YES QMIA Reports
The goal of Idaho’s Youth Empowerment Services (YES) program is to develop, implement, and sustain a child, youth, and family-driven, coordinated, and comprehensive children’s mental health delivery system of care. This enhanced child serving system will lead to improved outcomes for children, youth, and families who are dealing with mental illness.
The Quality Management Improvement and Accountability Reports are a critical aspect of YES monitoring based on data collected by the YES partners, which includes the Department of Health and Welfare’s Divisions of Behavioral Health (DBH), Medicaid, and Family and Community Services (FACS), as well as the Idaho Department of Juvenile Corrections (IDJC), and the Idaho State Department of Education (SDE).
The QMIA reports have information about the children, youth, and families accessing mental health care in Idaho primarily through the Medicaid/Optum Network and DBH’s Children’s Mental Health (CMH) Regional clinics. Most of the data is from Medicaid or DBH as these two child serving systems provide most of the outpatient mental health care for children and youth. Data in the report includes children and youth who have Medicaid, children who do not have insurance and children whose family’s income is over the Medicaid Federal Poverty Guideline, children having trouble in school because of mental illness, children under court orders for mental health services including child protection, and children with developmental disabilities and co-occurring mental illness.
The QMIA reports are published quarterly on the YES website and are delivered to all YES workgroups to support decision making related to plans for YES system improvement by building collaborative systems, developing new services, and creating workforce training plans.
Questions? If information provided within QMIA reports create questions or an interest in additional data collection, please contact YES@dhw.idaho.gov with your questions, concerns, or suggestions.
You can also submit input or a question using the form on this page.
Executive Summary – Q2 SFY 2023
The QMIA-Q report for SFY 2023, Quarter 2 (Q2) provides information about the delivery of YES services for October, November, December 2022, and trends over the past five years of YES implementation.
There have been some changes in the format which are intended to make the data that is provided more useful and easier to understand. The major changes are in Section 5 of the report on Medicaid Outpatient services. First, new information has been added to the statewide portion of the section. The statewide information now includes both a table with all services with number of youth serviced and a table with the penetration rates of all services. There is now data about services that had not previously been reported including: Case Management, Therapeutic After School (TASSP), Crisis Services, and Family Support Partners.
In this same section of the QMIA-Q report (Section 5), a switch has been made from reporting service utilization by service type to reporting on all services by region. For example, Region 1 has all the YES services in Region 1, Region 2 has all the YES services in Region 2, etc. All of the previously-available data about services remains, but by breaking out the utilization data for each service by region the QMIA-Q provides a clearer picture of how service utilization varies across the state. In addition, reports are provided for each region with the number of youth served, the percent of the type of services that were used by those accessing services, and the penetration rate. This change standardizes the information for each region and provides a basis for comparing each region to the statewide results.
Data for QMIA-Q Q2 includes the updated Estimation of YES Eligibility (E1) and also for Wraparound, statewide access to YES Outpatient Medicaid services (E2), the average Medicaid expenditure per member served by region (E3), access to intensive outpatient Medicaid services (E4), updates on quality improvement projects, and a list of the YES reports that have been published.
E1 Annual YES Eligibility Estimation SFY 2023- updated in Dec 2022
Type of insurance | |||||
Employer | Non-Group | Medicaid | Uninsured | Total | |
Insured rate based on 2020 Estimated Census | 50.70% | 5% | 34.90% | 7.10% | |
Population | 246,000 | 25,000 | 170,000 | 35,000 | |
Estimated prevalence | 6% | 6% | 8% | 12% | |
Estimated need | 14,760 | 1,500 | 13,600 | 4,165 | |
Expected Utilization Lower Estimate 15% | 2215 | 225 | 13,600 | 4,165 | 20,205 |
Expected Utilization Higher Estimate 18% | 2655 | 270 | 13,600 | 4,165 | 20,690 |
In addition to the annual estimate of YES eligibility, BSU completed an updated estimate of the need for Wraparound Intensive Services (WInS), also called “Wraparound”. Below is the Executive Summary of the report.
Executive Summary
Objective: The State of Idaho Youth Empowerment Services (YES) program aims to develop, implement, and sustain a youth- and family-driven, coordinated, and comprehensive system-of-care that meets the mental health needs of Idaho youth who experience a serious emotional disturbance. One important component of YES is the delivery of Intensive Care Coordination (ICC) that uses high-quality Wraparound. The Wraparound model is a specific method for delivering ICC that incorporates system-of-care values, well specified procedures, and standardized quality monitoring. ICC using high-quality Wraparound is designed to support youth with the most complex and intensive mental health needs so they can remain in the community rather than being placed outside their home. In order to monitor the State’s progress toward meeting the needs of this population, the Idaho Department of Health and Welfare, Division of Behavioral Health contracted with Boise State University in 2022 to develop biannual estimates of the need for ICC among Idaho youth. The purpose of this report is to project the initial estimate of need for ICC among Idaho youth for State Fiscal Year (SFY) 2023.
