Transcript Children’s Functional Assessment Rating Scale CFARS

Children’s Functional
Assessment Rating Scale
(CFARS)
Why change from the
Functioning Quadrants?
 Copyright concerns
 The Quadrants were based on an existing
copyrighted measure.
 County was advised that the Quadrants
were too similar to the original measure and
may be violating copyright.
 Needed to find a similar, cliniciancompleted measure to replace them.
CFARS
 Developed by the Florida Mental Health
Institute at the University of South Florida
 Provide a standard measurement to
assess functional needs and progress
and provide outcomes information
CFARS
 Developed to monitor agency level
quality improvement initiatives and assist
clinicians with individualized treatment
planning
 Used statewide in Florida, Illinois, New
Mexico, and Wyoming for Medicaidfunded mental health services
CFARS information
 Resource manual
 Hard copies distributed at Program
Managers’ mtgs
 Each program should have the manual
available for clinicians to review
 Website http://outcomes.fmhi.usf.edu
 Manual
 Training and test vignettes
 Training certification
CFARS official training
 The self-paced training and certification
process generally takes 2-3 hours
 It is not necessary to complete the training in
one sitting
 Instructions on how to register are on p. 7 of
the manual, or on the website
CFARS 16 Functional
Domains
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Depression
Anxiety
Hyperactivity
Thought Process
Cognitive Performance
Medical/Physical
Traumatic Stress
Substance Use
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Interpersonal Relationships
Behavior in “Home” Setting
ADL Functioning
Socio-Legal
Work/School
Danger to Self
Danger to Others
Security/Management Needs
*Refer to p. 14-29 in manual for definitions of
words/phrases in each domain and specific anchor
guidelines
CFARS Problem Severity
Ratings
 Each domain is rated on a scale of 1 (No
Problem) to 9 (Extreme Problem).
 Allows for more variation in ratings than the
Quadrants did (scale of 1 to 4)
 Rating should reflect the degree to which
the youth is currently experiencing
difficulty or impairment in the domains.
CFARS Problem Severity
Ratings
 Words and phrases (both positive and
negative) that are associated with
symptoms or behaviors in each domain
are given to help identify issues and help
make rating.
Guidelines for Determining
Problem Severity Ratings
1. Within each domain, begin by marking the
words/phrases that describes a behavior or
symptom of the child you are evaluating.
2. Next, using the general principles and
behavioral anchors, assign a Problem
Severity Rating to describe recent functioning
in each domain.
Severity Ratings are
associated with:
 How immediate is the need for
intervention in order to stabilize or correct
deficits in functioning within the rated
domain?
*Refer to p. 13 in manual for “Basic issues to consider
when assigning CFARS Problem Severity Ratings to
individual functional domains.”
Severity Ratings are
associated with:
 How intrusive is the intervention that is
needed to stabilize or correct deficits in
functioning within the rated domain?
*Refer to p. 13 in manual for “Basic issues to consider
when assigning CFARS Problem Severity Ratings to
individual functional domains.”
Severity Ratings are
associated with:
 How much does functioning in the rated
domain impact negatively on or
interfere with healthy functioning in other
domains?
*Refer to p. 13 in manual for “Basic issues to consider
when assigning CFARS Problem Severity Ratings to
individual functional domains.”
General Anchor Guidelines
1 = No Problem
 Functioning is consistently average or better
than what is typical for this person’s age, sex,
and subculture.
2 = Less than Slight Problem
General Anchor Guidelines
3 = Slight Problem
 Functioning falls short for a person of this age,
sex, and subculture most of the time.
 Problem may be intermittent or may persist at
a low level.
 Problem or symptoms have little or no impact
on other domains or may be currently
controlled by medications.
 Need for treatment is not urgent but may
require therapeutic intervention in the future.
General Anchor Guidelines
4 = Slight to Moderate Problem
5 = Moderate Problem
 Functioning is clearly marginal or inadequate,
not meeting the usual expectations of a typical
person of this age, sex, and subculture.
 Dysfunction or problem may persist at
moderate level or become severe on occasion.
