Acute%20Mental%20Health%20Care%20Services%20for%20Children%20in%20Pinellas%20County%20(Florida)

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Acute Mental Health Care Services for Children in
Pinellas County (Florida)

• Annette Christy, Ph.D.
• John Petrila, J.D., LL.M
• Kristen Hudacek, Psy.D.
• Diane Haynes, M.A.
• Department of Mental Health Law and Policy
• Louis de la Parte Florida Mental Health Institute
• Community Partner
• Personal Enrichment Through Mental Health
  Services
• Thomas Wedekind, ACSW
• Anne Pulley, B.S.

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Acknowledgement

• This project was funded by the USF Collaborative
  for Children, Families and Communities with Funds
  from the Pinellas County Juvenile Welfare Board
• The Pinellas County specific archival data
  analyses were made possible by the Pinellas
  County Data Collaborative
• Portions of the Baker Act data processing and
  entry were funded by a National Institute of
  Mental Health Grant to Paul Stiles (R01MH060217)

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• The burden of suffering experienced by children
  with mental health needs and their families has
  created a health crisis in this country. Growing
  numbers of children are suffering needlessly
  because their emotional, behavioral, and
  developmental needs are not being met by those
  very institutions which were explicitly created
  to take care of them. It is time that we as a
  Nation took seriously the task of preventing
  mental health problems and treating mental
  illness in youth.
• The Report of the Surgeon Generals Conference on
  Childrens Mental Health, Satcher, 2001, p. 3

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Study Components

• Review of records for 35 children who had a
  recent Baker Act examination
• Archival Database Analysis
• Statewide
• Analysis of Baker Act Data
• Analysis of Medicaid and FL Department of
  Children and Families claims data
• Pinellas County
• The above sources, plus..
• Additional data sources available via the
  Pinellas County Data Collaborative

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Baker Act Examinations

• The Baker Act is the term applied to Floridas
  civil commitment statute
• Individuals can undergo a short-term, involuntary
  psychiatric or Baker Act examination of up to
  72-hours if
• The are a person with mental illness
• There is evidence of harm to self, harm to others
  and/or self neglect
• Examinations may be initiated by
• law enforcement officials
• mental health professionals
• judges
• Individuals are examined in 115 Baker Act
  Receiving Facilities that are designated by the
  Florida Department of Children and Families

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Baker Act Reporting Center

• Legislative reforms were implemented in 1996 in
  response to elder abuse related to Baker Act
  examinations
• A form documenting each examination was required
  to be sent to the Florida Agency for Healthcare
  Administration
• FMHI agreed to serve as the repository for these
  data and has been receiving data from 1997 to
  present
• These are data on short-term examination (not
  longer term commitment)
• Florida is the only state to have a central
  repository of client level data on short-term,
  involuntary psychiatric examination

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Baker Act Data

• From 1997 to present the Baker Act reporting
  center has received over ½ million Baker Act
  examination forms.
• We currently receive over 100,000 forms annually
• This represents approximately 430 forms received
  on average every business day
• Approximately 16 of forms received are for
  examinations of children
• 80,000 forms received documenting examinations
  for children from 1997 through 2002
• 17,000 forms documenting examinations for
  children likely received in 2003

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Volume of Baker Act Data

• of forms received
• 1997 69,235
• 1998 73,900
• 1999 78,064
• 2000 83,989
• 2001 95,900
• 2002 105,046
• 2003 109,000

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Percentage Baker Act Data Adults vs. Children
Statewide
Data for children represented 15-17 of the data
received in the past 3 and a half years
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(No Transcript)
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Record Reviews
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Record Reviews

• 35 Children from the PEMHS Crisis Stabilization
  Unit
• Parent/Guardian Consented
• Children Assented (only after permission from
  parent/guardian to approach child)
• First two months focused on consenting only
  children in the foster care system
• Due to time and cost constraints, then attempted
  to consent/assent every child
• Review of PEMHS record for the Baker Act
  examination from which the child was recruited
  into the study

