County Funds Research Articles

FACTORS DETRIMENTAL TO MANAGEMENT OF DEVOLVED FUNDS IN KENYA. A CASE OF NAIROBI COUNTY

Decentralization is meant to improve public services, but relatively few studies examine this question empirically. Poverty, inequality and social exclusion are deeply-rooted structural and historical phenomena in Kenya. Successive Kenyan governments have attempted fiscal decentralization as a way of ensuring the country achieves equitable development across the many regions. Fiscal decentralization consists primarily of devolving revenue sources and expenditure functions to lower tiers of government. By bringing the government closer to the people, fiscal decentralization is expected to boost public sector efficiency, as well as accountability and transparency in service delivery and policy-making. Decentralization also entails greater complexity in intergovernmental fiscal relations. Coordination failures in fiscal relations are likely to have a bearing on the fiscal positions, nationally and sub nationally. The purpose of this project was to find the factors that are detrimental to the management of the devolved funds in two levels of government. Increased local financing after fiscal decentralization has opposite two effects, that is, (1) the local finance derives incentive for effective management, and (2) it may induce the lack of public resource for managing public expenditure, which is particularly needed in the basics of managing the lower levels of government. This project analyzed the detrimental factors that affect management of fiscal funds by a county government. The objectives used by this study were; To establish the effects of corruption in the management of devolved funds in Nairobi City County, to determine the effect of accountability in the management of devolved funds in Nairobi City County, to determine the effect of financial regulations in the management of devolved funds in Nairobi City County and to establish the effects of adoption of IFMIS in the management of county funds in Nairobi City County. The study adopted a descriptive research design. From the findings, Accountability, Adoption of IFMIS, and Financial Regulations were found to have positive and significant effect on Financial Management while the effect of corruption was found to have a negative relationship with financial management. From the findings and conclusions therefore, this study recommended that Nairobi County Government consider Accountability, Adoption of IFMIS, and Financial Regulations as the key factors that could determine the management of devolved funds.

Defining "county": A mixed-methods inquiry of county emergency medicine residency programs.

There is no clear unified definition of "county programs" in emergency medicine (EM). Key residency directories are varied in designation, despite it being one of the most important match factors for applicants. The Council of Residency Directors EM County Program Community of Practice consists of residency program leadership from a unified collective of programs that identify as "county." This paper's framework was spurred from numerous group discussions to better understand unifying themes that define county programs. This institutional review board-exempt work provides qualitative descriptive results via a mixed-methods inquiry utilizing survey data and quantitative data from programs that self-designate as county. Most respondents work, identify, and trained at a county program. The majority defined county programs by commitment to care for the underserved, funding from the city or state, low-resourced, and urban setting. Major qualitative themes included mission, clinical environment, research, training, and applicant recommendations. Comparing the attributes of programs by self-described type of training environment, county programs are typically larger, older, in central metro areas, and more likely to be 4years in duration and have higher patient volumes when compared to community or university programs. When comparing hospital-level attributes of primary training sites county programs are more likely to be owned and operated by local governments or governmental hospital districts and authorities and see more disproportionate-share hospital patients. To be considered a county program we recommend some or most of the following attributes be present: a shared mission to medically underserved and vulnerable patients, an urban location with city or county funding, an ED with high patient volumes, supportive of resident autonomy, and research expertise focusing on underserved populations.

Black Women, Indigent Medical Care, and Academic Medical Politics, 1950–1965: The Case of Birmingham, Alabama

