Much concern has been expressed about the high utilization rates of mental hospitals, both public and private, for children and adolescents in our nation. These restrictive settings may not meet the needs of many of the children so placed, perhaps causing harm in some cases, and are so expensive that they deplete what are already scarce fiscal resources. The extent of residential mental health treatment is much greater than previously realized once a broader system perspective that includes the primary medical sector is considered. Studies are needed on the factors associated with utilization and patterns of utilization in order to be able to more successfully shape systems of care in the future. Furthermore, models of utilization developed for adult mental health treatment need to be modified for and tested on child and adolescent populations. This program of research aims to begin filing such gaps in the data base regarding service systems issues. The proposed program of research responds to NIMH's call for services research to evaluate and improve the efficacy, organization, delivery, and accessibility of treatment and prevention services to children and adolescents with mental disorders. The continued high utilization of restrictive and expensive residential treatment settings (i.e., inpatient hospitals and residential treatment centers) contributes to the massive amount of resources consumed in those settings and jeopardizes efforts to implement a community-based system of care. A public-academic liaison model will be used to address critical research needs and to build research capacity. The goals will be realized by: 1. adapting a model of mental health treatment utilization to residential treatment for children and adolescents; and 2. applying the model to a child and adolescent population. A five-year program of research is proposed through the FIRST Award program to study utilization of inpatient hospitals and residential treatment centers for the mental health problems of children and adolescents for whom the State provides care. Mechanisms of State mental health care include: direct provision of inpatient care in State mental hospitals, supervision of children as custodian and responsibility for accessing and paying for care, and public payment for inpatient services through the Medicaid program. Data collected routinely by the State in these areas will be integrated, subjected to quality checks, and used in a two step model for determining the probability of admission to residential treatment and the level of utilization. Length of a stay and recidivism will also be examined. Information on associated charges for mental health treatment in these settings will be included as a secondary focus.
