Abstract
Objective
Limited alternatives exist to residential treatment or hospitalization for children with the most serious emotional disturbances. Community-based interventions are intended to offer less restrictive and expensive options than traditional treatment. One such program is New York State’s Home and Community-Based Services (HCBS) Waiver Program.
Methods
From 1996 to 2002, 169 children were enrolled in the Manhattan HCBS. All spent at least one month on the wait list prior to admission to the waiver program. We used our wait list as a control group (WLC), allowing for comparison of the HCBS intervention.
Results
Sample consisted of 169 children between the ages of five and eighteen. The ethnic composition was 46.8% Hispanic (N = 79), 47.9% African-American (N = 81), and 5.3% Caucasian (N = 9). Average stay was 12 months in the HCBS program and 3.5 months for the WLC. Only 30% of children in the WLC were maintained in the community, while 81% of children in the HCBS were similarly maintained (P < 0.001). Also, the rate of hospitalization for the HCBS group was significantly lower (3 versus 41%; P < 0.001). There was also a trend for the WLC group to have had substantially higher rates of removal by the Administration for Children’s Services (New York City’s protective service agency) (8.3 versus 1.8%) and to more frequently require residential treatment (13.0 versus 8.9%).
Conclusions
It would seem that the HCBS program appears to be a clinically and cost-effective method of maintaining children in their community.
Similar content being viewed by others
References
Collins BG, Collins TM: Child and adolescent mental health: Building a system of care. Journal of Counseling and Development 72:239–243, 1994
Hernandez M, Hodges S: Building upon the theory of change for systems of care. Journal of Emotional and Behavioral Disorders 11:19–26, 2003
Hocutt AM, Mckinney JD, Montague M: The impact of managed care on efforts to prevent development of serious emotional disturbance in young children. Journal of Disability Policy Studies 13:51–60, 2002
Farmer EMZ, Dorsey S, Mustillo SA: Intensive home and community interventions. Child and Adolescent Psychiatric Clinics of North America 13:857–884, 2004
Semansky RM, C Koyangi: Accessing Medicaid’s child mental health services: The experience of parents in two states. Psychiatric Services 54:475–476, 2003
Marsh DT, Fristad MA: Handbook of serious emotional disturbance in children and adolescents. New York, Wiley, 2002
Liu F, Minami H, Silva RR: Dexmethylphenidate hydrochloride in the treatment of attention deficit hyperactivity disorder. Neuropsychiatric Disease and Treatment 2(4):467–473, 2006.
Leblanc AJ, Tonner MC, Harrington C: Medicaid 1915(c) home and community-based services waivers across the states. Health Care Financing Review 22:159–174, 2000
Pandiani JA: After children’s services: A longitudinal study of significant life events. Journal of Emotional and Behavioral Disorders 9:131–139, 2001
Stroul BA, Friedman RM: A system of care for children and youth with severe emotional disturbances. Washington, DC, National Technical Assistance Center for Children’s Mental Health, Georgetown University Child Development Center, 1994
Osher DM: Creating comprehensive and collaborative systems. Journal of Child and Family Studies 11:91–99, 2002
Hoagwood K, Burns BJ, Kiser L, et al.: Evidence-based practice in child and adolescent mental health services. Psychiatric Services 52:1179–1189, 2001
Shaffer D, Gould MS, Brasic J, et al.: Children’s Global Assessment Scale (CGAS). Archives of General Psychiatry 40:1228–1231, 1983
Black MM, Krishnakumar A: Children in low-income, urban settings: Interventions to promote mental health and well-being. American Psychologist 53:635–646, 1998
Kazdin AE, Weisz JR: Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology 66:19–36, 1998
Trupin EW, Forsyth-Stephens A, Low BP: Service needs of severely disturbed children. American Journal of Public Health 81:975–980, 1991
Vitulano LA, Nagler S, Adnpoz J, et al.: Preventing out-of-home placement for high-risk children. Yale Journal of Biologic Medicine 63:285–291, 1990
Miller CL, Druss BG, Dombrowski EA, Rosenheck RA:Barriers to primary medical care among patients at a community mental health center. Psychiatric Services 54:1158–1160, 2003
Clark C, Mcgaughey K: A study of children’s residential services. Richmond: Virginia, Department of Planning and Budget, 1989
Landrum TJ, Singh NN: Characteristics of children and adolescents with serious emotional disturbance in systems of care. Part II: Community-based services. Journal of Emotional and Behavioral Disorders 3:141–150, 1995
Farmer JE, Clark MJ, Marien WE: Building systems of care for children with chronic health conditions. Rehabilitation Psychology 48:242–249, 2003
Garland AF, Hough RL, Mccabe KA, et al.: Prevalence of psychiatric disorders in youth across five sectors of care. Journal of the American Academy of Child and Adolescent Psychiatry 40:409–418, 2001
Henggeler SW, Schoenwald SK, Pickrel SG: Multisystemic therapy: Bridging the gap between University and Community-based treatment. Journal of Consulting and Clinical Psychology 63:709–717, 1995
Lambert W, Salzer MS, L Bickman Clinical outcome, consumer satisfaction, and ad hoc ratings of improvement in children’s mental health. Journal of Consulting and Clinical Psychology 66:270–279, 1998
Magrab PR, Young T, Waddel A: A community workbook for developing collaborative services for seriously emotionally disturbed children. Washington, DC, National Technical Assistance Center for Children’s Mental Health, Georgetown University Child Development Center, 1985
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented in part at the 50th annual meeting of the American Academy of Child and Adolescent Psychiatry, Miami, FL Oct. 14-19, 2003.
Rights and permissions
About this article
Cite this article
Solhkhah, R., Passman, C.L., Lavezzi, G. et al. Effectiveness of a children’s home and community-based services waiver program. Psychiatr Q 78, 211–218 (2007). https://doi.org/10.1007/s11126-007-9042-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11126-007-9042-2