Black Women, Indigent Medical Care, and Academic Medical Politics, 1950–1965:The Case of Birmingham, Alabama Charlotte G. Borst (bio) A "Negro child" had been born "'like an animal'" on the front lawn of the city's University Hospital, the Birmingham News reported on December 14, 1958, in a front-page story that seemed a modern reenactment of the biblical Christmas story. The paper explained that the mother, who was not named, but whom I shall refer to as Mary, had been turned away from the academic medical center's hospital because it had imposed "rigid charity regulations" that provided few maternity beds for poor Black mothers. Indeed, these regulations were so strictly enforced that the hospital's staff was even barred from offering Mary aid as she labored and delivered her baby on the lawn.1 Although Alabama and the city of Birmingham historically had supported what historian Sam Bass Warner Jr. has identified as "the [End Page 467] American tradition of privatism," where the quest for private gain prevented the establishment and support of public amenities, the very public display of such a failure of the welfare system, and the obvious nature of Mary's humiliation and degradation at the feet of an academic medical center, elicited significant coverage in the state's newspapers.2 Most people would not have been surprised—in 1951, a Black woman named Emma Dangerfield had died in the waiting room of Birmingham's Jefferson Hospital (part of the University Hospital complex) after being denied entrance.3 As the provider of 95 percent of the area's total indigent medical care in the 1950s, University Hospital was locked in a fierce debate with both local and state officials over the lack of sufficient public funds for the support of the sick poor. Long before becoming part of the university's medical school, this county-owned facility had served white poor and paying patients, as well as Black indigent-care patients, who were housed in segregated wards. Black middle-class patients who could pay mostly received their care in other private but segregated hospitals in Birmingham. Indigent care for all patients was reimbursed through [End Page 468] county funding. But when the county sold the hospital to the University of Alabama in 1945 (in exchange for county indigent-care subsidies), the hospital's mission changed from serving members of the community to providing medical education as well as charity care.4 The reasons Mary was left on the lawn to labor reflected three intertwining changes in the South—not just in Birmingham or Alabama—in the post–World War II era. One was the role that medical schools and their associated hospitals played in the South's postwar strategies for economic development. The rise of and resistance to the expanding civil rights movement and its link to the racialized and gendered history of southern welfare policy were two other key fundamentals. These elements help explain Mary's story, and she provides a human face for the larger argument in this article: that it is only when we braid multiple historiographies together—the economic development fostered by hospitals and medical centers that followed a particular trajectory unique to the South's economic history; the very particular gendered racialization of welfare that was tied to the history of segregation; and the complicated and evolving history of massive white resistance—that we can understand why modern medical facilities in the postwar South succeeded in economic ways for some people but failed to bring health-care equity to women like Mary and her children.5 Even in the twenty-first century throughout the South, Black neonatal mortality is twice that of white infants.6 This story is particularly evident in Birmingham. At the end of World War II, challenged by the economic, social, and political upheaval of the war years, local political, business, and social [End Page 469] leaders tried to set a new agenda for the South. They understood that their region lagged behind much of the rest of the country economically, and their political rhetoric echoed a determination to catch up and establish the South as a favorable place for new industry.7 Attracting industry...

Improving Outcomes of Mothers With Opioid Use Disorder Using a Community Collaborative Model.

Context:Increasing rates of Opioid Use Disorder among pregnant women are a significant public health issue. Care for these women is fragmented, and multiple barriers to care have been identified. Program: The Tides, Inc. is attempting to address these needs by providing comprehensive, coordinated care, beginning in pregnancy and extending beyond the birth of their infant.Implementation:Using a collaborative model, care is coordinated between multiple existing agencies in an effort to reduce barriers and improve access to care. Funding for these services is provided through county funding and existing payor sources (eg, insurance, Medicaid).Evaluation:Participant and program outcomes were evaluated at the end of each year of the program. In addition, participants who had completed the program at the end of year 1 were asked to complete a survey providing qualitative information about their experience in the program. Of these participants, 73% reported no opiate use and 100% had full custody of their infants.Discussion:The Tides, Inc. program utilizes existing resources to provide coordinated and comprehensive care for pregnant women with Opioid Use Disorder. In addition to improving outcomes for women and their infants, this program can reduce cost and burden on community entities such as the justice system and foster care networks. This program can serve as a model for other communities to coordinate care for women and their infants.

Mental Health Services in the United States Public High Schools.

Mental health services in the United States public schools are an important component of the academic success of a student. Not all schools, however, have the necessary personnel and funding to offer such services. In this paper, we provide an analysis of data collected from schools in 3 geographic locations. Comparisons were made of the availability of personnel to assess and treat mental health disorders in students enrolled in city, urban, and suburban schools, with over 10,000 schools represented. The data were part of the 2015 to 2016 School Survey on Crime and Safety. Accessibility of mental health practitioners and reasons that limited efforts of a school to provide the services were assessed. Statistically significant differences were identified by school location, demonstrating that those in rural communities were most challenged providing diagnostic assessment and treatment for students by school mental health professionals, for several reasons. Increased state and county funding to support mental health practitioners in public high schools is one suggestion to address mental health disorders in students. Other strategies are offered for timely and appropriate diagnoses and treatment for mental health disorders that may impact the quality of life of a student for a lifetime.

