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University of South Florida · College of Behavioral & Community Sciences · Mental Health Law & Policy


Key Personnel:
Svetlana Yampolskaya, Ph.D.
Paul E. Greenbaum, Ph.D.
Colleen Clark, Ph.D
Richard Briscoe, Ph.D.

Utilization of the Most Costly and Intense Mental Health Services Among Out-of-Home Care Children

Publication Date: 6/1/2009

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During the past four decades, health care expenditures in the United States have grown and have continued to grow substantially (Congressional Budget Office, 2008). A significant proportion of these expenditures is spent on mental health care including children's mental health services (Howell & Teich, 2008).

However, the costs for mental health services are not distributed evenly among all health care users and it has been recognized that a small proportion of users generally account for a disproportionate share of costs (Taube, Goldman, Burns, & Kessler, 1988). It has been documented that children in foster care have high mental health needs and they account for disproportionally large expenditures for mental health services compared to other Medicaid eligible youth (Allen, 2008). Therefore, it is critically important to assess costs of mental health services among foster children and to examine characteristics of children who account for the highest mental health service costs.

The purpose of this study was to describe the mental health costs for children served in out-of-home care and identify the characteristics of youth who are among the most costly users of mental health services (Rubin et al., 2004).

By identifying child characteristics such as demographic characteristics, maltreatment history, and mental health diagnoses associated with mental health service use and characteristics of children who are among the high-cost users, child welfare systems may be able to tailor mental health services and to more adequately address the needs of these youths.

An additional aim of our study was to examine child characteristics associated with inpatient mental health service use generally recognized as the most expensive category of mental health services, (Heflinger, Simpkins, & Foster, 2002). We specifically examined length of stay in an inpatient facility measured by the number of days, number of hospitalization episodes during one year, and during one year time to re-admission.