Illinois Children’s Behavioral Health Association Annual Winter Conference December 10-11, 2018 “Is Illinois Truly Embracing a System of Care Model for Children and Adolescents?” Sheila A. Pires Managing Partner, Human Service Collaborative Core Partner, National Technical Assistance Network for Children’s Behavioral Health Senior Consultant, Center for Health Care Strategies, Inc.
Let’s begin by talking about children and families ….and why they need a system designed for them.
Prevalence and Utilization How Many Children Face Prevalence/Utilization Triangle Mental Health Challenges? “ An estimated 13-20% of children Intensive More in the US (up to 1 out of 5 children) Services complex experience a mental disorder in a – 60% of Home and needs given year…” community 2 - 5% $$$ services and Prevention Centers for Disease Control and Prevention. Mental health surveillance among supports; and children – United States 2005-2011 . MMWR 2013;62 (Suppl; May 16, 2013):1- early 35. The report is available at www.cdc.gov/mmwr Universal 15% intervention Health –35% of $$ Promotion About one out of every ten youth is – 5% of $ estimated to meet the SAMHSA Less criteria for a Serious Emotional complex Disturbance (SED),defined as a needs 80% mental health problem that has a significant impact on a child's ability to function socially, Pires, S. (2010). Building systems of care: A primer, 2 nd Edition. Washington, academically, and emotionally D.C.: Human Service Collaborative for Georgetown University National Technical Assistance Center for Children’s Mental Health. Costello, EJ, Egger, H, Angold, A. 10-year research update review: The epidemiology of child and adolescent psychiatric disorders : 1. Methods and public health burden. J Am Acad Child Adolescent Psychiatry. 2005. Oct; 44 (10): 972-86
Costs Children in Medicaid Who Mental Health Costliest Health Use Behavioral Health Care Condition of Childhood Are Expensive Population $30.00 • 11% of children in Medicaid use BILLIONS of Dollars behavioral health care Mental $25.00 Health $8.90 • Account for 36% of all Medicaid Disorders child expenditures $20.00 • Mean expense at $10,259 is 4x Asthma higher than for children who do not $8.00 $15.00 use behavioral health services Trauma Related • Mean expense for children in foster care $10.00 Conditions (e.g. $6.10 at $12,130 is 5x higher accidents) • Mean expense for children on SSI at $5.00 Acute Bronchitis $3.10 $15,159 is over 6x higher Infectious Diseases $2.90 • Mean expense for children on TANF at $0.00 $5,082 is over twice as high Soni, 2009 (AHRQ Research Brief #242)) Pires, S., Gilmer, T., McLean, J. and Allen, K. 2018. Faces of Medicaid Series: Examining Children’s Behavioral Health Service Use and Expenditures:, 2005-2011 . Center for Health Care Strategies: Hamilton, NJ. Available at: https://www.chcs.org/resource/faces-medicaid-examining-childrens- behavioral-health-service-utilization-expenditures/
Children Using Behavioral Health Care in Medicaid with Top 10% Highest Expenditures Have mean expenditures Expense is driven by use of of $46,959 behavioral health, not physical • BH expense: $36,646 health care • PH expense: $10,314 Major cost drivers • Residential treatment and therapeutic group homes • Psychotropic medications Pires, S., Gilmer, T., McLean, J. and Allen, K. 2018. Faces of Medicaid Series: Examining Children’s Behavioral Health Service Use and Expenditures:, 2005-2011 . Center for Health Care Strategies: Hamilton, NJ. Available at: https://www.chcs.org/resource/faces-medicaid-examining-childrens-behavioral-health-service-utilization-expenditures/
Co-Morbid Physical Health Conditions Among Children in Medicaid Using Behavioral Health Care Frequency of Chronic Disability Payment System Categories among Children Using Behavioral Health Services in Medicaid, 2005, 2008, 2011 2005 2008 2011 No. of Most children (60%) do CDPS No. of No. of No. of not have co-morbid Categories % of Total % of Total % of Total Children Children Children physical health 0 520219 62.1% 475,316 56.0% 651,952 60.1% conditions 1 Of those that do - 219846 26.3% 237,555 28.0% 284,365 26.2% High prevalence of 2 66449 7.9% 83,862 9.9% 92,299 8.5% asthma 3 20012 2.4% 30,197 3.6% 32,072 3.0% Low prevalence of high- 4 6444 0.8% 12,292 1.4% 12,795 1.2% cost medical conditions 5 2412 0.3% 5,476 0.6% 5,594 0.5% 6 1028 0.1% 2,563 0.3% 4,045 0.4% 7+ 721 0.1% 1,971 0.2% 1,145 0.1% Total 837131 100.0% 849,232 100.0% 1,084,267 100.0% Pires, S., Gilmer, T., McLean, J. and Allen, K. 2018. Faces of Medicaid Series: Examining Children’s Behavioral Health Service Use and Expenditures:, 2005-2011 . Center for Health Care Strategies: Hamilton, NJ. Available at: https://www.chcs.org/resource/faces-medicaid-examining-childrens-behavioral-health-service-utilization-expenditures/