 Problems may be related to problems in other
domains and do require therapeutic
intervention(s).
General Anchor Guidelines
6 = Moderate to Severe Problem
7 = Severe Problem
 Functioning in this range is marked by obvious
and consistent failures, never meeting
expectations of a typical person of this age, sex,
and subculture.
 Dysfunction or problem may be chronic, extends
to other domains, and generally interferes with
interpersonal or social relationships with others.
 Hospitalization or some other form of external
control may be needed in addition to other
therapeutic intervention(s).
General Anchor Guidelines
8 = Severe to Extreme Problem
9 = Extreme Problem
 Highest level
 Situation is out of control, unacceptable, and/or
potentially life-threatening.
 The need for external control or intervention is
immediate.
General Anchor Guidelines
 A score of 4 or higher is considered
“Clinically Elevated” by the CFARS
developers
 Areas of strength are those rated 1 or 2
Rating Caveat:
 If a domain is being maintained or controlled by
medication or other supports, that domain
should not be rated as a “1” or “2”.
 There are still costs associated with
maintaining the intervention and it is possible
that decreased functioning could return if the
interventions were removed.
 Refer to pg. 11 in the manual for more information
How does the CFARS
relate to the GAF score?
 You cannot say that a score of XX on the
CFARS is equal to a score of YY on the GAF
 You can use the same information to develop
the CFARS and GAF scores.
 The scores should be similar in nature: a child
with severe problems on the CFARS should
have a GAF score that reflects those problems.
What about SED?
 There is no set score on the CFARS that
correlates to the SED definition.
 You can use the CFARS domain information to
determine if a child meets SED criteria.
What about SED?
 The CFARS scores should be similar in nature
to the SED classification
 A child with severe problems (ratings of 7 and
higher) on the CFARS would be likely to meet SED
criteria
 A child with slight problems (ratings of 3 and under)
would be unlikely to meet SED criteria.
What happens with the 16
domain scores?
 Entered on the County forms for UR /
DPR
 New forms have been distributed – contact
County if you still need them
What happens with the 16
domain scores?
 Entered into the Data Entry System
(DES) and used to generate 4 Index
Scores that summarize the domains
 New coversheets have been distributed by
email – if you still need them, contact
[email protected].
Index Scores & Related
Domains
1. Relationships:
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Hyperactivity
School / Work
Interpersonal Relationships
Cognitive Performance
Behavior in the Home
Danger to Others
Index Scores & Related
Domains
2. Safety:
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Socio-legal
Substance Use
Security Management Needs
Danger to Self
Index Scores & Related
Domains
3. Emotionality:
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Anxiety
Traumatic Stress
Depression
Index Scores & Related
Domains
4. Disability:
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ADL Functioning
Medical / Physical
Thought Process
What happens with the 16
domain scores?
 The Index Scores will appear on the
Assessment Summary printout from the
DES
 The Index scores are used in the
County’s outcomes objectives
 Example: For 80% of discharged clients whose
episodes lasted 2 months or longer, the CFARS
score shall be at least one level higher
(improvement) at discharge than at admission in
at least one index area.
Important MSR Note
 The CFARS report will be distributed in a
DES update in September, along with
several changes in preparation for the
MIS conversion.
 In order to run a outcomes report, client
need to have 2 CFARS timepoints.
 The soonest any program will have 2
CFARS tinmepoints is October 1, 2007.
 For most programs, it will be early 2008.
Learning how to complete
the CFARS
 Review the manual
 Score the 2 practice vignettes and then
check your scoring against the standards
 A range of answers is acceptable.
 Complete the free on-line certification
Training is important
 Ratings need to be consistent across
clinicians.
 All clinicians should work through the vignettes
and on-line training until their ratings are
consistent with the standard.
 On-line training is not required by the County,
but may be helpful.
Additional Resources in
CFARS Manual
 Examples of using CFARS ratings to develop
individualized treatment plans or to monitor
client change/improvement.
 Using the clinical scales derived from the 16
domains.
 Using CFARS domains to help gather info for
the mental status exam.