Chief Operating Officer,
Dr. Brad Holloway, Ph.D, LCSW
ABSTRACT
Birch Tree Communities:
A Qualitative and Quantitative Analysis
By
Dr. Brad Holloway, Ph.D, LCSW
THE PROBLEM
A severe shortage of services available for people with serious mental illness is amounting to a public health crisis in Arkansas and across the country. Recent studies estimate that 3.4% of Americans, more than 8 million people, suffer from serious psychological problems while the number of psychiatric beds decreased by 14% from 2005 to 2010. In 2010, there were 50,509 state psychiatric beds, meaning there were only 14 beds available per 100,000 people nationwide. Arkansas currently has over 3,000 seriously mentally adults in prison and incarcerates more individuals with serious mental illness than it hospitalizes at a rate of 3.3 to 1.
More recent data in Arkansas from 2017 reveals an even greater crisis. The Arkansas State Hospital (ASH) is the only acute psychiatric inpatient hospital operated by the state. With only 185 adult beds, the state ranks 46th nationally with only 7.5 beds per 100,000 population. A minimum of 50 beds per 100,000 people is considered necessary to provide minimally adequate treatment for individuals with serious mental illness. To compound the problem, 160 (86%) of all beds are occupied by court ordered forensic patients that leaves only a handful of acute psychiatric placement options in a state that provides mental health services to over 32,000 adults with serious mental illness every year.
METHOD
The quasi-experimental method was used in applied research, which is appropriate for data derived from an experimental control situation in which two separate groups are evaluated but are not selected purely at random.
The two groups are identical with respect to a diagnosed Serious Mental Illness (SMI) and separated with respect to the number of psychiatric hospital days one year prior to Birch admission and psychiatric hospital days for one year post Birch admission. The difference between the groups is, therefore, the result of the treatment. Predictors were restricted to a limited number of explanatory variables that included age, gender, and legal status.
A Qualitative Analysis was conducted by comparing the Daily Living Activities 20 (DLA 20) scores at admission between July 1, 2018 and June 30, 2019 compared to the DLA 20 score 6 months later at the next Treatment Plan Review date.
FINDINGS
This study documented the positive impact of Birch Tree Communities in reducing the number of acute psychiatric hospitalizations and improving the quality of life of those members served. The study documented the severe shortage in placement options for the seriously mentally ill and how Tier 3 Therapeutic Communities programs (TC3) are effective, efficient and improves the overall quality of life of those served.
The research showed an 87.3% decrease in the number of psychiatric hospitalization days of members one year prior to Birch admission and one year post admission for those who received services in the Therapeutic Communities Program between July 1, 2018 and June 30, 2019. In addition, the research showed a significant increase in Quality of Care as evidenced by an increase of DLA 20 scores of 26 points following 6 months of services.
The 78 members in the study had a total of 5,262 psychiatric hospitalization days in the year prior to admission to Birch and the same members were hospitalized 667 days while receiving care at Birch between July 1, 2018 and June 30, 2019. Prior to Birch admission, members spent an average of 67.46 days per year in the hospital and following Birch admission, the same members averaged 8.55 days in the hospital. This constituted an 87.3% reduction in Psychiatric Hospitalization days.
When analyzing the data by age, the group with the highest reduction in hospitalization days following admission to Birch was the 40-49 years old group (95.9%); The 30-39 years old group (86%); the 50-62 years old group (81.7%); and the 18-29 years old group reduced hospitalization days by 67.5%.
When analyzing the data by legal status, psychiatric hospitalization days were reduced for members on Act 911 Conditional Release by 97.3%. Only three members were admitted to the hospital following admission to Birch, and one member accounted for 67% of the days. 83% of the 911 members had no hospitalization days following Birch admission.
Quality of Life
A Qualitative Analysis of Daily Living Activities showed a significant positive increase in
the DLA 20 scores from admission through a six month review period. The average
DLA 20 score at admission was 67.46 and the score following 6 months of care improved
to 93.5. This is an increase of 26.04 points on an instrument that measures 20 quality of
life domains.
Cost Analysis
The cost of acute private psychiatric hospitalization is approximately $825 per day and
The cost of placement at the Arkansas State Hospital is approximately $650 per
day. For the purposes of this study, a median cost of psychiatric hospitalization will be
calculated at $737. The cost of the Therapeutic Communities program at Birch Tree
Communities is $175 per day.
The cost of providing inpatient psychiatric care to 78 members for one year is
approximately $20,982,390. The cost of providing Therapeutic Community Services at
Birch Tree Communities for one year is $4,982,250.