Method: Using two methodologies developed in prior work, two projections were generated of the number of Idaho youth who are likely to need ICC in SFY 2023. The first methodology used a predictive analytic model developed through an analysis of ICC utilization data from 11 States and the incorporation of Idaho population characteristics. The second methodology analyzed aggregate Idaho administrative data on publicly-funded, out-of-home and inpatient mental health services for youth in Quarter 1 of SFY 2023.
Results: Application of the predictive analytic model resulted in an estimate of 1,521 Idaho youth who are likely to need ICC in SFY 2023. Analysis of Idaho service utilization data yielded an estimate of 1,642 Idaho youth who are likely to need ICC in SFY 2023. The relative proximity of the two estimates, derived through different methodologies, increases confidence in their potential utility. In combination, these methodologies suggest 1,582 Idaho youth will need ICC using high-quality Wraparound in SFY 2023.
Conclusions and Recommendations: In SFY 2023, it is estimated that 1,582 Idaho youth will need ICC using high-quality Wraparound. Reflecting the growth and change in Idaho’s population, this represents a 17% increase in need for ICC compared to an estimate from SFY 2016. The estimates presented here will be updated as newer data become available. These estimates provide benchmarks for monitoring Idaho’s progress toward meeting the needs of youths with intensive mental health needs.
March 3, 2023
The entire report can be found on the YES Website at the following link: https://yes.idaho.gov/youth-empowerment-services/about-yes/yes-history/?target=8
E2: Statewide access to YES Outpatient Medicaid Services
A Quality Improvement Project (QIP) to address the need for service availability across all 7 regions has been implemented. The first step of the QIP is to identify the gaps in services.
One aspect of identifying the gaps is to analyze access statewide. As the chart below indicates the number of Medicaid members under the age of 18 that received outpatient services has varied over the last 18 quarters with the highest number being 18,105 in April – June 2019, and the lowest number of 15,347 in Oct- Dec 2022. The overall trend is decreasing (blue dotted line), although the numbers served did increase in 2022. An analysis of the past quarters indicates that the average number of children and youth receiving services per quarter is approximately 16,655 (black line) and for the most recent 6 quarters the number accessing services has been trending below the average.
E3 Average Medicaid Outpatient Expenditure Per Distinct User by Region
An analysis of Medicaid outpatient expenditure in SFY Q2 by region indicates that there continues to be substantial variation in expenditures across the state – from $89 per person served in Region 7 to $37 per person served in Region 5.
E4 Access to Intensive Outpatient Medicaid Services by Type and Region
The following tables show the number serviced and the penetration rate (number receiving services/number of Medicaid members) for outpatient services provided to Medicaid members under the age of 18, with rates noted by type of service and by the region in which the service was delivered.
# of Medicaid Members Accessing Intensive Outpatient Treatment Services | |||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 9 | Total | |
Intensive Outpatient | 18 | 4 | 50 | 77 | 32 | 12 | 10 | 1 | 203 |
TASSP[1] | 0 | 0 | 0 | 0 | 0 | 0 | 5 | 0 | 5 |
Partial Hospitalization (PHP) | 1 | 0 | 37 | 56 | 3 | 1 | 9 | 0 | 105 |
Day Treatment | 0 | 0 | 0 | 3 | 14 | 0 | 8 | 0 | 24 |
IHCBS[2] | 0 | 0 | 1 | 8 | 2 | 14 | 6 | 0 | 30 |
Penetration Rates for Intensive Outpatient Treatment Services | |||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 9 | Total | |
Intensive Outpatient | 0.1% | 0.0% | 0.1% | 0.2% | 0.1% | 0.1% | 0.0% | 0.0% | 0.1% |
TASSP | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
Partial Hospitalization (PHP) | 0.0% | 0.0% | 0.1% | 0.1% | 0.0% | 0.0% | 0.0% | 0.0% | 0.05% |
Day Treatment | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
IHCBS | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% | 0.0% | 0.0% | 0.0% |
[1] TASSP- Therapeutic After School Support Program
[2] IHCBS – Intensive Home and Community Based Services
Based on data about access to services and on-going concerns from families and advocacy groups, the QMIA Council recommended to the YES Sponsors and Defendants Workgroup (DWG) that a QIP be implemented for services needed specifically for children and youth with complex/high needs.
Short term goals for the QIP are to define the population, identify missing and needed services, identify the reason why services are not available and research interventions used in other states that have been successful in responding to this issue.
E5 Quality Improvement Projects (QIPs)
Crisis and Safety Plans
To help families with the need for higher quality, effective Crisis and Safety Plans, the Division of Behavioral Health implemented a QIP.
In state fiscal year (SFY) 2021, standardized forms for crisis and safety planning, and other helpful information related to a crisis, were added to the Youth Empowerment Services (YES) website. In addition, a collaborative workgroup of parents and youth, the IDHW Divisions of Behavioral Health and Family and Community Services, and the Idaho Department of Juvenile Corrections, and State Department of Education created a video for youth and parents about how to create an effective crisis and safety plan. The video is available in English and Spanish on YouTube and the YES website (yes.idaho.gov).
