AISP Network Site Research on Young Adult Outcomes of Individuals who Exited the Foster Care and/or Juvenile Justice System(s)

Multiple AISP Network sites have completed studies looking at the young adult outcomes of youth who exited either (1) the foster care system, (2) the  juvenile justice system, or (3) both the foster care and juvenile justice systems in order to understand their service use patterns and related costs across multiple agencies. These sites include:

Additional AISP Network Site Studies

The Services Homeless Single Adults Use and their Associated Costs: An Examination of Utilization Patterns and Expenditures in Los Angeles County over One Fiscal Year

This report presents estimates of the costs six Los Angeles County agencies incurred in providing services to roughly 150,000 single adults who experienced homelessness for varying periods of time during Fiscal Year (FY) 2014-15. The analysis informing the estimates was conducted at the direction of the Chief Executive Office’s (CEO’s) Ad Hoc Homeless Initiative, which is tasked with developing a coordinated set of recommended County strategies to combat hom­­­elessness. The information provided in what follows offers an overview of the fiscal significance of homelessness for the County as a whole, as well as from the point of view of the individual County agencies most intensively involved with the provision of services to homeless men and women. The analyses establish a basis in empirical data for the recommended strategies the Homeless Initiative delivered to the Board of Supervisors in January 2016.

Researchers integrated data from Los Angeles County’s Departments of Health Services (DHS), Mental Health (DMH), Public Health (DPH), Public Social Services (DPSS), the Sheriff, and Probation, and found that in FY 2014-2015 these six agencies spent an estimated combined total of $965 million in providing services, benefits, and care to the population of homeless single adults over the course of a 12-month period. The establishment of a coordinated policy and program environment that makes the most effective use of these resources is one of the fundamental objectives for the CEO’s ad hoc Homeless Initiative in delivering a set of County strategies to combat homelessness. The Chief Executive Office’s Research and Evaluation Services unit (CEO/RES) analyses show that 5% of single adults experiencing homelessness in the County – roughly 1 out of every 20 – consume 40 cents of every dollar spent on the full population. After evaluating the utilization patterns of the homelessness population, the researchers suggest that funds could be reinvested in alternatives that break the repetitive cycles of county service usage (emergency room visits, hospitalizations, arrests, etc.). Additionally, they recommend offering coordinated interventions as well as a link to subsided housing when homeless men and women have a mixture of interrelated issues, (physical health, mental health, substance abuse).

The University of South Florida’s Report on the Criminal Justice System and Mental Health ‘Heavy Users’

The Florida Mental Health Institute (FMHI) worked with Miami Judge Steve Leifman to analyze criminal justice and service utilization histories of 97 mentally ill “heavy users” of the Miami-Dade County criminal justice system.

FMHI used several statewide data sets to examine each individual’s service-use history over a five year period. These datasets included statewide Medicaid claims, arrests, civil commitments, and units of behavioral health services such as outpatient care and inpatient hospitalization. Researchers found that the vast majority of these individuals were diagnosed as schizophrenic, and over a five-year period, they accounted for 2,172 arrests (or 4.4 per individual year), 26,640 days in jail, and 710 civil commitments. On average, each person was arrested 22 times in five years, and spent 55 days in jail per year. Furthermore, through integrating data across these systems, researchers were able to demonstrate that, on average, each person spent 81 days annually—or nearly a quarter of each year—in a jail, hospital, or emergency room.

As a result, Miami-Dade created a service response that includes special care coordination, as well as evidence-based practices such as Illness Management Recovery (IMR). The evaluation of the intervention will be conducted over time, using linked administrative data.

Young Adult Outcomes of Foster Care, Justice, and Dually Involved Youth in New York City

The Center for Innovation through Data Intelligence (CIDI) in New York City’s Office of the Mayor, released a report on the young adult population in NYC who interact with the foster care and/or the justice system. The study examines the adult outcomes of three groups (adolescents who exited the foster care system, youth who were discharged from juvenile detention and/or jail, and youth discharged from foster care and at least one of the justice systems), and analyzes how much money was spent on health and human services for youth in each group in the six years after their exit.

The report found that dually-involved youth used more services and had higher rates of multi-system involvement than youth who only exited from one system. Furthermore, it notes that service costs for dually-involved youth were 40% higher than the other two study groups, though these groups also continue to incur costs after discharge.

The report also found that across all three groups 25 percent of the youth account for 80 percent of service use costs. Researchers were able to then look at risk factors related to high-cost service use for the dually-involved and foster care groups to determine the factors that predict who will become a high-cost user. They were unable to identify risk factors for the group that exited from justice due to lack of information.

Based on the results of this study, the de Blasio administration increased prevention services for this population. The city spent $231 million on prevention services in 2015, an increase of $15.2 million from 2014, with plans for additional funding increases.

Media Coverage: Capital Data: The city’s case for prevention programs targeting at-risk youth 

Becoming a Man (BAM) – Sports Edition, University of Chicago Crime Lab Research and Policy Brief, July 2012

Expanding Crisis Mental Health Care Using Telepsychiatry and Integrated Data Systems

Telepsychiatry is South Carolina’s solution to a shortage of mental health professionals in rural emergency departments. The state uses integrated administrative data to facilitate both patient treatment and program evaluation in order to connect more patients to skilled mental health practitioners who are better equipped to diagnose and treat psychiatric illness.

To evaluate the impact of the South Carolina Department of Mental Health telepsychiatry intervention, the state’s IDS was used to compare service use outcomes among the telepsychiatry recipients and a carefully chosen control group. The control group was determined using deidentified data from the South Carolina Office of Research and Statistics data warehouse, a statewide integrated data system that gathers and links data across both private and public sector client-level data. Evaluation results showed that telepsychiatry recipients were more likely to receive follow-up care, were less likely to be admitted to the inpatient setting as a result of their emergency department visit, had shorter length of stay if admitted to inpatient treatment, and had lower overall 30 day costs associated with their episode. The number of patients receiving care increased from 11% in hospitals without telepsychiatry to 22% in hospitals with telepsychiatry. Length of stay decreased from 1.35 days to 0.43 days in hospitals with telepsychiatry.

The study is an example of how integrated data can be utilized to create a matched control group, a thorough understanding of patients’ lives in order to provide better care, and follow up on service use outcomes. In this case, the IDS was able to demonstrate that telepsychiatry is a viable solution to the problem of psychiatric under staffing in rural areas of South Carolina.

Washington State Screening, Brief Intervention, and Referral Treatment Program

Case Western Reserve Uses Integrated Data to Improve NE Ohio’s Pre-K Programs