Evaluation of a Virginia Medicaid Waiver Program: Assessing the effectiveness and implementation fidelity of the Children's Mental Health Program

The study evaluates the Virginia's Children's Mental Health (CMH) Program, a 5-year Medicaid waiver demonstration project that provides an opportunity for Medicaid eligible children who are residents of a psychiatric residential treatment facility (PRTF) with a psychiatric diagnosis to receive services in the community. The evaluation of the CMH Program assesses whether children who transition out of residential care and receive community-based services through the CMH Program experience changes in their functional levels over time. The study also monitors the fidelity of the CMH program by comparing the adherence of the actual program implementation to the intended program theory and design.

A critical limitation of this evaluation was the potential selection bias due to lack of random assignment of participants. The study design attempts to minimize the selection bias by using a comparison group matched to the treatment group based on baseline characteristics most likely to affect functional levels. The observed changes in functional levels are compared to changes in functional levels for a group of children who remain in residential care but matched the CMH group on location (urban vs. rural), diagnosis, and baseline functional level. Functional levels are measured quarterly for both the CMH group and the comparison group using the Child and Adolescent Needs and Strengths Comprehensive instrument customized for the CMH Program. Program fidelity is monitored by caregiver and case manager interviews using the Wraparound Fidelity Index (version 4).