Partnerships Provide Effective Alternatives to Unnecessary Inpatient Care for Children and Youth

There is a high personal, psychosocial and economic toll for children and youth who experience mental, emotional and behavioral disorders. These challenges also impact their families and the communities in which they live, study, and grow up. Research suggests that in any given year, between 14 and 20 percent of all young people will develop one of these disorders, and about half of all diagnosable mental illnesses begin by age 14 (National Research Council and Institute of Medicine, 2009).

Optum believes that providing care for this population requires an integrated and comprehensive systems approach to prevention, timely and effective health and social services, and community-based resources to effectively support the needs of children and their families. So they have developed programs that help communities advance their systems of care for children and youth through effective partnerships among providers, community resources, and care coordination in order to assure evidence-based services and improved health outcomes.

In Salt Lake County, Utah, Optum has implemented the Family Access to Stabilization and Treatment (FAST) program. This collaboration between Optum and the Division of Youth Services in the county serve Medicaid-covered youth ages 6 to 17. These services are targeted for at-risk youth requiring hospitalization for behavioral health conditions, or post-hospital transition back to their homes and communities. In order to be enrolled in the FAST program, youth must be in the custody of their parents, and not in custody of the Division of Youth Services.

The primary outcome objectives for the FAST program are improved systems of care and the reduction in the number of children placed in acute inpatient psychiatric facilities where alternative community-based treatment is appropriate, as well as the reduction in recidivism to acute inpatient facilities for children. Therefore, the program promotes care for those they serve that is in the least restrictive and safest environment possible. In addition, because a child in a behavioral health crisis situation affects the entire family, the program connects family members with the full continuum of health, social, and community-based resources to address their needs as well as the immediate crisis situation. The FAST program’s recovery and resiliency model of care also empowers parents and families with tools and strategies to successfully maintain their children with mental illness in their homes, schools and communities.

Referrals to the FAST program can come from a range of sources, including crisis mobile outreach teams, emergency rooms, local police, and hospitals and other facilities. Crisis intervention services are available 24 hours per day, 7 days per week through the University of Utah Mobile Crisis Outreach Team (UNI MCOT). Following their initial assessment, this multidisciplinary clinical team will help the child and family develop a community-based care plan and coordinate the necessary services to implement the plan. If the involved youth is not in a life-threatening situation and can be managed in their home environment, a range of interventions are initiated through a provider (or providers) with a local short-term crisis program that provides in-home therapeutic support and guidance to ensure the safety for the entire family. The provider has a multidisciplinary clinical team of licensed professionals who offer in-home services such as individual therapy; family therapy; peer support; case management; behavior assessments and planning; parenting counseling; respite care; and medication management. Optum supports the coordination of care and services that bring together all of the needed resources to effectively help address the crisis situation with the goal of helping families manage the crisis within their own communities.

When care is required in a secure environment, Optum arranges for participants in the FAST program to receive short-term out-of-home care. This is provided by local Division of Youth Service facilities, which also conduct family crisis interventions aimed at stabilizing these situations. Their services may include: individual and family counseling; limited “time out” hours at youth services; overnight stay for age-appropriate youth; short-term residential care with family therapy; in-home services; Family Resource Facilitator services to help secure necessary supports and services; and family educational classes and group supports.

While children are enrolled in the FAST program, Optum arranges for all of their needed day treatment and school services. A key goal of the program is the successful transition of participating youth back into their family and community environment. Services that support this include home visits and therapy services for the whole family. Follow-up services include continued coordination of care, and individual and family therapy. Educational and in-home transition services are also provided along with substance use treatment as needed. The FAST program also employs a team of Family Resource Facilitators, who are family members that have received specialized coaching and training and have developed working partnerships with Community Mental Health Center staff to represent a family voice at the time services are being delivered.

The Salt Lake County FAST program has demonstrated notable outcomes. In 2015, Optum and the FAST program served 43 children. Among these, 16 of the original referrals were sent to the FAST program rather than going to inpatient care, only two children required follow-up hospitalization, and one required care in a residential facility. The remaining 40 children received follow-up care in their home and community environments. The average length of stay in the FAST program was 23.3 days, and only 10 children needed more than 30 days of service. Among the 14 cases to-date in 2016, 10 have been diversions from inpatient care, and no children have required inpatient services. All care has been provided in outpatient, day treatment, and in-home settings, with Family Resource Facilitators being active in half of the cases.

Optum’s FAST program demonstrates effective quality and cost-based outcomes, assuring evidence-based care for youth and their families, providing appropriate Inpatient diversions to the home and community, and reducing the expense of unnecessary inpatient hospital costs. It is another example of how partnering with payers, providers, communities, consumers, and other health stakeholders can improve local systems of care and clinical outcomes.

NOTE: Optum does not recommend or endorse any treatment or medications, specific or otherwise. The information provided is for educational purposes only and is not meant to provide medical advice or otherwise replace professional advice. Consult with your clinician, physician or mental health care provider for specific health care needs, treatment or medications. Certain treatments may not be included in your insurance benefits. Check your health plan regarding your coverage of services.

Reference: National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Committee on Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

Have a Comment?