Preliminary Assessment of a Novel Continuum-of-Care Model for Young People With Autism Spectrum Disorders.

Because of limited intermediate-care services, patients with autism spectrum disorders (ASDs) are increasingly being treated in emergency departments (EDs) and psychiatric hospitals. To address this growing problem, the authors developed a mobile outreach program, called Access to Psychiatry through Intermediate Care (APIC), for young (≤26 years) patients with ASD at risk for involvement with emergency medical services or the legal system. In its initial year, the average program duration per patient was 264.5 days. Clinical and Family Distress Scale scores indicated significant improvements for participating patients and caretakers. In the first year, among 40 patients with sufficient data for comparison, 13 (33%) went to the ED, and lengths of stay decreased up to 77% from pre- to postintervention. Given a cost per APIC-enrolled patient of $1,700, the net saving for the cost of ED treatment was $2,260-$2,559 per patient. The feasibility and cost-effectiveness of the APIC model has attracted additional state and county funding.

The Problem of Cooperatives and Housing Cooperatives Policy Towards the Millennium in Turkey

Kooperatifçilik dünya ve Türkiye açısından son derece önemli bir olgudur. Kooperatifler aynı amaçla güçlerini birleştiren bireylerin, belediye, köy, il özel idaresi gibi kamu kuruluşlarının, dernekler, sendikalar gibi özel hukuk tüzel kişilerinin de üye olduğu, kâr amacı gütmeyen, özüne yardım, karşılıklı yardımlaşma ve dayanışmaya dayalı örgütler olup bir sermaye ortaklığı değildir. Dolayısıyla kooperatif örgütlerle sermaye ve kâr birbirlerinin tersi amaçlara sahiptirler. Konut kooperatifçiliği ise kooperatif sektörünün tek başına lokomotifi gibidir. Bu yönüyle hem ülke ekonomisine katkıları hem genel kooperatifçilik sektörü içindeki yeri hem de konut hakkı gibi bir insani hakkı eldeki tüm olanaklarla karşılamaya çalışan araçlar olması yine toplumsal dayanışmayı artırması bakımlarından son derece önemli ve gerekli olduğu ortadadır. Bu çalışmada ikibinli yılların başındaki kooperatifçilik alanından seçilen bir kamu politikası analizinin bulgularına yer verilmektedir. Kooperatifçilik hareketi belirgin olarak ilk kez, Avrupa’da, 19.yüzyılın ortalarından itibaren görülmeye başlamıştır. Bu anlamda Türkiye’deki kooperatifçiliğin ortaya çıkışı da aynı döneme rastlamakta, 1863 yılında, “Memleket Sandığı” adı altında bu yönde ilk örgütlenme gerçekleştirilmiş bulunmaktadır. İlk örgütlenme nitelik itibariyle tarım alanında olsa da benzer yapıların kısa bir süre konut alanında gerçekleştirildiği de görülmektedir. Türkiye’de konut kooperatiflerinin kuruluş ve işleyişi 1969 tarihli 1163 sayılı Kooperatifler Kanunu ile düzenlenmiştir. Kamu politikası anlamında böylesi bir geçmişi olan kooperatifçiliğin ve özelde de konut kooperatifçiliğinin bu çalışmada incelenmesinin gerekçesi özellikle ikibinli yıllardaki hızlı gelişmelerin varlığı ve etkisinin çokluğudur.

North Carolina seeking more mental health professionals

After securing nearly $5.6 million in county funding, Charlotte‐Mecklenburg Schools (CMS) hired 25 new social workers for the 2019–20 academic year — and the district is looking to hire 30 additional mental health professionals, including counselors and psychologists, The Charlotte Observer reported Jan. 25. But once those positions are filled, Charlotte‐Mecklenburg Schools will still lack hundreds of staff members who are needed to adequately address social and emotional learning. Staffing deficits at the Charlotte‐Mecklenburg Schools call for recruiting 500 more social workers, as well as 150 counselors and 115 psychologists, according to an analysis provided to the Mecklenburg County commissioners ahead of their annual board retreat last week. Nationally recommended ratios suggest there should be a single school psychologist designated for every 700 students. But that ratio is drastically skewed at CMS, with one school psychologist serving nearly 1,600 students, according to the county's retreat material. There should also be one school social worker for every 250 students, according to the national recommendations.

