University of Louisville ThinkIR: The University of Louisville's Institutional Repository Electronic Theses and Dissertations 8-2019 Comparative spending of medicaid dollars on child participants of Kentucky’s sobriety treatment and recovery teams program versus a matched comparison group. Matthew Thomas Walton University of Louisville Follow this and additional works at: https://ir.library.louisville.edu/etd Part of the Emergency Medicine Commons, Health Economics Commons, Health Policy Commons, Pediatrics Commons, Social Statistics Commons, Social Welfare Commons, and the Social Work Commons Recommended Citation Walton, Matthew Thomas, "Comparative spending of medicaid dollars on child participants of Kentucky’s sobriety treatment and recovery teams program versus a matched comparison group." (2019). Electronic Theses and Dissertations. Paper 3276. https://doi.org/10.18297/etd/3276 This Doctoral Dissertation is brought to you for free and open access by ThinkIR: The nivU ersity of Louisville's Institutional Repository. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of ThinkIR: The nivU ersity of Louisville's Institutional Repository. This title appears here courtesy of the author, who has retained all other copyrights. For more information, please contact [email protected]. COMPARATIVE SPENDING OF MEDICAID DOLLARS ON CHILD PARTICIPANTS OF KENTUCKY’S SOBRIETY TREATMENT AND RECOVERY TEAMS PROGRAM VERSUS A MATCHED COMPARISON GROUP by Matthew Thomas Walton B.S., University of Kentucky, 2009 M.S.S.W., University of Louisville, 2012 A Dissertation Submitted to the Faculty of the Raymond A. Kent School of Social Work in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Social Work Raymond A. Kent School of Social Work University of Louisville Louisville, Kentucky And College of Social Work University of Kentucky Lexington, Kentucky August 2019 Copyright 2019 by Matthew T. Walton All rights reserved COMPARATIVE SPENDING OF MEDICAID DOLLARS ON CHILD PARTICIPANTS OF KENTUCKY’S SOBRIETY TREATMENT AND RECOVERY TEAMS PROGRAM VERSUS A MATCHED COMPARISON GROUP by Matthew Thomas Walton B.S., University of Kentucky, 2009 M.S.S.W., University of Louisville, 2012 A Dissertation Approved on: June 13, 2019 By the following dissertation committee: ______________________________ Martin T. Hall, Ph.D., MSSW chair ______________________________ Anita Barbee, Ph.D., MSSW ______________________________ Jose Fernandez, Ph.D. ______________________________ Seana Golder, Ph.D., MSW ______________________________ Glen Mays, Ph.D., MPH ii DEDICATION To Anna Marie, Caroline Swift, and Lincoln Bosworth iii ACKNOWLEDGEMENTS This document is the fruition of a years-long labor of love; both for myself and for those who have supported me through the process. This has been a team effort, and I would like to acknowledge and thank those team members without whom this would have been impossible. First, I would like to thank my devoted wife Anna. Her willingness to have her husband resign from his job in order to go back to school in order to fulfill a dream was an uncommon display of support and sacrifice. She has been a constant source of encouragement to me during times of discouragement, patience during times of restiveness, and confidence during times of self-doubt. She has endured many hours of discussion of child abuse research, data analysis, and study design for my sake. She has worked diligently over the last four years to make this goal a reality for me, and for that, I will be forever grateful to her. Anna also gave birth to our beautiful little twins during this process. So she has navigated the twists and turns of learning to become a mother while braving the travails of the wife of a student. I want to thank my two year olds Caroline and Lincoln for the many ways that their presence in my life has enriched my perspective and taught me how to be a father. It was never lost on me that the children that I have written about here are wonderful little souls like them. Because of those two, the work of the START teams became that much more cherished to me as I meditated on how precious the relationship between a child and iv their parent is. The CPS workers who serve these families and protect these children from harm are storing up treasure in Heaven. I would also like to thank the members of my dissertation committee – Martin Hall, Seana Golder, Anita Barbee, José Fernandez, and Glen Mays. I knew after the first sessions in Martin’s MSSW practice class that he and I shared a common perspective, but I never imagined that I would eventually have the chance to publish academic papers with Professor Hall. Martin has been so incredibly generous to me with his time and attention during these last few years, and has taught me a great deal about program evaluation, working with large datasets, and how to