In SFY 2022, training for community providers on the creation and use of effective safety planning was provided in five total sessions. Attendance at the training was very good with over 500 participants. Based on the 2022 family survey[3], there has not yet been an improvement in the effectiveness of crisis safety plans (still at 60%), however the training took place later in the fiscal year (FY), so it is possible that there will be more of an impact that can be evaluated in SFY 2023.
The Crisis and Safety plan training provided in the fall of 2022, was based on recommendations from family representatives on the Family Advisory Subcommittee (Q-FAS), families gave input on the training and participated in the fall training. We will continue to collect data about the issue of Crisis and Safety Plans through the survey sent to families each spring.
Hospital Discharge Standard
Over the past several years, there have been complaints related to children/youth being discharged home without families having input on the discharge plan. During SFY 2022, a small workgroup (DBH Quality staff and Family Members from the Council) began research into the development of a hospital discharge standard. The workgroup’s goal was to draft a standard based on policies, guidelines for best practices and rules in other states in order to propose a new standard be adopted by Idaho and used by Idaho’s’ community hospitals. This team felt that “Transitions of Care” would be a more appropriate name for this standard as there are times in which individuals require a higher level of care. A draft of this Behavioral Health Transitions of Care standard was forwarded to the DBH Policy Unit for review on June 27, 2022. The proposed standard has not yet been adopted.
[3] A YES Family Survey is conducted annually to assess the YES Principles of Care
YES reports:
The following are links to the YES reports noted within the QMIA-Q
QMIA-Q historical reports: https://yes.idaho.gov/yes-quality-management-improvement-and-accountability/
YES Rights and Resolutions: https://yes.idaho.gov/yes-quality-management-improvement-and-accountability/, click on “Additional QMIA Data and Reports” and scroll down the page
Quality Review (QR): Provider Survey; https://yes.idaho.gov/youth-empowerment-services/about-yes/yes-history/?target=8
YES Family Survey Results : https://yes.idaho.gov/youth-empowerment-services/about-yes/yes-history/?target=8
Executive Summary – Q1 SFY 2023
The QMIA-Q report for SFY 2023, Q1 provides information about the delivery of YES services for July, August, September 2022, and trends over the past five years of YES implementation. There have been some changes in the format for the QMIA-Q for Q1 which are intended to make the data that is provided more useful and easier to understand.
The major changes are in Section 5 of the report on Medicaid Outpatient services. First, we have added new information into the statewide portion of this section. The statewide information now includes both a table with all services with number of youth serviced and a table with penetration rates of all services. There is also new data about services that had not previously been reported including: Case Management, Therapeutic After School (TASSP), Crisis Services, and Family Support Partners. In this portion of the report there is a new analysis that includes a statewide comparison of 5 specific targeted services: Psychotherapy, Case Management, Community Based Rehabilitation (CBRS), Targeted Care Coordination (TCC) and Intensive Home and community Based Services (IHCBS).
In this same section of the QMIA-Q report (Section 5), a switch has been made from reporting service utilization by service type to reporting on all services by region. For example, Region 1 has all the YES services in Region 1, Region 2 has all the YES services in Region 2, etc. All of the previously-available data about services will remains, but by breaking out the data about utilization of service by region the QMIA-Q provides a clearer picture of how service utilization varies across the state. In addition, reports are provided for each region with the number of youth served, the percent of the type of services that were used by those accessing services, and the penetration rate. This change standardizes the information for each region and provides a basis for comparing each region to the statewide results.
Data for QMIA-Q Q1 includes the updated Estimation of YES Eligibility (E1), statewide access to YES Outpatient Medicaid services (E2), average Medicaid expenditure per member served by region (E3), access to intensive outpatient Medicaid services (E4), updates on quality improvement projects, and a list of the YES reports that have been published.
E1 Annual YES Eligibility Estimation, updated for Dec 2022
Type of insurance | |||||
Employer | Non-Group | Medicaid | Uninsured | Total | |
Insured rate based on 2020 Estimated Census | 50.70% | 5% | 34.90% | 7.10% | |
Population | 246,000 | 25,000 | 170,000 | 35,000 | |
Estimated prevalence | 6% | 6% | 8% | 12% | |
Estimated need | 14,760 | 1,500 | 13,600 | 4,165 | |
Expected Utilization Lower Estimate 15% | 2215 | 225 | 13,600 | 4,165 | 20,205 |
Expected Utilization Higher Estimate 18% | 2655 | 270 | 13,600 | 4,165 | 20,690 |
E2: Statewide access to YES Outpatient Medicaid Services
A Quality Improvement Project (QIP) to address the need for service availability across all 7 regions has been implemented. The first step of the QIP is to identify the gaps in services.
