Effectiveness of Intensive Alternative Family Treatment on Reducing Re-Admissions to Psychiatric Residential Treatment Facilities

Abstract

Children and youth with high behavioral health needs can receive care in a psychiatric residential treatment facility (PRTF). Overutilization of PRTFs is concerning because they are highly restrictive and costly residential care settings. Intensive Alternative Family Treatment (IAFT®) is an intensive therapeutic foster care program combined with service implementation strategies that is designed to reduce risk for entry to PRTF among youth with high behavioral health needs. This article presents findings from a quasi-experimental study examining the effectiveness of IAFT services in such a population of youth. In this study, we balanced treatment and comparison groups by first sampling youth with intensive care needs as indicated by having a prior PRTF spell. We then used propensity score weighting and covariate adjustment to estimate the effectiveness of IAFT in preventing PRTF re-entry. We found that receipt of IAFT was associated with a 24% lower risk of PRTF re-entry compared with youth who exited from a PRTF in the same state but did not receive IAFT. Sensitivity tests yielded mixed results regarding the effect of IAFT. Overall, results suggest that IAFT is an effective treatment approach for reducing risk for PRTF entry among youth with high behavioral health needs.

Comparing Medicaid Expenditures for Standard and Enhanced Therapeutic Foster Care

“…Evidence from quasi-experimental studies indicates that among youth with or without prior institutionalization, IAFT reduces the likelihood of subsequent admission to psychiatric residential treatment facilities (PRTFs) by 23% and 28%, respectively, compared to usual care (Lanier et al, 2021a , b ; Rose et al, 2021 ). Given the high costs of PRTFs, it is reasonable to expect potential cost savings associated with an intervention that reduces use of higher levels of care.…”

“…No known studies have examined the net effects of standard TFC (hereafter, “TFC”) on Medicaid spending trajectories. Prior quasi-experimental studies have compared IAFT to usual care, which included TFC placements as well as other types of services (Lanier et al, 2021a , b ; Rose et al, 2021 ). Although these studies demonstrated that IAFT reduced the rate of PRTF admissions, they did not assess whether the higher reimbursement rate for IAFT could be offset by future cost savings resulting from better child health outcomes, which would prevent more expensive and restrictive placements.…”

“…Few research studies have compared the effectiveness of standard TFC to intensive TFC services (Lanier et al, 2021a , b ; Rose et al, 2021 ). Further, although a prior cost analysis compared TFC to group care in Sweden, no known studies have provided a cost analysis of different levels of TFC intensity, let alone in the U.S. specifically (Åström et al, 2020 ).…”