CHILD AND ADOLESCENT MENTAL HEALTH DATA

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CHILD AND ADOLESCENT MENTAL HEALTH DATA SHEILA
A. PIRES HUMAN SERVICE COLLABORATIVE KIDS COUNT
GRANTEE MEETING ANNIE E. CASEY FOUNDATION BALTIMOR
E, MARYLAND SEPTEMBER 25, 2003
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• Children and families eligible for Medicaid
• Children and families eligible for the State
  Childrens Health Insurance Program (SCHIP)
• Poor and uninsured children and families who do
  not qualify for Medicaid or SCHIP
• Families who are not poor or uninsured but who
  exhaust their private insurance, often because
  they have a child with a serious disorder
• Families who are not poor or uninsured and who
  may not yet have exhausted their private
  insurance but who need a particular type of
  service not available through their private
  insurer and only available from the public sector

The Total Population of Children and Families Who
Depend on Public Systems Pires, S.
(1996). Human Service Collaborative, Washington,
D.C.
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Examples of Sources of Behavioral Health Funding
for Children and Families in the Public Sector

• Child Welfare
• CW General Revenue
• CW Medicaid Match
• IV-E (Foster Care and Adoption Assistance)
• IV-B (Child Welfare Services)
• Family Preservation/Family Support

• Medicaid
• Medicaid In-Patient
• Medicaid Outpatient
• Medical Rehabilitation Services
• Medicaid Early Periodic Screening, Diagnosis and
  Treatment (EPSDT)

• Other
• WAGES
• Childrens Medical Services/Title V - Maternal
  and Child Health
• Mental Retardation/Developmental Disabilities
• Title XXI - State Childrens Health Insurance
  Program (SCHIP)
• Vocational Rehabilitation
• Local Funds

• Education
• ED General Revenue
• ED Medicaid Match
• ED Block Grant

• Substance Abuse
• SA General Revenue
• SA Medicaid Match
• SA Block Grant

• Mental Health
• MH General Revenue
• MH Medicaid Match
• MH Block Grant

• Juvenile Justice
• JJ General Revenue
• JJ Medicaid Match
• JJ Block Grant

Pires, S. (1995). Examples of sources of
behavioral health funding for children families
in the public sector. Washington, D.C. Human
Service Collaborative
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Current Systems Problems Pires, S.
(1996). Human Service Collaborative, Washington,
D.C.

• Lack of home and community-based services and
  supports
• Patterns of utilization
• Cost
• Administrative inefficiencies
• Knowledge, skills and attitudes of key
  stakeholders
• Poor outcomes

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Categorical vs. Non-Categorical System Reforms
Pires, S. (1996). Human Service
Collaborative, Washington, D.C

• Categorical System Reforms

Mental Health
Child Welfare
Juvenile Justice
Etc.
Child Welfare
Shared Population Focus
etc.
Non-Categorical Reforms
Mental Health
Juvenile Justice
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System of Care Operational Characteristics
Pires, S. (1996). Human Service
Collaborative, Washington, D.C.

• Collaboration across agencies
• Partnership with families
• Cultural and linguistic competence
• Blended, braided, or coordinated financing
• Shared governance across systems and with
  families
• Shared outcomes across systems, reflecting
  community values
• Organized pathway to services and supports
• Interagency/family services planning teams
• Interagency/family services monitoring teams

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System of Care Operational Characteristics(conti
nued) Pires, S. (1996). Human
Service Collaborative, Washington, D.C.

• Single plan of care
• One accountable care manager
• Cross-agency coordination
• Individualized services/supports wrapped around
  child and family
• Home-and community-based alternatives
• Broad, flexible array of services and supports
• Integration of clinical treatment services and
  natural supports, linkage to community resources
• Integration of evidence-based treatment
  approaches
• Cross-agency management information systems

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HENNEPIN COUNTY CHILD MENTAL HEALTH SPENDING AND
UTILIZATION STUDY

• What public dollars by type and amount are being
  spent on
• mental health services for Hennepin County
  children and adolescents?
• What services and supports are these dollars
  buying?
• What populations of Hennepin County children
  (e.g., by
• demographics, severity), and how many children,
  are receiving
• mental health services?
• What are the outcomes achieved by the dollars
  that are spent?
• How do Hennepin County expenditures and
  utilization compare
• to other jurisdictions?

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TYPES OF DATA EXAMINED

• Medicaid Fee-for-Service
• Medicaid Managed Care
• Child Mental Health State MH Authority and
  County
• Child Welfare extrapolate behavioral health
  spending from
• larger service contracts
• Education multiple school districts plus State
  Education Dept.
• Juvenile Justice State and local
• Developmental Disabilities Home and Community
  Based Waiver

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MISSING DATA

• Substance abuse
• Cost data from Medicaid managed care systems
• Public health department (e.g., Title V)
• Cost of uncompensated care
• Psychotropic medications
• Prevention

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PROBLEMS WITH AVAILABLE DATA

• Data from multiple sources cover different years
• Data from multiple sources are gathered and
  reported in
• different formats
• Data from single sources changed format and
  content over
• successive years (difficult to to trend analysis)
• Data from multiple sources sometimes differed on
  reporting
• the same variable (e.g., out of home placement
  expenditures)

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EXAMPLES OF WHAT THE DATA SHOW

• Medicaid FFS spends in total 3x what Medicaid
  managed care
• spends, and 2x per child
• Medicaid is overspending on hospital and
  residential care and
• underspending on home and community based
  services (in spite of
• broad service coverage in the State Medicaid
  plan)
• Actual expenditures by county mental health
  agency are
• decreasing even though budgets are increasing
• The child welfare agency spends more than the
  mental health agency
• on mental health services
• The schools spend more than the mental health
  agency on mental
• health services

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EXAMPLES OF WHAT THE DATA SHOW (CONT.)

• Racial and ethnic disparities (e.g., African
  American boys over-
• represented in out of home and out of school
  placements)
• Enrollment in special education is growing
• Out of home placements are creeping upwards

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COMPARISON TO NATIONAL BENCHMARKS

• Childrens Mental Health Benchmarking Project
  Medicaid and
• State MH authority expenditures and utilization
• Medicaid spending less per child than national
  median
• County mental health spending more per child than
  national median
• Larger percentage spent on inpatient and day
  treatment than
• national medians
• Lower percentages spent on outpatient and case
  management than
• national medians
• Medicaid penetration rate of 17.2 children per
  1,000 lower than
• national mean of 21.2 children per 1,000

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HEALTH CARE REFORM TRACKING PROJECT

• One third of Medicaid managed care systems
  reportedly do not
• have adequate data to support decision making
  with respect to
• childrens behavioral health services
• Over half (55) are in early stages of
  development or have
• developed but not yet implemented data systems to
  measure
• clinical and functional outcomes
• Nearly 40 do not know what effect they are
  having on child
• BH penetration rates over half (56) do not know
  what impact
• they are having on cost or on outcomes (58)

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WHAT WOULD BE GOOD INDICATORS TO TRACK?

• Utilization
• Penetration
• Expenditures and utilization on inpatient,
  residential treatment, and
• day treatment compared to expenditures and
  utilization on
• in-home, behavioral aides, respite, intensive
  care management,
• mobile crisis, therapeutic after school and day
  care, family
• support services
• s of children stuck in hospital beds
• s of children and lengths of stay in residential
  treatment
• s of children and lengths of stay in out of
  state residential
• Hospital and RTC recidivism
• s of children with EBD identified through
  special ed
• Youth suicide
• Expenditures on prevention and early intervention