Understanding Multisystem Youth and their Patterns of Services Use - Dennis P. Culhane

Many youth in Philadelphia face challenges at home, at school, and in their communities.   Philadelphia’s education, health and human service systems are, in turn, challenged to help these young people address a myriad of needs before they make the transition to adulthood.  Recent attention by policymakers and researchers has focused in particular on the challenges of serving youth who are moving between and across service systems, often being served by multiple agencies simultaneously.  While highlighting the complex needs of these youth, not all multi‐system services involvement is negative or unplanned.  Indeed, some system transfers are intentional and appropriate, and some youth who have needs in one domain, require support from other services as well.  Nevertheless, multiple systems involvement may reveal a potential complexity to these intersecting problems, possible areas for collaboration between systems, and opportunities for leveraging public service investments to better

serve vulnerable youth.   
This study, commissioned by the Stoneleigh Foundation, is intended to take a close look at the nature and extent of multisystem services involvement of youth in Philadelphia.  Access to administrative data maintained and integrated by the City of Philadelphia’s health and human services agencies and by the School District of Philadelphia, make it possible to undertake a population‐based examination of services use longitudinally.  In other words, these records make it possible to identify a cohort of youth (in this case youth in grades 7‐9 in the 2004‐2006 school years), and to look at the proportion of them who experience multiple exposures to service system involvement in that period, and in which domains.  Further, having identified them in this “index period,” the integrated administrative data make it possible to look backwards at “antecedent” services use that may predict to multisystem involvement, and to look forward at “consequent” services use that may result.
Because each service system has its own “window” onto the experiences of youth, and sees its services through the vantage point of its own service system configurations, this study is organized according to the major departments with which these youth interact:  the Department of Human Services, which has responsibility for both dependency and delinquency services; the Department of Behavioral Health Services; the Office of Supportive Housing, which has responsibility for emergency shelter for families; and the School District of Philadelphia which identifies youth who experience significant absenteeism (i.e. truancy) and which provides special education services.  For our purposes, we focused on the most significant forms of service involvement, particularly experiences that involved out‐of‐home placements.  
So, while many youth may receive preventive child welfare services, or juvenile probation services, we examine here primarily those with placements out of their homes.  Similarly, while we look at all users of mental health or family homeless services, we pay particular attention to youth with “heavy service use” patterns, including those with inpatient hospital stays and residential treatment, in the case of behavioral health, and repeated or lengthy shelter stays.     
The four chapters provided here are organized according to a similar format.  The users of a given service system are first identified with respect to their characteristics and the patterns of services use.  Cluster analysis and other techniques are used to identify where different types of services use may reflect underlying differences in the population.  Second, these various types of services users are examined with respect to their multiple systems involvement, first looking at two systems users, and then three systems users, and so on.  Each chapter also includes a multivariate analysis of a facet of multiple systems use that appeared to be of significant interest; for example, looking at youth who cross over between the child welfare to the foster care system.   
DennisCulhane Multisystem.pdf1.2 MB