2013 annual gathering: workshop#11b: using ansa for client assessment
TRANSCRIPT
7/27/2019 2013 Annual Gathering: Workshop#11B: Using ANSA for Client Assessment
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Using ANSA for Client Assessment and Program
Evaluation
Catholic Charities USA Conference, 2013
Dan Bowersox
Shona Q. Baum, LCSW[[email protected]]
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• Who we are, and how we got here
• Choosing ANSA
• A deeper look at ANSA
• Examples and vignettes
• Our implementation and results
• Discussion
Agenda
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• Who we are – Founded in 1989
– Serving 3,300 families per year
– Diverse staff of 70
• Education
• Work experience,• Case management skill level
• What we do
– Case Management
• Substance Abuse
• Domestic Violence• Child Welfare
– Housing
– Wellness Center
In partnership with our families, break the cycle of childhood poverty
Homeless Prenatal Program (HPP)
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• Intensive job training program
• Participants are low-income parents – Many are former clients of the agency
– Limited education/employment experience
• Majority of HPP case managers are graduatesof the program
– First agency in San Francisco to hire former clients
CHW Training Program
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The Challenges
• Ensure consistent quality of client service
• Meet increasing need from funders for data and formal program
evaluation
Or: We know we are doing great work. How do we prove it?
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• Ensure consistency in assessing clients’ needs and strengths
• Facilitate creation of service plans
• Allow monitoring of outcomes
• Standard language for communication between team members
The Solution:
Standardized Assessment
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Why ANSA?
• Open domain tool, widely used
– Interface with other agencies
• DPH, Child Welfare
• Cross-disciplinary
• Focus on necessary actions• Non-judgmental
• Appropriate for multi-cultural environment
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About ANSA
• Developed and copyrighted by the Praed Foundation*
• Free to use
• Training and certification available
* Copyright 1999, the Praed Foundation, www.praedfoundation.org
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ANSA Categories
Life Domain Functioning
– Physical/Medical
– Family Functioning
– Employment
– Social Functioning
– Recreational
– Intellectual
– Sexuality
– Living Skills
– Residential Stability
– Legal
– Sleep
– Self Care
– Medication Compliance
Acculturation
– Language
– Identity
– Ritual
– Cultural Stress
Mental Health Needs
– Psychosis
– Impulse Control
– Depression
– Anxiety
– Interpersonal Problems
– Antisocial Behavior
– Adjustment to Trauma
– Anger Control
– Substance Use
– Eating Disturbance
Risk Behaviors
– Suicide Risk
– Self Injurious Behavior
– Other Self Harm
– Exploitation
– Danger to Others
– Sexual Aggression
– Criminal Behavior
Strengths
– Family Involvement
– Social Connections
– Optimism
– Educational
– Job History
– Talents/Interests
– Spiritual/Religious – Natural Supports
– Resiliency
– Resourcefulness
– Volunteering
– Community Connection
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HPP Assessment Categories
Life Domain Functioning
– Physical/Medical
– Family Functioning
– Employment
– Social Functioning
– Recreational
– Intellectual
– Sexuality
– Living Skills
– Residential Stability
– Legal
– Sleep
– Self Care
– Medication Compliance
Acculturation
– Language
– Identity
– Ritual
– Cultural Stress
Mental Health Needs
– Psychosis
– Impulse Control
– Depression
– Anxiety
– Interpersonal Problems
– Antisocial Behavior
– Adjustment to Trauma
– Anger Control
– Substance Use
– Eating Disturbance
Risk Behaviors
– Suicide Risk
– Self Injurious Behavior
– Other Self Harm
– Exploitation
– Danger to Others
– Sexual Aggression
– Criminal Behavior
Strengths
– Family Involvement
– Social Connections
– Optimism
– Educational
– Job History
– Talents/Interests
– Spiritual/Religious – Natural Supports
– Resiliency
– Resourcefulness
– Volunteering
– Community Connection
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ANSA Ratings: Needs
0 1 2 3
Evidence of
need
No evidence of
need
Mild degree of
need
Moderate
degree of need
Severe or
disabling
degree of need
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ANSA Ratings: Needs (Action-based)
0 1 2 3
Need for
Action
No need for
action
Watchful
waitingNeed for action
Need for
immediate or
intense action
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ANSA Ratings: Strengths
0 1 2 3
Presence of
strength?
Significant
strength
Moderate
level of
strength
Mild
level of
strength
No
strength
present
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ANSA: Physical/Medical
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Physical/Medical Rating
0 1 2 3
Evidence of
physical/
medical
problems?
