Youths Admitted to Parsons Residential Care (1990-2005)

1. Youths Admitted to Parsons Residential Care (1990-2005) Lynn Warner, PhD School of Social Welfare University at Albany

2. Study Hypothesis • Clinical severity of youths admitted to residential care has increased over time

3. Data Collection Form Development • Preliminary case file review • Other relevant data collection instruments • (e.g., the Client/Patient Sample Survey used to estimate national prevalence of inpatient, outpatient and residential care mental health services) • Research on risk factors for out-of-home placement and correlates of severity of psychiatric illness in youths

4. Case Record Review a Does not include cases for youths still in residence

5. To estimate changes over time • Combined data from 1990 and 1995 , 2000 and 2005 • Chi-square tests with Fisher’s Exact specifications (categorical variables) • Independent t-tests (continuous variables)

6. Cautions • Relatively low retrieval rate • Absence of information in file is difficult to interpret (esp. substance use history, prior use of outpatient mental health care) • Most challenging data to collect related to experiences while at Parsons (home visits, AWOLs) Handwritten entries of staff, details and legibility varied • Analyses are not multivariate

7. YOUTH CHARACTERISTICS SIMILARITIES OVER TIME

8. Demographics • Mean age at admission 13.3 years • Primarily White 73.7 % • Female 52.6 %

9. Diagnoses & Other Problems • Axis I diagnosis(typically in combination) • Mood 35% • Conduct 25% • Anxiety 18% • ADHD 18% • Axis II diagnosis51.3% • Multiple symptoms(“sub-threshold” disorders) • Suicidal ideation, attempt • Impulsivity • Sexualized behavior • Sleep problems • Thought disturbance

10. Other Problems • Medical problems 60% • Asthma 22.4% • Fetal alcohol, other drug effects 18.4% • Obesity 15.8%

11. ADVERSE CHILDHOOD EXPERIENCES • 47.4% of youth with parent(s) with drug abuse or psychiatric problems • More than half exposed to domestic violence • 72.4% experienced sexual or physical abuse, or neglect …almost always occurred before age 6 years

12. DISRUPTED LIVES • Half were not in the custody of a parent or other family member • Approximately four placements prior to Parsons • 61.8% hospitalized for psychiatric illness • 34.2% admitted to Parsons directly from the hospital • Multiple service system involvement • 60.5% Child welfare • 53.9% Special education • 36.8% Juvenile justice -- 32.9% PINS, other juv. justice status at admission

13. YOUTH CHARACTERISTICS DIFFERENCES OVER TIME

14. Clinical Profile –Multiple Axis I Diagnoses 2000, 2005 1990, 1995

15. “System Differences” Custody Status at Admission

16. “System Differences”Ever Lived in Foster Care

17. “System Differences” • Older age at first out-of-home placement • 9.3 versus 6.7 years • More psychiatric hospitalizations prior to Parsons • 1.7 versus 1 hospitalization • Shorter LOS at Parsons • 11.8 vs. 15.8 months

18. Treatment Differences -Medications and Side Effects # of medications 1.2 (then) vs. 2.1 (now) 61% Percentage Reporting Side Effects 19% 2000, 2005 1990, 1995

19. Conclusions • Clinical profiles and psychosocial histories MORE rather than less similar across time • The characteristics that do differ suggest changes in the service system landscape may be contributing to the challenges of providing care at least as much, if not more, than characteristics of the youths themselves