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Record Reviews

• 40 (n 14) of children had a history of abuse
• 26 (n 9) sexual abuse
• 23 (n 8) physical abuse
• 11 (n 4) emotional abuse
• The most common presenting problem was suicidal
  ideation/gestures (n 19 54)
• Just prior to their examination 80 of children
  (n 28) were living with family
• Children had between one and four Axis I
  diagnoses (Mean 2.31)

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Record Reviews - Diagnoses
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Record Reviews

• The most common referral sources were
• Police 34 (n 12)
• Medical Facilities 34 (n 12)

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Record Reviews

• The most common referral sources were
• Police 34 (n 12)
• Medical Facilities 34 (n 12)
• 43 (n 15) had past or current justice system
  involvement

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Record Reviews

• The most common referral sources were
• Police 34 (n 12)
• Medical Facilities 34 (n 12)
• 43 (n 15) had past or current justice system
  involvement
• 46 (n 16) had past or current substance abuse
  documented

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Record Reviews

• The most common referral sources were
• Police 34 (n 12)
• Medical Facilities 34 (n 12)
• 43 (n 15) had past or current justice system
  involvement
• 46 (n 16) had past or current substance abuse
  documented
• Insurance Status
• 51 Private Insurance
• 26 Medicaid as Primary (6 as Secondary)

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Record Reviews

• The most common referral sources were
• Police 34 (n 12)
• Medical Facilities 34 (n 12)
• 43 (n 15) had past or current justice system
  involvement
• 46 (n 16) had past or current substance abuse
  documented
• Insurance Status
• 51 Private Insurance
• 26 Medicaid as Primary (6 as Secondary)
• 63 Receiving TANF benefits at time of exam

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Record Reviews - Medications
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Record Reviews Baker Act Data
32 children had ssns necessary for
identification of Baker Act Data

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Record Reviews Baker Act Data
32 children had ssns necessary for
identification of Baker Act Data These 32
children had 56 examinations over a period of
almost three years

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Record Reviews Baker Act Data
32 children had ssns necessary for
identification of Baker Act Data These 32
children had 56 examinations over a period of
almost three years Certificate Type 57 (n 32
exams) Law Enforcement 41 (n 23 exams) mental
health professional 2 (n 1) judge

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Record Reviews Baker Act Data
32 children had ssns necessary for
identification of Baker Act Data These 32
children had 56 examinations over a period of
almost three years Certificate Type 57 (n 32
exams) Law Enforcement 41 (n 23 exams) mental
health professional 2 (n 1) judge Evidence
Type 88 (n 49) Harm 2 (n 1) Harm and
Neglect 9 (n 5) Neglect 2 (n 1) No
Evidence type

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Record Reviews Baker Act Data
32 children had ssns necessary for
identification of Baker Act Data These 32
children had 56 examinations over a period of
almost three years Certificate Type 57 (n 32
exams) Law Enforcement 41 (n 23 exams) mental
health professional 2 (n 1) judge Evidence
Type 88 (n 49) Harm 2 (n 1) Harm and
Neglect 9 (n 5) Neglect 2 (n 1) No
Evidence type Harm Type 66 (n 33) harm
to self 24 (n 12) harm to self and
others 8 (n 4) harm only

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Record Reviews Baker Act Data
32 children had ssns necessary for
identification of Baker Act Data These 32
children had 56 examinations over a period of
almost three years Certificate Type 57 (n 32
exams) Law Enforcement 41 (n 23 exams) mental
health professional 2 (n 1) judge Evidence
Type 88 (n 49) Harm 2 (n 1) Harm and
Neglect 9 (n 5) Neglect 2 (n 1) No
Evidence type Harm Type 66 (n 33) harm
to self 24 (n 12) harm to self and
others 8 (n 4) harm only Repeated
Examinations 1 exam 38 (n 12) 5 exams 3 (n
1) 2 exams 13 (n 13) 7 exams 9 (n 3) 3
exams 6 (n 2) 4 exams 3 (n 1)

