close

Вход

Забыли?

вход по аккаунту

?

Bethesda 2007 Slides

код для вставкиСкачать
Developing a Community-Based Mental Health
System for Children and Adolescents in Maine:
Service Use, Cost, and Policy Directions
James T. Yoe, Ph.D.
Robert DuBrow
Maine Department of Health and Human Services
Office of Quality Improvement Services
2008 SAMHSA/CMS Invitational Conference on Medicaid and Mental Health
Services/ Substance Abuse Treatment
Baltimore, Maryland
September 25 & 26, 2008
Maine DHHS Children’s Behavioral Health
Services: Guiding Principles
1. Services based on the family’s and child’s strengths.
2. Families are full participants in all aspects of planning and delivery of
services
3. Children have access to a comprehensive array of services that meet the
child’s physical, emotional, educational and social needs.
4. Children receive individualized services guided by an individualized service
plan (ISP).
5. Children receive services in the least restrictive, most normative environment
that is clinically possible.
6. Children receive integrated services with linkages between agencies.
7. Early identification and intervention for children with emotional problems
should be promoted.
8. Children are ensured smooth transitions to adult service systems, as they reach
maturity
9. The rights of children should be protected and effective advocacy efforts for
emotionally disturbed children and youth be promoted.
10. Children receive services without regard to race, religion, national origin, sex,
physical disability or other characteristics and services should be sensitive and
responsive to cultural differences.
Children’s Behavioral Health Services:
Target Populations
пѓ�Children with Emotional and/or Behavioral Disorders
пѓ�Children with Developmental Disabilities or Severe
Developmental Delays
пѓ�Children with Mental Retardation or Autism
Children’s Behavioral Health Services:
Medicaid (MaineCare) Core Services
пѓ� Emergency/Crisis Resolution Services (Sec. 65 A&C)
пѓ� Targeted Case Management (13.12)
пѓ� Outpatient Services (Sec. 65F & K
Outpatient Psychotherapeutic Assessment and Treatment 65 F
Outpatient Medication Assessment and treatment 65 K
пѓ� In Home Treatment Services
Home Based Mental Health Services - 37
Child and Family Behavioral Health Treatment Service – 65 M&N
Assertive Community Teams (ACT) 65 J
пѓ�
пѓ�
пѓ�
пѓ�
Day Treatment Services
Children’s Habilitation Services (Sec. 24 )
Out of Home Residential Treatment Services – PNMI (Sec. 97)
Inpatient Psychiatric Hospital Treatment (Sec. 45)
Hospital Inpatient treatment (Community Hospital Psychiatric Units & Psychiatric Inpatient Hospitals)
Children’s Behavioral Health Services:
Facts on Child MaineCare Members Diagnosed
with Mental Health/Substance Abuse Challenges
пѓ� Total Number of Children (Birth to 21 years) eligible for full Medicaid
(MaineCare) Benefits (any time during the year): SFY 2007 = 148,350 - SFY
2008 = 147,901
пѓ� One quarter of eligible children had at least one paid medical claim where a
mental health or substance abuse diagnosis was present in 2007 (23.4% 34,736) and 2008 (24.8% - 36,641)
пѓ� 24.9% of males and 21.9% of female eligibles received a MH/SA diagnosis
on a claim.
пѓ� School-age Children and older youth were more likely to be diagnosed with
a MH/SA conditions.
Children’s Behavioral Health Services:
Study Purpose
пѓ� Develop methodology to accurately identify and extract
MaineCare Paid Claims for children and youth diagnosed with
a MH/SA challenges and specifically members that used one or
more of the identified Core Children’s Mental Health Services.
пѓ� This analysis specifically focuses on the characteristics of
children and youth recipients of ME- DHHS Children’s
Behavioral Health Services and examines MaineCare
(Medicaid) service use patterns and expenditures over a twoyear study period.
Children’s Behavioral Health Services
Study Design
пѓ� All data was obtained from the MaineCare Paid Claims Data System over a 2
year period: SFY 2007 (7/1/2006 to 6/30/2007) and SFY 2008 (7/1/2007 to
6/30/2008) – (Paid Claims extracted based on service dates)
пѓ� Initial extract identified claims for children and youth birth thru 21 years
who had a mental health or substance abuse diagnosis. Selection was
refined using specific CBHS procedures and, for hospital services, a
combination of provider type, provider specialty and MH/SA diagnosis.
