the strengths assessment was being incorporated into actual practice by reviewing progress notes. If the supervisor was reviewing Personal Recovery Plans, they would be looking to make sure the goal was obtained from the Strengths Assessment and used the client s language, had specific and measurable steps, contained target dates to generate forward movement, evidence that the tool was being used on a regular basis with the client, etc. Try to come to some agreement with the supervisor about how much time they actually spend conducting this type of quality review of the tools. Some supervisors may do this differently. For example, some supervisors might set aside a specific time of the week to review tools while others might review the tools as part of a larger quality review of the chart. Others still might have case turn in Strengths Assessments and Personal Recovery Plans directly to their supervisor who reviews them prior to being filed in the chart. While it may be difficult to determine an exact time, especially when it may occur at various times throughout the month, try to negotiate a time with the supervisor that can most accurately reflect this as possible. Only count time that is spent on quality review of the tools. 9

10 Make note if they only review one of the tools (e.g. only reviews Strengths Assessments). While they would still rate a 5 on this item if they only reviewed Strengths Assessment for at least two hours per week, we would want them to know that if their agency started using the Personal Recovery Plans, they would want to include this tool in their quality review process. Protocols for Rating Item 5b Ask the supervisor if they devote any specific time during the week to giving case feedback on skills/tools related to the Strengths Model of Case Management. If the answer is yes, have them describe this process. Write down the type of feedback they typically give and where/when this occurs. What you are looking for in this item is an active approach toward giving staff feedback on skills/tools related to the model. Here are few examples: 1) sitting down with a case manager to over one of their strengths assessments and discussing how areas could be expanded or how to engage the person to obtain additional information; 2) having the case manager practice motivational interviewing with you through role play; 3) sitting down with a case manager who is struggling with several clients who are not taking medications and discussing how they might help the person process any decisional ambivalence; or 4) reviewing Personal Recovery Plans with the case manager to show them how to break down the goal into smaller measurable steps to generate movement. Try to come to some agreement with the supervisor about how much time they actually spend giving this type of specific feedback. Most supervisors will probably give feedback to new case when they are just starting. If this is the only time that the supervisor gives any structured feedback on skills/tools, this would not count in the rating. The intent of this item is that feedback on skills/tools should be an ongoing process for the professional development of all staff in implementing and sustaining Strengths Model practice. Protocols for Rating Item 5c Field mentoring is a structured form of supervision where the supervisor and case manager meet together with a client for the specific purpose of the case manager learning, developing, and/or enhancing skills or use of tools related to the model. Ask the supervisor if they go out into field with case. Ask them how often they do this and whether or not they do this with all case. Have them describe some of the typical things they do when they go out in the field with case. List these things down. Listen for differences between field mentoring and other supervisor activities in the field (e.g. doubling up with a case manager for extra support, having the supervisor meet the client, etc.). If the supervisor describes doing any type of field mentoring, try to negotiate the time that the actually occurs. If it does not occur on a weekly basis, but does happen within any given month, add the number of hours per month and divide by 4.5 for a weekly average. 10

11 Protocols for Rating Item 5d Ask the supervisor how many case they directly supervise. It is possible that a supervisor may supervisor may supervise case on more than one team. Final Scoring for Item 5 Add the ratings for Item 5a, Item 5b, Item 5c, and Item 5d and divide by 4. Strengths Assessment Item #6: Strengths Assessment The strengths assessment is a stand-alone tool used according to the strengths model of case management; not mixed with any other type of assessment tool a) The SA is regularly updated. 44% or less SA s are updated quarterly. 45% to 59% of the SA s are updated quarterly. 60% to 74% of the SA s are updated quarterly. 75% to 89% of the SA s are updated quarterly. 90% or more of the SA s are updated more than quarterly. 6b) Client interests and/or aspirations are identified in some detail and with specificity. 33% or less of SA s reviewed identified client interests / aspirations -- 34% to 66% of SA s reviewed identified client interests / aspirations -- 67% or more of SA s reviewed identified client interests / aspirations 6c) Consumer language is used, e.g. I want more friends rather than increase socialization skills 33% or less of SA s reviewed use consumer language -- 34% to 66% of SA s reviewed use consumer language -- 67% or more of SA s reviewed use consumer language 11

