The IV-E Waivers and Family First Prevention Services Act prioritize prevention services, including services that reduce out-of-home placements. Placement in out-of-home care is associated with a variety of adverse outcomes as well as high costs to society. Studies that focus on utilization of health services suggest that these costs are not evenly distributed among recipients, and that high utilizers make up a small percentage of individuals who utilize a disproportionate share of resources. The purpose of the paper is to examine child characteristics and child welfare services associated with high welfare costs, defined as the top decile of child welfare costs. Results indicate that older age of child, child sexual abuse and/or neglect, and inability of parent to provide care are associated with high child welfare costs. Parental substance abuse or domestic violence in the household are less common among children with high costs. High cost children are more likely to have serious behavioral problems perhaps reflecting the severity of these problems. Residential treatment and group home placements and services were also associated with having high costs.

This article compares and contrasts the services needed by families in child welfare systems with the services that families receive. A mixed-methods approach was used to triangulate data from a variety of sources, including administrative databases, case file reviews, and focus groups with child welfare caseworkers and clients. Through this analysis, four overarching themes are explored: (a) perceptions of system-involved families’ needs, (b) engagement of families in service planning, (c) availability and accessibility of services, and (d) the quality and appropriateness of services provided to families. Findings suggest that considerable gaps and barriers exist that prevent system-involved families from receiving the services they need. The manuscript concludes with research and practice recommendations about meeting the service needs of families in child welfare systems.

This study examined whether the disposition of juvenile justice encounters among youth with severe emotional disturbance was associated with the likelihood of recidivism. Court dispositions, such as probation and diversion, as well as Medicaid-funded out-of-home mental health treatment, were compared. Data sources included the Florida Department of Juvenile Justice and Medicaid claims data. Youth receiving probation had the highest recidivism rates. Among youth in out-of-home treatment, those receiving treatment in foster care services had the lowest recidivism rates. Youth placed into a diversion program were less likely to be re-arrested for a felony, whereas youth receiving inpatient psychiatric services were less likely to be re-arrested for a misdemeanor. Mental health treatment may reduce the likelihood of youth continuing on increasing criminal trajectories.

BACKGROUND:High rates of mental health disorders and exposure to trauma among the juvenile justice population highlight the importance of understanding whether and how mental health services can help prevent further justice system involvement as well as provide treatment.AIMS:We had two principal questions: Is out-of-home mental health treatment after arrest associated with reduced recidivism among young people who have been exposed to trauma? Are particular types of out-of-home treatment associated with better outcomes? We hypothesised that type of residential setting would affect outcomes among those with histories of serious trauma.METHODS:Primary data sources included Florida Juvenile Justice, Child Welfare and Medicaid data from July 2002 through June 2008. We identified all Florida Juvenile Justice cases with a record of 'severe emotional disturbance'. Two groups were identified - one for whom an arrest was followed within 90 days by out-of-home placement for mental health treatment and the other for whom there was some other out-of-home placement. Generalised estimating equations (GEE) were used to calculate associations with likelihood of re-arrest during a 12 month at risk period.RESULTS:Young people who had experienced severe trauma and were sent to out-of-home treatment settings after conviction for a criminal offence had lower recidivism rates when receiving treatment in foster care than other out-of-home placements, while those with less severe or no trauma histories had lower recidivism rates with any out-of-home placement.CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:We believe that this is the first study to have considered how trauma histories may mediate outcomes for young people in out-of-home placements after arrest or conviction for a criminal offence. Findings suggest that case managers and clinicians should consider the trauma histories when making decisions about the appropriate treatment setting in these circumstances. Copyright © 2017 John Wiley & Sons, Ltd.

