MHDDAD G-5 with DFCS Regional DirectorsAugust 7, 2008

BEHAVIORAL HEALTH SERVICES TO DFCS CUSTODY FOSTER CARE YOUTH

1

What questions are we asking? Purpose is to provide DFCS Regional Directors

with snapshot of DFCS custody youth in their region involved with DMHDDAD’s community behavioral health services.

How many kids? How many authorized for MH/AD services? How many receiving (billed) MH/AD services? What is the intensity (amount) of service

provided? Who are the providers of behavioral health

services? What sort of behavioral health problems are

being treated?

2

Data from DFCS

DFCS Custody Youth in Foster Care as of 3/31/08

• 11,175 youth

3

MHDDAD Data MICP Service Authorizations active in FY08 for

consumers <=23 MRO claims for service date 7/1/07-6/30/08

matching these authorizations State encounters for service date 7/1/07-

6/30/08 matching these authorizations PRTF spreadsheets maintained by regional

offices (analyzed separately)

NOTE: All data current through June 2008 processing period. State Hospital data not yet included as part of the analysis 4

MH service language

MICP –the form for authorizing MH services

MICP authorizations—reflects the number and types of services authorized

MRO claims—services billed through the Medicaid Rehab. Option

State claims—MH services billed non-Medicaid

5

Note on MRO Claims and State Encounters•Providers have 180 days from date of

service to submit claim/encounter•DMHDDAD community service data for

FY08 will not be considered final until 2009.

6

Matching Procedures for DFCS RBWO and MHDDAD MICP files 3 matching variables

1. SSN (800+ DFCS youth had no SSN)2. First 3 letters of first name + first three letters

of last name + DOB (the “twins” problem)3. First 3 letters of last name + last 4 digits of

SSN

Match (deterministic) = match on one or more of the matching variables

7

DFCS Custody Youths in Foster Care

MICP – MRO Claims – State Encounters Analysis

8

4,696 (or 42%) of DFCS custody foster care youths had MICP authorizations

Analysis in March indicated that 3,936 RBWO youths had MICP authorizations

9

Estimated prevalence for mental disorders among Medicaid-eligible foster care youth = 57%

S. dosReis, et al. (July 2001) “Mental Health Services for Youths in Foster Care and Disabled Youths,” American Journal of Public Health

“MICP Penetration” by DFCS Region “Region” based upon county listed in

DFCS file Highest penetration rate

DFCS Region 8 (53%) (Columbus/Americus) Lowest penetration rate

DFCS Region 7 (28%) (Augusta) DFCS Region 12 (34%) (Savannah)

10

Current “Unknowns” about DFCS Custody Foster Care Youth without MICP authorizationsOf the 6,479 youth in foster care without a MICP authorization:

How many receive mental health services through the Medicaid psychology program?

How many did not require behavioral health services?

11

4,108 youths in foster care (87% of those authorized) with MRO claims or state encounters in FY08

Of the 4,108 consumers with community claims/encounters:

• 91% of consumers had only MRO claims (no state encounters)

• 3,871 (94%) had claims/encounters for core services

• 657 (16%) had claims/encounters for intensive family intervention (IFI)

12

Service Penetration by DFCS Region Consumers receiving core services varies

from 85% – 99% Of those receiving core services, most likely to

receive dx assessment, physician services, and individual counseling

IFI - Highest in metro Atlanta, where most IFI services exist DFCS Region 14 (DeKalb) – 39% of consumers

receive IFI Little to no utilization of other specialty

services13

Core Service Providers

DFCS regional breakout provided on separate sheets

14

Diagnostic Categories (Axis I Primary) of Foster Care Youth with MICP AuthorizationsConduct DisordersConduct Disorders 32.4%32.4%

Affective DisordersAffective Disorders 28.5%28.5%

Anxiety DisordersAnxiety Disorders 9.6%9.6%

Childhood DisordersChildhood Disorders 5.9%5.9%

All OthersAll Others 23.6%23.6%

15

Top Diagnoses (Axis I Primary) of Foster Care Youth with MICP AuthorizationsADHD, combined type (314.01)ADHD, combined type (314.01) 25.5%25.5%

Oppositional Defiant (313.81)Oppositional Defiant (313.81) 13.8%13.8%

PTSD (309.81)PTSD (309.81) 7.2%7.2%

Adj. Disorder w/Emotions & Conduct Adj. Disorder w/Emotions & Conduct (309.4)(309.4)

4.5%4.5%

Depressive Disorder NOS (311)Depressive Disorder NOS (311) 4.5%4.5%

16

CAFAS Types

Thought Problems 14%

Maladaptive Substance Use 7%

Self Harmful Potential 13%

Delinquent Behavior 21%

Behav Prob – Mild Mood 30%

Behav Prob 12%

Mod Mood/Mild Behav 3%

17

DFCS Custody Youths

PRTF Analysis

18

Notes on PRTF data

Utilization pulled from regional spreadsheets

DFCS custody and region based upon designation in spreadsheet, not matching

Missing admission dates – supplemented with APS initial auth date when available

Length of time treatment – based upon original admission date

19

PRTF: Average Daily Census

DFCS Custody Total

October 159 239

November 163 250

December 160 252

January 153 251

February 144 247

March 138 248

April 142 252

May 140 251

June 137 255

Total 149 24920

PRTF: Length of Time in Treatment, June 30, 2008

21

DFCS Custody

Total

N 141 261

Median 269 250

Mean 344 316

Min 4 1

Max 1,987 1,987