Behavioral Health Needs of Child Welfare and Other High Risk Children A presentation to The 2015 Colorado Children’s Caucus January 12, 2015 Claudia A. Zundel, MSW, Director, Child, Adolescent and Family Services

Today’s Agenda  Behavioral health needs, costs and agency involvement of child welfare and other system involved youth  State Response Children's Caucus21/12/2015

3 National Institute of Mental Health; Cocozza, et. al. (2010); Simms, Dubowitz, & Szilagyi (2000) 1/12/2015 Children's Caucus

−PTSD prevalence in foster care children  60% among sexually abused  42% among physically abused  18% among non-abused children −PTSD prevalence in juvenile justice children  11% of males  18% of females −PTSD prevalence in military conflict  14% among returning service members from Iraq and Afghanistan 4 BH Needs of System-Involved Children and Youth National Child Traumatic Stress Network, U.S. Dept. of Veteran’s Affairs 1/12/2015Children's Caucus

CCAR Scores at Admission by Child Welfare Status 1/12/2015Children's Caucus5

Psychotropic Medication Use By Foster Care Status Children's Caucus61/12/2015 DUR Report Skaggs School of Pharmacy AP: Antipsychotic, AD: Antidepressant, MS: Mood Stabilizer, Stim: Stimulant, AA: Antianxiety Medication

Funding Agency Number of Children Agency Expenditure Additional Medicaid Contribution Total Child Welfare 2,063$51,719,376$5,922,691$57,642,068 Medicaid – BHO, Inpatient and Residential Treatment 1,749$17,339,065N/A$17,339,065 DYC 577$12,960,211$1,495,839$14,456,050 Colorado Mental Health Institutes (Ft. Logan and Pueblo) 132$5,041,972N/A$5,041,972 Office of Behavioral Health (non-Medicaid) 31$656,148$147,845.69$803,993 Total 4,552$87,716,773$7,566,376$95,283,149 Children's Caucus71/12/2015 FY High Intensity Services 4,022 Unique Individuals, 488 had services paid by more than one agency

8 Clients in the Top 10% of BHO Medicaid Spending Accounted for 37.7% of the Total Spending Clients were organized into two groups comprised of the top 10% and the bottom 90% of utilization. The % of total spending and cost per client were calculated by group. 1/12/2015Children's Caucus

CW (n=1,881) MH (n=1,728) 92% of CW has MH DYC (n=873) 46% of CW has DYC SA (n=377) 20% of CW has SA CW High Utilizers System Overlap CW Only n=119, 6.3% CW/MH, n=883, 47% of CW has MH only CW/MH/DYC, n=854, 45% of CW has DYC & MH CW/SA, n=6, 0.3% of CW has SA only CW/DYC/SA, n=10, 0.5% of CW has DYC and SA CW/MH/SA, n=100, 5.3% of CW has MH and SA CW/DYC, n=18, 1.5% of CW has DYC only CW/DYC/MH/SA, n=266, 14% of CW has all 1/12/2015Children's Caucus9

Colorado’s Response Children's Caucus101/12/2015 Three Decision Items 1)Medical Director 2)Electronic Health Record 3)TRAILS Update Two System reforms 1)Title IV-E trauma work 2)System of Care–Care Management Entity

Psychotropic Medications Foundational WorkThree Decision Items Children's Caucus 11  Federal Meeting  Task Group  Report and Recommendations  Medical Director  Electronic Health Record  TRAILS Update 1/12/2015

Trauma Work Children's Caucus121/12/2015 Title IV-E Waiver screening, assessments and treatment Partnership with CDHS and HCPF

System of Care –Care Management System of CareCare Management Entity Children's Caucus 13  14 counties  Boulder, Eagle, El Paso, Garfield, Gunnison/Hinsdale, Jefferson, Lake, Montezuma/Dolores, Montrose, Pueblo, and Weld Counties, and the San Luis Valley + 2  Wraparound (evidence-based model of care coordination)  Family Advocacy  Ongoing Evaluation −Improvement in school attendance −Eliminate system involvement  Pilot in El Paso County  25 youth referred from child welfare and probation  Positive Results −High parent satisfaction −Youth improved in multiple mental health domains −Cost savings for Child Welfare and Medicaid 1/12/2015

Resources and Reports Children's Caucus141/12/2015 Psychotropic Medication Guidelines for Children and Adolescents in Colorado’s Child Welfare System 2013 HCPF/CDHS Youth with High Behavioral Health Needs in Colorado 2014 COACT Colorado Care Management Entity Pilot Site in El Paso County Evaluation Report 2014 COACT Colorado