Children and adolescents with emotional, behavioral, and mental health needs often are "stuck" in inpatient facilities or long-term out-of-home placements due to a number of factors, such as lack of appropriate treatment options in their communities and ineffective discharge planning.
Through CHCS' Best Clinical and Administrative Practices workgroup Improving Managed Care Quality for Adolescents with Serious Behavioral Health Disorders, ValueOptions New Jersey, the administrative services organization for the NJ Division of Child Behavioral Health Services (DCBHS), set a goal to identify and reduce the number of children remaining in out-of-home treatment settings who are ready to be discharged. By returning children who no longer require out-of-home care to their families or communities after shorter lengths of stay, DCBHS can better ensure that children are in the appropriate levels of care, and spaces are available for those who need more intensive services.
"New Jersey has about 2,000 children in out-of-home treatment facilities," said Angelo McClain, PhD, Executive Director, ValueOptions. "There is a cultural mindset among some providers that certain children need to be in a program until they complete high school. However, best practice indicates that these children need to be treated for their specific issues and returned home as soon as possible. Through projects like this we are beginning to see a bit of a cultural change."
For its pilot BCAP project, ValueOptions NJ is seeking to reduce the percentage of potentially-discharge-ready children in out-of-home treatment settings by 30 percent in a 12-month period.
The plan defined two criteria to identify discharge-ready children: a length-of-stay (LOS) much longer than the average LOS for their out-of-home provider type (e.g., group home, residential treatment center, etc.) and having low needs according to their most recent Child and Adolescent Strengths and Needs Assessment. The children are grouped according to their assigned case management agency, which includes 15 care management organizations and 21 youth case management agencies.
These agencies receive quarterly potentially-discharge-ready reports from ValueOptions NJ listing assigned children who meet the identification criteria for designation as "low-needs." In turn, the case and care management agencies are trained on follow-up expectations, protocols, and reporting requirements. Case and care management agencies are required to report back to ValueOptions NJ and DCBHS the results of their efforts to address barriers to discharge and develop discharge solutions. This includes action plans for each youth, and agency performance improvement plans, as needed.
Through this process, ValueOptions NJ identified 44 low-needs children in April 2005, and by June 2005, 66 percent of these children had moved back home or to community-based care. In addition, the plan identified 78 additional children by June 2005 and 72 more by September 2005.
Overall, 85 percent of the children identified through the project returned to their communities, with many of them going back to their home. "Our clinicians report that many providers are now telling case management entities that their programs are more focused on getting children ready for transition back to the community within six months," said Mr. McClain. "A year ago, we were not hearing this."
"We attribute the success of this project to several factors," said Mr. McClain. "We have a statistical method to identify the children by examining the assessment scores and the length of stay. Also, this project created a synergy between case management entities and providers focused on moving kids out of residential placements. DCBHS requirements for feedback reports sent a clear message that people were going to be held accountable. The project involved multiple parts of the system working together, which resulted in more comprehensive discharge planning. And having the influence of BCAP gave us the opportunity to get people's attention."
Under DCBHS' direction, ValueOptions NJ set a goal to identify a second wave of children at the rate of 300 per quarter - an increase from an average of 75 per quarter currently. DCBHS is working to establish out-of-home setting benchmarks for length-of-stay.
"We didn't think this project would have an impact on the overall discharge rate, but it has," said Mr. McClain. "Through this effort we identified the discharge opportunities that were the most challenging for agencies. We've found that the project has had an impact on a second wave of kids. The clear message is that out-of-home treatment needs to be preparing children to return to their communities."