NORTHWEST REGION

CHILDREN’S SERVICES

WESTERN MO MENTAL HEALTH CENTERChild and Adolescent UnitDesigned for 10 beds, but staffed for fewer

Acute psychiatric inpatientFront Door – Emergency Room typically, frequently Central or Regional Office recommendation

WMMHC StatsApproximately 200 admissions in a yearMood Disorder, Not Otherwise Specified by

far the most frequent diagnosis (7x more frequently given than the next diagnosis which was Psychotic Disorder, NOS)

Approximately 45% referred by family/relatives

Approximately 25% referred by courts/law enforcement

10% were involuntary commitments

WMMHC Stats17% had dual diagnoses of MI/DD

Payor Sources38% Medicaid33% MC+ Managed Care17% “guest of the state”12% private insurance

WMMHC StatisticsAverage Length of Stay 11.5 days with a

range from 2-126 days (10% exceeded 30 days)

Of the 10%, the classic presentation was Dually diagnosed with MI/DDExtreme Behavioral Presentations (typically

aggression)Co-occurring medical conditionsMultiple admissions to inpatient services

Complicated Medical ConditionsOne youth had the following medical conditions on

Axis IIIHYPOTHYROIDISM UNSPEC OBESITY UNSPEC TEAR FILM INSUFFIC UNSPEC ALLERGIC RHINITIS UNSPEC ESOPHAGEAL REFLUX UNSPEC CONSTIPATION ACUTE DERMATITIS SOLAR RAD OBSTRUCTIVE HYDROCEPHALUS STEVENS-JOHNSON SYNDROME OTHER CONVULSIONS OTHER DRUG ALLERGY

NW Region Inpatient Bed Capacity for Children and Adolescents

Crittenton 41

Research Psychiatric 25Heartland –St. Joseph 0St. Luke’s Northland 6Two Rivers 20___________________________Total Beds 102Royal Oaks 33

Capacity DevelopmentBased on model developed by Robert

Friedman out of Southern Florida in 1987 – updated through discussions in 2003

Balanced system of care – excess or deficit in any area, impacts all other areas

Does not include services for prevention or early intervention

Public mental health services and funding, so would include schools, juvenile courts, child welfare and Medicaid

NW Region Capacity DevelopmentCategory Total

Slots*Specific Service Specific

Slots

Hospitalization/ Stabilization less than 6 months

43 Non-Medical Crisis Bed 4

Medical Crisis Bed 4

Residential 9

Inpatient 26

Hospital/Residential Treatment Centers greater than 6 months

43 Transitional/Independent Living

37

Residential 5

Inpatient greater than 6 months

1

Treatment Family Homes/Group Homes

340 Treatment Family Homes 255

Group Homes 86

NW Region Capacity DevelopmentCategory Total

SlotsSpecific Service Specific Slots

Home -Based 851 Respite 247

Family Assistance 238

In-home Therapy 247

Intensive CPR 119

Day Treatment 851 Full Program 153

Individual Therapy1 247

Group Therapy1 451

Outpatient 3404 Physician Services 2247

Access/Intake 511

Evaluation Services 34

Therapy Services 6131 Individual services added to existing program

NW Region Capacity DevelopmentCategory Service Slot Specific

ServiceSpecific Slot

Case Management with WrapAround2,3

5504 POS CM 1021

TCM Bachelors 613

TCM Masters 340

Maintenance CPR

545

Rehab CPR 885

WrapAround3 2100

Parent Support4 1260 Support and Educational Groups

Total Service Slots

8396

Total Youth 63002 Peer to Peer case management and parent partner models of cm would be included

in this category3 WrapAround was calculated based on access for 70% of the youth receiving CM or

home-based services4 Based on 20% of children served

Current UtilizationCurrent Service

Current Utilization or Slots

Capacity Development Slots Recommended

Acute Inpatient 102 26

Residential under 6 months

129/67* 9

Crisis Beds (TFH) 8

Inpatient over 6 months

1

Residential over 6 months

50* 5

Transitional/ Independent Living

* 37

Group Homes * 86

Current UtilizationCurrent Service Utilization/Slots Capacity

Development Slots Recommended

Treatment Family Homes

9 (27) 255

Respite 133 247

Family Assistance 238

In-home Therapy 247

Intensive CPR 230 119

Rehab CPR 226 885

Maintenance CPR 545

POS CM 2555 1021

Bachelor level TCM 1656 613

Master level TCM 1045 340

Current UtilizationCurrent Service Current

Utilization/SlotsCapacity

Development Slots

Recommended

WrapAround 188 2100

Day Treatment-Full Program 49 153

Individual Therapy Enhancement

247

Group Therapy Enhancement 81 451

Physician Services 3216 2247

Access/Intake 1458 511

Evaluation Services 377 34

Therapy Services 499 613

Current UtilizationTotal of 4921 youth served (unduplicated

within a service but may be duplicated across services)

Total billings not included inpatient and residential = $10,838,534

In a year, on average approximately 5 youth exceed 6 months in residential

Profiles 15 year old female – Truman/Kansas City Regional Office

Currently at Mid Mo since 2/09 (2nd transfer from WMMHC upon closing)

Children’s Division custody 10 hospitalizations at Western Mo MHC 2 KCRO placements 1 Private sector In-patient Acute Hospitalization Physical health issues prohibit SCL psychiatric placements Has been denied out of state placements

12 year old male – Swope/Kansas City Regional Office Currently at (DMH/CPS)Hawthorn Children’s Hospital in St.

Louis since 10/08 Children’s Division custody 2 hospitalizations at Western Mo MHC In-patient Unit No community placement prospects with SCL or KCRO

Profiles16 year old male – Comprehensive MHS

Parents custodyCrossed 3 Jackson Co Administrative AgentsPlaced in SCL psychiatric placement at the

State’s most elevated rate; no other statewide options

9 year old female - Tri-County MHSParents custodyIn SCL psychiatric placement for over 15

months in St. James, MO as there are no closer placements that will accept her

Profile15 year old male – Comprehensive MHS/Kansas City

Regional OfficeGrandparents custodyCurrently in JAG Unit - no other SCL/VPA Placement

options4 combined SCL/MRDD placements

14 year old male – ReDiscover MHSParents custodyCurrently in JAG Unit – no other SCL/VPA Placement

optionsHas been denied SCL psychiatric and Children’s Division

placements statewide

Profiles 14 year old female – Family Guidance Center/Albany

Regional Office Parents custody Currently in SCL/MRDD Interdivisional Agreement in St. Louis; only

placement that would accept her with very rigid conditions 3 hospitalizations at Western Mo MHC 1 hospitalization at Hawthorn Children’s Hospital in St. Louis 4 SCL placements

  12 year old female – Swope/Kansas City Regional Office

Children’s Division custody Currently in Children’s Division placement 4 hospitalizations at Western Mo MHC 1 SCL psychiatric placement 1 KCRO community placement