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Creating a Shared Vision in a Therapeutic Day School Setting Jewish Child & Family Services Emily Shapiro Melissa Villegas
Creating a Shared Vision in a Therapeutic Day School Setting
Jewish Child & Family Services
Emily Shapiro Melissa Villegas
1. Our journey to the TDS CANS2. Pilot year results3. Lessons learned & looking forward
Our Agency: JCFS
Mission: to provide help, healing, and caring services infused with Jewish values to strengthen lives in our community
Program Areas1. Counseling & Support2. Support for Communities3. Education4. Child Welfare5. Services for People with Disabilities6. Employment Services
JCFS Therapeutic Day School (TDS)
Emotional Disturbance
Learning Disability
Autism
Intellectual Disability
Traumatic Brain Injury
Other Health Impairment
TDS Philosophy
Supportive & Therapeutic
Individualized Supports & Instruction
Strengths-based
Collaborative Problem Solving
Skill, not will
Communication & Collaboration
Remember your ABC’s
Mutual Satisfaction
A
B
C
TDS Key Outcomes
Reintegration
Academic Growth Social/Emotional Growth
156 students served
1.5 years average stay
Majority elementary
TDS Demographics
TDS Demographics
Majority are male
Average age
Over a third are low-income
13
Primary Diagnoses
Why we chose the CANS
Measurement Conundrum
Reintegration
Academic Growth Social/Emotional Growth ?
Existing methods of measurement
CAFAS: Child and Adolescent Functional Assessment Scale
IEPs: Individualized Education Program plans
Student Incident Reports
Existing methods of measurement
Lacked reliability
Did not capture the whole picture
Ignored student strengths
Focused on the negatives
Reliable StrengthsTreatment Planning
Program Evaluation
Multiple Perspectives
Bigger Picture
CAFAS P P P P
IEPs P
Incident Reports P
Shared Vision?
Achenbach Instruments
Youth Self Report Form
Child Behavior Checklist
Teacher Report Form
In-House Tools
Youth Information Form
Educational Placement Form
Reliable StrengthsTreatment Planning
Program Evaluation
Multiple Perspectives
Bigger Picture
CAFAS P P P P
IEPs P
Incident Reports P
CANS P P P P P P
Implementation
Summer 2016
Clinical Team review the CANS, CANS-EI
and Ohio Scales
What questions do we want to
answer?
Weighed the pros and cons
Let’s do the CANS!
Finalized the tool & manual
Training & Reliability Testing
It’s go time!
Fall 2017
The JCFS TDS CANS
Required Domains
Student Strengths
Educational Needs
Functioning Needs
Behavioral/Emotional Needs
Risk Behaviors
Life Domain Needs
Required if “Actionable”
Trauma
Traumatic Stress Symptoms
Substance Use
Family Together
Students 13.5+ Years Old
Transition to Adulthood
Results
87 of 156 students were assessed twice
Time 1: Fall Semester
Time 2: Spring Semester
Top Strengths of Elementary Students
62%
70%
73%
71%
73%
68%
71%
73%
75%
84%
Spiritual/Religious
Family Strengths
Cultural Identity
Caregiver Availability
Staff RelationshipsTime 1
Time 2
Top Strengths of High School Students
63%
63%
88%
63%
79%
63%
42%
63%
67%
67%
75%
75%
Spiritual Religious
Talents/Interests
Cultural Identity
Staff Relationships
Caregiver Availability
Family StrengthsTime 1Time 2
Top Needs of Elementary Students
51%
52%
48%
40%
52%
70%
70%
41%
48%
51%
54%
59%
62%
70%
Aggression Twrd People
Verbal Aggression
Social Perception
Irritability
Anger Control
Impulsivity
Self RegulationTime 1Time 2
Top Needs of High School Students
54%
54%
54%
46%
42%
38%
33%
29%
46%
46%
46%
46%
46%
50%
Social Perception
Building Relationships
Irritability
Self Regulation
Decision Making Skills
Academic Persistence
AnxietyTime 1
Time 2
4
3
24
15
10
9
5
1
8
15
17
20
21
22
28
31
31
34
Anxiety Disorders
Psychotic Disorders
AD/HD
Autism Spectrum Disorder
Depressive Disorders
Disruptive, Impulse-Control, Conduct
Bipolar and Related Disorders
Intellectual Disabilities
Trauma/Stressor-Related
Average Needs by Diagnosis
Average Actionable Needs
Students in Diagnostic Category
Reliable Improvement – Any Domain
68% 9% 23%
ALL Studentsn=87
Improvement No Change Decline
67% 12% 22%
Open Episodesn=69
72% 28%
Dischargedn=18
Reliable Improvement by Domain
Improvement No Change Decline
14%
15%
18%
20%
22%
26%
57%
62%
67%
60%
60%
55%
29%
23%
15%
21%
18%
18%
Life Domain Needs
Risk Behaviors
Behavioral/Emotional
Educational Needs
Functioning Needs
Strengths
Significant Change*
Improved
Staff Relationships
Sensory Integration
Declined
Empathy
Suicide Risk
Sexual Aggression
Medical/Physical
Sexual Development
*when p < 0.05
Reliable Improvement - Length of Stay
72%
59%67%
57%
100% 100%
Less Than 1Year (n=25)
1 Year(n=32)
2 Years(n=15)
3 Years(n=7)
4 Years(n=5)
5+ Years(n=3)
Attendance
40% 60% 80% 100%
Attendance Raters = -0.71 (p = .01)
Low Attendance Top NeedsAttendanceSelf-RegulationAcademic PersistenceIrritabilityMood Disturbance
Incidents per Student
Total Incidents
Average = 20 incidents/studentMedian = 14 incidentsSD = 24.5
Incidents Groups
57
19
11
0-20 Incidents 21-45 Incidents 46+ Incidents
LOW MEDIUM HIGH
Incidents Groups
10 Years11 Years14 YearsAverage Age:
Top Diagnoses:AD/HDAutismTrauma
Disruptive, ConductAD/HD
Depressive
Disruptive, ConductAD/HD
LOW MEDIUM HIGH
Incidents & Top Needs
LOW Incident Group*
Self Regulation
Anger Control
Irritability
Impulsivity
Building Relationships
MEDIUM Incident Group
Self Regulation
Anger Control
Irritability
Verbal Aggression
Refusal to Follow Directions
HIGH Incident Group
Self Regulation
Impulsivity
Aggression towards People
Verbal Aggression
Refusal to Follow Directions
*Identical to overall results
Lessons Learned & Feedback
• Training Improvements
• Assessment Schedule
• Desire to see results!
• Overall, a first-year success
Looking forward…Scales Development
• Reintegration• Aggression• Social• AD-HD
Reporting Results• Individual students• Clinician’s caseload• Schoolwide
Social/Emotional Curriculum
