Expanding Access to Home-Based Behavioral Health Services for Children in Foster Care.
Expanding Access to Home-Based Behavioral Health Services for Children in Foster Care.
复制标题
扩大寄养儿童获得家庭行为健康服务的机会。
DOI：
10.1007/s10488-024-01357-3
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Seltzer,RebeccaR
中科院分区：
文献类型：
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作者：
Chorniy,Anna;Moffa,MichelleA;Seltzer,RebeccaR
到5岁时，罗西·d遭受了身体和性虐待的创伤，至少住过8个寄养家庭。在大多数孩子进入小学的6岁时，罗茜进入了为期3个月的精神病院，随后因表现出攻击性和自残行为而被连续安置在寄宿设施中。她的养父母寻求密集的、以家庭为基础的行为健康服务（HBHS），这样罗茜就可以安全地在家里生活，但他们的努力失败了。相反，罗西在医院和机构度过了她的成长岁月。2001年，罗茜·D.代表数千名患有严重情绪障碍的符合医疗补助资格的儿童，在一起针对马萨诸塞州的集体诉讼中成为首席原告。2006年，法院裁定马萨诸塞州违反了联邦医疗补助早期和定期筛查、诊断和治疗（EPSDT）条款，该条款要求儿童接受医学上必要的行为健康服务，包括家庭和社区服务。作为对法院判决的回应，马萨诸塞州实施了一项补救计划，增加了HBHS的使用机会，希望像Rosie这样的孩子有机会在家里长大（Ponsor, 2006）。今天，在具有里程碑意义的Rosie D.裁决近二十年后，越来越多的行为健康儿童需要在医疗上没有必要的情况下寄宿在医院（McEnany等人，2020）。不堪重负和支持不足的护理人员无法为他们的孩子获得所需的护理，他们在危机中前往急诊室（McEnany等人，2020年）。家庭福利院的儿童被不再有能力或不愿照顾他们的寄养父母或团体之家的工作人员遗弃在医院。一些亲生父母在用尽其他选择后，自愿将监护权交给儿童福利机构，以获得行为保健服务（Hill, 2017）。一旦进入医院，这些儿童可以在医院停留数周或数月，而不是医疗需要，因为儿童福利机构会寻找能够满足他们需求的出院场所（Seltzer等人，2022年）。与此同时，他们被剥夺了上学、社区活动和社交的权利。作为回应，许多州一级的集体诉讼已经代表FC的儿童提起，以防止不适当的住院限制并扩大HBHS的可及性（Oppenheim et al., 2012）。在参加医疗补助的儿童中，FC儿童的行为健康服务使用率和平均费用最高，限制更多的环境（即住院、住院治疗）所占的支出比例明显高于HBHS （Pires等人，2018）。对于这一群体，精神药物的过度处方也有充分的记录（Pires等人，2018）。扩大健康卫生服务的可及性有可能解决这些挑战。随机试验表明，以家庭和社区为基础的替代儿科住院精神科护理具有相似或更好的临床结果，通常具有更高的家庭满意度和更低的成本（Kwok等人，2016）。可用性
By age five, Rosie D. had suffered traumatizing physical and sexual abuse and lived in at least eight foster care (FC) placements. At six, when most children enter elementary school, Rosie entered a 3-month psychiatric hospitalization followed by back-to-back placements in residential facilities for exhibiting aggressive and self-injurious behaviors. Her foster parents sought intensive, home-based behavioral health services (HBHS) so Rosie could live safely at home, but their efforts to obtain such services failed. Instead, Rosie spent her formative years living in hospitals and institutions. In 2001, Rosie D. became the lead plaintiff in a class-action lawsuit against the state of Massachusetts on behalf of thousands of Medicaid-eligible children with serious emotional disturbance. In 2006, the court ruled Massachusetts in violation of federal Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provisions, which require that children receive medically necessary behavioral health services, including home-and community-based services. In response to this court decision, Massachusetts implemented a remediation plan increasing access to HBHS, with the hope that children like Rosie get a chance to grow up at home (Ponsor, 2006).Today, nearly two decades after the landmark Rosie D. ruling, there are a growing number of children with behavioral health needs boarding in hospitals when not medically necessary (McEnany et al., 2020). Overwhelmed and under-supported caregivers, unable to access needed care for their child, are presenting to emergency rooms in crisis (McEnany et al., 2020). Children in FC are being abandoned at hospitals by foster parents or group home staff no longer able or willing to care for them. Some biological parents, after exhausting other options, are voluntarily relinquishing custody to child welfare in order to access behavioral health care (Hill, 2017). Once in the hospital, these children can remain there for weeks or months beyond medical necessity as child welfare searches for discharge placements equipped to meet their needs (Seltzer et al., 2022). Meanwhile, they are deprived of schooling, community activities, and socialization. In response, numerous state-level class action lawsuits have been filed on behalf of children in FC to prevent inappropriately restrictive hospital stays and expand the accessibility of HBHS (Oppenheim et al., 2012). Among Medicaid-enrolled children, children in FC have the highest rates of use and mean expense for behavioral health services, with more restrictive settings (ie, inpatient, residential treatment) making up a significantly higher percentage of spending than HBHS (Pires et al., 2018). Overprescribing of psychotropic medications has also been welldocumented for this group (Pires et al., 2018). Expanding access to HBHS has the potential to address these challenges. Randomized trials show home-and communitybased alternatives to pediatric inpatient psychiatric care have similar or better clinical outcomes, often with higher family satisfaction and lower costs (Kwok et al., 2016). Availability