OBJECTIVE:This article examined individual characteristics associated with having higher costs in a 5-year period to identify patients that may potentially benefit from case management.METHODS:Florida Medicaid claims data from 2005 to 2010 were used to examine the characteristics, diagnoses, and services (in 2005) associated with individual costs in 5 future years (2006-2010). The data were divided into estimation and prediction samples with regression models estimated using diagnoses and service use in 2005 to predict future costs. Predictive power was assessed by applying the model results to the prediction sample and comparing predicted costs to actual costs.RESULTS:Demographics, service use, and diagnosis in 2005 were associated with costs in the following 5 years. Models were predictive of future costs with a significant relationship between the predicted costs and actual costs.CONCLUSION:Diagnosis-based models in conjunction with prior costs can predict future costs. Individuals predicted to have higher costs may be candidates for case management to potentially avoid reduce costs.

Norm-based grading has been associated with a reduction in student incentives to learn. Thus, it is important to understand faculty incentives for using norm-based grading. This paper used two waves of the National Study of Postsecondary Faculty to examine faculty characteristics related to the use of norm-based grading. Results suggest that norm-based grading is more likely when faculty and departments are more research oriented. Faculty who are at lower rank, male, younger, in science and social science departments are more likely to use norm-based grading, while faculty who feel that teaching should be the primary promotion criterion use criteria-based grading.

Although there is a vast amount of literature on differences in the perceived experiences of general health care among different racial/ethnic groups, few studies have examined the relationship between race/ethnicity and perceptions of mental health care. The purpose of this study was to determine whether non-Hispanic African Americans and Hispanics had more negative (or less positive) perceptions of the mental health treatment they receive compared to non-Hispanic Whites. Data were from the 1998-2006 Florida Health Services Surveys. The findings indicated that African Americans and Hispanics were less likely than Whites to have favorable perceptions of the mental health care services they received, even after adjusting for demographic and health status variables. Interventions should be designed to address disparities in mental health treatment and the perceptions of such treatment. (PsycINFO Database Record

The purpose of this paper was to compare employment outcomes for individuals who majored in economics and business administration. Economics majors were more likely to work in a job unrelated to the degree field than business administration majors. Economics majors earned higher wages, and mismatch had a smaller effect on wages for economics majors than business majors. Mismatch also had a smaller effect on aspects of job satisfaction for economics graduates compared to business graduates. (c) 2015 Elsevier Ltd. All rights reserved.

Objective : The Affordable Care Act requires care coordination for individuals with behavioral health problems due to frequent physical health problems.  The potential for cost savings is often used to motivate the use of care coordination.  This paper examined Medicaid physical and behavioral health expenditures over a six year period for individuals with a behavioral health diagnosis to explore whether current and future costs are sufficient to justify care coordination. Objective: The Affordable Care Act requires care coordination for individuals with behavioral health problems due to frequent physical health problems. The potential for cost savings is often used to motivate the use of care coordination.  This paper examined Medicaid physical and behavioral health expenditures over a six year period for individuals with a behavioral health diagnosis to explore whether current and future costs are sufficient to justify care coordination. Methods: The analysis used Florida Medicaid enrollment and claims data. Transitions between expenditure quintiles were examined for people with a behavioral health diagnosis, as was the likelihood of exiting the Medicaid program. We also examined the distribution of expenditures related to physical and mental health problems and how this changed over time. Results: Individuals with a behavioral health diagnosis were in higher expenditure groups in 2005, were more likely to move to higher expenditure groups, and were less likely to exit the Medicaid program between 2005 and 2010 than people without a behavioral health diagnosis. Individuals with behavioral health problems had higher expenditures for physical health care than behavioral health care. Conclusions: Medicaid expenditures are high for people with a behavioral health diagnosis and have a higher likelihood of increasing over time. Given high current and future costs, modest reductions in costs may be sufficient to justify the use of care coordination programs for people with physical and behavioral health diagnoses.