One aspect of identifying the gaps is to analyze access statewide. As the graphic chart below indicates the number of Medicaid members under the age of 18 that received outpatient services has varied over the last 16 quarters with the highest number being 18,105 in April – June 2019, and the lowest number of 15,501 in July – Sept 2022. An analysis for the past quarters indicates that the average number of children and youth receiving services per quarter is approximately 16,800 (bold black line). For the most recent 5 quarters the number accessing services has been trending below the average.
E3 Average Medicaid Outpatient Expenditure Per Distinct User by Region
An analysis of Medicaid outpatient expenditure by region indicates that there is substantial variation in expenditures across the state – from $94 per person served in Region 7 to $43 per person served in Region 5.
E4 Access to Intensive Outpatient Medicaid Services by Type and Region
Based on data about access to services and on-going concerns from families and advocacy groups, the QMIA Council recommended to the YES Sponsors and Defendants Workgroup (DWG) that a QIP be implemented for services needed specifically for children and youth with complex/high needs.
The following tables show the number serviced and the penetration rate (number receiving services/number of Medicaid members) for outpatient services provided to Medicaid members under the age of 18, with rates noted by type of service and by the region in which the service was delivered.
# of Medicaid Members Accessing Intensive Outpatient Treatment Services | |||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 9 | Total | |
TASSP[1] | 0 | 0 | 0 | 0 | 0 | 0 | 19 | 0 | 19 |
Partial Hospitalization (PHP) | 0 | 0 | 29 | 39 | 4 | 0 | 6 | 0 | 78 |
Day Treatment | 0 | 0 | 1 | 1 | 12 | 1 | 9 | 0 | 24 |
IHCBS[2] | 0 | 0 | 4 | 8 | 1 | 16 | 5 | 0 | 34 |
Penetration Rates for Intensive Outpatient Treatment Services | |||||||||
1 | 2 | 3 | 4 | 5 | 6 | 7 | 9 | Total | |
TASSP | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.5% | 0.0% | 0.0% |
Partial Hospitalization (PHP) | 0.0% | 0.0% | 0.1% | 0.1% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
Day Treatment | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% |
IHCBS | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.1% | 0.0% | 0.0% | 0.0% |
[1] TASSP- Therapeutic After School Support Program
[2] IHCBS – Intensive Home and Community Based Services
Short term goals for the QIP are to define the population, identify missing and needed services, identify the reason why services are not available and research interventions used in other states that have been successful in responding to this issue.
E5 Quality Improvement Projects (QIPs)
Crisis and Safety Plans
To help families with the need for higher quality, effective Crisis and Safety Plans, the Division of Behavioral Health implemented a QIP.
In SFY 2021, standardized forms for crisis and safety planning, and other helpful information related to a crisis, were added to the Youth Empowerment Services (YES) website. In addition, a collaborative workgroup of parents and youth, the IDHW Divisions of Behavioral Health and Family and Community Services, and the Idaho Department of Juvenile Corrections, and SDE created a video for youth and parents about how to create an effective crisis and safety plan. The video is available in English and Spanish on YouTube and the YES website ( https://yes.idaho.gov/).
In SFY 2022, training for community providers on the creation and use of effective safety planning was provided in five total sessions. Attendance at the training was very good with over 500 participants. Based on the 2022 family survey[1], there has not yet been an improvement in the effectiveness of crisis safety plans (still at 60%), however the training took place later in the FY, so it is possible that there will be more of an impact that can be evaluated in SFY 2023.
The Crisis and Safety plan training provided in the fall of 2022, was based on recommendations from family representatives on the Family Advisory Subcommittee (Q-FAS), families gave input on the training and participated in the fall training. We will continue to collect data about the issue of Crisis and Safety Plans through the survey sent to families each spring.
[1] A YES Family Survey is conducted annually to assess the YES Principles of Care
Hospital Discharge Standard
Over the past years, there have been several complaints related to children/youth being discharged home without families having input on the discharge plan. During SFY 2022, a small workgroup ( DBH Quality staff and Family Members from the Council) began research into the development of a hospital discharge standard. The workgroup’s goal was to draft a standard based on policies, guidelines best practices and rules in other states and to propose a new standard be adopted by Idaho and used by Idaho’s’ community hospitals. This team felt that “Transitions of Care” would be a more appropriate name for this standard as there are times in which individuals require a higher level of care. A draft of this Behavioral Health Transitions of Care standard was forwarded to the DBH Policy Unit for review on June 27, 2022. The proposed standard has not yet been adopted.
YES reports:
The following are links to the YES reports noted within the QMIA-Q
QMIA-Q historical reports: https://yes.idaho.gov/yes-quality-management-improvement-and-accountability/
YES Rights and Resolutions: https://yes.idaho.gov/yes-quality-management-improvement-and-accountability/, click on “Additional QMIA Data and Reports” and scroll down the page
Quality Review (QR): Provider Survey; https://yes.idaho.gov/youth-empowerment-services/about-yes/yes-history/?target=8
YES Family Survey Results : https://yes.idaho.gov/youth-empowerment-services/about-yes/yes-history/?target=8
Review the full SFY 2023 Quarter 1 QMIA report here.
