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Penn Child Research Center

Challenged Youth, Challenged Public Services

    Albert M. Greenfield Memorial Lecture, May 8, 2012

    Dr. Dennis Culhane

    Dr. Dennis Culhane, the Dana and Andrew Stone Professor of Social Policy at the University of Pennsylvania, has devoted his career to tackling society’s toughest problems.  From his groundbreaking work on homelessness to revealing studies on vulnerable youth, Culhane has worked to transform research into positive social action. As he has investigated the pressing issues of the day, he has also promoted a powerful tool for assessing and addressing these issues. Integrated data systems allow disparate public agencies to coordinate and share information and give researchers and policy makers a clear and complete picture of the populations these agencies serve. 

    When it comes to integrated data, Culhane serves as innovator, advocate and guide; he, along with his colleague John Fantuzzo, has been instrumental in creating the precedent-setting KIDS (Kids Integrated Data System), in establishing Philadelphia’s Policy Action Center and, most recently, in spearheading a national integrated data system education and support network, the MacArthur Foundation-funded Intelligence for Social Policy. At the 4th Annual Albert M. Greenfield Memorial Lecture on May 8, “Challenged Youth, Challenged Public Services: Putting Integrated Data Systems to Use,” Culhane spoke as both researcher and integrated data champion. Not only did he offer an intriguing preliminary look at a soon-to-be published study of Philadelphia youth served by multiple public agencies, he also made a persuasive case for the power of integrated data systems to diagnose problems, spark dialogue, and ultimately inform policy.

    Indeed, he began his talk with a plug for Philadelphia’s Policy Analysis Center, an outgrowth of KIDS, which links “individual records across departments to try to understand how populations are being served, how they can be better served, and how we can improve overall the functioning of these programs.” Culhane and his research team used these linked records to take an in-depth look at Philadelphia’s “multi-system” or “crossover” youth in Philadelphia.  The young people who live in group homes or city shelters, who have foster placements, who are delinquent, who receive special education accommodations, or have been treated for mental or behavioral health disorders are among society’s most challenged and most vulnerable.  “A very specific and needy population,” Culhane called them, “…whose needs don’t end when they are emancipated and become adults.” A study following crossover youth in Los Angeles into young adulthood found high rates of incarceration, public assistance, and poor health. And society pays the price: Culhane cited a Chapin Hall study showing that multi-system families, 20% of the population served, accounted for 86% of service costs.

    So while the population of multi-system youth may be relatively small, the very nature of the challenges they face, “enormous, complex and overlapping,” suggests, says Culhane, “there may well be significant opportunities to achieve better outcomes by collaboration and better use of [the] resources that are currently being spent.” Four questions propelled the investigation:

    • What is the extent of multi-system involvement?
    • Can we identify risk factors?
    • What are the consequences of multi-system involvement?
    • What are the intervention opportunities?

    To address all these questions in an hour-long lecture, Culhane acknowledged, would be overwhelming. “Maybe in a semester length course, we could get through each of these,” he joked. Instead, the Greenfield Lecture offered a foretaste of the more detailed analysis to come. Culhane focused on answering the first question regarding the extent of multi-system involvement, as he outlined for the audience what he called “the epidemiology” of the problem.

    He and his team combed records for the 54,000 7th, 8th, and 9th graders enrolled in Philadelphia’s public schools between 2004-2006, and searched for matching individual data from five public agencies:

    • The School District of Philadelphia (SDOP) for involvement in special education and/ or significant absenteeism (defined as 25 days or more).
    • Department of Human Services (DHS) for dependency and/or delinquency placement. 
    • Department of Behavioral Health (DBH) for Medicaid paid mental health care.
    • The Office of Supportive Housing (OSH) for time spent in a family shelter, signifying homelessness.

