behavioral health needs of child welfare and other high risk children a presentation to the 2015...
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Behavioral Health Needs of Child Welfare and Other High Risk Children
A presentation to The 2015 Colorado Children’s Caucus January 12, 2015
Claudia A. Zundel, MSW, Director, Child, Adolescent and
Family Services
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Today’s Agenda
Behavioral health needs, costs and agency involvement of child welfare and other system involved youth
State Response
1/12/2015
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General Child/Ado-lescent Population
Juvenile Justice Involved
Child Welfare Involved
0
20
40
60
80
21%
67%
80%
Prevalence Estimates of Mental Health Disorders in System Involved Children and
Youth
National Institute of Mental Health; Cocozza, et. al. (2010); Simms, Dubowitz, & Szilagyi (2000)
1/12/2015
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Children's Caucus
− PTSD prevalence in foster care children 60% among sexually abused 42% among physically abused 18% among non-abused children
− PTSD prevalence in juvenile justice children 11% of males 18% of females
− PTSD prevalence in military conflict 14% among returning service members from Iraq and
Afghanistan
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BH Needs of System-Involved Children and Youth
National Child Traumatic Stress Network, U.S. Dept. of Veteran’s Affairs1/12/2015
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*Overall Symptom Severity
*Overall Level of Functioning
*Legal Problems
Alcohol Use
*Drug Use
*Need for Supervision
*Aggression
*Problematic Family Relationships
*Interpersonal Relationships
*Role Performance
*Hope
*Activity Involvement
*Interpersonal Relationships
Attention
*Mania
*Anxiety
Depression
0 1 2 3 4 5 6 7 8 94.87
4.02
1.45
1.141.27
2.76
2.95
4.39
2.82
3.65
3.273.58
3.41
3.50
1.60
3.69
3.65
5.054.21
1.57
1.13
1.24
3.22
3.23
5.543.15
3.74
3.40
3.67
3.72
3.54
1.74
3.89
3.69
CW EverNo CW Ever
Higher scores indi-cate more severe problems. * Statistically signifi-cant difference be-tween groups.
CCAR Scores at Admission by Child Welfare Status
1/12/2015
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Psychotropic Medication Use By Foster Care Status
1/12/2015
DUR Report Skaggs School of Pharmacy
AP: Antipsychotic, AD: Antidepressant, MS: Mood Stabilizer, Stim: Stimulant, AA: Antianxiety Medication
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Funding AgencyNumber of Children
Agency ExpenditureAdditional Medicaid
ContributionTotal
Child Welfare2,063 $51,719,376 $5,922,691 $57,642,068
Medicaid – BHO, Inpatient and Residential
Treatment 1,749 $17,339,065 N/A $17,339,065
DYC577 $12,960,211 $1,495,839 $14,456,050
Colorado Mental Health Institutes (Ft. Logan
and Pueblo) 132 $5,041,972 N/A $5,041,972
Office of Behavioral Health (non-Medicaid)31 $656,148 $147,845.69 $803,993
Total4,552 $87,716,773 $7,566,376 $95,283,149
1/12/2015
FY2010-11 High Intensity Services
4,022 Unique Individuals, 488 had services paid by more than one agency
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Clients in the Top 10% of BHO Medicaid Spending Accounted for 37.7% of the Total Spending
% of Clients % of Medicaid Spending0
10
20
30
40
50
60
70
80
90
100
90.0
62.3
10.0
37.7
Top 10%Lowest 90%
Perc
ent
Cost per Client:$7,694.99
Cost per Client:$41,899.76
Clients were organized into two groups comprised of the top 10% and the bottom 90% of utilization. The % of total spending and cost per client were calculated by group.
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CW (n=1,881)
CW High Utilizers System Overlap
CW Only n=119, 6.3%
CW/MH, n=883, 47% of CW has MH only
CW/MH/DYC, n=854, 45% of CW has DYC & MH
CW/SA, n=6, 0.3% of CW has SA only
CW/DYC/SA, n=10, 0.5% of CW has DYC and SA
CW/MH/SA, n=100, 5.3% of CW has MH and SA
CW/DYC, n=18, 1.5% of CW has DYC only
CW/DYC/MH/SA, n=266, 14% of CW has all
1/12/2015
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Colorado’s Response
1/12/2015
Three Decision Items1)Medical Director2)Electronic Health Record3)TRAILS Update
Two System reforms4)Title IV-E trauma work5)System of Care–Care
Management Entity
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Psychotropic Medications
Foundational Work Three Decision Items
Children's Caucus
Federal Meeting Task Group Report and
Recommendations
Medical Director Electronic Health Record TRAILS Update
1/12/2015
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Trauma Work
1/12/2015
Title IV-E Waiver screening, assessments and treatment
Partnership with CDHS and HCPF
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System of Care –Care Management
System of Care Care Management Entity
Children's Caucus
14 counties Boulder, Eagle, El Paso, Garfield,
Gunnison/Hinsdale, Jefferson, Lake, Montezuma/Dolores, Montrose, Pueblo, and Weld Counties, and the San Luis Valley + 2
Wraparound (evidence-based model of care coordination)
Family Advocacy
Ongoing Evaluation− Improvement in school attendance− Eliminate system involvement
Pilot in El Paso County 25 youth referred from child
welfare and probation Positive Results
− High parent satisfaction− Youth improved in multiple
mental health domains− Cost savings for Child Welfare
and Medicaid
1/12/2015
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Resources and Reports
1/12/2015
Psychotropic Medication Guidelines for Children and Adolescents in Colorado’s Child Welfare System 2013 HCPF/CDHS
Youth with High Behavioral Health Needs in Colorado 2014 COACT Colorado www.COACTColorado.org
Care Management Entity Pilot Site in El Paso County Evaluation Report 2014 COACT Colorado