Serious Emotional Disturbance (SED) Home and Community Based Services: Understanding Patterns of Service Utilization Among the SED Waiver Population

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. For most SED Waivers, parental income is disregarded in the determination of Medicaid eligibility. Instead, eligibility is determined using the child or adolescent’s assets and income. If deemed clinically and financially eligible, children and adolescents may access specialty mental health services funded by Medicaid. 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 (Kaye, LaPlante, & Harrington, 2009), and it is estimated that nearly one million individuals access some form of Waiver-based services nationally (Medicaid, 2018). Recent estimates show that Waiver spending in the U.S. exceeds $48 billion per year (Eiken, Amos, Sredl, & Saucier, 2018). In 1997, Kansas began to offer a Serious Emotional Disturbance Waiver to children and families. Despite the frequent and growing use of HCBS SED Waivers, and the long-term implementation of the Kansas SED Waiver, little is known about the populations accessing Waiver services and the services that comprise the Waiver. Overall, there is a paucity of empirical findings pertaining to HCBS SED Waivers in relation to their effectiveness in both cost containment and effectiveness. Using two theoretical frameworks, Bronfenbrenner’s Ecological Systems Theory and Social Ecology this dissertation begins to address this gap in the literature. For this dissertation, using administrative community mental health center data, a latent class analysis was conducted to determine if there were classes of service use among the Waiver population, specifically regarding the types and frequency of services used by children, adolescents, and their families. Additionally, a multinomial logistic regression was enumerated to determine if child and adolescent characteristics at Waiver initiation or onset were significant in predicting class membership. Findings from the latent class analysis revealed five classes of Waiver service use. Additionally, age, CBCL total score, academic performance, suspensions, and location of CMHC were all significant in predicting class membership. Results are presented and discussed. Additionally, implications for social work theory, research, policy, and practice are discussed.

Grantor dc:publisher

University of Kansas

Year dc:date.issued

2020

Author dc:creator

• Grube, Whitney

Advisor dc:contributor.advisor

• Mendenhall, Amy

• Mental health
• Social work
• adolescents
• children
• serious emotional disturbance
• waivers

Statement dc:rights

• Copyright held by the author.

Language dc:language.iso

en

Dc Identifier Other

http://dissertations.umi.com/ku:17458

OAI identifier oai:identifier

oai:kuscholarworks.ku.edu:1808/36361