Psych home care is a quality alternative
Program for kids saves thousands
Children and adolescents suffer from the same serious psychiatric illnesses as adults. These young patients frequently require long-term care, including residential treatment, and the cost is high. However, a quality alternative to high-cost residential treatment exists. A recent study by Western New York Staff Builders in Buffalo found that psychiatric home care successfully stabilized young psychiatric patients in an average of 35 days at a total cost of about $700, compared with about $500 daily for an inpatient stay.
"Psychiatric home care is a bargain," says Verna Carson, PhD, RN, CSP, national director of behavioral health for Staff Builders, which is based in Lake Success, NY. "A home health nurse visit costs between $65 and $115 a visit and is an intense hour to two hours of one-to-one interaction between the nurse and patient," she explains. "Unfortunately, most psychiatric inpatient stays are more for containment than therapy. The patient gets very little personal one-to-one attention. The focus is simply on stabilizing the patient to ensure that the patient is no longer a threat to self or others."
In any given year, almost 4% of children and adolescents ages 9 through 17 are diagnosed with a severe psychiatric disorder. An estimated 7.5 million youths under 18 have psychiatric, behavioral, or developmental disorders. Yet only about 20% or 1.5 million of these youths receive the treatment they need, Carson says.
Even among those who receive treatment for their psychiatric disorders, the interventions offered often fall into the "too little, too late" category, she says. "These young people are often socially isolated, fail in school and in relationships, and come to the attention of the juvenile [justice] system. Their parents often feel hopeless. In addition, the stress of raising a troubled child often rips apart the fabric of family life. Psychiatric home care offers a viable treatment option that addresses the needs of both the patient and the family."
Staff Builders designed an outcomes study to demonstrate that psychiatric home care is an effective treatment model for youths with mental illness. Its RESTORE family behavioral health program provides a broad scope of interventions, including crisis stabilization, medication management, community linkages, family support and education, and long-term management for the seriously and persistently mentally ill.
RESTORE delivers care using a proprietary model called PIECESS. (See details of model, p. 9.) Its seven components provide a theoretical and philosophical framework for the program.
Previous Staff Builders’ studies of adult populations suggested that psychiatric home care decreased the need for inpatient hospitalization, decreased utilization of emergency services, and resulted in overall increase in treatment compliance. In a study of 54 children and adolescents who received mental health home care from Western New York Staff Builders between January 1995 and December 1996, researchers collected information on these outcomes: treatment compliance, rehospitalization rates, emergency department admissions, functional ability, lengths of stay, number of home care visits, and cost of care.
The information was taken from chart reviews; central intake; field nurse interviews; mental health providers such as psychiatrists, case managers, psychologists, and social workers; family members; and patients themselves.
The findings were encouraging, Carson says. Roughly 90% of patients referred to the program required nursing assistance with medication management. Nurses assessed compliance at each visit by observing medication consumption and questioning the patient, caregiver, or home health aide. Nurses rated compliance from 0% to 100% at each visit. The overall average medication compliance rate for this sample was 89%.
However, compliance to other treatment modalities also is essential to recovery from psychiatric illness, Carson notes. Nurses also assessed the patients’ attendance to physician, clinic, case manager, and counselor appointments. Patients had a 60% compliance rate to other treatment modalities.
Of the 54 patients in the sample, 43, or 80%, were on a behavioral plan. Plans required nurses to educate patients and their primary caregivers about implementing the plan in the home. In some cases, nurses also educated school staff about specific behavioral plans. These interventions maintained children in school and prevented suspen- sions or expulsions for inappropriate behaviors.
Other findings include:
• 65% of patients were stable at discharge and met goals designed in their treatment plan.
• 35% were discharged for a variety of reasons, including persistent noncompliance.
• 11% were rehospitalized for psychiatric reasons.
• 4% were arrested and removed from their homes.
• 17% used emergency services while in the RESTORE program.
"The cost savings with psychiatric home care are tremendous," Carson says. "Children were stabilized in an average of 35 to 36 days with between 10 and 11 nursing visits. The average costs of those visits ranged from $650 to $710. Compared to $500 for one day of inpatient care, the study clearly demonstrates both the clinical and cost-effectiveness of psychiatric home care for young patients."
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