12 6d) Talents and / or skills are listed on the SA in some detail and specificity. 33% or less of SA s reviewed list talents / skills % to 66% of SA s reviewed list talents / skills % or more of SA s reviewed list talents / skills. 6e) Environmental strengths are listed on the SA in some detail and specificity. 33% or less of SA s reviewed list environmental strengths -- 34% to 66% of SA s reviewed list environmental strengths -- 67% or more of SA s reviewed list environmental strengths Protocols for Rating Item 6a Look for Strengths Assessments in all of the charts that have been pulled for the review. For each review it is good to have at least two charts for each case manager on the team. For each Strengths Assessment that you review check to see when it was last updated. Make note whether the Strengths Assessment was updated within ninety days of the review. Check for instances where a Strengths Assessments may have the original date on the top, but have updates within the body (noted by a more recent date). If there is not a Strengths Assessment in the chart, it is counted as outdated, unless someone at the agency can locate a strengths assessment that has been completed but not yet filed. Add the total number of Strengths Assessments from all the charts reviewed that have been updated within the quarter and divide by the total number of charts reviewed. Protocols for Rating Item 6b For each Strengths Assessment that you review, check the middle column (Individual s Desires; Aspirations) and note the level of detail and specificity provided. Look for detail and specificity like I want to go back to school and get my degree, I want to learn how to play the guitar, I want to buy my own car, etc. What would not count are one word aspirations like school, friends, hobbies, etc. or vague statement like improve heath, have more fun, etc. While it is okay to have some vague statements on a strengths assessment, if it is still early on the relationship and the strengths assessment is currently being further developed, there should be evidence of detail and specificity in some areas. A good place to check is the priorities section of the strengths assessment. At minimum these priorities should have some detail and specificity. Give credit to overall detail and specificity, if the priorities reflect this and there is some at least two or three areas detail and specificity in the body of the middle column of the strengths assessment. 12

13 Add the total number of all strengths assessments that meet the criteria for listing client s interests and aspirations in some detail and specificity and divide by the total number of charts reviewed. Protocols for Rating Item 6c Review all strengths assessments for use of client language. Use of I statements are good indicators of client language. Look for language that would be in the person s own words I want a girlfriend versus professional jargon increase social relationships. To meet the criteria for this item, a majority of the statements on the strengths assessment should clearly reflect the client s language. Add all of the strengths assessments that meet the criteria for use of client language and divide by the total number of charts reviewed. Protocols for Rating Item 6d Review all strengths assessments for evidence of talents and skills listed in some detail and specificity. For example, statements like has painted landscapes that are hung in apartment, can type 50 words per minute, knows a lot about baseball cards, etc. At least three talents or skills should be listed in some detail and specificity on a strengths assessment to meet the criteria for this item. Add all of the strengths assessments that meet the criteria for talents and skills listed in some detail and specificity and divide by the total number of charts reviewed. Protocols for Rating Item 6e Review all strengths assessments for evidence of environmental strengths listed in some detail and specificity. Environmental strengths are strengths that exist outside of the person that helps or has helped them in their recovery or well-being. For example, family, friends, neighbors, pets, car, job, church, bowling league, support group, etc. To meet the criteria for this item, the environmental strengths should contain some detail about how it is used as a strength. For example, mom has a car and is able to get me to appointments, playing with my dog keeps my stress level low, I have two friends at church (Mary and Elizabeth) who I go to lunch with. Add all of the strengths assessments that meet the criteria for environmental strengths listed in some detail and specificity and divide by the total number of charts reviewed. Final Scoring for Item 6 13

14 Add the ratings for Item 6a, Item 6b, Item 6c, Item 6d, and Item 6e and divide by 5. Integration of Strengths Assessment Item #7: Integration of Strengths Assessment into Practice a) Strengths Assessment is used to help clients develop treatment plan goals 60% or less of the goals listed on the current treatment plans were clearly derived from the SA 61-70% of the goals on the current treatment plan are clearly derived from the SA % of the goals on the current treatment plan are clearly derived from the SA % of the goals on the current treatment plan are clearly derived from the SA % of the goals on the current treatment plan are clearly derived from the SA Protocols for Rating Item 7a For each chart that you review, list all of the goals on the client s most recent treatment plan. Also only review treatment plan goals written or intended for case management (e.g. do not include psychiatrist, therapists, nurses goals, etc.). Compare these with the client s priorities and other interests and aspirations (listed in middle column of strengths assessment) listed on the strengths assessment. Count all of the treatment plan goals that have a clear relationship to a priority or interest and aspiration on the strengths assessment. You will need to use some discretion if a treatment plan goal is written in professional jargon, but seems to have a link to what the person is saying they want. For example, a treatment plan goal might vaguely state Improve mental health, while the top priority for the client might read I want to think clearly without all the voices. While it is ideal that two match up almost exactly, an example such as this would count as meeting criteria. You can give feedback to the agency that if they are going to use professional jargon for the treatment plan, it would be good to at least put the client s own words in quotes next to it, so that it clearly shows the link. Add the total number of goals that are clearly derived from the strengths assessment and divide by the total number of goals for case management that are found in treatment plan you have reviewed. Additional Information for Item 7 Project Sites Only During interviews with clients, ask how many of them are aware of the strengths assessment. You can show clients a blank copy of a strengths assessment and ask how many of them have ever seen it. For those that have seen it, ask them how often they work on this tool with their case manager. 14

