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Bringing (Keeping) the Kids Home Update – February 2009

A collaboration of Department of Health and Social Services, Alaska Mental Health Trust Authority & partner boards, Denali Commission, Rasmuson Foundation, Alaska Native health providers & other service providers, parents, advocacy groups

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Exponential Growth In Use of Out-of State Residential Psychiatric Treatment Centers (RPTC)

TotalOut of StateIn State

Medicaid RPTC Recipients

83149

247

429

536

637

749

0

200

400

600

800

1000

1200

SFY98

SFY99

SFY00

SFY01

SFY02

SFY03

SFY04

State Fiscal Year

Und

uplic

ated

Cou

nt Total

Out ofState

In State

OOSLinearRegression

Data are from Behavioral Health, Policy and Planning based on Medicaid claims paid for unduplicated RPTC recipients. Recipients include all children served per fiscal year – including those admitted in a previous year but served during the current year.

Between 1998- 2004, out-of-state RPTC placements for children with severe emotional disturbances (SED) grew by nearly 800%

Results:

•Disconnection

•Transition Problems

•Weaker Outcomes

•Expense

•Erosion of In-State Services

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Who does this effort impact? • In SFY04, 749 Alaskan children received care in

out-of-state RPTC– Add 2 parents and 1 sibling = 2,996 Alaskans.

• The DBH prevalence estimate for children with SED is 7.2% (12,725 Alaskan children) – Add 2 parents and 1 sibling = 50,900 Alaskans.

Primary goals:• Reduce the number of children in out-of-state RPTC

• Keep future use of out-of-state RPTC at a minimum

• Build capacity to serve children with SED in Alaska

• Develop integrated, seamless, culturally competent, least restrictive services, close to home

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Progress: Decrease in RPTC Admissions (Youth who enter RPTC during each fiscal year)

Data are from Behavioral Health, Policy and Planning based on Medicaid claims paid for unduplicated RPTC admissions. Includes only those admitted during the current year.

Drop of 73% in out-of-state admissions between FY04 and FY08

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Progress: Recidivism

Overall Recidivism Rate for RPTC Care within 1 Yr. of Discharge

20.00%

11.00%

14.00%

8.75% 8.40%

0

0.05

0.1

0.15

0.2

0.25

SFY04 SFY 05 SFY 06 SFY 07 SFY 08

State Fiscal Year

Per

cen

t o

f Y

ou

th

Recidivism Rate:

Recidivism: Significant decrease since FY04 from 20% to 8.4%

Data are from Behavioral Health, Policy and Planning

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Progress: Medicaid Expenditures for Residential Psychiatric Treatment Centers (RPTC)

Shift In RPTC Expenditures

$20,896,822

$14,297,112

$40,008,891

$26,848,252

$0

$5,000,000

$10,000,000

$15,000,000

$20,000,000

$25,000,000

$30,000,000

$35,000,000

$40,000,000

$45,000,000

SFY

98

SFY

99

SFY

00

SFY

01

SFY

02

SFY

03

SFY

04

SFY

05

SFY

06

SFY

07

SFY

08

State Fiscal Year

Ex

pe

nd

itu

res

In-state

Out-of-state

Data for FY05-07 are from Behavioral Health based on paid claims for Medicaid data. Expenditure data for FY08 are from Finance Management Services and includes all claims incurred and paid in FY08 and claims incurred in FY08 and paid in the first quarter of FY09.

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BTKH Activities

1) Gatekeeping, Care Coordination & Individualized Funding

2) BTKH Capacity Enhancement Grants

3) Training and TA

4) Leverage Other Funding Sources

5) Rate Increases

88

Ahead in FY 2010: Support for On-going Efforts

*Includes Federal match not listed separately.

ITEM MHTAAR GF/MH

incrm Total

Enhance Home, School & Community-based Services

Outpatient Grants $250.0 $1,100 $1,350

Crisis Bed Stabilization $150 $0 $150

School-Based Tool Kit $100 $0 $100

School-Based Grants $200 $0 $200Tribal/Rural System Development $400 $400 $900*Individualized Services into Base

$0 $500 $500

Enhance Best Practices

Technical Assistance $100 $100 $275*Parent & Foster Parent Training $75 $0 $75

99

Ahead in FY2010: Expanding In-State Capacity

*Includes Federal match not listed separately.

ITEM MHTAARGF/MH incrm Total

Intervene Earlier to Prevent Problems

Early Childhood Grants $75 $100 $175Early Childhood Learning Network $100 $100 $250*

Assist in the Transition to Adulthood

Transitional Aged Youth $200 $200 $400

BTKH Capital Development (matches Denali Commission funding) $2,316 $2,316

Group Homes, Transitional-aged Youth & Crisis Stabilization

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Reports and detailed information on BTKH at: http://www.hss.state.ak.us/commissioner/btkh/

DHSS BTKH Coordinator: Brita Bishop, LCSW brita.bishop@alaska.govP.O. Box 110601 Phone: 907-465-4994Juneau, Alaska 99811-0601 Fax: 907-465-3068