Review the Quarterly Utilization by Service Spreadsheet for SFY 2023 Quarter 1
Executive Summary – Q4
Total Number of Medicaid Members Accessing YES Outpatient Medicaid Services
The number of Medicaid members under the age of 18 served has varied over the last 16 quarters with the high number being 18,097 in April – June 2019, and the low of 15,289 in October – December of 2021. The overall trend had varied but the average number of children and youth receiving services is 16,809. There was a notable decrease in April to June of 2020 (shown by solid green line) which may have been due in part to COVID 19.
Statewide Access to YES Outpatient Medicaid by Service Type and Region
The following table shows the utilization of outpatient services provided to Medicaid members under the age of 18 are noted by type of service and the region in which the service is delivered. The number served is unduplicated within the specific category of services (e.g., the number children and youth who received that specific service).
Outpatient services CANS Assessments, Psych and Neuropsych Testing, Psychotherapy, Medication Management, Skills Building, Targeted Care Coordination, Substance Use, Crisis Intervention, Child and Family Interdisciplinary Teams are available statewide. Behavior Assessments, Skills Training and Development (STAD), and Behavioral Modification and Consultation are not available statewide.
Intensive outpatient services such as Partial Hospitalization, Day Treatment, and Intensive home and Community based services are not available statewide and overall appear to be very limited even in regions in which they are available.
It is notable that intensive outpatient services in Regions 1 and 2 appear to be the most limited.
| SFY 2022 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Out of state | Total |
| Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | |
| Assessments | |||||||||
| CANS- Billed to Medicaid | 124 | 324 | 2,746 | 3,381 | 1,412 | 774 | 2,959 | 37 | 12,754 |
| Psych and Neuropsych Testing | 238 | 77 | 361 | 470 | 173 | 294 | 723 | 6 | 2339 |
| Behavior Assessment | 70 | 1 | 20 | 68 | 0 | 0 | 0 | 0 | 157 |
| Outpatient Treatment Services | |||||||||
| Psychotherapy | 1,981 | 669 | 4,020 | 4,831 | 2,136 | 1,262 | 4,055 | 83 | 18,742 |
| Med Management | 207 | 210 | 1,164 | 1,453 | 378 | 435 | 807 | 18 | 4,598 |
| Skills Building (CBRS) | 132 | 128 | 418 | 680 | 96 | 178 | 1,109 | 11 | 2,711 |
| Targeted Care Coordination (TCC) | 27 | 51 | 138 | 265 | 87 | 134 | 591 | 11 | 1,283 |
| Substance Use Services | 57 | 12 | 105 | 96 | 168 | 57 | 279 | 4 | 771 |
| Crisis Intervention | 44 | 26 | 38 | 36 | 27 | 21 | 239 | 1 | 432 |
| Child and Family Interdisciplinary Team (CFIT) | 33 | 26 | 36 | 82 | 70 | 40 | 118 | 0 | 402 |
| Skills Training and Development (STAD) | 0 | 30 | 2 | 3 | 135 | 4 | 107 | 1 | 281 |
| Behavior Modification and Consultation | 73 | 1 | 18 | 54 | 0 | 0 | 0 | 0 | 144 |
| Intensive Outpatient Treatment Services | |||||||||
| Partial Hospitalization (PHP) | 0 | 1 | 11 | 155 | 8 | 5 | 22 | 1 | 301 |
| Day Treatment | 0 | 0 | 2 | 5 | 31 | 4 | 31 | 1 | 73 |
| Intensive Home and Community Based Services (IHCBS) | 0 | 0 | 5 | 17 | 0 | 28 | 10 | 0 | 60 |
| Support services | |||||||||
| Respite | 6 | 64 | 103 | 195 | 40 | 67 | 238 | 4 | 705 |
| Youth Support Services | 4 | 22 | 65 | 219 | 96 | 45 | 125 | 3 | 572 |
| Family Psychoeducation | 29 | 0 | 11 | 27 | 122 | 2 | 18 | 0 | 209 |
Quality Improvement Projects (QIPs)
Crisis and Safety Plans
To help families with the need for higher quality, effective Crisis and Safety Plans, the Division of Behavioral Health implemented a QIP.
In SFY 2021, standardized forms for crisis and safety planning, and other helpful information related to a crisis, were added to the Youth Empowerment Services (YES) website. In addition, a collaborative workgroup of parents and youth, the divisions of Behavioral Health and Family and Community Services, and the Idaho Department of Juvenile Corrections, and SDE created a video for youth and parents about how to create an effective crisis and safety plan. The video is available in English and Spanish on YouTube and the YES website.
In SFY 2022, training for community providers on the creation and use of effective safety planning was provided in three sessions. Attendance at the training was very good with over 300 participants. Based on the 2022 family survey, there has not yet been an improvement in the effectiveness of crisis safety plans (still at 60%), however the training took place later in the FY, so it is possible that there will be more of an impact that can be evaluated in SFY 2023.