15 Also, when reviewing progress notes in the chart, look for evidence that case are collecting information for the strengths assessment or using information from the strengths assessment to achieve goals the client has stated. Personal Recovery Plan Item #8: The Personal Recovery Plan goal is integrated into CM practice a) Agency uses the Personal Recovery Plan as a stand-alone tool for helping clients achieve goals Agency does not use Personal Recovery Plan or any systematic way of breaking down client s goals into measurable steps Agency uses Personal Recovery Plan, but not in any systematic way with all client s who have recovery goals. Agency uses Personal Recovery Plan in a systematic manner with all client s who have recovery goals. 8b) Goals on the Personal Recovery Plan should use the client s own language and reflect something they are passionate about. Less than 25% of goals on the goal worksheet use client s own language Between 26-50% of the goals on the goal worksheet use the client s own language Between 51-99% of the goals on the goal worksheet use the client s own language. All the goals on the goal worksheet use the client s own language 8c) Long-term goal on the Personal Recovery Plan is broken down into smaller, measurable steps. Less than 25% of goals on the goal worksheet are broken down into smaller, measurable steps Between 26% and 50% of goals on the goal worksheet are broken down into smaller, measurable steps Between 51% and 99% of goals on the goal worksheet are broken down into smaller, measurable steps All goals on the goal worksheet are broken down into smaller, measurable steps 8d) Specific and varying target dates are set for each step on the Personal Recovery Plan. Less than 25% of steps on the goal worksheet are specific and have variation Between 26% and 50% of steps on the goal worksheet are specific and have variation Between 51% and 99% of steps on the goal worksheet are specific and have variation All steps on the goal worksheet are specific and have variation 8e) Goal worksheets are updated during nearly every contact with the client. Less than 25% of goal worksheets are frequently updated Between 25% and 50% of goal worksheets are frequently updated Between 51% and 99% of goal worksheets are frequently updated All goal worksheets are frequently updated 15

16 Protocols for Rating Item 8a Talk with both case and agency leadership (i.e. front-line supervisors, CSS Director, Executive Director) about the use of the Personal Recovery Plan. If the agency does not use the Personal Recovery Plan, ask about how they go about breaking down goals on the treatment plan. If they talk about breaking down goals through the use of objectives or action steps on the treatment plan, ask how often these objectives and action steps are discussed with clients. You can also get information for this item from interviews with clients. If the agency does use the Personal Recovery Plan, ask about the agency expectations for its use. To rate a 5 on this item, agency would need to have an expectation that all case used the Personal Recovery Plan when a client had a specific recovery goal and there was evidence that these were actually being used with the majority of clients on a regular basis. To distinguish between a rating of 3 or 5 on this item, you will probably need to rate the remaining items to determine if the Personal Recovery Plan is being used in a systematic manner or just occasionally by some case. Protocols for Rating Item 8b * Only rate items 8b through 8e if the agency has stated they use the Personal Recovery Plan. Otherwise the rating on 8a will serve at the final rating for this item. Ask the supervisor to provide you with at least two Personal Recovery Plans for each case manager on their team. It does not matter if these Worksheets are associated with the charts you have pulled for the review, since it is possible that one of the client s whose charts have been pulled for the review may not yet have a specific recovery goal in which to use the Personal Recovery Plan with. If you are not able to get two Personal Recovery Plans for each case manager on the team, this might indicate that a rating on 4 is warranted for Item 4a. If you are not able to get any Personal Recovery Plans, then this might indicate that a rating of 2 or 3 is warranted for item 4a. Review the goal(s) on each Personal Recovery Plan(s). This would be located at the top of the page where it says long-term goal or client s passion statement. This should be written in the client s own language. If any professional jargon is listed in order to tie it more closely to a goal on the treatment plan, there should still be a clear statement that is quoted from the client as to what their exact goal is. These goals should reflect something the client is passionate about. You should not see goals like take medications as prescribed or improve hygiene. Even if this is something a client might have said, it is the responsibility of the case manager to go beyond these words and get at why this might be important to the person and use this language on the Personal Recovery Plan. Add all the goals on the Personal Recovery Plans that use the client s language and divide by the total number of Personal Recovery Plans requested (i.e. two per case manager). If only a few case turn in Personal Recovery Plans, you would still count the total number requested as being what you would have had to review if all case each turned in two. 16

