Examining the Impact of Policy Change on a Community-Based Mental Health Treatment Program for Children and Adolescents

Background and Purpose:

Despite the vast amount of literature focusing on community-based mental health treatment, minimal research has focused on the impact of policy change on the macro-micro continuum of social work practice. This poster aims to address this gap by exploring the impact of policy changes on Therapeutic Day Treatment (TDT), which is a community-based mental health treatment program.

Methods:

Using a case study design, multiple units of analysis were collected and analyzed.  Units of analysis included structured interviews with eight stakeholders who interface with the TDT program, policy guiding the implementation of the TDT program, and annual fee-for-service fiscal data for the TDT program.  The stakeholders were recruited via electronic mail. The structured interview questions allowed stakeholders to share their perspective on how the Department of Medical Assistance Services (DMAS) regulatory changes impacted the implementation of TDT services. The interviews were transcribed, coded and re-coded. Once the coding process was completed, the researcher organized the codes and identified and labeled sub-themes. The last stage of the analytic phase was to develop and operationalize the final themes, based upon the sub-themes.

The TDT policies were obtained via a Freedom of Information Act request. TDT policies were analyzed using a comparative contextual analysis to determine changes in content, formatting, and meaning of the policy. Fee-for-service data reflecting the expensive paid to providers for implementing the program were obtained from a DMAS representative as was analyzed using Excel. The analysis examined the change in overall fee-for-service expenditures that occurred to determine the percentage change between each fiscal year as well as the total percentage change. Lastly, the findings from the analyses were triangulated in an effort to increase the study’s rigor and allow for more confidence in the findings.

Findings:

Four themes emerged through the analysis of the structured interviews. These themes include: 1) Fraudulent Practices and Misuse Of TDT Services, 2) Regulatory Oversight, 3) Cost Containment, and 4) Evaluation. The analysis of the policy found DMAS added language to provide greater clarity to the existing policy. Additionally, staff requirements changed and paraprofessionals were no longer able to provide TDT services. Caseload limits were also set for the program. The fee-for-services analysis found that there was a 269% increase in fee-for-service expenditures between fiscal years 2007 and 2011; with the rate of increasing slowing down after 2009 when a majority of the regulatory changes occurred.

Conclusion and Implications:

Findings from this study begin to address the aforementioned gap in the literature. The negative impact on service provision, based upon implementation of rapid policy change, was apparent. The fiscal and programmatic impact of vague policy and limited oversight of the TDT program illustrated the need for clearly defined policy to guide programming. These findings can inform how social workers develop and implement policy in community mental health.  Lastly, the potential fraud and misuse of resources highlights the role of social justice in policy practice, an important issue for social workers to develop, implement, revise, and evaluate policy that guides programming.