No evidence
Mild or
well-managed
conditions
Chronic or
moderate
conditions
Severe or
life-threatening
conditions
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ANSA Principles
• Rating pertains to the individual, irrespective of services theyare receiving
• Rating must be based on stated or observed need, not
assumed need
• Culture and development should be considered when rating – Examples: Housing, religion, family
• 30-day window to ensure "freshness"
• Needs rated 2 or 3 should appear in service plan
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ANSA: Residential Stability
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Residential Stability Rating
0 1 2 3
Current
Situation Stable Housing
Mostly Stable
Housing
Unstable
Housing Homeless
Risk Factors:Could the client
lose their housing due
to problems with
self-care, disruptivebehavior, financial
situation, or another
reason?
No Evidence of
Risk
Some Warning
Signs
Moderate Risk
Level
Severe Risk
Level
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Brenda
Brenda left a DV situation last year and she and her daughter have been
staying in a DV shelter ever since. She is suffering from major depression
and speaks only limited English.
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Anthony
Anthony and his family have been living in a rental apartment for the
past 2 years. He just got laid off from his job as a mechanic and is
worried about paying his bills. He has been in recovery for 1 year.
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Courtney
Courtney was evicted a few months ago and went to
stay with her cousin. Her cousin wants her to leave,
but she has been unable to find another place due to
the eviction on her record.
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The Client Interview
Coaching case managers on how to interview clients
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Assess Current Living Situation
– How do you feel about your living situation? – Is it clean/safe/healthy there?
– Do you feel like you are in control of your housing?
– Are you and your kids sleeping well at night?
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Assess History
– Have you ever been homeless?
– Have you ever been evicted?
– How did that happen?
– Where did you stay?
– How long?
– Who helped you?
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HENRI (HPP database) Demo
• ANSA in HENRI
– Built-in 30-day time limit
– Rating, plus note for justification
– UNCOPE and other add-ons
– Exporting data (e.g. KFT assessments)
– Outsourced development
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HPP’s Results So Far
Over 1700 assessments conducted in first year
E m ploym ent
P hysical/M edical
R esidential S tability
Fam ily Functioning
Legal
Living S kills
C ultural S tress
Fam ily Involvem entS ocial C onnectedness
D epression
A nxiety
A djustm ents to Traum a
S ubstance Abuse
0% 5% 10% 15% 20% 25% 30% 35% 40%
% w ith 2 or 3 R ating
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Issues encountered
Data quality/consistency Instituted manager approval process
Resistance to change:
“This feels like a college exam”
Slow rollout with lots of training and
support
Issue Action
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Benefits of implementation
• Winning federal demo grant – HPP's use of ANSA strengthened proposal
– Other grants require evidence-based assessment
• Linking assessment to case plans
• Smoother transfer of clients between case managers
• Using as basis for discussion of housing stability risks
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HPP’s Future Plans
• Follow-up assessments
• Comparisons to baseline
– Individual -- tracking client's progress
– Aggregate -- several possibilities for doing
comparisons
• Number of clients who improved total score
• Number improved within a specific category
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ANSA Certification
http://www.canstraining.com
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Discussion
• Your experiences with assessment?
• Questions?
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Backup
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HENRI Screen Shots
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Backup
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Backup
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Vignettes
• How would you interview the client to obtain the necessary information?
• What additional questions would you ask?
• How would you rate the client in the given category?
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Vignette 1: Employment
• Client reports history of short-term employment.
• Client has worked at fast food restaurants, retail, hotels.
• Client's longest employment was working part-time with a friend's
mother in home daycare for one year, in 2009.
• Client reports most recent employment was at a supermarket in 2010.• Client states she has never been fired.
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Vignette 2: Family Functioning
• Client has history of instability and trauma in her family life.
• Mother is in recovery for substance use.
• Client reports father is not in her life.
• Client reports older brother was murdered last year due to a possible
gang dispute.• Client reports has 2 sons from two different partners.
• Client states having no parental rights of 2 sons. Children are currently
staying with partners' families.
• Client reports she is excited about present partner's release from jail in
about 9 months. They are considering having a baby as soon as he is free.• Client does not want to disclose cause of partner's jail sentence.
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Vignette 3: Mental Health
• Client is a 35-year-old mother of three children.
• Client lives with her partner and her children.
• She states "I don't know what is happening to me. I just want to sleep. I
have to force myself to get out of bed to cook, or to take the children to
school. I just don't have the energy to do anything. I feel tired, and have
no interest in doing things, or going out. I am often feeling very sad and
crying, but I don't want to talk to my family or friends about my feelings. I
sometimes wonder what is the point of having a life like mine."