System of Care Approaches in Residential Treatment Facilities Serving Children with Serious Behavioral Health Needs (original) (raw)

2010, RePEc: Research Papers in Economics

roviding an appropriate continuum of mental health services for the estimated one in five children and adolescents in the U.S. who have a mental health disorder is imperative. 1 While it is well established that such services should emphasize community-based care, 2 children and youth with challenging behavioral health problems are often placed instead in residential treatment facilities (RTFs). Those in residential treatment settings can benefit from a system of care approach that facilitates coordination between residential and community-based providers and engages youth and their families as partners in care. P A system of care is a strengths-based approach that recognizes the importance of family, school and community, and addresses the physical, emotional, intellectual, cultural, linguistic and social needs of every child and youth. Through this approach, families and youth work with public and private organizations to design a coordinated network of community-based services and supportsimproving functioning at home, in school, and in the community. 3 The federal Comprehensive Community Mental Health Services Program for Children and Their Families has funded systems of care for children's mental health in states, tribes and communities across the country, with demonstrated improvements in behavioral and emotional health. 4 Insufficient home-and community-based options, financial incentives that drive residential placements, and reduced use of inpatient psychiatric care all contribute to increases in the use of RTFs. 5 Accordingly, it is vital to understand how these facilities are delivering mental health services to children and youth to begin to address questions about RTF overuse, lengths of stay, long-term effectiveness, and adoption of evidence-based principles of care. 6 This paper describes the findings of a national survey of RTFs that serve children and youth with serious behavioral health challenges. The survey sought to identify the extent to which: System of care principles are reflected in the policies and practices of RTFs; and Residential treatment is providing home-and community-based services and supports in addition to traditional offerings. Survey findings are particularly relevant to Medicaid and other public purchasers of residential treatment, given the high cost of residential care, its history of overuse, and the potential for home-and community-based services to reduce inappropriate RTF placements and lengths of stay. The findings can also inform child behavioral health policymakers, RTF providers, and child and family advocates seeking promising approaches to better meet the extensive behavioral health needs of children and youth in this country. This issue brief is made possible through support from the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services and the Annie E. Casey Foundation. The intent is that these findings catalyze discussion among these constituencies to increase incorporation of system of care principles and practices throughout the continuum of care, particularly in RTFs, where they are needed most. Survey Partnership While systems of care emphasize home-and community-based services, their growing use has coincided with increased reliance on RTFs-driving tension between advocates of communitybased and residential care. The reasons are many, including limited resources, differing philosophies, and a lack of research demonstrating the effectiveness of residential treatment. Based on mutual concern about these issues, the Child and Family Branch of the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS), the Annie E. Casey Foundation, and the Center for Health Care Strategies (CHCS) engaged Mathematica Policy Research to conduct this survey. This effort follows CMHS' Building Bridges Initiative, launched in 2006 to create partnerships and improve relationships among residential and community service providers, families and youth. The Building Bridges Initiative encourages community-based and residential providers to better communicate and coordinate their services within a system of care framework. 7 Survey Methodology Development of the Survey of Residential Treatment Facilities ("RTF survey") was guided by an advisory panel of parents, youth, RTF directors, policymakers, advocates, researchers, and other community-based providers, as well as key-informant interviews. Survey items were designed to gather information on RTF: (1) characteristics; (2) values and principles; (3) treatment and assessment practices; (4) workforce needs; (5) cultural and linguistic diversity; (6) relationships with other providers; and (7) financing. Highlights of Survey Results Survey results indicate both evidence of and opportunities for improvement in the incorporation of system of care values in RTF policies and practices, and an orientation to community-based care. * RTFs that operate under the auspices of child welfare were only included in the NSMHTF if they offer mental health treatment services.