Serious Emotional Disturbance Waiver: An Analysis of Service Use Patterns

Background/Purpose: To reduce the institutionalization of children and adolescents with serious emotional disturbances, several states have instituted a 1915(c) Serious Emotional Disturbance Home and Community-Based Services (HCBS) Waiver. Over the last several years, use of Waivers has grown exponentially. Between 1995 and 2005 HCBS spending doubled from 19% of Medicaid long-term support services expenditures and 6% of total Medicaid spending to 37% and 12% respectively. This presentation presents findings pertaining to a secondary data analysis, which used community mental health center (CMHC) and Medicaid billing data, to examine service use patterns among the Kansas child and adolescent SED Waiver recipients.

Methods: A secondary data analysis was conducted using CMHC administrative data and Medicaid billing data as captured by the Results Oriented Management (ROM) system. Specifically, Latent Class Analysis (LCA) methods were employed to determine class membership for a sample of first episode Waiver recipients in Kansas. Kansas Waiver services were categorized or grouped based on principles derived from Systems Theory. After Waiver services were grouped, a monthly average of services used was calculated for each Waiver recipient.

Data included in analysis spanned from January of 2013 to June of 2016. The final sample size included in analysis was 1,179. Descriptive analysis revealed that close to 56% of the sample was male and the majority of Waiver recipients were White and Non-Hispanic. The average age of the adolescents included in analysis was 11.9 years and the average length of first Waiver episode was 10.6 months.

Results: Descriptive analysis revealed some Waiver services are used frequently, while others are used sparingly. LCA methods revealed the following five class solution:

1. Under Utilizers: averaged less than one Waiver service a month
2. Care Coordination: only used Wraparound services
3. Multi-Level Needs: used all types of services available to them one to four times a month
4. Moderate Needs Caregiver: used caregiver level services only and, on average, three to four times a month
5. High Needs Caregiver: used caregiver level services only and, on average, more than four times a month

Implications: To date, this study is the only known study that utilizes LCA methods to classify Waiver recipients based on their service use patterns. While the classes that emerged from analysis were specifically conceptualized for this study, there are numerous implications from this study’s findings for social work. First, when examining the response proportions of the service use indicator variables used in analysis, there appears to be a disconnect between the theoretical principles and Waiver utilization by families and CMHCs, leading to Waiver service design implications. Additionally, based on this study’s findings, it can be concluded that the Waiver is being used as family/caregiver intervention, as opposed to an individual level intervention for children and adolescents. This also has significant implications for Waiver program design and policies, as findings reiterate the need for empirically supported treatment available not just for the children and adolescents experiencing SED, but also for their families and caregivers.