County Funds, Delays in Procurement Process, and Budget Absorption in County Governments in Kenya

County governments in Kenya have been consistently accused of poor budget absorption. This article sought to assess misallocation of county funds and the delays in procurement process on budget absorption in county governments in Kenya. Descriptive research design was used. The study found out that there was misallocation of funds from the national governments to county treasuries and from the county treasuries to various department projects and activities which in effect affected the procurement processes. Procurement functions in the county governments were inefficient owing to the lead time and bureaucracies involved in procurement. The study therefore recommended for county governments in collaboration with commission for revenue allocation and the national treasuries to come up with a criterion for ensuring smooth flow of funds from the national treasury to the end user departments.

Show Me the Money: Impact of County Funding on Retention Rates for Extension Educators

Extension administrators contemplating the challenge of employee turnover should consider potential motivation factors. Through the lens of Herzberg's motivation-hygiene theory, we explored the relationship between financial uncertainty and employee turnover in Ohio State University Extension. The Human Resources department and Business Office of the university's College of Food, Agricultural, and Environmental Sciences provided raw data sets for the 2005–2014 study period. Through regression analyses and the use of descriptive statistics, we clarified aspects of the relationship between county funding challenges and employee turnover. Extension administration needs to proactively strengthen county funding streams and reduce the impact of funding disruptions to lessen the potential of employee turnover.

Cancer costs and trends for newly diagnosed malignancies at an academic institution.

8 Background: The financial cost of cancer is a large burden and continues to rise substantially. Expenditures can be divided into the initial phase after diagnosis, the continuing phase, and the last year of life. Typically costs are greatest in the initial phase and last year of life. The major determinant of cost during the initial phase is hospitalizations. We sought to examine cancer costs of patients with newly diagnosed malignancies at an academic institution during the initial phase and compare outcomes based on insurance status. Our institution serves a significant portion of South Texas, a population facing serious cancer health disparities. Methods: This was a prospective, non-randomized study evaluating patients with new cancer diagnoses from 2014-2016 at an academic hospital. Patients meeting eligibility criteria were screened and consented for participation. A total of 74 patients were included in analysis. Results: The average age was similar in both the self-pay group and the insurance group (including government-sponsored, private, and county funding); 51.1 vs 54.8 years respectively (p = 0.09). Ethnicity between the two groups was not significantly different, 46.2% were Hispanic in the self-pay group vs 45.8% in the insurance group (p = 0.94). The majority of patients in both groups presented with advanced disease, 61.5% in the self-pay group vs 70.8% in the insurance group (p = 0.44). The average number of days of hospitalization was significantly higher in the insurance group compared to the self-pay group, 15.4 days vs 10.6 (p = 0.04). Congruently, average total cost of hospitalization was higher in the insurance group, $96,200 vs $64,200 (p = 0.05). 26.9% of patients in the self-pay group enrolled in hospice within 6 months of their diagnosis vs 20.8% in the insurance group (p = 0.26). Conclusions: With the limitation of a small sample size, our study demonstrates a statistically significant difference in hospitalization days and cost in insured vs uninsured patients with new cancer diagnoses at an academic hospital.

Government Funding of Arts Organizations: Impact and Implications

ABSTRACTNonprofit organizations are told to diversify their revenue sources to avoid relying on any one source as a way to manage financial risk. However, arts organizations in the United States frequently do rely on government funding as part of their revenue mix. The purpose of this research is to determine to what extent arts organizations are dependent on government grants and the implications of government funding on other revenue such as individual and foundation support. The findings suggest that arts organizations that receive state-level public funding are more successful in gaining donations from other sources (e.g., board members, foundations, corporations, special event fundraising and in-kind support), but they receive less city and county funding.

Provider Commitment Is Key for High Vaginal Birth After Cesarean Delivery Rate in a Community Hospital [274