    Special education accounted for 18% of the population, 10,911 students. Three percent of students (1,620 kids) were DHS dependents, with out-of-home placements during the index period. And five percent (2,794 kids) had episodes in delinquent placement. Thirteen percent of public school students received some kind of mental health service, with just under 2%, 648, treated as inpatients or in residential mental health facility. And 794 kids, 1.5% of the total population, were classified as homeless, though Culhane noted, based on previous research, that homeless youth are a tough population to track through agency records; to obtain more accurate numbers warrants further research.

    After finding the matched cases, the research team further differentiated the services used, categorizing them by length of stay or intensity. For example, a little over half of the kids qualified by DHS under “dependency” stay for a short term (26 months average); a third, called the “long stayers” had been in placement about six years. Delinquency placement, mental health treatment, or time in a family shelter similarly varied in duration, from brief stints to long stays, and, for mental health, from outpatient to residential treatment.

    In comparing data across agencies, Culhane identified several noteworthy patterns:

    • 28% of the dependent population ends up in delinquent placement by late middle school/ early high school (the index period). These “crossover youth” tend to have entered DHS after age 11, to be male, and to have been placed in group homes.
    • Students in a special education program were much more likely to be involved in other systems. Almost one out of five kids in Philadelphia’s public schools receives some form of special education, Culhane noted. These students are more than twice as likely to receive some kind of dependency or delinquency placement, or inpatient/residential mental health treatment.
    • Students in dependency or delinquent placements were less likely to show significant absenteeism than their schoolmates. The majority of students receiving mental health treatment, on the other hand, do miss 25 days or more of school, with 60% absenteeism in 4th, 5th and 6th grades rising to 80% in 7th, 8th and 9th grades.
    • The small number of kids identified as homeless had significant attendance problems, but much lower rates of co-occurring use of other systems: 10% used inpatient mental health services; 5% were delinquent; and 6% in out-of-home placements. “That make sense,” said Culhane, because during homelessness episodes, families are staying together.

    Culhane discussed the student population’s use of mental health services in some depth, finding encouraging news in the fact that students in dependency or delinquency placements were getting diagnosed and treated for behavioral and mental health disorders. Most of the shift from delinquency to mental health treatment was planned and intentional, Culhane explained; the city shifted youth into residential treatment routinely because Medicaid then pays for students’ care. Mostly male, 70% of the population who cross over from delinquency to residential mental health treatment have been diagnosed with a conduct disorder. On the other hand, in the dependent population, those moving to inpatient treatment tend to be female, with diagnoses of depression. In breaking down mental health service in terms of duration and intensity, Culhane’s team discovered that, while only 12% of the population was in residential treatment, they accounted for 50% of the total mental health spending.   

    Despite the profound challenges these statistics reveal, Culhane found reason for hope. “If there’s a good news story,” he said, it’s that “we’re not talking about lots and lots of people.” Around 1,500 kids of the population studied were involved in two systems and around 3-400 in more than two at the same time. The relatively small numbers, though they account for significant resources, make focused intervention all the more possible and certainly more cost effective than standard practice. And while early intervention is one strategy, Culhane advocates planning interventions for young adults as they emerge from multi-system involvement. “The literature is almost entirely focused on how to avoid the transfers [from one system to another], while I think even more profoundly important is what happens to them after they are teens.”

    As he outlined the next steps, from identifying early risk factors to investigating the young adult outcomes, Culhane made a plea for continued, expanded dialogue across public agencies: “It’s really our responsibility to start talking about what’s happening with those youth and with those children in an effort to really improve the outcomes for those kids and families.  And, oftentimes, what we find is that our agencies act in silos and we are not collaborating; we are not communicating.”

    In “Challenged Youth, Challenged Services,” Culhane demonstrated how collaboration and communication not only can expose the patterns of risk and vulnerability, but also reveal the opportunities for intervention and further dialogue.

    John Fantuzzo, in concluding the Greenfield Lecture, continued: “This is not the time for polite conversations about research and theory at the University, but it’s a time for us to address our need for research to produce actionable intelligence to guide collective civic engagement.”  Culhane’s revealing look at multi-system youth in Philadelphia offers just such intelligence, data that can lead to engagement, action – and answers.