17 Protocols for Rating Item 8c Review each of the steps short-term goals on each of the Personal Recovery Plans. These would be located on the far left column of the Personal Recovery Plan under the long-term goal. Rather than vague steps like explore employment or get apartment, you should see steps like Pick up application for Henry s Restaurant, Practice job interview by doing role play or Fill out application for apartment or Fill out Section 8 application. Count this item as meeting criteria if the majority of steps are broken down and measurable. Add all Personal Recovery Plans that have are broken down into smaller, measurable steps and divide by the total number of Personal Recovery Plans requested (i.e. two per case manager). Protocols for Rating Item 8d Review each of the steps listed on the Personal Recovery Plan and look for evidence that specific target dates are being set. If all of the steps have the same date (e.g. geared toward the 90-day treatment plan review date), this would not count as meeting criteria. An exception to this would be if this was a new Personal Recovery Plan and the client and case manager had only step some steps for the next meeting at this time. Check the date on when the Personal Recovery Plan was started. If it is less than a month old, consider it a new Recovery Worksheet. Otherwise, you should see multiple dates on the worksheet, ideally with steps that show that something is being done each time the client and case manager meet. Add all Personal Recovery Plans that have steps with specific and varying target dates and divide by the total number of Personal Recovery Plans requested (i.e. two per case manager). Protocols for Rating Item 8e Review the dates on the Personal Recovery Plans to determine if they are being frequently updated. If they have been updated at least more than once in the last month, you can count this as being regularly updated. An exception would be a newly started Personal Recovery Plan which only has a few steps. If this Personal Recovery Plan has at least one step in the last month, count it as being regularly updated. If you are noticing that a large number (half or more) of Personal Recovery Plans are new ones, you might want to ask case to provide you with other Personal Recovery Plans that have had more time to develop. It is possible that some case might start some Personal Recovery Plans after learning a review is taking place, when they actually do not use these in practice. Final Scoring for Item 8 If the agency does not use Personal Recovery Plans, then only count the rating for Item 8a for the final rating for Item 8. 17

18 If the agency does use Personal Recovery Plans, add the rating for Items 8a, 8b, 8c, and 8d and divide by 4. Community Contact (This item is still under review) Item #9: The majority of consumer contact occurs in the community a) What percentage of consumer contact occurs in the community? Note: include time spent in consumers homes. Less than 49% of CM contact is spent in the community with clients or information is not able to be determined % of CM contact is spent in the community with clients % of CM contact is spent in the community with clients % of CM contact is spent in the community with clients. 85% or more of CM contact is spent in the community with clients. Protocols for Rating Item 9a This can be accomplished in two ways: 1) If the agency tracks time spent in the community, ask them to provide you with a sheet that breaks down the percentage of time each case manager spends in the community versus the office. Add the percentage of time each case manager spends in the community and divide by the total number of case on the team. 2) Review all progress notes for a period of 90 days prior to the date of the review. If the progress notes state where the contact occurred, then use the Location of Contact Worksheet to mark where each contact occurred (i.e. either office or community). If a progress note is not marked, see if you can determine from the language in the progress note where the contact occurred. If you are not able to decide, skip over this progress note and do not count it as anything. If there is no way to gather this information from the agency or if there are not enough progress notes to deduce this information (less than 75% of progress notes read), then rate the agency a 1 and give them the feedback that this information will need to be tracked in order to give them additional credit for location of contact in the community. 18

19 Additional Information for Item 9 Project Sites Only Obtain information, if possible, on the number of contacts that occur in either the office, the client s home, or in the community. While home visits are counted as community in 9a, it is important to distinguish between home and actual community time, because actual community time most clearly reflects the intention of this model. You should see time in the community outweigh the time spent in the home. Naturally Occurring Resources (This item is still under review) Item #10: Case make use of more naturally occurring resources than formal mental health resources in the helping relationship a) During the past 3 months, what percentage of goals worked on did the case manager specifically help the client access a naturally occurring resource to help achieve this goal Less than 25% of goals have evidence of the case manager helping to access at least one naturally occurring resource % of goals have evidence of the case manager helping to access at least one naturally occurring resource % of goals have evidence of the case manager helping to access at least one naturally occurring resource % of goals have evidence of the case manager helping to access at least one naturally occurring resource. More than 75% of goals have evidence of the case manager helping to access at least one naturally occurring resource. 10b) During the past 3 months, what percentage of goals clearly reflected a trend toward the use of formal mental health services More than 75% of goals clearly reflect a trend toward the use of formal mental health services 41-75% of goals clearly reflect a trend toward the use of formal mental health services 26-40% of goals clearly reflect a trend toward the use of formal mental health services 11-25% of goals clearly reflect a trend toward the use of formal mental health services Less than 10% of goals clearly reflect a trend toward the use of formal mental health services 19