This paper examined individual characteristics associated with being a high-cost case in multiple years for Medicaid-covered health care services. In addition, the accuracy of models that predict future persistent high-cost cases was examined. Florida Medicaid claims from 2005 to 2010 were used to examine characteristics, diagnoses, and services associated with individual costs being in the top 1% of recipients. Regression models were estimated with diagnoses and service use in a base year used to predict future high-cost cases. Several different perspectives were used that focus on predicting current year high-cost cases based on prior persistence, predicting future persistence of high costs, and a combination of using past persistence to predict future persistence. Average annual costs for persistent high-cost cases were more than $140,000. Overall, models were predictive of future high-cost cases. The receipt of intermediate case facility (mental retardation) services was the strongest predictor of future high-cost cases. Inpatient, outpatient, pharmacy, and nursing home services, along with diagnoses, all provided important information for predicting high-cost cases. Diagnosis-based models in conjunction with prior costs can predict future high-cost cases with a high degree of accuracy. However, given that many high-cost cases reside in intermediate care facilities, it is not clear that such individuals would benefit from intensive case management. Service use patterns in prior years, diagnoses, and prior costs should all be used to identify individuals who may benefit from intensive case management.

Although there is a vast amount of literature on differences in perceptions of general health care among different racial/ethnic groups, few studies have examined the relationship between race/ethnicity and perceptions of mental health care. The purpose of this study was to determine whether blacks and Hispanics had more negative (or less positive) perceptions of the mental health treatment they receive compared to whites. Data were from the 1998-2006 Florida Health Services Surveys. The findings indicated that blacks and Hispanics were less likely than whites to have favorable perceptions of the mental health care services they received, even after adjusting for demographic and health status variables. Interventions should be designed to address disparities in mental health treatment and the perceptions of such treatment.

BACKGROUND To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS). METHODS A total of 53 children (ages 3-7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up. TRIAL REGISTRATION ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563. RESULTS There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT. CONCLUSIONS Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers.

In 2007 the Joint Commission National Patient Safety Goals included a requirement addressing risks associated with patient suicidality. The rational for this requirement was that suicide has been the most frequently reported sentinel event since the inception of the Sentinel Event Policy in 1996. The Patient Safety Goals on suicide required hospitals implement actions to assess suicide risk, meet client's immediate safety needs and provide information such as a crisis hotline to individuals and family members for crisis situations. This study performed a secondary data analysis to assess the effect of the 2007 Joint Commission Patient Safety Goals on suicide attempts among patients following treatment at hospital emergency rooms among individuals enrolled in the Florida Medicaid program. A difference-in-difference approach compared changes in rates of suicide attempts for individuals with a primary mental health diagnosis and individuals with a physical health diagnosis after emergency room treatment. In the 6 months following treatment, suicide rates declined after implementation of the goals among patients treated for a primary mental health diagnosis, and increased among patients with a poisoning diagnosis, compared to individuals with a physical health diagnosis. The goals were associated with a reduction in suicide attempts after emergency room treatment.

The relationship of antiretroviral therapy (ART) adherence to total healthcare expenditures for Medicaid-insured people living with HIV or AIDS (PLWHA) is not well understood, especially among asymptomatic HIV-positive patients.

The high rates of both mental health disorders and exposure to trauma among the juvenile justice population highlights the importance of understanding whether and under what conditions mental health services can prevent further justice system involvement among youth with previous juvenile justice encounters. The relationship between mental health treatment and juvenile justice recidivism is examined for youth distinguishing between those who have experienced trauma and those who have not. This article examines whether mental health treatment reduces the likelihood of juvenile justice recidivism among youth with several risk factors associated with adverse outcomes.

Objective: This paper examined individual characteristics associated with having higher costs in a five year period. Methods: Florida Medicaid claims data from 2005-2010 were used to examine the characteristics, diagnoses and services (in 2005) associated with individual costs in five future years (2006-2010). The data were divided into estimation and prediction samples with regression models estimated using diagnoses and service use in 2005 to predict future costs. Predictive power was assessed by applying the model results to the prediction sample, and comparing predicted costs to actual costs. Results: Demographics, service use and diagnosis in 2005 were associated with costs in the following five years. Models were predictive of future costs with a significant relationship between the predicted costs and actual costs. Conclusion: Diagnosis-based models in conjunction with prior costs can predict future costs. Individuals predicted to have higher costs may be candidates for case management to potentially avoid reduce costs.