пѓ� Primary diagnosis was determined for each child by assigning each
member to one MH/SA diagnostic category, based on category that
appeared most frequently on claims during the study years.
пѓ� MH/SA conditions identified using ICD-9 codes: 291 thru 314.99 and 316.
Excludes Mental Retardation (315 – 315.99)
пѓ� Mental Health pharmacy claims were not included in study.
Children’s Behavioral Health Services:
Child and Youth Characteristics
Children By Gender and Age: FY 2007 & 2008
Percent Child Service Users
70%
0 to 3 Years
4 to 5 Years
6 to 12 Years
13 to 18 Years
19 Years and Over
60%
50%
42%
40%
42%
38%
37%
39%
33%
30%
17%
20%
10%
13%
10%
8%
4%
3%
5%
4%
7%
0%
Male
Female
Total
N (unduplicated children 2007 – 2008) = 30,271
Children’s Behavioral Health Services:
Child & Youth Characteristics
Child Primary Diagnosis: FY2007 - 2008
Other Dx, 825, 3%
Conduct Related , 1675, 6%
Substance Abuse, 2190, 7%
Stress/Adjustment , 7657, 24%
ADHD Related, 5608, 19%
Other Psychotic, 2363, 8%
Major Mood, 3136, 10%
Neurotic/Other Depression,
6817, 23%
N (unduplicated children 2007 – 2008) = 30,271
Children’s Behavioral Health Services:
Child & Youth Characteristics
Child Gender By Diagnosis Category: 2007 - 2008
Male
50%
Female
40%
31%
28%
30%
25%
21%
18%
20%
12%
11%
9%
7%
10%
11%
6%
4%
9%
8%
11%
3%
x
er
D
Ot
h
Su
bs
ta
nc
e
Ab
us
e
d
Re
la
te
AD
HD
Ot
h
er
P
sy
ch
ot
ic
oo
d
M
aj
or
M
io
n
ep
re
ss
er
D
ic
/O
th
Ne
ur
ot
St
re
ss
/A
dj
us
tm
Re
la
te
en
t
d
0%
Co
nd
uc
t
Percent Child Service Userrs
60%
N (unduplicated children 2007 – 2008) = 30,271
Children’s Behavioral Health Services:
The Service Array and Utilization
Child Service Users By Serice Category: FY 2007 - 2008
Hospital Outpatient Tx
2008
2007
Inpatient Psychiatric Tx
Out-of-Home Residential
Day Treatment
Emergency-Crisis Services
Medication Assessment & Tx
Outpatient Treatment
Day Habilitation
Assertive Community Tx
Home-based Services
In-Home Treatment (65N)
In-Home Treatment (65G)
In-Home Treatment (65H)
In-Home Behavioral Tx (65M)
Case Management
0%
10%
20%
30%
40%
50%
60%
70%
Percent Child Service users
N (undup. 2007) =21,520
N (undup. 2008) =22,712
Children’s Behavioral Health Services:
The Costs
Service Expenditures By Service Category: FY 2007
Hospital Outpatient Tx
4%
Inpatient Psychiatric Tx
19%
Case Management
9%
In-Home Behavioral Tx
(65M&N,H,G)
7%
Home-based Services
3%
Assertive Community Tx
1%
Day Habilitation
4%
Outpatient Treatment
6%
Medication Assessment & Tx
2%
Emergency-Crisis Services
2%
Day Treatment
2%
Out-of-Home Residential
41%
FY 2007 CBHS Expenditures = $240,497,244
Children’s Behavioral Health Services:
The Costs
Service Expenditures By Service Category: FY 2008
Case Management
9%
Hospital Outpatient Tx
5%
In-Home Behavioral Tx (65M)
5%
In-Home Tx (65N)
0%
Home-based Services
1%
Inpatient Psychiatric Tx
17%
Assertive Community Tx
1%
Day Habilitation
5%
Outpatient Treatment
7%
Medication Assessment & Tx
2%
Emergency-Crisis Services
2%
Out-of-Home Residential
43%
Day Treatment
3%
Total Expenditures (FY2008) =$216,650,343
Service expenditures in 2008 may under-represent actual
expenditures for the year since claim payments continue to be processed
Children’s Behavioral Health Services:
The Costs
Average Per User Expenditures By Diagnostic Category: FY2007 and FY2008
35
2007
2008
30
25
21
21
19
20
18
15
9
10
9
8
9
8
9
7
11
8
5
5
7
10
7
4
To
ta
l
Pe
rU
se
r
Dx
Ot
he
r
Ab
us
e
e
an
c
Su
bs
t
AD
HD
Re
ho
Ps
yc
Ot
he
r
rM
ajo
M
lat
ed
tic
d
oo
n
io
De
ot
ic/
Ot
he
r
Ne
ur
St
re
ss
/A
d
uc
t
jus
pr
e
ss
tm
Re
la
en
t
te
d
0
Co
nd
Per Child Annual Expenditures
(Thousands of Dollars)
40
Service expenditures in 2008 may under-represent actual
expenditures for the year since claim payments continue to
be processed.
Children’s Behavioral Health Services:
Expenditures By Mental Health Service Category
Service Category
Children
Paid Claims
2007
2007
Avg. 2007 Per
Child Expenditure
Children
Paid Claims
2008
2008
2007
Avg. 2008 Per Child
Expenditures
2008
Case Management (13.12)
7012
$20,999,955
$2,995
7065
$19,750,001
$2795
Outpatient Psych. ( 65F)
11397
$13,984,897
$1227
12406
$15,455,288
$1246
In-Home Behavioral Tx (65M)
1632
$11,626,862
$7124
2049
$10,062,067
$6044
In-Home Behavioral Tx (65N)
411
$200,924
$489
476
$201,300
$423
Out-of-Home Residential (97)
2009
$99,460,083
$49,507
1933
$92,904,139
$48,062
Assertive Community Tx (65J)
328
$3,197,806
$9749
394
$3,095,359
$7856
