Psychiatric Residential Treatment Facilities for Child Behavioral Health Services in North Carolina Medicaid

Background Psychiatric residential treatment facilities (PRTFs) are non-hospital inpatient treatment settings for children with severe be­havioral health disorders. PRTFs are a restrictive and costly form of care that can potentially be avoided with community-based behavioral health services. Methods Statewide Medicaid enrollment and claims data for 2015–2022 were used to describe PRTF utilization in North Carolina. We examined annual episodes of care in PRTFs and compared trends before and during the COVID-19 public health emergency. Results From 2015 to 2022, 10,038 children insured by NC Medicaid entered a PRTF across 10,966 episodes of care. In the past five years (2018–2022), care in PRTFs resulted in Medicaid expenditures of over $550 million total, or over$100 million per year. In 2022, 42% of children who entered PRTFs were in foster care and 44% of children were placed in PRTFs outside of North Carolina. Limitations The analysis was limited to data collected for administrative purposes. Conclusions Current trends indicate an ongoing overrepresentation of children in foster care placed in PRTFs and increased out-of-state PRTF placements. Coordinated efforts in future research, policy, and practice are needed to determine the cause of these trends and iden­tify solutions

Mental Health And The Role Of The States

Researchers from the State Health Care Spending Project -- a collaboration between The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation -- sought to better understand the country's mental health challenges and, in particular, the states' role in addressing them. The project found that:In 2013, approximately 44 million adults -- 18.5 percent of the population 18 and older -- were classified as having a mental illness. Of these, 10 million had a serious mental illness. The rate of serious mental illness varied from state to state.In 2009, the most recent year for which national mental health data are available, $147 billion was spent on mental health treatment in the United States. A majority of the spending, 60 percent, came from public sources such as Medicaid, state and local governments, Medicare, and federal grants. Private sources, including health insurance and individual out-of-pocket spending, made up the difference.Funding from states and localities totaled$22 billion (15 percent) in 2009. This total does not include state and local Medicaid expenditures. Counting those contributions brings total state and local spending up to $35.5 billion (24 percent).This report is intended to help federal, state, and local policymakers working to address the country's mental health challenges to better understand their prevalence, treatment, and funding trends

A Longitudinal Study of Child Maltreatment and Mental Health Predictors of Admission to Psychiatric Residential Treatment Facilities

The child welfare system is an access point for children’s mental health services. Psychiatric residential treatment facilities (PRTFs) are the most restrictive, and most expensive setting for children to receive long-term care. Given the high rates of behavioral health concerns among maltreated children in out-of-home care, research is needed to examine the factors that predict entry in PRTFs among children investigated for maltreatment. This exploratory study used cross-sector administrative records linked across multiple systems, including child welfare records and Medicaid claims, from a single state over a five-year period (n = 105,982). Cox proportional hazards modeling was used to predict entry into a PRTF. After controlling for many factors, PRTF entry was predicted by diagnosis code indicating a trauma-related condition, antipsychotic medication prescriptions, and entry into lower levels of out-of-home care, supporting the view that youth are admitted to PRTFs largely due to clinical need. However, PRTF admission is also associated with characteristics of their experiences with the social service system, primarily foster care placement stability and permanency. Implications for practice and research are discussed

Too Many Teens: Preventing Unnecessary Out-Of-Home Placements

The child welfare system was created to care for abused and neglected children. But too often, teenagers are landing in the system because they simply aren't getting along with their parents. This paper traces Casey's efforts to learn from communities that are preventing teens from landing in the system by helping families while the teen remains at home. A survey of the states, interviews with experts, secondary research and visits to several communities show common elements of successful programs.The paper presents information on related laws and policies, funding sources and programs for families while including the infrastructure and services needed to support such initiatives

A review of children's behavioral health services S.C. Department of Health and Human Services

Members of the General Assembly requested an audit of the S.C. Department of Health and Human Services to determine how the agency’s reimbursement policy and other policy changes since 2007 have impacted children’s behavioral health services in the state

A Systematic Review of the Effectiveness of Children’s Behavioral Health Interventions in Psychiatric Residential Treatment Facilities

Objective The purpose of this systematic review was to synthesize quantitative or mixed-method studies that evaluate the efficacy of interventions with youth in the context of psychiatric residential treatment facilities (PRTFs) in the United States. Methods Systematic review procedures were conducted to identify relevant studies, both published and from the gray literature in the United States. Search terms were informed via consultation with a university social science reference librarian, and four electronic databases were searched. Using a priori inclusion and exclusion criteria, team-based search procedures yielded a final sample of 47 relevant studies. Results Studies varied with respect to publication status; sample size; research design; youth gender identity; youth racial/ethnic identity; youth behavioral, psychological, and developmental or intellectual concerns at intake; outcomes measures; and interventions evaluated. Evaluated interventions could be clustered into one of five categories: (a) modifications to system of treatment, (b) therapeutic modalities, (c) educational/alternative programs, (d) practice behaviors, and (e) post-discharge engagement. The majority of studies noted youth outcome improvements; however, some studies also yielded mixed, inconclusive, or null results. Conclusions We would characterize the breadth and depth of research in this area to be insufficient in providing PRTF stakeholders a clear and firm understanding of “what works” for youth. Thus, one major implication of our review is the need for more research and efforts to incentivize the evaluation of ongoing practices in youth PRTFs. Still, this systematic review can serve as a convenient reference that can inform tentatively PRTF stakeholders’ decisions about the selection of interventions or practice behaviors

Every Kid Needs A Family: Giving Children in the Child Welfare System the Best Chance for Success

This KIDS COUNT policy report underscores a simple fact about childhood: Family matters. Yet, today in America, 57,000 children are still living in group placements. Readers will learn about limiting the role of residential treatment care to its intended purpose and how state and local leaders can work together to enhance family-oriented services and supports. The end goal? Brighter futures -- and loving families -- for some of our country's most vulnerable children

Children\u27s Behavioral Health Services in Baltimore: Walking the Continuum

This site visit explored the range of behavioral health services available for children in the city of Baltimore and in the state more broadly. Like many states, the policy community in Maryland has been working hard to meet the challenges of providing an effective continuum of care in the context of complex financing incentives and an overburdened educational and public health care system. Several promising practices have emerged, including the Wraparound practice model that offers individualized, comprehensive services and natural supports to achieve a positive set of outcomes for the child and family. The wraparound model incorporates both traditional services (counseling, therapeutic foster care) and nontraditional activities (community-based art or music lessons, Big Brother/Big Sister mentoring, recreation and sports) activities to create an environment that helps ensure the child’s safety while improving her ability to thrive in the community. The site visit program consisted of a mix of speaker panels convened at the headquarters hotel, the Admiral Fell Inn in Fells Point, and excursions to several sites in Baltimore that “walked” participants through the continuum of care from school-based behavioral health services to nonpublic special education services (the Kennedy-Krieger Institute) to inpatient and residential psychiatric services (Sheppard Pratt Health System)

Mental Health in Mississippi: Analysis and Recommendations

Thousands of Mississippians struggle with some type of mental illness, and their experiences illustrate that mental health is more than just a medical issue. Mental health has a profound impact on Mississippi’s economy and overall standard of living; it is deeply connected to education, unemployment rates, crime, drug use, and public assistance. Given the far-­‐reaching impact of mental health, it is important that all stakeholders (e.g., mental health professionals, state legislators, local policymakers, educators, attorneys), have access to detailed information about the current state of Mississippi’s mental health system as well as an in-­‐depth analysis of the system’s most pressing issues