Celeste G. Simpkins

Using the CBCL to determine the clinical status of children in state custody

Abstract This manuscript reviews information on past use of the CBCL to describe the clinical status of children in state custody and the results of a recent study of a representative statewide sample. The sample included a random sample of children in state custody, including those in foster care, kinship care, group residential facilities, and state institutions. One third (34%) of the children in state custody were reported as having significant behavior problems. The narrow band scales reflecting greatest difficulties included Aggressive, Delinquent, and Withdrawn behavior. The youngest teenage group was significantly more likely to have Internalizing problems in the clinical level, and those living in family homes were more likely to have scores in the non-clinical range than those in foster homes or group placements. There were no effects of gender, race, adjudication status, or length of time in custody. Implications for policy makers, caseworkers, and researchers are discussed.

Comorbidity of Mental Health Problems and Chronic Health Conditions in Children

Both mental and physical health problems have significant, costly effects on children and on society, particularly through the health-care delivery system. Many years of research show more mental health problems among children with chronic health conditions, but the research is contradictory and inconclusive. This study is the first to examine the physical health status and problems of children with known mental health problems.The study compares Medicaid children with and without serious mental health problems (n = 965) using parent reports of global health status, physical functioning, and general health perceptions. Children with more serious mental health problems were significantly more likely to have chronic health conditions.The number of chronic health conditions was the most powerful variable in predicting childrens global health status, physical functioning, and general health perceptions. Childrens mental health status, however, was a significant predictor as well, and the inclusion of this variable in the analyses significantly improved the fit of the regression model. Implications for the health-care delivery system are discussed.

The unnoticed majority in psychiatric inpatient care

Introduction. Hospitalization for Mental and Other Disorders. Public Policy Issues Affecting Psychiatric Inpatient Treatment. The National Context. Methods. The Baseline and Overall Data from 1980. Predicting Hospital LengthofStay for Psychiatric Inpatients. Who is Treated in Psychiatric Scatter Beds in General Hospitals? Changes in Site and Development of QuasiUnits. Who Pays? and to Whom? Case Mix and Dual Diagnoses. The Psychiatric Inpatient Treatment of Children and Youth in General Hospitals. Psychiatric Inpatient Treatment of the Elderly. Psychiatric Inpatient Treatment of the Disabled. Effects of Hospital Exemption from the Prospective Payment System. Summary of Empirical Findings. Some Scientific and Research Issues. Some Public Policy Issues. Conclusions. Index.

The psychiatric inpatient treatment of children and youth in general hospitals

National attention has recently focused on the mental health needs and services of children and youth. The lack of outpatient services and their coordination has been noted, as well as the consequent press towards inpatient care. We describe the inpatient treatment of children and adolescents (ages 0-18) in short-term, non-Federal general hospitals in 1980. Nationally, 128,300 children were treated for mental disorders in general hospitals at an estimated cost of over

Changes in site of inpatient psychiatric care in general hospitals, 1980–1985

1.5 billion. Compared to adults, children were more likely to be treated in scatter beds (vs. specialty units); have a diagnosis of mental disorder (vs. alcohol/drug disorder); stay much longer; and pay with commercial insurance. Previous work focusing on psychiatric units of general hospitals identified less than 40% of the total episodes, a figure very similar to that for adults. The majority of psychiatric inpatient episodes for children and youth in the United States takes place in short-term general hospitals. Community psychologists need to be aware of national trends in inpatient care and be involved in the development and promulgation of alternative models of care.

Medicaid limits on support of institutional psychiatric care

Changes in inpatient treatment in short-term, non-federal, general hospitals from 1980 to 1985 are investigated. Using the Hospital Discharge Survey, the authors found total episodes in psychiatric units decreased, but became more homogeneous by concentrating on the treatment of schizophrenia and affective disorders. Specialty hospitals decreased treatment of mental disorders, but increased treatment of chemical dependency. A shift towards treatment in hospitals with no formal specialty units was observed. However, the increase was more than accounted for by hospitals with organized psychiatric services, although not a formal unit meeting AHA standards. The influence of external factors, such as Medicares Prospective Payment System, is discussed.

Some Public Policy Issues

This article summarizes a Report to Congress concerning Medicaid limits on assistance for patients in institutions for mental diseases (IMDs). There is little or no basis for changing this policy. Court judgments have found that the policys application has been reasonable and consistent with congressional intent. Also, the general trend in the alcohol, drug abuse, and mental health (ADM) service system has been in outpatient or partial care, not institutional care. Research supports the conclusion that alternatives to IMD treatment are the most cost-effective. Finally, eliminating the IMD policy would be expensive, and simply substitute federal for state funding.

Summary of Empirical Findings

This volume has been concerned with psychiatric inpatient care in general hospitals. To discus the public policy issues properly, we need to place our data in the context of all psychiatric inpatient care, and that in the context of all mental health care. However, one sees very little evidence of any national planning, organization, or funding of mental health care.

Who Pays? And to Whom?

This book is really a research monograph. We have taken as our task the detailed investigation of psychiatric inpatient care in general hospitals, most of which has never been systematically investigated before. That is, care in psychiatric units has been rather thoroughly explored and routinely updated by the National Institute of Mental Health (NIMH). But care in psychiatric units (PU) represents less than 40% of the psychiatric inpatient episodes in general hospitals. We have expanded that to include the totality and looked in detail at 2 years, 1980 and 1985, that bracket a rather turbulent public policy time.

The Baseline and Overall Data from 1980

In this chapter, we consider the distribution of payors of general hospital psychiatric care. For medical care in general hospitals, we know that 29% of all expenditures are paid by Medicare (Stevens, 1989). Medicaid is much less of a player in general hospitals, because the majority of its funds go to nursing-home care nationally.