Additional training is being provided in the fall of 2022. Based on recommendations from family representatives on the Family Advisory Subcommittee (Q-FAS), families will give input on the training and will participate in the fall training. We will continue to collect data about the issue of Crisis and Safety Plans through the survey sent to families each spring.
YES Service Availability in all 7 Regions
The QMIA Council recommendations listed in the QMIA-Q report for YES quality improvement based on data SFY 2021 were reviewed by the Defendants Workgroup (DWG) and a determination was made to focus on the following as a
priority:
“YES partners will develop a plan for increasing service availability and access in all 7 regions with a goal to increase access statewide. “
The Council has drafted a QIP to address the recommendation was approved by the Defendants Work Group (DWG).
Short Term Actions are listed below:
| Short Term Actions | Lead | Timeline | Status |
| Identify gaps in services by service type and by region | Candace | Nov 30, 2022 | Services gaps type and region are reported quarterly in the QMIA-Q. New data regarding penetration rates has been added to the report. Evaluation based on penetration rates will be include as of SFY 2023 Q1 |
| Identify which services to target | Candace | Dec 31, 2022 | On-going analysis is in progress |
| Develop plan to assess why services are not available- availability, capacity or other | Candace | Dec 31, 2022 | Draft plan in progress 1) Add to QR – completed 2) Added this into University RFP |
Hospital Discharge Standard
Over the past years, there have been several complaints related to children/youth being discharged home without families having input on the discharge plan. During SFY 2022, a small workgroup began research into the development of a hospital discharge standard. Their goal was to draft a standard based on policies, guidelines best practice and rules in other states and propose this new standard be adopted by Idaho and used by Idaho’s’ community hospitals. This team felt that “Transitions of Care” would be a more appropriate name for this standard as there are times in which individuals require a higher level of care. A draft of this Behavioral Health Transitions of Care standard was forwarded to the DBH Policy Unit for review on June 27, 2022. The proposed standard has not been adopted yet.
QMIA Council recommendations for QIP SFY 2023
Based on data about access to services and on-going concerns from families and advocacy groups, the QMIA Council has recommended to the YES Sponsors and Defendants Workgroup (DWG ) that a QIP be implemented for services needed specifically for children and youth with complex/high needs. Several interventions have already been implemented including training on Therapeutic Behavioral Services (an intervention within Intensive Home and Community Based Services), development of agencies to re-introduce Therapeutic Foster Care. Short term goals for the QIP are to define the population, identify missing and needed services, identify the reason why services are not available and research interventions used in other states that have been successful in responding to this issue.
New data:
Monitoring by Percent of Utilization (Penetration*) rate
New data that is being added to the QMIA-Q for SFY 2022 is the percent of Medicaid members by region that access services. This rate or utilization, also called “penetration rate” is calculated by using the number reviewed services divided by the total number of Medicaid members. Using a penetration rate allows the state to do a comparison between regions that is standardized rather than based on number served.
One example of this data is included below. Based on the predictive models for Idaho, the penetration rate for psychotherapy that is desired is at least 8 percent. Over the past 16 quarters, the median** rate has been 6.25 percent.
Currently the penetration rate is trending down. The high of 7.2 percent was in Q3 of 2020 and there have been 9 quarters of lower rates since that time. The decrease is most likely due to workforce shortages across the state.
* Penetration Rate – Percent of the relevant population that has accessed the service at least once in the time period under study.
** Median – The value lying at the midpoint of observed values.
Executive Summary – Q3
The purpose of the QMIA-Q is to provide YES Partners and children’s mental health stakeholders with information about the children and youth accessing YES services, the services they are accessing, and the outcomes of the services. The data in the QMIA-Q tells the story about whether YES is reaching the children, youth and families who need mental health services, if the services are meeting their needs, and if they are improving as result of the services. The 3rd Quarter 2022 QMIA-Q report includes data from January, February, and March 2022, and trend data from previous quarters and SFYs.
Some of the key points data in the Q3 QMIA-Q are the total number of Medicaid children and youth served , YES Medicaid Outpatient Services Provided by type and region, and Outcomes/Impact of Care.
Access to Services
The number of Medicaid members under the age of 18 served has varied over the last 15 quarters with the high number being 18,097 in April – June 2019, and the low of 15,289 in October – December of 2021. The average number of Medicaid served over the last 15 quarters is 16,736 (represented by the solid black line). The overall trend has been decreasing (shown by the blue dotted line) . The cause of the decrease is not known however may be due at least partially to COVID as the initial large drop did occur in about April to June of 2020 (shown by solid green line).
Medicaid Outpatient services by type and region
The following table shows the outpatient services provided to Medicaid members under the age of 18 are noted by type of service and the region in which the service is delivered. The number served is 2022 year-to-date ( quarters 1, 2, and 3) and is unduplicated within the specific category of services (e.g., the number children and youth who received that specific service).
