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7.2 Waterfall of Items First, Discovered and Resolved Insights

The Waterfall of Items First, Discovered and Resolved (WIP) Insights help determine the proportion of people who present with a need, strength or underlying item or are later discovered to have one. These insights identify which areas are more often resolved and which are unresolved after reassessment. By identifying needs/strengths that are often resolved by a program or staff, you can begin to identify program and staff strengths. Staff who are found to resolve needs or build strengths more often can be identified for leadership opportunities to share their approaches and methods with other staff. Conversely, you can also identify needs/strengths which are less often resolved and identify program supports and staff training needs. An example of the WIP is presented in  Figure 7.2.a.

Figure 7.2.a WIP Insights Example

This report looks across an entire episode of care to find all items which were indicated at any point in care, and then identifies which of those indicated items were resolved or unresolved by the last available assessment. The report can narrow in on one youth at a time, or report on an entire group’s average indicated items. 

The  People Matching Filters table identifies the number of total people available and the number of people matching the filters and represented in the insights. A person must have been assessed at least once to have insights.

Throughout the dashboard you will see this icon ( ⓘ ), highlighting informative text related to the chart or table. For example, the  People Represented table states: “This table shows the number and demographic of people represented in this report.” You are reminded that “Sex and Race Criteria can be selected using the report filter dropdowns”.

The  Waterfall Chart identifies the number of items that were indicated and resolved on average per person represented. Indicated items fall in one of two categories: first or discovered. First, is a count of all items indicated on the first available assessment. Discovered, is a count of items indicated on any following assessment. 

  • Description of Bars in Waterfall Chart:
    • First: The average number of items per person that were indicated on the first assessment.
    • Discovered: The average number of items per person that were not indicated on the first assessment but were indicated sometime after the first assessment.
    • Ever: The total number of items indicated per person, on average, ever during care.
    • Resolved: The per person average number of items ever indicated that were resolved by the last assessment.
    • Unresolved: The per person average number of items ever indicated that were left unresolved on the last assessment.

In the example in  Figure 7.2.a, there were 22 items (per person on average) indicated on first assessment, and 7 items (per person on average) discovered on later assessments, for a total of 29 items ever indicated (per person on average). As of the last available assessment, 8 items had been resolved and 21 were unresolved/ still needing to be addressed. The Narrative for the Waterfall Chart at the bottom of these insights helps describe the specific numbers in the chart, and narratives update each time the insights return new data.

Many outcome tools simply look at first and last available assessments. If you did that here, you would see 22 items indicated on the first available and 21 items indicated on the last available. This would seem that there was not much change, and we would miss out on the important work that was done resolving these 8 items that improved. 

Note: Pre and post reviews of  first and final assessments do not accurately represent the complexity of the work and transformations of people’s stories in mental health, behavioral health and social services.

In the  Item Level Detail table below, you can take a closer look at the items making up the Waterfall Chart. You see a list of items presenting and items discovered, which together make up the items ever indicated count and percentage. You can mouse over for information about each column definition. 

  • Description of Columns in Item Level Detail Table:
    • First %:  The proportion of people assessed for this item who had this item indicated on the first assessment.
    • Discovered %:  The proportion of people assessed for this item who had this item indicated on an assessment after the first assessment.
    • Ever (Count): The total number of people who ever had this item indicated during care. 
    • Ever %:  The proportion of people assessed for this item who ever had this item indicated during care.
    • Resolved: The number of items that were at one point indicated, but were resolved by the last assessment.
    • Resolved %:  The proportion of items that were at one point indicated, but were resolved by the last assessment.
    • Unresolved: The number of items that were at one point indicated, but were resolved by the last assessment.

You can sort by any of the columns. Maybe you’re curious about the indicated items Resolved. Sorting by the Resolved column, shows items that were most often resolved. Sorting by the Unresolved column, shows items that were most often unresolved.

The next chart shows the  Average Number of Items Ever and Last Indicated. This section describes, for each category, the number of items indicated on the first assessment plus those discovered on subsequent assessments, compared to the number of items indicated on the last assessment.

  • Description of Columns in Item Level Detail Table:
    • First:  The average number of items per person indicated on the first assessment, by category of item.
    • Discovered:  The average number of items per person indicated on a subsequent assessment (not the first), by category of item.
    • Discovered %:  The proportion of people who ever had this item indicated who had it discovered sometime after the first assessment.
    • Ever:The average number of items per person indicated on any assessment ever, by category of item.
    • Last:The average number of items per person indicated on the last assessment, by category of item.
    • Resolved: The average number of items per person ever indicated that were resolved by the last assessment, by category of item.
    • Resolved %:  The proportion of items per person ever indicated that were resolved by the last assessment, by category of item.

In the example in  Figure 7.2.a, you can see that on the first assessment, for TRM (trauma) category, there was initially an average of 1.8 trauma experiences per person, an additional trauma experience was later discovered on average for each person (0.9), for a total of 2.7 average trauma experiences per person ever known during care. Few of those experiences were resolved, which is expected, as even the best care cannot take away the events that someone has experienced. As of the last assessment, those 2.6 trauma experiences were still indicated on average per person. The categories detail below is similar to the item level detail for the Waterfall Chart, but the counts across columns are now grouped by category.

These graphs and tables give us a powerful tool for viewing strengths and needs across time, both at the category level and at the item level.

At the end of the Item Detail narrative, we see some suggestions of ways to sort the table for additional insights. As the charts and tables in the dashboard are updated through filters and over time, these narratives will update as well. These narratives are meant to be quick highlights from the dashboard, and may be helpful as text that can be copied and pasted into agency reports and documentation.