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

Brave

New World

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.

Total (N=4,147) SPC only (N=3,036) RTF only (N=717) Both (N=404)*0%

25%

50%

75%

100%

76%

95%

28%

17%14%

4%

35%

45%

7%

0%

23%27%

3%0%

12%10%

Lt 1 Year

1 to 2 years

Gt 2 to 3 years

3 to 5 years

Gt 5 Years

*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.

0 0.5 1 1.5 2 2.5 340%

50%

60%

70%

80%

90%

100%

Time to IP Admission after Discharge from Youth's Last RTF Episode (N=1607)

Overall

Time to IP Admission in Years

% n

ot

ho

spit

aliz

ed 154 Days

0 0.5 1 1.5 2 2.5 340%

50%

60%

70%

80%

90%

100%

Time to IP Admission after Discharge from Youth's Last RTF Episode, by having inpatient events during the RTF stay (N=1607)

No IP during RTF

With IP during RTF

Time to IP Admission in Years

% n

ot

ho

spit

aliz

ed

89 Days

162 Days

Median 528 Days

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.

Childr

en's

Home

RTF/dba

Still

water

RTF

Hillside

Fing

er L

akes

Cam

pus,

RTF

House

of t

he G

ood

Sheph

erd

RTF

Astor

Hom

e fo

r Chil

dren

David

Hall R

TF

Gold

smith

Cen

ter f

or A

doles

cent

Tre

atm

ent

Linde

n Hill

RTF

Parso

ns C

hild

& Fam

ily C

ente

r RTF

The C

hildr

en's

Village

Cotta

ge F

acilit

y, R

TF

McK

eown

House

RTF

Augus

t Aich

horn

Cen

ter

Henry

Ittle

son

Cente

r RTF

Ottil

ie Hom

e fo

r Chil

dren

(RTF)

Baker

Vict

ory

Servic

es R

TF

Conne

rs R

TF

Crest

wood

Childr

en's

Cente

r RTF

Hillside

Chil

dren

's Cen

ter R

TF

St. Jo

seph

's Villa

RTF

0%

10%

20%

30%

40%

50%

60%

42% 41%43%

36%

41%45% 45%

39%

57%

45%42%

35% 36%

54%

33%

40%38%

35%

26%

Percentage of Youth Hospitalized after discharge from RTFs by RTF Facility Across Regions

Central New York

Greater NYC Hudson River

Greater NYC Long Island

Greater NYC New York City

Western New York

Total Youth Hospitalized after Discharge from RTF During Study Period*

REGION_NAME Facility Total Discharged

Total hospitalized

N %

Central New York Children's Home RTF/dba Stillwater RTF 55 23 42%

Central New York Hillside Finger Lakes Campus, RTF 113 46 41%

Central New York House of the Good Shepherd RTF 67 29 43%

Hudson River Astor Home for Children 25 9 36%

Hudson River David Hall RTF 29 12 41%

Hudson River Goldsmith Center for Adolescent Treatment 155 69 45%

Hudson River Linden Hill Residential Treatment Facility 188 84 45%

Hudson River Parsons Child & Family Center RTF 51 20 39%

Hudson River The Children's Village 30 17 57%

Long Island Cottage Facility, RTF 65 29 45%

Long Island McKeown House RTF 45 19 42%

New York City August Aichhorn Center 65 23 35%

New York City Henry Ittleson Center RTF 70 25 36%

New York City Ottilie Home for Children (RTF) 170 91 54%

Western New York Baker Victory Services Residential Treatment Facility 147 49 33%

Western New York Conners Residential Treatment Facility 42 17 40%

Western New York Crestwood Children's Center RTF 60 23 38%

Western New York Hillside Children's Center RTF 165 58 35%

Western New York St. Joseph's Villa RTF 65 17 26%

Total   1607 660 41%

*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

2728C

TOCT

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-