Of outpatient services such as CANS Assessments, Psych and Neuropsych Testing, Psychotherapy, Medication Management, Skills Building, Targeted Care Coordination, Substance Use, Crisis Intervention, Child and Family Interdisciplinary Teams are available statewide. Behavior Assessments, Skills Training and Development (STAD), and Behavioral Modification and Consultation are not available statewide.
Intensive outpatient services such as Partial Hospitalization, Day Treatment, and Intensive home and Community based services are not available statewide and overall appear to be very limited even in regions in which they are available.
It is notable that services in Regions 2 and 6 appear to be the most limited.
SFY 2022, YTD (Q1, Q2 & Q3) | 1 | 2 | 3 | 4 | 5 | 6 | 7 | Out of state | Total |
Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | Distinct Utilizers | |
Assessments | |||||||||
CANS- Billed to Medicaid | 1078 | 284 | 2,395 | 2,926 | 1,215 | 669 | 2,593 | 27 | 11,100 |
Psych and Neuropsych Testing | 169 | 65 | 272 | 354 | 132 | 221 | 297 | 6 | 1,754 |
Behavior Assessment | 37 | 0 | 15 | 53 | 0 | 0 | 0 | 0 | 119 |
Outpatient Treatment Services | |||||||||
Psychotherapy | 1,722 | 583 | 3,547 | 4,274 | 1,879 | 1,119 | 3,639 | 67 | 16,593 |
Med Management | 185 | 184 | 1,028 | 1,289 | 343 | 385 | 744 | 14 | 4,113 |
Skills Building (CBRS) | 119 | 113 | 372 | 601 | 70 | 149 | 947 | 7 | 2,348 |
Targeted Care Coordination (TCC) | 27 | 45 | 127 | 244 | 53 | 118 | 536 | 7 | 1,140 |
Substance Use Services | 46 | 9 | 94 | 80 | 142 | 45 | 214 | 4 | 627 |
Crisis Intervention | 34 | 22 | 32 | 25 | 23 | 17 | 184 | 2 | 338 |
Child and Family Interdisciplinary Team (CFIT) | 30 | 22 | 27 | 69 | 56 | 31 | 93 | 0 | 326 |
Skills Training and Development (STAD) | 0 | 29 | 2 | 3 | 100 | 2 | 85 | 1 | 221 |
Behavior Modification and Consultation | 52 | 0 | 12 | 44 | 0 | 0 | 0 | 0 | 107 |
Intensive Outpatient Treatment Services | |||||||||
Partial Hospitalization (PHP) | 0 | 1 | 90 | 126 | 8 | 4 | 12 | 0 | 240 |
Day Treatment | 0 | 0 | 2 | 4 | 28 | 4 | 226 | 1 | 64 |
Intensive Home and Community Based Services (IHCBS) | 0 | 0 | 2 | 14 | 0 | 21 | 9 | 0 | 46 |
Support services | |||||||||
Respite | 6 | 51 | 90 | 186 | 37 | 62 | 211 | 3 | 635 |
Youth Support Services | 4 | 18 | 55 | 204 | 93 | 41 | 104 | 3 | 516 |
Family Psychoeducation | 18 | 0 | 5 | 18 | 102 | 2 | 17 | 0 | 162 |
Outcomes and Impact of Services
YES services are leading to improved outcomes. In Q3 of SFY 2022 the percent of children and youth whose overall rating improved at least one level (e.g., from a 3 to a 2, 1, or 0) remained approximately stable at 35.58%.
The above method of measuring outcomes is very broad and does not give the kind of detail that can be used to develop plans for how to improve services. For more information about how services are impacting children and youth work has been initiated with Praed to analyze the CANS datafor the impact of services.
The following table is a sample of data from Praed’s analysis of the impact of YES over time for children and youth who stay in services and who have 2 or more CANS in the system.
Description of columns:
- % Presenting: The percentage of youth in the cohort that have an actionable need,
- % Improved: The percentage of youth with any rating over 0 at any CANS Assessment that decreased by 1 point or more at the latest reassessment.
- % Worsened: The percentage of youth with a rating of 2 or lower that subsequently had a rating of 3 at latest assessment.
| % Presenting | % Improved | % Worsened |
Anger Control | 48.7% | 41.2% | 2.2% |
Suicide Watch | 7.7% | 80.6% | .02% |
Psychosis | 3.1% | 67.5% | .01% |
In this sample data we see that approximately 48% of the children and youth with a CANS have issues with Anger Control (48.7%) and at the time of the last CANS assessment for 41% of them it has improved by 1 point or more. When compared with the Suicide Watch for which approximately 8% of the children and youth have actionable issue and at the time of the last CANS assessment for 80% of them it has improved by 1 point or more. When compared with the Psychosis for which approximately 3% of the children and youth have actionable issue and at the time of the last CANS assessment for 67% of them it has improved by 1 point or more. This is an indicator that while YES services seem to be effective for Suicide Watch and Psychosis there may be a need to improve skills in Anger Control interventions.
