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    Document Summary
    - Report Published -

    Report Document No. 23
    PUBLICATION YEAR 2008
    View PDF Version*

    Document Title
    Residential Services for Children in the Comprehensive Services Act, Utilization, Length of Stay and Expenditures Statewide and by Locality

    Author
    Office of Comprehensive Services for At-Risk Youth and Families

    Enabling Authority
    Appropriation Act - Item 279 B.2.d. (Regular Session, 2007)

    Executive Summary
    The 2007 Appropriations Act (Item 279, B 2.d3) requires the Office of Comprehensive Services for At Risk Youth and Families (OCS) to provide this report to the Governor and Chairs of the money committees by December 15th each year. It reports utilization, length of stay, and expenditure data on children who received residential services and funding through the Comprehensive Services Act (CSA) state pool of funds. It provides data statewide and by locality for program year 2007, compared to 2006 and 2005. Residential care is defined as group homes, residential treatment facilities, and psychiatric hospitals.

    The statutory purpose of CSA is to create a collaborative system of services and funding for troubled youth and their families that is child-centered, family-focused and community-based. A fundamental purpose of CSA is to preserve and strengthen families through providing appropriate services for children and their families in the least restrictive setting.

    Yet, one out of every four CSA children were placed outside of their homes, schools and communities in residential care at some point during program year 2007 (PY07). This percentage of 23.3% of children placed in residential care is significantly higher than the national average of 18% and the reported best practices of less than 10% of children served in residential care. This percentage declined from 25% in both PY06 and PY05.

    There were 4,301 children placed in residential care who received services and funding through CSA at some point during PY07. There were 29 more children placed in residential care in FY07 than in PY06, representing less than a 1% increase (0.7%). This percentage declined from a 5.7% increase in PY06 when 231 more children were placed in residential care than in PY05. Demographic information is provided on the children served in PY07.

    In PY07, children spent 7 months on average in residential care, which increased by 6 days over PY06. This calculation is based on the total number of residential days children received during the year.

    State and local governments spent $145.3 million in CSA net expenditures on children in residential care during PY07, representing a 9.6% increase over the prior year. State government paid on average 64% of these costs; local governments paid on average 36% in required local match. The average cost per child in residential care increased 8.8% from $31,042 in PY06 to $33,774 in PY07.

    Residential care costs represented 42.4% of all CSA state pool net expenditures ($342.2 million). This percentage declined from 45% ($132.6 of $295 million) in PY06 and 46.9% ($128.1 of $273.2 million) in PY05.

    In addition to CSA funds, communities used Medicaid funds to pay for residential services to maximize other funding sources. Medicaid expenditures totaled $85.8 million from July 1, 2006 through June 30, 2007. These costs represent 50% federal; 32% state on average; and 18% local match on average.

    Thus, over $231 million in state, local and Medicaid funds were spent on residential care in PY07. This represents a 16% increase over PY06 when $199.1 million was spent. These costs do not include federal IV-E expenditures and other Medicaid services paid for CSA children during these placements.

    Children were placed in three different types of residential care:

    Residential treatment facilities include secure treatment facilities and campus programs.

    In PY07:
    2,971 children were served;
    they stayed on average 6.7 months (209 days);
    $102 million was spent in CSA funds; and
    the average CSA cost per child was $34,332.

    In PY07 compared to PY06:
    the number of children served decreased by 3.7% (113 fewer children);
    length of stay increased by 12 days (was 197 days);
    CSA expenditures increased by 9% in PY07; and
    the average CSA cost per child increased 13.1%.

    In PY06 compared to PY05:
    the number of children served increased by 2.9% (86 more children);
    length of stay decreased by 16 days (was 213 days);
    CSA expenditures increased by 1.7% in PY06; and
    the average CSA cost per child decreased 1%.

    Group homes.

    In PY07:
    1,800 children were served;
    they stayed on average 5.3 months (165 days);
    $41.6 million was spent in CSA funds; and
    the average CSA cost per child was $22,338.

    In PY07 compared to PY06:
    the number of children served increased by 3.5% (63 children);
    length of stay increased by 2 days (was 163);
    CSA expenditures increased by 10.3%; and
    the average CSA cost per child increased 6.7%.

    In PY06 compared to PY05:
    the number of children served increased by 6.7% (113 more children);
    length of stay decreased by 15 days (was 178);
    CSA expenditures increased by 9.4% in PY06; and
    the average CSA cost per child increased 2.4%.

    Psychiatric hospitals.

    In PY07:
    79 children were served;
    they stayed on average 3.1 months (97 days);
    $1.65 million was spent in CSA funds; and
    the average CSA cost per child was $20,872.

    In PY07 compared to PY06:
    the number of children served increased by 1.9% (1 child);
    length of stay increased by 19 days (was 78 days);
    CSA expenditures increased by 29%; and
    the average CSA cost per child increased 26.9%.

    In PY06 compared to PY05:
    the number of children served decreased by 20.4% (20 fewer children);
    length of stay decreased by 20 days (was 98 days);
    CSA expenditures decreased by 17.4% in PY06; and
    the average CSA cost per child increased 3.8%.

    The Joint Legislative Audit and Review Commission (JLARC) found in its 2006 study of residential services provided through CSA that some children are placed in more restrictive, intensive settings than necessary. They reported that mismatched services can result in increased: lengths of stay, number of placements, and mental or behavior problems. Mismatched services also resulted in unnecessary higher costs since residential services are four times more costly than community services (average annual cost of $48,129 vs $11,360 in 2005 which includes state, local and Medicaid funds). They concluded that managing residential expenditures would likely yield the largest fiscal impact in controlling CSA costs.

    The Child Welfare League of America (CWLA) reports that outcome studies on residential services have significant shortcomings. While many studies have been conducted, Casey reports that there is no evidence that residential care achieves better outcomes for children.

    Casey, CWLA, and other experts agree, however, that residential care is an integral and important part of an array of services. They concur that services should be individually designed based on a comprehensive assessment of the unique strengths and needs of each and their family.

    Residential care can be appropriate for children who need short term crisis stabilization or comprehensive assessments when they cannot effectively receive these through intensive in-home services. It can also be appropriate for children who require intensive treatment in restrictive settings when they cannot be served safely or effectively in family settings. The CWLA reported some characteristics of residential programs with long term positive outcomes which are listed in the report.

    The report concludes with highlights of the major initiatives launched by the State and many localities. These initiatives strive to improve outcomes for children and families. Many are also working to more appropriately serve children and their families through reducing the use of residential care for those children who can be served effectively in family, school and community settings.