Abstract
This study assessed whether administrative data from the public child welfare system could be used to develop risk-adjusted performance reports for residential mental health programs for adolescents. Regression methods were used with 3,759 residential treatment spells for 2,784 children and youth to determine which outcomes could be adequately risk adjusted for case mix. Expected outcomes were created for each residential program given its case mix; then, expected and achieved outcomes were compared. For most programs, achieved results did not differ significantly from expected results for individual outcomes. Overall, outcomes achieved were not impressive. Only one quarter of spells resulted in a youth being maintained in a single less restrictive setting in the year following discharge. Methodological implications of this study suggest further refinements are needed for child welfare administrative data in order to develop risk-adjusted report cards of program performance.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ash, A. S., Shwartz, M., & Pekoz, E. A. (2003). Comparing outcomes across providers. In L. Iezzoni (Ed.), Risk adjustment for measuring health care outcomes, 3rd edn. (pp. 297–333). Chicago: Health Administration Press.
Banks, S. M., Pandiani, J. A., Schacht, L., & Gauvin, L. (1999). A risk-adjusted measure of hospitalization rates for evaluating community mental health program performance. Administration and Policy in Mental Health, 26(4), 269–279.
Burns, B. J., & Friedman, R. M. (1990). Examining the research base for child mental health services and policy. The Journal of Mental Health Administration 17, 87–98.
Chamberlain, P., Price, J. M., Reid, J. B., et al. (2006). Who disrupts from placement in foster and kinship care? Child Abuse & Neglect, 30(4), 409–424.
Child Welfare League of America (2003). State child welfare agency survey. Washington: Author.
Child Welfare League of America (2004). Special tabulation of the adoption and foster care analysis reporting system. Washington: Author.
Code of Federal Regulation (2004). Title 45 code of federal regulation section 1355.40 foster care and adoption data collection (pp. 281–283). Washington: US. Government Printing Office.
Courtney, M. E., Needell, B., & Wulczyn, F. (2004). Unintended consequences of the push for accountability: The case of national child welfare performance standards. Children and Youth Services Review, 26, 1141–1154.
Drake, B., & Jonson-Reid, M. (2007). Social work research methods: From conceptualization to dissemination. Boston: Allyn and Bacon.
Greenberg, G. A., & Rosenheck, R. A. (2004). Consumer satisfaction with inpatient mental health treatment in the Department of Veteran Affairs. Administration and Policy in Mental Health, 31(6), 465–481.
Hendryx, M. S., Moore, R., Leeper, T., Reynolds, M., & Davis, S. (2001). An examination of methods for risk-adjustment of rehospitalization rates. Mental Health Services Research, 3(1), 15–24.
Hendryx, M. S., & Teague, G. B. (2001). Comparing alternative risk-adjustment models. The Journal of Behavioral Health Services & Research, 28(3), 247–256.
Herman R. C. (2003). Risk adjustment for mental health care. In L. Iezzoni (Ed.), Risk adjustment for measuring health care outcomes, 3rd edn. (pp. 349–361) Chicago: Health Administration Press.
Hermann, R. C., Leff, H. S., Palmer, R. H., et al. (2000). Quality measures for mental health care: Results from a national inventory. Medical Care Research and Review, 57(2), 136–154.
Hermann, R. C., & Provost, S. (2003). Interpreting measurement data for quality improvement: Standards, means, norms, and benchmarks. Psychiatric Services, 54(5), 655–657.
Hoagwood, K., Jensen, P. S., Petti, T., & Burns, B. J. (1996). A comprehensive conceptual model. Journal of the American Academy of Child and Adolescent Psychiatry, 35(8), 1055–1064.
Institute of Medicine (2006). Improving the quality of health care for mental and substance-use conditions. Washington: National Academies Press.
James, S., Landsverk, J., & Slymen, D. J. (2004). Placement movement in out-of-home care: Patterns and predictors. Children and Youth Services Review, 26(2), 185–206.
Knaus W. A., Zimmerman, J. E., et al. (1981). APACHE - acute physiology and chronic health evaluation: A physiologically based classification system. Critical Care Medicine, 9, 591–597.
Lyons, J. S., Libman-Mintzer, L. N., Kisiel, C. L., & Shallcross, H. (1998). Understanding the mental health needs of children and adolescents in residential treatment. Professional Psychology: Research and Practice 29, 582–587.
McMillen, J. C., Proctor, E. K., Megivern, D., Striley, C. W., Cabassa, L. J., Munson, M. R., & Dickey, B. (2005). Quality of care in the social services: Research agenda and methods. Social Work Research, 29(3), 181–191.
McMillen, J. C., Scott, L. D., Zima, B. T., Ollie, M. T., Munson, M. R., & Spitznagel, E. (2004). Use of mental health services among older youths in foster care. Psychiatric Services, 55(7), 811–817.
Phillips, S. D., Hargis, M. B., Kramer, T. L., Lensing, S. Y., Taylor, J. L., Burns, B. J., & Robbins, J. M. (2000). Toward a level playing field: Predictive factors for the outcomes of mental health treatment for adolescents. Journal of the American Academy of Adolescent Psychiatry, 39(12), 1485–1495.
Proctor, E. K. (2002). Quality of care and social work research (Editorial). Social Work Research, 26(4), 195–197.
Ringel, J. S., & Sturm, R. (2001). National estimates of mental health utilization and expenditures for children in 1998. Journal of Behavioral Health Services & Research, 28(3), 319–333.
Ryan, J. P., & Testa, M. F. (2005). Child maltreatment and juvenile delinquency: Investigating the role of placement and placement instability. Children and Youth Services Review, 27(3), 227–249.
Schacht, L., & Hines, H. (2003). Recent applications of risk adjustment for performance measures used by state inpatient psychiatric facilities. Harvard Review of Psychiatry, 11, 220–224.
Shirley, C. (2002). Group home program cost analysis. In Reexamination of the role of group care in a family based system of care: A status report to the legislature, Sacramento: California Department of Social Services.
Shwartz, M., & Ash, A. S. (2003). Evaluating risk adjustment models empirically. In L. Iezzoni (Ed.), Risk adjustment for measuring health care outcomes, 3rd edn. (pp. 231–273) Chicago: Health Administration Press.
Smith, B. D. (2003). After parental rights are terminated: Factors associated with exiting foster care. Children and Youth Services Review, 25(12), 965–985.
Tuma, J. (1989). Mental health services for children. American Psychologist, 44, 188–199.
Wells, K., & Guo, S. (1999). Reunification and reentry of foster children. Children and Youth Services Review, 21(4), 273–294.
Wulczyn, F., Kogan, J., & Harden, B. J. (2003). Placement stability and movement trajectories. Social Service Review, 77(2), 212–236.
Acknowledgement
This research was supported by grants from the National Institute of Mental Health (R245 50857, P30 MH068579).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
McMillen, J.C., Lee, B.R. & Jonson-Reid, M. Outcomes for Youth Residential Treatment Programs Using Administrative Data from the Child Welfare System: A Risk-Adjustment Application. Adm Policy Ment Health 35, 189–197 (2008). https://doi.org/10.1007/s10488-007-0155-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10488-007-0155-6