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

Children's Caucus 2

Today’s Agenda

Behavioral health needs, costs and agency involvement of child welfare and other system involved youth

State Response

1/12/2015

3

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

Children's Caucus

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

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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