Begin with the end in mind…

1. Begin with the end in mind… Accessing effective psychosocial treatment options Nadia Sexton, Ph.D. Casey Family Programs Senior Fellow to ACYF & CMS

6. Medicaid Expenditures for Children in Child Welfare • On average, states spend three times more for this population than for nondisabled children in Medicaid — approximately $4,336 for children in child welfare versus $1,315 for the general child population without disabilities. • R. Geen, A. Sommers, and M. Cohen. Medicaid Spending on Foster Children. The Urban Institute, Brief No. 2, August 2005. Available at: http://www.urban.org/UploadedPDF/311221_medicaid_spending.pdf. • In California, for example, Medicaid-eligible children in foster care accounted for 53 percent of all psychological visits, 47 percent of psychiatry visits, 43 percent of the public hospital inpatient hospitalizations, and 27 percent of all psychiatric inpatient hospitalizations among the program’s entire child population. • Excerpt from Testimony from John Landsverk, PhD, at Testimony to the Little Hoover Commission Children’s Mental Health in Child Welfare and Juvenile Justice, a Public Hearing on Children’s Mental Health Policy on October 26, 2000, in Sacramento, California. • A Pennsylvania study found that Medicaid mental health-related expenditures for children in foster care are nearly 12 times greater than costs for non-foster children. This study found that utilization rates, expenditures, and prevalence of psychiatric conditions for children in foster care were comparable to those of children with disabilities (i.e., children receiving Supplemental Security Income). • J. S. Harman, G. E. Childs, and K. J. Kelleher. “Mental Health Care Utilization and Expenditures by Children in Foster Care.” Archives of Pediatrics & • Adolescent Medicine, 2000,154:1114-1117. • From: Allen, Kamala (2008) Issue Brief: Medicaid Managed Care for Children in Child Welfare; Center for Health Care Strategies, Inc.

8. Screening and Assessment is an entitlement to youth in the public system.

9. Medicaid expenditures on psychotropic medications for children in the child welfare system. Raghavan et al (2012) http://www.ncbi.nlm.nih.gov/pubmed/22537361 RESULTS: Children surveyed in NSCAW had over thrice the odds of any psychotropic drug use than the comparison sample. Each maltreated child increased Medicaid expenditures by between $237 and $840 per year, relative to comparison children also receiving medications. On average, an African American child in NSCAW received $399 less expenditure than a white child…………..Children scoring in the clinical range of the Child Behavior Checklist received, on average, $853 increased expenditure on psychotropic drugs. CONCLUSION: Each child with child welfare involvement is likely to incur upwards of $1482 in psychotropic medication expenditures throughout his or her enrollment in Medicaid.

13. Interventions Addressing Child Exposure to Trauma: Child Maltreatment (Part 1) Have a look: Part 1 (in draft) focuses on the comparative effectiveness of interventions that address child exposure to familial trauma in the form of maltreatment, including post-traumatic stress disorder as an outcome of interest. Research protocol: www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=846&pageaction=displayproduct subscribe:!: http://effectivehealthcare.ahrq.gov/index.cfm/join-the-email-list1/

14. http://store.samhsa.gov/product/Interventions-for-Disruptive-Behavior-Disorders-Evidence-Based-Practices-EBP-KIT/SMA11-4634CD-DVDhttp://store.samhsa.gov/product/Interventions-for-Disruptive-Behavior-Disorders-Evidence-Based-Practices-EBP-KIT/SMA11-4634CD-DVD

15. There is a positive effect of either maintaining or improving children’s functional outcome in juvenile justice, school functioning, substance abuse, and involvement with child protective services.”

16. Building Capacity: TheEffective Providers for Child Victims of Violence Program

17. Goal: Increase mental health professionals’ capacity to provide effective treatments to children victimized by violence. • Objective: Develop a national training program to: • mobilize mental health professionals and allied professionals to embrace evidence-based trauma assessment tools and treatment models • increase the number of mental health professionals informed about and prepared to make decisions about adopting family-oriented, culturally sensitive, evidence-based treatments for children who are victims of violence

18. Core Elements for Effective Treatment • Adopt empirically-supported assessment tools • Be culturally competent • Adopt evidence-based treatment models • Involve families • Collaborate with other professionals and system of care

19. Curriculum • Basic overview of the best available science about: • Impact of exposure to violence and trauma on children • Six Trauma-Focused Assessment Tools • Five Trauma-Focused Evidence-Based Treatments • Role of Culture and Diversity in Victimization and Treatment • Family-Centered, Collaborative Treatment Approach • Clinician’s Self-Care www.apa.org/pi/prevent-violence/programs/child-victims.aspx www.Facebook.com/APAEPprogram

20. Places to go… The California Evidence-Based Clearinghouse for Child Welfare

21. Begin with the end in mind. Know your own landscape. Have your data ready: youth, services, $ Find, adopt, charm, and engage partners. Choose and step and make it.