20 The intent here is to measure whether case are making more use of naturally occurring resources than formal mental health services over a three month period. Formal mental health services are defined as those services provided by the mental health center. These services can only be accessed by a person meeting the eligibility criteria of the mental health center. Formal mental health services would include: medication services, psychosocial programs, attendant care, MHC payee services, supported employment, MHC housing, etc. Naturally occurring resources are defined as those resources can be accessed by anyone in the community whether or not they are a client of the mental health center. Naturally occurring resources would include: family, friends, neighbors, faith community, schools, pets, library, YMCA, bowling league, etc. Community Services do not count as either formal mental health services or naturally occurring resources. Community Services would include things like Social Security, Social and Rehabilitative Services, Red Cross, food banks, drug and alcohol programs, homeless shelters, etc. Protocols for Rating Item 10a Write down every goal from the treatment plan that is being actively worked on during the past 90-days prior to the review. To be considered active, there would need to be at least one progress note written mentioning this goal. Read each progress note that mentions this goal, and record whenever a naturally occurring resource is actually accessed with the help of the case manager. Just talking about a naturally occurring resource would not count. The case manager would have to assist the person in some active way. There are two means of active help that could be counted for this item: 1. The case manager directly assisting the client to access the naturally occurring resource For example, going with a client to sign up for a cooking class in the community, helping the client pick up a job application, sitting down with a client and a family member to discuss how they might support the client in reaching a particular goal, taking the client to look for apartments in the community. 2. The case manager indirectly helping the client to access the naturally occurring resource Some examples might include: 1) the case manager brainstorming with the client some naturally occurring resources that might help them to reach their goal; 2)discussing how the client might access a naturally occurring resource; or 3) making a plan for the client to access a naturally occurring resource. For this means to be counted for scoring, there must be evidence that the client was able to successfully access the naturally occurring resource on their own. By doing this, it prevents counting resources that are continually discussed but never followed up on. If the agency uses Personal Recovery Plans, this is also a good source of information for this item. 20

21 Add the number of goals which have evidence of the case manager helping the client to access at least one naturally occurring resources and divide by the total number of goals you have reviewed. Protocols for Rating Item 10b Taking the goals you have listed in 10a, look for the overall trend of where the case manager is headed in trying to help the person achieve the goal. Write down for each goal, which ones move clearly in the direction of a formal mental health service being the primary means of achieving the goal. For example, if the persons goal is get an apartment, is getting into an agency-owned apartment the primary resource being used to meet this goal. Other examples would be, getting a payee at the agency for a goal around managing money, getting an agency sponsored transitional employment job for a work related goal, getting into psychosocial groups as a means of increasing socialization or improving mental health or wellbeing, getting attendant care services around the goal of staying out of the hospital. This does not mean that any of these formal services are to be avoided in all circumstances, but if they are used as the primary means or even end to achieving a goal on the treatment plan, then you would count this as trending toward the use of formal mental health services. Add the number of goals that clearly reflect a trend toward formal mental health services and divide by the total number of goals you have reviewed. Final Scoring for Item 10 Add the ratings for Items 10a and 10b and divide by 2. 21

22 Hope Inducing Behaviors (This item is still under review) Item #11 Case Managers exhibit hope behaviors when interacting with people receiving services or other staff a) Case demonstrate hope- behaviors in the following areas: Interactions at group supervision Interacting with clients in the field Language in progress notes Responses to interview questions None of the sources behaviors The minority of the sources behaviors The majority of sources behaviors. All sources behaviors. 11b) s exhibit hope- behaviors in the following areas: Interactions at group supervision Interacting with staff and clients during field mentoring Responses to interview questions None of the sources behaviors The minority of the sources behaviors The majority of sources behaviors. All sources behaviors. 11c) Consumers state that case exhibit hope- behaviors None of the answers from the consumers behaviors The minority of the answers from the consumers behaviors. The majority of the answers from the consumers behaviors. All of the answers from the consumers behaviors. 22