INTRODUCTION: As a community hospital committed to vaginal birth after cesarean delivery (VBAC), we reviewed our experience from 2000 to 2013 to identify contributors to successful VBAC. Our health care providers were both midwives and physicians. METHODS: Using an electronic clinical database that served as a partial electronic medical record, we reviewed records from 2000 to 2013 for all women who had a prior cesarean delivery. We collected patient demographics, insurance, epidural use, and health care provider type. All labor trials were examined for details of labor management, indication for and dilation at cesarean delivery, and neonatal morbidities. Although we reviewed all VBACs in the final analysis, we excluded women who had had a prior vaginal birth. The analysis was then confined to women who had had one prior birth that was via cesarean section. RESULTS: A total of 1,788 women with a single prior birth that was a cesarean delivery were studied, among whom 617 had a VBAC attempt (34.5%); 431 VBAC attempts were successful (70%). Among 289 VBAC attempts among private patients (epidural rate of 73%), the success rate was 66%. For 328 MediCal public patients (epidural rate of 50%), the success rate was 73%. Neither maternal age at delivery nor maternal BMI prior to gestation influenced VBAC success rates. However, private patients were approximately 7 years older than the public patients (mean private age of 36 years old with a standard deviation of 4 years versus the mean public age of 29 years old with a standard deviation of 5 years). Private patients also had a lower pregestation BMI than the public patients (private BMI of 24 versus public BMI of 27 with a standard deviation of 5). Due to changes in county funding in 2011, a combined public and private foundation model was established and a hospitalist care model for labor and delivery was expanded. Although public patients remained primarily managed by midwives as they had been in the past, now private foundation patients had access to both the midwives and hospitalists that may be different from their prenatal doctor. All other variables remained the same, namely, in house 24/7 anesthesia and pediatrics along with in-house OB (as the hospitalist) and in-house midwife. As this collaborative model progressed from 2011 to 2013, we were able to see a reversal of decreasing VBAC rates combined with continued high VBAC success along with good maternal and neonatal safety profiles. Among private patients, the VBAC rate starting at 19% in 2010 (had been as low as 12% in 2007), ended up at a high of 33% in 2013. In addition, neonatal outcomes among VBAC attempt patients were excellent with a single uterine rupture (0.2%) and a 5-minute Apgar less than 7 rate of 0.4%, both unchanged from the earlier period. CONCLUSION: Despite calls for more VBACs, a 10% VBAC rate nationally has not budged much in the last 5 years. Within the same small community hospital (1500 births/year), among all health care provider groups, VBAC rates started high, then followed the descending national rates and then in 2011 reversed. This reversal was due to an increase in VBAC attempts and largely related to a new collaborative model in which private doctors allowed other providers to manage and deliver their patients. Those providers could be either the in-house midwife or the OB hospitalist. In addition, the VBAC success rate was uniformly high at 70%. Health care provider commitment is critical to achieving higher VBAC rates in hospitals that offer VBAC. In this setting, VBAC was quite safe.

An Evaluation of the Connection between Economic Volatility and Governmental Savings Levels for Illinois, North Carolina, and Mississippi Counties

Local governments are continually facing challenges that can drastically influence savings levels and service provisions. From deteriorating fiscal environments to escalating internal costs, maintaining adequate undesignated revenue streams becomes increasingly difficult. The authors evaluate the connection between economic volatility and governmental savings levels. They find that volatility influences counties’ level of saving, but there are differences in how volatility in specific revenue sources affects the size of savings. The findings indicate that counties in Illinois, North Carolina, and Mississippi are able to save in accordance with evolving fiscal conditions. Volatility among various revenue streams, unemployment, and even ideology of the electorate all have significant influence on county fund balance levels. The authors conclude that savings increase with volatility and counties use their savings to fill budget gaps in times of fiscal stress.

Table of Contents

AbstractCMS Proposes Free SBI for Medicare Patients, but Barriers Still Exist for PCPsSmall Wis. Facility Redefines Itself After Shock of County Funding LossThe Medicare SBI Counseling Interventions for Positive ScreensLouisiana Budget Passes Without Welfare Drug‐Test ProvisionNational Council to Poll Substance Abuse Providers on Primary CareHow Substance Abuse Fits in to Federal Integration InitiativesNIAAA Study Finds Low Response to Alcohol is Main Cause of Alcohol ProblemsBriefly NotedBusiness NewsComing up

Abstract B91: Predictors of worsened survival among medically underserved hepatocellular carcinoma patients

