Every year Telos does a comprehensive review of all of the available data from the year including all progress monitoring and outcome data. It also includes feedback surveys from parents, students, and staff regarding the Telos experience and the service provided. All of this valuable information is reviewed by the leadership team and used to discuss necessary improvements which are added to the annual strategic plan and evaluated throughout the year for successful implementation.
Quality Improvement
Telos is dedicated to the highest quality of treatment for our students. This requires accurate and timely measurement of company wide trends. This data is continually collected and is compiled and analyzed at the end of each year. In addition, the leadership team sends out surveys to parents, students, and staff to identify areas of needed improvement to ensure safety, effective treatment, and to create a healthy therapeutic environment.
These reviews cover a wide array of topics including, nursing, milieu staff, therapy, food, facilities, program design, school, family days seminars, activities budgets, peer culture, psychiatry, communication, sports, life coaching, transitional and aftercare services, and many more.
Each year the leadership team holds an annual strategic planning conference to review all of this data and to make strategic goals for program improvement. This is followed up on throughout the coming year and reviewed for effectiveness.
Figure 1: An example of how data from standardized surveys is used to identify areas for clinical improvement. This represents a review of the Family Assessment Device GF. It measures family progress including looking at Parent and self report as well as question by question improvements or areas of continued struggle that need to better be addressed in therapy. This research led to a goal for the entire clinical team to improve family therapy by giving more direct training and support to families needing to address conflict rather avoid it.
Progress Monitoring
The cutting edge approach to measurement is to track progress throughout the course of treatment rather than just collecting outcomes. This important approach gives feedback to the student and family so that they can build confidence as progress is made or make course corrections when things are off track. Monthly data points also help project the trend of improvement across the arc of treatment and can give insight into probable paths that students may follow.
Telos uses a visual dashboard to review valuable data regarding progress of students, the group they live with, and treatment team goals:
Figure 1: Team Culture Scores. When the team culture needs improvement this can be discussed as a team, worked on with the students in emotional safety groups, daily community meetings, therapy, and targeted individual intervention.
What does the Treatment Team review?
Treatment team process for reviewing a student:
- Therapist reviews the current treatment goals
- Reports
- Culture Scores
- Staff observations
- Customized behavioral measures (counts and scales related to specific goals on treatment plan)
- Progress Monitoring graphs
- Individual, Family, Group, and Recreational Therapy observations
- Academic observations
- Parent involvement
- Analysis and discussion
- Intervention
- Decisions about readiness for passes, challenges, the next step in the process, etc.
- 360 Analysis
- Special staffings
Figure 2: A sample of the scores dashboard in treatment team
What individual measures are used?
Telos Academy
- Executive Function Assessment
- Youth Outcome Questionnaire (parent and student report)
- McMasters Family Assessment Device III-Global Functioning Scale
- NATSAP Demographic and Outcomes Questionnaires for Student and Parent
- Scales targeting progress from maladaptive to adaptive behaviors through daily staff
observation - Culture Scores (impact on the team)
- Mindfulness Center Monitoring (1-10 scale on anxiety)
Telos U
- Executive Function Assessment
- Outcome Questionnaire 45
- McMasters Family Assessment Device III-Global Functioning Scale
- PHQ9- Progress monitoring of depression symptoms
- GAD7- Progress monitoring of anxiety symptoms
- NATSAP Demographic and Outcomes Questionnaires for Student and Parent
- Culture scores (impact on the team)
Figure 3: An example of a student’s progress over time with reduced anxiety as measured by the GAD7. The GAD7 measures reported anxiety symptoms. This data could be used to inform the treatment team, give feedback to the student (to reinforce or redirect therapy) and report to parents.
Figures 4 and 5: YOQ scores showing two students over time progress with general symptom reduction in the following areas: Intrapersonal Distress, Somatic, Interpersonal Relations, Social Problems, Behavioral Dysfunction ,Critical Items (suicide risk, etc)
How does Telos use data in Executive Function Coaching?
In order to pinpoint the individual executive function areas to focus on for each student, Telos developed the Executive Function Assessment (EFA), which measures current capabilities in eight areas of executive functioning: Time Management, Organization, Task Initiation and Completion, Attention, Metacognition, Flexibility and Shifting, Working Memory, and Resilience.
These areas are rated by the student, parents, teachers, milieu staff, and therapist. The combined scores are used to target the top three areas of concern and gear coaching toward skills development in these areas. At the end of a period of coaching, the same surveys are given to assess improvements.
Figure 6: A sample of the scores dashboard in treatment team
Sometimes we need to create Customized Measures
No student is the same. Each person has different strengths and weaknesses. Individualized treatment plans include individualized measurements that are customized to their clinical needs. These include dichotomies, scaling, and counts.
Dichotomies: A measurement on a 1-5 Likert scale that allows staff to rate students on how much growth they have made on a given day. Examples of dichotomies include anxious vs. calm, engaged vs. disengaged, proactive vs reactive, resilient vs avoidant, etc.
Scaling: Students can often score themselves or seek feedback from others on a 1-10 scale on a particular measurement such as consideration of others, positive self talk, etc.
Counts: Staff count during a shift how many times a student uses a new skill or struggles with a particular behavior that they are trying to improve.
