Out of Home Care Study
Norín Dollard, PhD
- Mary Armstrong, PhD
- Norín Dollard, PhD
Agency for Healthcare Administration
Statewide Inpatient Psychiatric Programs (SIPP), Specialized Therapeutic Foster Care (STFC), and Specialized Therapeutic Group Care (STGC) provide out of home behavioral health treatment options for Florida's Medicaid population. In the past, these three treatment options have been evaluated separately; however, since these are the most restrictive treatment options funded by Medicaid and similar evaluation questions have been raised about all three treatment alternatives, the evaluation projects were combined in FY 2005-06 so that systemic issues concerning out of home care can be addressed. The common themes and issues addressed include treatment fidelity, the service trajectories of youth across the three residential programs, service use, and the costs and outcomes of care.
The 2005-06 evaluation of the three Medicaid-funded out-of-home treatment option alternatives includes several sub-studies, which looked at evaluation questions at the child and family, provider, and system levels. The first of the six sub-studies included all three Medicaid-funded out of home alternatives, while three focus solely on the Statewide Inpatient Psychiatric Program (SIPP). The final study consisted both of original analysis of administrative data, as well as provided a synthesis of sub-study findings to provide a broader look at Medicaid funded out of home treatment options.
The first sub-study was a pre-treatment/post-discharge comparison of youth enrolled in one of the three Medicaid-funded out of home alternative programs (SIPP, STFC, STGC). Data was analyzed from Medicaid claims data and other available sources, examining and comparing the demographic, clinical, and service needs of youth admitted to one of the three out of home care programs. The study looked at overall post service patterns and costs of behavioral health treatment compared to pre-admission public behavioral health utilization patterns and costs of enrollees. The comparison study looked at a period of 12 months prior to treatment and 12 months post-discharge. The study also examined the cost-effectiveness of STFCs and STGCs.
The second sub-study focused on treatment fidelity within each of the three Medicaid-funded out of home care programs; SIPPs, STFC, and STGC. Specifically, the sub-study looked at how well treatment plans reflect the client's needs and strengths, the extent to which the service plans reflect and address these needs and strengths and the extent to which treatment objectives are being delineated and implemented.
The third sub-study analyzed administrative data collected from the SIPP Provider Monthly Report Database. The analysis included client demographic data, clinical information, and several outcome measures; including the Child Behavior Checklist, Children's Global Assessment Scale, and 60-day follow-up information. The sub-study looked at SIPP enrollees' prior treatment history, presenting problems, medication utilization, critical incidents, length of stay, discharge reason, and placement.
FY05-06 served as a pilot year to provide technical assistance to STGC providers to implement the database, so that comparable data will be available across programs in future evaluation activities.
The fourth sub-study focused on youth who were readmitted to a SIPP within six months after-discharge and included a description of the characteristics of these youth, as well as their service use between the initial discharge and readmission. The sub-study focused on the process leading up to readmission, treatment trajectories, how well treatment reflected treatment recommendations, whether access to appropriate levels of care influences recidivism, how formal and informal supports were utilized after discharge, and whether there are any processes or services the child's family and case manager feel could have prevented the readmission.
The fifth sub-study continued and expanded on the Regional Care Coordinator study. Using quantitative and qualitative data, this sub-study looked at the evolving role of the Regional Care Coordinator (RCC). Continued attention was paid to the impact RCCs have had on length of stay (LOS) and the system processes that facilitate or impede the RCCs' ability to affect LOS.
The sixth-study looked at trajectories of residential care and the degree of complexity and integration of the system of care. Interviews with caregivers, parents, providers and other key stakeholders examined what factors facilitate or impede client movement across different levels of care, to what extent the three Medicaid-funded out of home care programs are appropriately utilized, and whether or not home and community-based service alternatives are appropriately utilized.