In this section, you can view additional data and documents related to Quality Management Improvement and Accountability (QMIA) published before July 2022. Included are the YES QMIA Plan, Quarterly QMIA, Wraparound Intensive Services (WInS), and Rights and Resolutions Reports, as well as annual estimates of the YES Class Size.
You can also view all QMIA Quarterly Reports published before July 2022. For QMIA Quarterly Reports published after July 2022, select the QMIA Quarterly Reports tab.
Quality Management Improvement and Accountability (QMIA)
A QMIA Plan Development Workgroup, which included representatives from the Divisions of Behavioral Health, Medicaid, Family and Children’s Services (FACS), Idaho Department of Juvenile Corrections (IDJC) and State Department of Education, as well as families and mental health providers was formed to create a plan. The QMIA Workgroup met between September 2015 and March of 2016. Agencies designated representatives for the workgroup who were knowledgeable about quality assurance, quality improvement, or quality review processes. The Plaintiffs asked for and were included on the workgroup as their time permitted.
Quality Management Improvement and Accountability (QMIA) Plan
The Quality Management, Improvement, and Accountability Plan (QMIA) Plan describes the development of a collaborative, cross-system, practice, performance monitoring, and clinical quality improvement system. The QMIA Plan explains how Idaho’s child serving systems will monitor, assess, and report on the progress toward the execution of the commitments set forth in the Jeff D. Settlement Agreement.
Idaho’s YES Quality Review Process
The Quality Review Process is used to objectively assess and imporve clinical practice and program effectiveness system wide.
QMIA Quarterly Reports
The Quality Management Improvement and Accountability (QMIA) Report is a requirement of the Jeff D. Settlement Agreement and is a critical aspect of the YES project. The QMIA Report is assembled with information about children, youth, and families in Idaho and from data collected by the Department of Health and Welfare’s Divisions of Behavioral Health (DBH), Medicaid, and Family and Community Services (FACS), as well as the Idaho Department of Juvenile Corrections (IDJC), and the Idaho State Department of Education (SDE).
2022
2021
- QMIA Quarterly 18 – September 2021
- QMIA Quarterly 17 – July 2021
- QMIA Quarterly 16 – April 2021 revised May 2021
- QMIA Quarterly 15 – January 2021
2020
- QMIA Quarterly 14 – September 2020
- QMIA Quarterly Addendum – September 2020
- QMIA Quarterly 13 – May 2020
- QMIA Quarterly 12 – January 2020
2019
- QMIA Quarterly 11 – October 2019
- QMIA Quarterly 10 – July 2019
- QMIA Quarterly 9 – April 2019
- QMIA Quarterly 8 – January 2019
2018
2017
2016
Rights and Resolutions Reports
The purpose of this report is to monitor youth and family concerns or complaints relating to informing, access, service appropriateness, service effectiveness, and quality.
- Rights and Resolutions March 2023
- Rights and Resolutions January 2023 (Revised)
- Rights and Resolutions October 2022
- Rights and Resolutions June 2022
- Rights and Resolutions March 2022
- Rights and Resolutions January 2022 (Revised)
- Rights and Resolutions September 2021
- Rights and Resolutions April 2021
- Rights and Resolutions January 2021
- Rights and Resolutions October 2020
- Rights and Resolutions May 2020
- Rights and Resolutions December 2019
- Rights and Resolutions September 2019
- Rights and Resolutions June 2019
- Rights and Resolutions January 2019
Idaho WInS: Wraparound Intensive Services Reports
The Division of Behavioral Health (DBH) initiated the Idaho WInS model of Wraparound in February 2018. A small pilot of current DBH Children’s Mental Health (CMH) youth and families were enrolled in Idaho WInS. DBH had three goals: implement Wraparound to fidelity; build capacity of trained Wraparound coordinators, coaches and supervisors across the system; and increase the number of youth and families served to 250 by August 2020. Typically, this report will look at data from several sources. The DBH Electronic Health Record (WITS), referrals and referral dispositions, a standardized fidelity tool called the Wraparound Fidelity Index, shortened version (WFI-EZ), CANS data, and a Quality Service Review. All these methods for evaluating this program comprise the Quality Monitoring of the Idaho WInS program.
- SFY 2022 WInS and CANS Summary Report
- Quarterly Report for Idaho WInS: Q3 SFY 2022
- Quarterly Report for Idaho WInS: Q2 SFY 2022
- Quarterly Report for Idaho WInS: Q1 SFY 2022
- Quarterly Report for Idaho WInS: Q4 SFY 2021
- Quarterly Report for Idaho WInS: Q3 SFY 2021
- Quarterly Report for Idaho WInS: Q2 SFY 2021
- Quarterly Report for Idaho WInS: Q1 SFY 2021
YES Estimated Class Size
As one of the required annual deliverables to the plaintiffs in the Jeff D. lawsuit, the YES Data and Reports committee provides an estimate of how many children in the state of Idaho have serious emotional disturbance (SED) and would qualify as class members in the YES Project (Youth Empowerment Services).