A presentation to The 2015 Colorado Childrens Caucus January 12 2015 Claudia A Zundel MSW Director Child Adolescent and Family Services Todays Agenda Behavioral health needs costs and agency involvement of child welfare and other system involved youth ID: 240957
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Slide1
Behavioral Health Needs of Child Welfare and Other High Risk Children
A presentation to The 2015 Colorado Children’s Caucus
January 12, 2015
Claudia A. Zundel, MSW, Director, Child, Adolescent and Family Services Slide2
Today’s Agenda
Behavioral health needs, costs and agency involvement of child welfare and other system involved youth
State Response
Children's Caucus
2
1/12/2015Slide3
3
National Institute of Mental Health;
Cocozza, et. al. (2010
); Simms
, Dubowitz, &
Szilagyi (2000)
1/12/2015
Children's CaucusSlide4
PTSD
prevalence in foster care children
60% among sexually abused
42% among physically abused
18%
among
non-abused childrenPTSD prevalence in juvenile justice children
11% of males
18% of females
PTSD prevalence in military conflict
14% among returning service members from Iraq and Afghanistan
4
BH Needs
of
System-Involved
Children and Youth
National Child Traumatic Stress Network, U.S. Dept. of Veteran’s Affairs
1/12/2015
Children's CaucusSlide5
CCAR Scores at Admission by Child Welfare Status
1/12/2015
Children's Caucus
5Slide6
Psychotropic Medication Use By Foster Care Status
Children's Caucus
6
1/12/2015
DUR Report Skaggs School of Pharmacy
AP: Antipsychotic, AD: Antidepressant, MS: Mood Stabilizer, Stim: Stimulant, AA: Antianxiety MedicationSlide7
Funding Agency
Number of Children
Agency Expenditure
Additional Medicaid Contribution
Total
Child Welfare
2,063
$51,719,376
$5,922,691
$57,642,068
Medicaid – BHO, Inpatient and Residential Treatment
1,749
$17,339,065
N/A
$17,339,065
DYC
577
$12,960,211
$1,495,839
$14,456,050
Colorado Mental Health Institutes (Ft. Logan and Pueblo)
132
$5,041,972
N/A
$5,041,972
Office of Behavioral Health (non-Medicaid)
31
$656,148
$147,845.69
$803,993
Total
4,552$87,716,773$7,566,376$95,283,149
Children's Caucus
7
1/12/2015
FY2010-11 High Intensity Services
4,022 Unique Individuals, 488 had services paid by more than one agencySlide8
8
Clients in the Top 10% of BHO Medicaid Spending Accounted for 37.7% of the Total Spending
Clients were organized into two groups comprised of the top 10% and the bottom 90% of utilization. The % of total spending and cost per client were calculated by group.
1/12/2015
Children's CaucusSlide9
CW High Utilizers System Overlap
CW Only n=119, 6.3%
CW/MH, n=883, 47% of CW
has
MH only
CW/MH/DYC, n=854, 45% of CW has DYC & MH
CW/SA
, n=6,
0.3
% of CW
has
SA only
CW/DYC/SA, n=10,
0.5
% of CW
has
DYC and SA
CW/MH/SA, n=100, 5.3% of CW
has
MH and SA
CW/DYC,
n=18
, 1.5% of CW
has
DYC only
CW/DYC/MH/SA, n=266, 14% of CW
has
all
1/12/2015
Children's Caucus
9Slide10
Colorado’s Response
Children's Caucus
10
1/12/2015
Three Decision Items
Medical Director
Electronic Health Record
TRAILS Update
Two System reforms
Title IV-E trauma work
System of Care–Care Management EntitySlide11
Psychotropic Medications
Foundational Work
Three Decision Items
Children's Caucus
11
Federal Meeting
Task Group
Report and Recommendations
Medical Director
Electronic Health Record
TRAILS Update
1/12/2015Slide12
Trauma Work
Children's Caucus
12
1/12/2015
Title IV-E Waiver
screening, assessments and treatment
Partnership with CDHS and HCPFSlide13
System of Care –Care Management
System of Care
Care Management Entity
Children's Caucus
13
14 counties
Boulder, Eagle, El Paso, Garfield, Gunnison/Hinsdale, Jefferson, Lake, Montezuma/Dolores, Montrose, Pueblo, and Weld Counties, and the San Luis Valley + 2
Wraparound (evidence-based model of care coordination)
Family Advocacy
Ongoing Evaluation
Improvement in school attendance
Eliminate system involvement
Pilot in El Paso County
25 youth referred from child welfare and probation
Positive Results
High parent satisfaction
Youth improved in multiple mental health domainsCost savings for Child Welfare and Medicaid
1/12/2015Slide14
Resources and Reports
Children's Caucus
14
1/12/2015
Psychotropic Medication Guidelines for Children
and Adolescents in Colorado’s Child Welfare System
2013 HCPF/CDHS
Youth with High Behavioral Health Needs in Colorado
2014 COACT Colorado
www.COACTColorado.org
Care Management Entity Pilot Site in El Paso County Evaluation
Report
2014 COACT Colorado