Session: Abstracts of Distinction: A Randomized Controlled Trial to Test the Use of Medicaid Funding to Finance an Evidence-Based Gang Prevention Intervention (Society for Prevention Research 25th Annual Meeting)

Mental, emotional, and behavioral (MEB) disorders and related problems are preventable and treatable conditions. In particular, interventions that improve parenting and family functioning across the developmental continuum (from prenatal programs through young adulthood) have been shown to reduce antisocial behavior, violence or aggression, substance use disorders and other problem behaviors. Research has also shown that when such evidence-based interventions are delivered with fidelity, they lead to substantial cost savings.

However, historically, our nation’s approach to MEB disorders has been largely reactive rather than preventative. One of the major structural barriers to prevention service engagement and utilization has been inadequate insurance coverage. The Affordable Care Act (ACA) was enacted in 2010 to “improve the accessibility, affordability, and quality of health care.” Following its implementation in 2014, the rate of uninsurance among children/youth declined to a historic low of 6 percent, with 25 states recording statistically significant declines in the number of uninsured youth. The ACA provides a significant expansion of MEB disorder coverage to include mental health, substance use disorder services and other rehabilitative services that support individuals with behavioral health challenges. The ACA further expands behavioral health benefits and federal parity protections to an estimated 62 million Americans. As a result, all state Medicaid programs now provide mental health services and Children’s Health Insurance Program (CHIP) beneficiaries are eligible to receive a full service array of medically necessary services to include preventive assessments, counseling, therapy, medication management, social work services, peer supports, and substance use disorder benefits. This expansion has the potential to significantly reduce MEB problems if effective prevention strategies can be delivered through this mechanism.

The state of Pennsylvania, through the Pennsylvania Commission on Crime and Delinquency (PCCD), began its efforts to bring effective preventive services to the state nearly two decades prior to the ACA. Working with the Penn State Prevention Research Center (PRC), and later the EPISCenter, Pennsylvania created the infrastructure necessary to support the adoption, implementation, and continuing quality improvement of evidence-based prevention and intervention program. Thus, when the ACA was enacted, Pennsylvania already had the necessary infrastructure to deliver evidence-based practices using the expanded funding.

It is within this context that researchers at the University of Maryland and Temple University conducted a randomized controlled trial that demonstrates the utility of this Pennsylvania model for delivering evidence-based programming using Medicaid funding. The study tests the effectiveness of an adaptation of the Functional Family Therapy model to a court-involved population in Philadelphia that was at-risk for gang involvement. It documents how this Medicaid-funded evidence-based practice was used by the Philadelphia Family Court in Philadelphia, what the outcomes were achieved through the use of the model, and the public cost of the effort.