Title: Office of Mental Health and Substance Abuse Services Children
1Office of Mental Health and Substance Abuse
ServicesChildrens Advisory Committee
Residential treatment facility research and
data overview
Andy Keller, Boulder Peter Selby, Seattle
2Current residential capacity in Pennsylvania
- 3,038 in-state accredited residential treatment
facility (RTF) beds as of September 1, 2008
(versus 3,223 in October of 2007) - 1,309 non-accredited RTF beds
- Non-Medicaid beds
- Youth development centers 4 facilities, 696 beds
- Secure care 9 facilities, 267 beds
- Secure residential 4 facilities, 98 beds
- Juvenile detention centers (JDCs) 22 facilities
with 870 beds - What does it mean that 1,700 youth per year from
other states use Pennsylvania RTF facilities?
3What kind of transformation is needed?
- Goals related to RTF for transforming the
behavioral health system for youth - Reduce reliance on RTFs
- This will require enhancement of community
capacity - This will require a reduction in RTF capacity
- Intensify and improve the quality of the
treatment in RTFs. - This will require improved quality standards for
RTF care across the board standards that are
enforced - This will require development of specialized RTF
capacity for key groups trauma, young women,
youth with aggressive behavior, co-occurring
substance use and mental health needs - Bring youth back to their communities from out of
state, as well as from distant out of community
placements - Make family involvement a fundamental component
of RTF services
4Can the strategy be statewide, regional or
county-level?
- It must be county-level because local systems of
care vary widely in their needs, available
services, and strategies - It must be regional because smaller counties will
need to share some specialized capacity - It must be statewide because the funding and
standards to drive the transformation require
that scope - Bottom line It must be an integrated strategy
encompassing all three levels
5Example one Residential treatment facility
service use patterns vary at the county level
- 2005 2006 patterns of RTF service by Child in
Substitute Care (CISC) / non-CISC are stable at
multi-county level - But there are major differences at the
county-level
6Example two Diagnoses of residential treatment
facility users also vary by county
- Same pattern of CISC/non-CISC diagnoses is seen
at each level of analysis - But there are major differences in proportion at
county-level
Primary diagnosis CISC versus non-CISC
60.0
50.0
40.0
30.0
20.0
10.0
0.0
Statewide
HealthChoices
Expansion
Allegheny
Philadelphia
Conduct disorder (CISC)
Conduct disorder (Non-CISC)
Mood disorder (CISC)
Mood disorder (Non-CISC)
ADHD (CISC)
ADHD (Non-CISC)
Adjustment disorder (CISC)
Adjustment disorder (Non-CISC)
7Will require new rate structure
- Evolution of rate structure over time
- Historically, there had been cost-based methods
to develop rates - With the statewide implementation of managed
care, there has been less focus on cost-based
reimbursement with rates more subject to
negotiation - Current rates are low, creating pressure to limit
quality of care and sell capacity to other states
at higher prices - There is now a need to develop cost-based
methodologies for targeted new RTF modalities and
partner with providers and behavioral health
managed care organizations (BHMCOs) to implement
them
8Infrastructure for new rate structure
- New RTF regulations include a review of the
fee-for-service (FFS) rate setting - New FFS rate structure can serve as a benchmark
for BHMCO rate setting - BHMCOs have historically used FFS rates as a
reference point for their rates - The new structure should include
- A base rate for all accredited RTF care
- Differential rates to be paid in addition to the
base rate for each of the areas of specialization
prioritized by OMHSAS - Development of a process to engage RTF providers
in transformation efforts, including inclusion of
performance incentives
9Essential to define the need for residential
treatment facility capacity at the county and
regional levels
- Important to carry out needs assessment to
determine appropriate capacity for basic and
specialized RTF services - Will require a collaborative process involving
the Department of Public Welfare (DPW), Office of
Children, Youth and Families (OCYF), OMHSAS,
counties, BHMCOs, families, and key stakeholders
in each county - Determine each countys need for RTF capacity in
each area of specialization identified by the
service array subgroup - Transformation will require reductions in current
RTF capacity and more RTF specialization - Without reductions, beds will continue to be
filled even if community options are expanded - Increased costs to deliver enhanced RTF care and
expanded community services will require offsets
10Need to set standards to enhanced continuum of RTF
- Standards would be developed for the following
areas of specialization - Specialized residential programming
- Gender-responsive services
- Secure RTF
- Other specialized programs, including treatment
for co-occurring mental health (MH)/developmental
disability, autism spectrum, co-occurring
MH/substance abuse - Placement options that vary by intensity and
focus - Extended sub-acute stabilization and evaluation
- Family-based RTF (30 60 days, fewer beds)
- Longer-term intensive and restrictive RTF
- Small group homes in community (non-RTF)
11Examples of success from other states
- In many ways, Pennsylvania must be a leader on
this initiative - No other state that we know of has the amount of
existing RTF capacity that OMHSAS has - No other large state has fully implemented a
similar statewide strategy - That being said, we can learn from the
experiences of other states and RTF providers
12Examples of success from other states
- Oregon cut its RTF use in half through policy
changes and changes to the RTF referral process - Without any new funding, the State, in
partnership with stakeholders, significantly
enhanced capacity to track resources and outcomes - Oregon also targeted improved services at the
local level, using evidence-based practices - State administrative rules were rewritten to make
sure all clinical procedural codes needed were in
place and care coordinators were accessible in
each community - The State used policymaking and purchasing to
leverage changes focused on increasing family
voice across all levels - Success was seen in changes in the role of family
members, the location of services and type of
services provided
13Examples of success from other states
- New York is in the early stages of a transition
driven by their Office of Child and Family
Services that will - Establish criteria to access services that
include standardized assessment tools (Child and
Adolescent Needs Strengths), integrated use of
evidence-based practice, and requirements to
expand community-based services - Commit 620,000 per year to the operation of a
statewide evidence-based dissemination center
that has already trained over 400 clinicians in
trauma-focused cognitive behavioral therapy
14Examples of success from other states
- Individual RTF providers have successfully
transitioned from large institutional models to
family-based group home, therapeutic foster care,
mobile crisis and stabilization services and
wraparound-based community approaches - Two programs in California
- Hathaway-Sycamores Child and Family Services
- EMQ Children and Family Services
- The Drenk Center in New Jersey
15Services provided by Mercer Health Benefits LLC