Research Objective
To estimate behavioral health expenditures one year pre, during, and one year post implementation of a High Fidelty Wraparound (Wrap) intervention targeting children diagnosed with a Serious Emotional Disturbance (SED).
Study Design
Pre-post intervention study measuring expenditures for behavioral health services (pharmacy claims not included) one year prior to a youth’s first enrollment into Wrap, which began after 2008 and ended by 2011, during the intervention, and one year after discharge from Wrap services. To ensure access to all behavioral health expenditures during the entire study period, behavioral health claims were summed from Medicaid and all state and block grant-funded behavioral health services provided from January 2007 through December 2012. Actual enrollment months were used to calculate the “during” program costs. If youth had more than one enrollment episode in Wrap services, the episodes were combined to calculate “during” program costs if less than 12 months transpired between episodes. Twelve months were used to calculate the monthly pre- and post-program costs. Total behavioral health expenditures are reported by period and per youth.
Population Studied
This study includes 244 youth between the ages of six and 18 who were diagnosed with an SED, met an institutional level of care, enrolled in Wrap services after 2008, and were discharged from Wrap by December 31, 2011.
Principal Findings
All but four of the 244 youth utilized behavioral health services sometime during the pre-period, while 50 youth did not receive behavioral health services in the post-period.*These youth averaged $65,196 per year in behavioral health expenditures during the year prior to their enrollment in Wrap services (a total of $15,646,978). Many of these youth spent substantial time in psychiatric residential treatment facilities (PRTFs). During their period of enrollment in Wrap services (average length of stay: 287 days), while they received additional services to transition them back into a home and community setting, their behavioral health costs averaged $34,243. During the post period, these same youth averaged $27,766 in behavioral health expenditures which was less than half of their expenditures during the pre-period – an annual savings of $37,450 per youth. These savings accrued from decreased stays in PRTFs for the majority of youth served.
Conclusions
This study adds to the growing research evidence on the cost-effectiveness of the High Fidelity Wrap model as a home and community-based alternative to residential institutional services for youth with SEDs. It suggests that even one year post discharge, youth behavioral health expenditures are less than half what they were during the year prior to receiving Wrap services.
Implications for Policy and Practice
The national evaluation of this Community-Based Alternative demonstration for Youth compared costs in home and community-based care with care in PRTFs and found savings during enrollment in the additional Home and Community-Based Services (HCBS). This study provides some evidence to extend the time period during which youth with SEDs continue to show reduced behavioral health expenditures (for up to a year) after they are discharged from these transitional services. This study may help to inform states considering the implementation of HCBS to serve children living with SEDs.
Acknowledgement
The authors would like to acknowledge the following individuals from the CHIRPA data team for their contributions to this analysis: Wendy Tiegreen, John Quesenberry, and Erika Stinson.
This document was developed under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However, these contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.
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