Abstract Introduction: We reported that hepatocellular carcinoma (HCC) patients in the Harris County Hospital District (HCHD) have an overall survival (OS) of 3.4 months. This is the third largest public hospital district in the U.S. and a high percentage of HCC patients appear to survive less than 1 month (OS<1 mo). We sought to explore possible factors associated with this observed disparity in OS. Methods: An IRB-approved review of the HCHD Tumor Registry was conducted. Insurance and payor status, race, treatment, clinicopathologic parameters were recorded, including liver function tests, alpha-fetoprotein (AFP), international normalized ratio (INR), Child-Pugh score and model for end-stage liver disease (MELD) score. Outcomes were compared using Kaplan-Meier survival analysis and log-rank tests. Chi-square, Student's t-test, univariate, multivariate logistic regression and Cox proportional hazards model statistical tests were also used (p<0.05). Results: A total of 337 HCC patients (N= 272 men and N= 65 female) from 1998-2010 were identified. Only 4% of patients had medicare; whereas 96% relied upon county funding. OS<1mo was noted in 90 patients (26.7%). There were no racial or gender differences between those with an OS<1mo and OS>1 mo. In the OS<1mo group, 22% were Stage I-II, 39% were stage III and 39% were stage IV. In contrast in the OS>1 mo cohort, 38% were Stage I-II, 33% Stage III and 28% were stage IV. Only 6% (N=5) of OS<1mo patients received therapy for HCC, whereas 27% (N=91) patients in the OS>1 mo group received therapy (p=0.00). Both individual laboratory parameters associated with advanced liver disease (elevated bilirubin and decreased albumin) and composite score (Child-Pugh and MELD) were predictive of OS<1 mo. In addition, elevated AFP, elevated creatinine, stage, and lack of treatment were independent predictors of OS<1 mo. A Cox proportional hazards model demonstrated gender, AFP, bilirubin, INR, presence of ascites and stage were predictive of median survival. Conclusions: Median stage-adjusted survival of medically underserved HCC patients seen in a large urban hospital remains lower than the national average. Although advanced stage and advanced liver disease likely preclude treatment in many patients, there are still a large proportion of patients who receive no treatment. Additional studies are necessary to determine the reasons for lack of treatment and survival disparities in this patient population such as lack of early detection, non-referral to surgeons by primary care physicians, lack of availability of advanced treatments such as transplantation, or a combination of these factors. Furthermore, accurate prediction of those patients unlikely to survive beyond one month may prevent futile use of limited resources. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B91.

What Does It Take? California County Funding Requests for Recovery-Oriented Full Service Partnerships Under the Mental Health Services Act

The need to move mental health systems toward more recovery-oriented treatment modes is well established. Progress has been made to define needed changes but evidence is lacking about the resources required to implement them. The Mental Health Services Act (MHSA) in California was designed to implement more recovery-oriented treatment modes. We use data from county funding requests and annual updates to examine how counties budgeted for recovery-oriented programs targeted to different age groups under MHSA. Findings indicate that initial per-client budgeting for Full Services Partnerships under MHSA was maintained in future cycles and counties budgeted less per client for children. With this analysis, we begin to benchmark resource allocation for programs that are intended to be recovery-oriented, which should be evaluated against appropriate outcome measures in the future to determine the degree of recovery-orientation.

How Medicaid Agencies Administer Mental Health Services: Results From a 50-State Survey

This brief report describes some notable variations in how state Medicaid agencies administer and fund Medicaid mental health services. Hour-long telephone interviews were conducted with all state and District of Columbia Medicaid directors or their designees. Responses indicated that Medicaid and mental health agencies were located within the same umbrella agency in 28 states, potentially facilitating collaboration. The mental health agency provided funding for some Medicaid mental health services in 32 states, and counties provided such funding in 22 states. Medicaid agencies generally delegated more authority to state mental health agencies in states where some Medicaid funding came from mental health sources and also in states where both agencies were in the same umbrella agency. The increasing role of Medicaid in funding state mental health services, combined with new federal limits on Medicaid financing of these services, underscores the importance of interagency collaboration and better alignment of Medicaid and mental health responsibilities.

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

This study examined whether inpatient psychiatric treatment and forensic treatment and incarceration were reduced among adolescents and young adults with severe and persistent mental illness after they received services in the Program of Assertive Community Treatment (PACT). The pre-post evaluation compared length of inpatient treatment and forensic treatment or incarceration for the year before and after PACT enrollment. Participants (N=15) were their own controls. Annual psychiatric hospitalization fell from 66.2 days before enrollment to 8.7 days in the first year of PACT (p=.025, Cohen's d=.54). Similarly, combined days of inpatient psychiatric treatment and forensic treatment or incarceration fell from 104.1 in the year before enrollment to 24.1 days in the year after (p=.015, Cohen's d=.61). PACT services significantly reduced time in inpatient psychiatric treatment. These preliminary results may have implications for long-term treatment, service delivery, and cost of care for adolescents and young adults with severe and persistent mental illness.