Emergency - Crisis Services (65 A&C)
2593
$5,137,123
$1981
2496
$4,817,640
$1930
Day Habilitation (24)
724
$10,068,337
$13,906
840
$11,778,825
$14,022
Day Treatment
710
$5,766,212
$8121
643
$5,558,782
$8645
Inpatient Psychiatric Hospital
1248
$46,089,323
$36,930
1100
$37,256,820
$33,869
Hospital Related Outpatient Tx.
7743
$9,407,420
$1215
8286
$9,788,883
$1181
Home-Based Services (37)
950
$6,075,152
$6395
464
$2,142,360
$4617
Medication Management (65K)
4621
$4,026,181
$871
4609
$3,838,878
$833
In-Home Beh. Tx. (65G, 65H)
1966
$4,456,968
$2654
0
0
0
21,520
$240,497,244
$11,175
22,712
$216,650,343
$9539
Total
Children’s Behavioral Health Services:
Summary of Results
пѓ� 30,271 children received a core MaineCare MH service over the 2 year
study period – 21,520 in FY2007 & 22,712 in FY 2008 accounting for 14.5%
of eligible children in 2007
пѓ� Most children (77%) were between the ages of 6 and 18 years with more
males represented in the younger age groups.
пѓ� Most common diagnoses were stress/adjustment (24%), Neurotic/Other
(23%) and ADHD related (19%)
пѓ� Male service users were significantly more likely to receive conduct related,
other psychotic, and ADHD related diagnoses while females were more
likely to receive stress & adjustment, neurotic-depressive, major mood and
substance abuse diagnoses.
пѓ� Service Expenditures for children diagnosed with MH/SA abuse conditions
who receive MH Services represented 37.3% of total Child MaineCare
expenditures in FY 2007.
пѓ� Inpatient Psychiatric Hospital and Out-of-Home Residential Treatment
accounted for 60% of the overall MH expenditures in FY2007 representing
13% of child service users.
Children’s Behavioral Health Services:
Summary of Results - Continued
пѓ� Most frequently used services in 2007 and 2008 included: OutpatientClinical Services ( 53%, 54%), Targeted Case Management (33%,31%);
Hospital -Related Outpatient Treatment (36%) and Medication Assessment &
Tx (21%,20%);
пѓ� Child and youth diagnosed with Major Mood Disorders and Other Psychotic
Disorders had the highest annual service expenditures.
Children’s Behavioral Health Services: Policy and
Service System Initiatives
пѓ� Contract established with Administrative Services Organization for MaineCare
Behavioral Health Services – operational since December 2007;
� Focus on identification, dissemination and use of Evidence-based Practices (EBP’s)
and measurement of outcomes in children’s behavioral health programs;
пѓ� Initiation of Child Steps, an evidence-based mental health research project in 3
Maine clinics to evaluate the effectiveness of manualized clinical interventions and
use of “family partners” for children 8-14 years.
пѓ� Development and implementation of a Trauma-Informed System of Care (THRIVE
Initiative) and implementation System of Care Principles state-wide.
пѓ� Target resources to Increase the use of effective, intensive community-based
treatments and reduce the use of high-cost, out-of-home treatment.
пѓ� Work to enhance service system coordination and collaboration and develop a
single, fully integrated children’s behavioral health system.
пѓ� Mental Health screening of all children who have contact with Child Welfare
пѓ� Enhance the role of families and youth at all levels of CBHS program operations,
including: Policy Development, Quality Improvement Activities and Training.
Children’s Behavioral Health Services:
Evaluation Next Steps
пѓ� Conduct study of the demographic and clinical characteristics
of children and youth users of inpatient psychiatric treatment
and out-of-home residential treatment services and variation in
service use across geographic areas.
пѓ� Examine utilization and cost of behavioral health pharmacy
data in child and youth recipients of Children’s Behavioral
Health Services.
пѓ� Evaluate MaineCare primary health care service use and costs
for CBH service users compared to MaineCare children without
mental health challenges.
Acknowledgements: The leadership of the Maine Department of
Health and Human Services: Brenda Harvey, DHHS Commissioner;
Geoffrey Green, Deputy Commissioner; Joan Smyrski, Doug Patrick,
Office of Child & Family Services – Children’s Behavioral Health
Services, & Elsie Freeman, Andrew Hardy, Kimberly Cook, Office of
Quality Improvement Services
Jay.yoe@maine.gov
Документ
Категория
Презентации
Просмотров
6
Размер файла
2 514 Кб
Теги
1/--страниц
Пожаловаться на содержимое документа