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Archival Database Analyses
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Archival Database Analyses
1,559 children with 2,696 Baker Act examinations
during three fiscal years (July 1999 through June
2002) in Pinellas County Facilities and/or with a
Pinellas County Residence
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Archival Database Analyses
1,559 children with 2,696 Baker Act examinations
during three fiscal years (July 1999 through June
2002) in Pinellas County Facilities and/or with a
Pinellas County Residence Repeated Examinations 1
exam 67 4 exams 3 2 exams 18 5 or more
5 3 exams 6
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Archival Database Analyses
1,559 children with 2,696 Baker Act examinations
during three fiscal years (July 1999 through June
2002) in Pinellas County Facilities and/or with a
Pinellas County Residence Repeated Examinations 1
exam 67 4 exams 3 2 exams 18 5 or more
5 3 exams 6 Gender 50 Male Age
Average age at time of first examination 13.60
years
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Archival Database Analyses
1,559 children with 2,696 Baker Act examinations
during three fiscal years (July 1999 through June
2002) in Pinellas County Facilities and/or with a
Pinellas County Residence Repeated Examinations 1
exam 67 4 exams 3 2 exams 18 5 or more
5 3 exams 6 Gender 50 Male Age
Average age at time of first examination 13.60
years Certificate Type 62 Law
Enforcement 33 Mental Health Professional 4
Judges
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Archival Database Analyses
1,559 children with 2,696 Baker Act examinations
during three fiscal years (July 1999 through June
2002) in Pinellas County Facilities and/or with a
Pinellas County Residence Repeated Examinations 1
exam 67 4 exams 3 2 exams 18 5 or more
5 3 exams 6 Gender 50 Male Age
Average age at time of first examination 13.60
years Certificate Type 62 Law
Enforcement 33 Mental Health Professional 4
Judges Evidence Type 89 Harm Only 5
Neglect Only 4 Both Harm and Neglect 1
Evidence Type Missing
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Baker Act Exams for Children in 2002 By
MonthStatewide
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Pinellas County Cross System Analysis
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Pinellas County Cross System Analysis
The majority of children with a Baker Act
examination in the three fiscal years also had
data in one of the four other data systems 18 -
only Baker Act data 8 - 3 other data
systems 31 - 1 other data system 14 - 4 other
data systems 29 - 2 other data systems
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Archival Analyses IDS DataFiscal Years 1999,
2000 and 2001
Pinellas Statewide 41 40
Crisis Support/Emergency 41 35
Crisis Stabilization 18 42
Medical Services 18 36
Outpatient Individual 18 19
Treatment Alternatives for Safer Communities
17 34 In Home and Onsite
Services 16 40 Case
Management 6 25 Assessment
6 6 Substance Abuse
Detoxification 5 17
Intervention 5 2
Intensive Case Management
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Archival Analyses Medicaid Data Fiscal Years
1999, 2000 and 2001
Children w/ Service Cost and of Total
Cost Pinellas Statewide
Pinellas Statewide TOTAL COST FOR 3 YEARS
8.2 M 208 M 78 61
Counseling Therapy and Treatment Services
505,000 6.5 M 5.2
3.1 76 65 Evaluation and
Testing Service
155,000 3.6 M
1.6 1.8 74 57
Treatment Planning and Review
113,000 1.7 M
1.2 0.8 45 39
Targeted Case Management
1.7 M 22.8 M
17.6 11.0 40 36
Childrens Behavioral Health
1.2 M 16.9 M
12.1 8.1 36 28
Child Ancillary Inpatient Services
75,000 1.8 M
0.8 0.9
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Archival Analyses Medicaid Data Fiscal Years
1999, 2000 and 2001
Children w/ Service Cost and of
Total Cost Pinellas Statewide