In this study we examine two assumptions that underlie the hypothesis that the outcomes of children with emotional disturbances are negatively affected by the loss of access to mental health services during their transitions to adulthood. The first is that children access mental health services during the pre-transition years, and the second is that these services are effective in reducing poor outcomes. We tested these assumptions using children who lost Medicaid enrollment between their 18th and 20th birthdays in Florida’s Medicaid program using arrests as the outcome. All children with an emotional disturbance received at least one outpatient service. However, while the mean days of service per month were 3, more than half the children received less than one day of service. Fifty-six percent of children received some psychotherapeutic medication treatment. Children with ADHD had the highest number of days of medication per month in both univariate and multivariate analysis. In multivariate analysis, children with disruptive behavior disorders had significantly more days per month of outpatient services than children with any other diagnoses except anxiety disorders. Medication days but not outpatient service days were negatively associated with arrests. Post hoc analysis suggested that children with ADHD who had high medication days had significantly fewer arrests than children with disruptive behavior disorders. This was not the case for children with ADHD and low medication days. Children with ADHD and high medication use may be most at risk of increases in arrests after Medicaid disenrollment as many will lose access to a service that was associated with fewer arrests. Findings suggest the need for reform of the children’s mental health system.

Youth treated in a residential treatment center (RTC) receive an array of services to address their mental health and behavioral issues, including psychotherapy and medication. Prior studies have shown that youth continue to receive a considerable number of services after discharge from a RTC. This study describes the characteristics of children and youth served in Florida's Medicaid-funded residential treatment facilities, examines whether family involvement in treatment is associated with discharge to a family-like setting, and assesses continuity of treatment after discharge. Data for this study were obtained from the SIPP Provider Monthly Report Database from January 2005 through December 2011. These data contain information on family involvement during treatment. Post-discharge data were from Medicaid enrollment/claims files and Prepaid Mental Health Plan encounters. Results of this study suggest that family contacts for interventions and treatment planning are associated with a greater likelihood of discharge to a family-like setting. Among youth discharged to a family-like setting, family involvement during treatment was associated with receiving follow-up outpatient care. Results support the continued emphasis on including family members in the treatment of youth with mental health needs to ensure better outcomes and continuity of treatment.

This pilot study explored the preliminary efficacy, parent acceptability and economic cost of delivering Step One within Stepped Care Trauma-Focused Cognitive Behavioral Therapy (SC-TF-CBT). Nine young children ages 3-6 years and their parents participated in SC-TF-CBT. Eighty-three percent (5/6) of the children who completed Step One treatment and 55.6 % (5/9) of the intent-to-treat sample responded to Step One. One case relapsed at post-assessment. Treatment gains were maintained at 3-month follow-up. Generally, parents found Step One to be acceptable and were satisfied with treatment. At 3-month follow-up, the cost per unit improvement for posttraumatic stress symptoms and severity ranged from $27.65 to $131.33 for the responders and from $36.12 to $208.11 for the intent-to-treat sample. Further research on stepped care for young children is warranted to examine if this approach is more efficient, accessible and cost-effective than traditional therapy.

This article examined the continuity of atypical antipsychotic medications among children and adolescents following discharge from a residential mental health treatment facility in the state of Florida from 2005 through 2011. Discharge data are reported by the residential providers, while post-discharge data are from Medicaid enrollment and claims files. Fifty-five percent of youth were receiving antipsychotic medications when discharged from residential treatment. Of those receiving such medications, 55% continued with their medication after discharge. Antipsychotics were more likely at discharge among youth who were older, had longer treatment episodes, showed greater improvements during treatment, and had prior involuntary examinations and out-of-home treatment episodes. Continuation of antipsychotic medication was more common among youth who had greater family involvement in treatment, longer treatment episodes, improved more during treatment, and had prior involuntary examinations. Continuation was less likely for youth with prior out-of-home treatment episodes. These results contribute to the existing literature by examining the continuity of atypical antipsychotic medication among children and adolescents following residential treatment.