It’s Not Just about Length of Stay Implementing Best Practices to Support Better Outcomes for Children and Families in a Managed Care World

It’s a Brave New World Affordable Care Act Systems of Care Evidenced Based/Promising Practices BHO’s and Medicaid Managed Care – Phase 1 Reduction in Inpatient Bed Capacity – Art. 28’s, 31’s and State Operated Children's Psychiatric Centers

May You Be With The Forces Expanding coverage and access Improving quality, efficiency and cost of care Care that is coordinated across multiple systems and providers and is: Family driven/youth guided Home and community based and connected to natural helping networks Strength based and individualized Culturally and linguistically competent Data driven, outcomes oriented

What Does This Mean for Rtf’s Movement away from” placement “orientation and long lengths of stay Residential as a short term treatment intervention, part of an integrated continuum and connected to the community Shared decision making with families/youth and other providers and agencies Individualized treatment approaches through a child and family team process Trauma-informed care

Looking at a Cohort LOS by treatment setting Youth who moved between SPC/RTF treatment settings (‘Both’) tended to be in care longer than youth who had either SPC or RTF placements during that time frame. *Note that 101 (66%) out of 153 youth in care greater than 2 years utilized ‘Both’ - compared to 92 (36%) out of 259 youth in care greater than 2 years who utilized RTF only were still in care as of 4/20/11

What Happens to Youth Discharged from RTF’s 1622 Youth who had an episode of care in RTF during 1/1/2003 and 3/31/2011 and who were discharged from RTF during 4/1/2005 through 3/31/2011 were identified from CAIRS. We chose this period because complete Medicaid data are available for analysis of hospitalization after discharge. This cohort includes 67% (N=2420) of all youth admitted to RTF during this time period; By definition – the last RTF ‘episode’ for youth was selected for this analysis; Of the 1622 Youth identified, 1607(99.1%) youth with valid Medicaid ids were included in the final discharge cohort; Inpatient admission during and subsequent to the Youth’s RTF episode were characterized using OMH rate codes (FFS) for State IP, Article 28 & Article 31 hospitalizations; Data for Subsequent hospitalizations were extracted from Medicaid data as of 8/31/2011. For example, youth discharged 3/31/11 would have 5 months of time in the study; We examined ‘Time to’ patterns of hospitalizations using Survival Statistical Analysis; Time to patterns of hospitalizations were examined separately by embedded hospitalization (defined as hospitalizations that occurred during an RTF episode), gender, age group, RTF provider region and RTF provider.

Youth with IP admission during an RTF episode had higher rates of hospitalization after discharge from RTFs*. In this cohort, 130 (8%) of youth were hospitalized during the RTF stay. 54% of those youth were hospitalized within 3 years after the RTF discharge compared to 46% of youth hospitalized after RTF discharge who did not have an IP stay during the RTF Episode. The risk of hospitalization among youth with inpatient stays during RTF is significantly higher compared to those who did not have an IP admission during the RTF episode. (p=.0026) *As determined from Medicaid data.

Total Youth Hospitalized after Discharge from RTF During Study Period* REGION_NAMEFacilityTotal Discharged Total hospitalized N% Central New YorkChildren's Home RTF/dba Stillwater RTF552342% Central New YorkHillside Finger Lakes Campus, RTF % Central New YorkHouse of the Good Shepherd RTF672943% Hudson RiverAstor Home for Children25936% Hudson RiverDavid Hall RTF291241% Hudson RiverGoldsmith Center for Adolescent Treatment % Hudson RiverLinden Hill Residential Treatment Facility % Hudson RiverParsons Child & Family Center RTF512039% Hudson RiverThe Children's Village301757% Long IslandCottage Facility, RTF652945% Long IslandMcKeown House RTF451942% New York CityAugust Aichhorn Center652335% New York CityHenry Ittleson Center RTF702536% New York CityOttilie Home for Children (RTF) % Western New YorkBaker Victory Services Residential Treatment Facility % Western New YorkConners Residential Treatment Facility421740% Western New YorkCrestwood Children's Center RTF602338% Western New YorkHillside Children's Center RTF % Western New YorkSt. Joseph's Villa RTF651726% Total % *within 3 years, as of 8/31/11

From This Day Forward..... Leadership Commitment to Change Focus on maintaining connection to family and community throughout residential treatment Building strong partnerships among RTF’s, community providers, families, child welfare and education Concurrent planning

We Can Do This Youth and Family Advocates on Board Peer councils established Positive Alternatives to Restraint and Seclusion Implemented OMH Support for Technical Assistance-