Distribution of Psychiatric Diagnoses among Children in Medicaid Using Behavioral Health Services* ADHD 36.4% Conduct Disorder 32.5% 31.9% Mood Disorder Anxiety 21.4% SUD 6.1% PTSD 5.9% *Do not add to DD 5.3% 100% because children may receive multiple 2.7% Psychosis diagnoses Pires, S., Gilmer, T., McLean, J. and Allen, K. 2018. Faces of Medicaid Series: Examining Children’s Behavioral Health Service Use and Expenditures:, 2005-2011 . Center for Health Care Strategies: Hamilton, NJ. Available at: https://www.chcs.org/resource/faces-medicaid-examining-childrens-behavioral-health-service-utilization-expenditures/
Racial and Ethnic Disparities in Behavioral Health Use NH/PI, 0.2% NH/PI, 0.5% 100% AI/AN, 1.4% 8% AI/AN, 1.2% 11% Asian, 0.7% Asian, 2.4% 90% 17% 80% Other/Unknown 28% 70% Native Hawaiian or Pacific 23% Islander 60% American Indian or Alaska Native 23% 50% Asian 40% 30% Hispanic or Latino 47% 37% 20% Black or African American 10% White 0% All Children in Medicaid* Behavioral Health Service Users** Pires, SA, Gilmer, T, Allen, K., McClean, J. 2017. Faces of Medicaid: Examining Children’s Behavioral Health Service Utilization and Expenditures Over Time, 2005-2011 . (In process). Center for Health Care Strategies: Hamilton, NJ
Children and Youth with Serious Behavioral Health Conditions Are A Distinct Population from Adults with Serious and Persistent Mental Illness Have different mental health diagnoses (ADHD, Conduct Disorders, Anxiety; not so Do not have the same much Schizophrenia, Psychosis, Bipolar as in high rates of co- adults), and diagnoses change often. morbid physical health conditions. Coordination with other children’s systems (CW, JJ, schools) and among behavioral health providers, as well as family issues, consumes most of care coordinator’s time, not coordination with primary care, though Are multi-system primary care coordination also important. involved – two-thirds typically are involved with CW and/or JJ systems and 60% may be To improve cost and quality of care, focus in special education – must be on child and family/caregiver(s) – systems governed by takes time – implies lower care coordination legal mandates. ratios and higher rates. Pires, S. March 2013 Customizing Health Homes for Children with Serious Behavioral Health Challenges. Human Service Collaborative. Washington, D.C.
Factors Leading to System of Care Reforms Patterns of utilization; Lack of home and Deficit-based/medical racial/ethnic community-based models, limited types Poor outcomes disproportionality and services and supports of interventions disparities Administrative Knowledge, skills and Rigid financing Cost inefficiencies; attitudes of key structures fragmentation stakeholders Pires, S. (2010). Building systems of care: A primer, 2 nd Edition. Washington, D.C.: Human Service Collaborative for Georgetown University National Technical Assistance Center for Children’s Mental Health.
Identified Needs in Illinois* • Additional care coordination across service systems • Reduce psychiatric hospitalization and residential placements • Reduce segregation of funding that results in fragmentation • Family-driven, youth-guided care • More flexible array of services • Culturally competent services • Maximize funding through blending, braiding, pooling funds • Transparency in utilization and cost data *Source: DHS: Pathways – Illinois’ Strategic Plan for Children’s Mental Health. 2013 11
What is a System of Care? A broad, flexible array of evidence-informed services and supports for defined populations, which: Is organized into a coordinated network; Integrates care planning and care management across multiple levels; Is culturally and linguistically competent; Builds meaningful partnerships with families and with youth at service delivery, management, and policy levels; Has supportive and collaborative management and policy infrastructure; Is data-driven; and Is co-financed across child-serving systems Pires, S. (2010). Building systems of care: A primer, 2 nd Edition. Washington, D.C.: Human Service Collaborative for Georgetown University National Technical Assistance Center for Children’s Mental Health. 12
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