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The Evidence Base for Effective Services in the Community

The Evidence Base for Effective Services in the Community. The example of Psychological Centers’ Intensive Home-Based Services (CCBS). What’s the problem? . 16-22% of US children have some mental health issue Psychiatric hospitalization accounts for 70% of mental health care costs

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The Evidence Base for Effective Services in the Community

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  1. The Evidence Base for Effective Services in the Community The example of Psychological Centers’ Intensive Home-Based Services (CCBS)

  2. What’s the problem? • 16-22% of US children have some mental health issue • Psychiatric hospitalization accounts for 70% of mental health care costs • 30-50% of hospitalized children/adolescents are re-hospitalized within one year

  3. What are the services? • PC CAITS/EOS II • Focused on family system/empowering caregivers • Targets factors that place youth at risk • PC EOS • Same focus, but with use of behavior assistants to provide daily “clinician extension” to empower and guide caregivers in working with the children

  4. What’s the difference?EOS vs. CAITS • BAs are in the homes when the families need help (which is often NOT 9-5) • BAs receive specific training • Parent behavior management • Functional behavior analysis • Facilitating parent self-regulation • Legal and ethical issues • Many, many others …

  5. What’s the difference?EOS vs. CAITS THE BEHAVIOR ASSISTANT

  6. What’s the difference?EOS vs. CAITS • In CAITS, PC uses the 18 available case management hours to allow BAs to do parent training • In EOS, BA hours are used flexibly throughout treatment—based on what is being targeted for a specific client in a specific week

  7. Where did we get the data? • This is an ongoing program evaluation project • Data is collected from charts when child is discharged • Outcome phone calls are placed at 3, 6, and 12 months post-discharge • We ask if the child has been hospitalized or placed out of the home

  8. Who are the children? • 2-20 years old (average age = 9) • 54% Anglo, 23% Latino/a, 9% African-American, 8% Bi/multi • 40% Providence, 20% Pawtucket/CF, 20% Warwick/Cranston, 10% North • 52% have 2 or more sibs in the home (25% have 3 or more)

  9. What is the severity? • HALF of all CCBS clients have been previously hospitalized • Half are diagnosed with a disruptive behavior disorder • 15% have an internalizing disorder • 25% have BOTH internalizing and externalizing disorder diagnoses • Combined: 3/4 externalizing, 2/5 internalizing

  10. Who are their caregivers? • 78% are mothers, many single • 60% self-report a mental health dx • 20% report MORE than one • Caregivers with diagnoses in more than one category tend to have kids with previous hospitalizations

  11. Who gets what service? • 56% receive CAITS only • 24% receive EOS only • 20% receive EOS and CAITS as a step-down • Average length of stay in any CCBS program is slightly less than 3 months

  12. Who gets what service? • Children referred to CAITS tend to be younger (average age = 8; average age of child referred to EOS = 10) • CAITS-referred children are less likely to have had a previous hospitalization … • BUT, 31% of CAITS referrals have at least one prior hospitalization (12% >1) • 71% of EOS referred children have a previous hospitalization (38% >1)

  13. So … what happens after?

  14. What about the kids who were hospitalized before?3 months post-discharge:

  15. 6 months post-discharge:

  16. 12 months post-discharge * This number should be interpreted with caution given initial difficulties contacting caregivers

  17. What about CAITS vs EOS?At 3 months:

  18. CAITS vs. EOS6 months post-discharge

  19. What predicts hospitalization (from published studies)? • Previous hospitalization and other out of home placements • Diagnosis—disruptive behavior • PARENTING • Parent-child relationship • Parent punishment style • Parent engagement

  20. Conclusions? • Based on results from PC CCBS services: Effective, parenting-focused services can significantly reduce risk of rehospitalization • HOWEVER, children who have been previously hospitalized should receive an appropriate level of care, such as services that include well-trained behavior assistants facilitating parenting effectiveness

  21. What next? • We keep collecting data • this is a moving target (e.g., funding cuts to BA services resulted in changes to services) • We want to know: • Are there significant differences in hospitalization rates for CAITS vs. EOS? • Does a parent engagement intervention decrease hospitalization post-discharge?

  22. ACKNOWLEDGEMENTS KATIE FISCHER Monica Beebe Jo-Ann Clinton Jaime Viti Imari Barboza Stephane Colato

  23. ACKNOWLEDGEMENTS THE ENTIRE CCBS STAFF: THANK YOU FOR YOUR INCREDIBLE WORK WITH THESE FAMILIES!!!

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