Pinellas Statewide 34
21 Hospital Outpatient Mental Health Services
96,000 1.8 1.0
0.9 33 39 Physicians
Services 24,000 497,000
0.3 0.3 26 28 Child
Inpatient Care 1.7M 50.0
M 17.8 24.1 26
17 Other Mental Health 74,000
894,000 0.8 0.4 25
22 Emergency Mental Health Services
18,000 1.0 M 0.2
0.5 24 21 Physicians
Services Clinic or Outpatient 16,000
497,000 0.2 0.2
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Archival Analyses Medicaid Data Fiscal Years
1999, 2000 and 2001
Children w/ Service Cost and of
Total Cost Pinellas Statewide
Pinellas
Statewide 19 37 Lab with
Mental Health Diagnosis
4,400 376,000
0.1 0.2 17 20
Rehabilitative Services
115,391 2.7 M
1.2 1.3 13
13 Behavioral Health Overlay Services
608,057 10.3 M
6.3 5.0 10
16 Day Treatment Services
154,478 6.3 M
1.6 3.1 6
5 Therapeutic Foster Care
1.5 M 22.3 M
15.9 10.8 6
4 Substance Abuse Inpatient
156,368 35.0 M
1.6 1.7
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7 Key Findings
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Key Finding 1 System Findings
Multiple programs are accessed by children at
PEMHS The type and timing of the services are
based on factors such as whether children are in
the dependency system, their legal status
(voluntary vs. involuntary), their needed level
and type of care, and availability of
services Interaction of staff from PEMHS and
from the Family Continuity Program (FCP) is key
to the access and continuity of care for some
children
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Key Finding 2 Certificate and Evidence Type
Baker Act examinations of children were more
likely to be initiated by law enforcement
officials and to be based on evidence of harm
than examinations for adults, suggesting that a
focus on factors related to law enforcement
initiated Baker Act examinations would help us to
better understand examinations of children and
associated factors
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Key Findings 3 - Seasonality
The number of Baker Act examinations for children
was less in the summer, both statewide and for
Pinellas County Although cause and effect cannot
be determined from this correlational finding,
they suggest some seasonality in Baker Act
examinations for children and is highly suggested
that school is involved in this seasonality
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Key Findings 4 Repeated Examination
Thirty-three percent of the children with a Baker
Act examination over a three-year period in
Pinellas County experienced more than one
examination during this time period Focused
attention on this subset of children with
multiple involuntary examinations is warranted,
given that the purpose of crisis stabilization
units is to offer emergent care not the longer
term care that may be needed by many of these
children Multiple examinations may suggest
discontinuity of care Additional focus on this
subpopulation could yield information about the
causes of repeated examinations and ways to
intervene to prevent them
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Key Findings 5 History of Trauma
The finding that 40 or the children from the
case studies had experienced sexual, physical
and/or emotional abuse suggests that trauma is an
important factor to address when planning and
implementing care for some children who receive
acute mental health care
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Key Findings 6 Therapeutic Foster Care
The 41 children who experienced at least one
Baker Act examination over a three-year period in
Pinellas County who also had Medicaid reimbursed
therapeutic foster care accounted for 6 of the
children with Medicaid reimbursed services, but
their therapeutic foster care reimbursed care of
over 1.5 million accounted for almost 16 of the
cost of Medicaid reimbursed services Almost 5 of
children statewide with at least one Baker Act
examination over a three-year period had Medicaid
reimbursed therapeutic foster care services, at a
cost of over 22 million representing almost 11
of Medicaid reimbursed services The high cost of
these services for a relatively small number of
children, particularly in Pinellas County
compared to statewide, suggests that a focus on
healthcare needs for children in this group may
be warranted This may be particularly important
within the current context of privatization of
foster care across Florida and the focus on
integration of the foster care and behavioral
health care system
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Key Findings 7 Intensive Case Management

• The use of case management and intensive case
  management is lower than we expected for the
  population of children who had contact with the
  involuntary, acute-care system
• For example
• At least one case management claim over three
  years
• 16 Pinellas
• 40 Statewide
• At least one intensive case management claim over
  three years
• 5 Pinellas
• 2 Statewide

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Contact Information
Annette Christy - achristy_at_fmhi.usf.edu -
813-974-7419 FMHI http//www.fmhi.usf.edu Baker
Act Reporting Center http//bakeract.fmhi.usf.ed
u Click on Documents link to go to page with
pdf file of complete report Collaborative for
Children, Families and Communities
http//usfcollab.fmhi.usf.edu/