conduct oneself as a scholar. I have been incredibly fortunate to have had the opportunity to study under and learn from Martin, and have truly enjoyed our collaboration. I am also indebted to the other members of my committee for their time and their input on the many drafts they have read along the way to this final copy. Each has been a collegial and supportive guide to me as I completed this project. Dr. Golder provided crucial insights from her expertise in substance use disorders, especially considering the unique ways it affects women and mothers. Dr. Barbee shared her knowledge as a respected authority in the field of child welfare (a field that I was only tangentially familiar with prior to entering the doctoral program) to ensure that my thoughts were consistent with the scholarship. As a health economist, Dr. Fernandez offered an invaluable economic and methodological perspective on how to approach design and analyses. Finally, my thanks to Dr. Mays for his insights on how to approach the process of securing Medicaid claims data and for his counsel on the proper way to incorporate health services research design elements v into this project. It has been an honor for me to have the involvement of these esteemed faculty on this dissertation. I am blessed to have had the involvement of my family during this process of research and writing. For my parents, Tom and Carol Walton, who have made it their mission over the last 32 years to do everything they could for me to help me thrive and be successful. They taught me to love the process of learning, and modeled for me what it looks like when people apply their gifts towards the service of others. Since June 5, 2017, their love has taken the form of providing countless hours of care to their grandchildren and reminding their son and daughter in law that hard work eventually does get rewarded. They have been stalwarts of steady support for me as I set about completing this degree. My brother and sister-in-law, Reese and Leah Walton have also been constant sources of fellowship and comradery during the process of writing this dissertation. Our Friday night dinners were a welcome reward for a week full of sitting in front of a computer by myself, and our weekend trips to the Louisville Zoo were always a rejuvenating source of joy. I wish to thank the many other members of the University of Louisville who supported this research project. To Eric Schneider, who spent hours upon hours helping to prepare the dataset. To Dr. George Higgins, who advised me, made methodological recommendations, and helped to execute the propensity score matching process. My thanks to Dr. Gilbert Liu, who supported this project from his role at the Kentucky Department of Medicaid Services, and to Dr. David Lohr, who entertained several meetings with me from his role as the DCBS Medical Director. vi I also wish to thank the many people from the Kentucky Cabinet for Health and Family Services. In no particular order, I am grateful to Mr. Maik Schutze, Ms. Angela Taylor, Ms. Pamela Wright, Mr. Michael Jourdan, Mr. Jason Reed, Mr. Chris Cordell, and Ms. Jessica Brown. Thank you for your openness to this project and for your daily service to the Commonwealth of Kentucky. Lastly, I wish to acknowledge the START teams and the clients that they serve. Without their work and the many hours they have spent recording data I would have had nothing to work with, and this dissertation would have been impossible. Thank you for the work that you do, and for involving me in it. You will likely never know the full extent of the benefits you’ve brought to the world. Hopefully our research helps some. vii ABSTRACT COMPARATIVE SPENDING OF MEDICAID DOLLARS ON CHILD PARTICIPANTS OF KENTUCKY’S SOBRIETY TREATMENT AND RECOVERY TEAMS PROGRAM VERSUS A MATCHED COMPARISON GROUP Matthew T. Walton June 13, 2019 Child protective services agencies have long observed the complicating role that parental substance use and addiction plays in cases of child maltreatment. Families who struggle with these problems present unique challenges for child welfare professionals. These families are typically more difficult to engage, more likely to have children removed from the home, and have poorer outcomes when compared to other families. These poorer outcomes often include health problems. Addiction has well-known effects on health, and the specific manifestations of these problems for parents have been documented for years in child protection casework. However, what has been less investigated are the ways that these issues correspond to the health of the children involved in these cases. In many instances, children in these homes are severely injured and require acute medical care. These harms commonly result in significant increases in public spending; especially for state Medicaid programs.