Clinical Case Vignette - Andrea

Andrea is a 12 year old girl who was ordered to Kids Oneida for community-based treatment by the Family Court. At the time of her enrollment in Kids Oneida she was being discharged from a detention program and the Family Court judge was seriously considering placing her out of the community in a residential treatment center (RTC). Relevant past history includes a persistent pattern of truancy from school and incorrigible behavior at home including numerous runaway episodes. Andrea suffered repeated instances of sexual abuse from her biological father between the ages of 8 and 10 years. Current psychiatric diagnoses include: conduct disorder, post-traumatic stress disorder and depression. At the time of enrollment in Kids Oneida, Andrea's CAFAS (Child and Adolescent Functional Assessment) score was 110 (scores greater than or equal to 80 indicate youth needs intensive treatment).

Andrea lives with her mother Virginia and three younger siblings. Virginia is employed and struggling to raise 4 children as a single parent without child support payments. Assessment of the home indicated that there is some family cohesiveness. Virginia is described as a proud woman who is hesitant to ask for help. She is concerned and nurturing toward the children, however, she is inconsistent and has great difficulty controlling the children's behavior. All members of the family have needs. Andrea's current problems include: severe on-going conflicts with her mother, unresolved issues related to past sexual abuse, not attending scheduled clinic appointments, not taking prescribed antidepressant medication, and being strongly influenced by antisocial peers.

The Kids Oneida plan of care was based on a careful assessment of both strengths and needs and resulted from a joint effort between the individual service coordinator, Andrea and her mother. Goals include: attending school daily, not running away from home, acting appropriately at home, in school and in the community and maintaining all appointments. In addition to on-going individual service coordination provided by Kids Oneida, services include: in-home treatment, community supervision, intensive supervision and psychiatric evaluation/medication follow-up. In-home treatment which is accessible 24hrs/day includes parent support/skill building, behavior management and family therapy. Community and intensive supervision provide Andrea with an individual worker to insure that she attends school daily and does not runaway from home. In addition, flexible discretionary funds as well as recreation services for Andrea's younger siblings were included to lessen family stress and burden. See below for a sample month from Andrea's plan of care detailing specific services and projected costs. The total possible cost for Andrea's community-based care in Kids Oneida is $3,425/month compared to $5,000-6,000/month for residential treatment care.

Monthly Plan of Care - Andrea

Kids Oneida Service	Units approved	Unit Cost	Service Cost during month
Service Coordination	1 month	$480/mo.	$480
Community Supervision	16 hrs	$50/hr.	$800
Intensive Supervision	9 hrs	$75/hr.	$675
Psychiatric Review/Medication	2 hrs	$60/hr.	$120
In-Home Treatment	12 hrs	$70/hr.	$840
Recreation	12 hrs	$30/hr.	$360
Discretionary Funds	150	$1 each	$150
		TOTAL COST for month	$3,425