Financing medically-oriented child protection teams in the age of managed health care: a national survey

OBJECTIVE: The direct and indirect costs to society from child maltreatment are estimated to be quite high. The costs related to medical care are of interest to professionals serving on medically-oriented child protection teams that conduct medical evaluations of alleged abuse. This study was designed to explore a number of financially related issues on medically-oriented child protection teams specifically examining the team's staffing, funding sources, reimbursement, budgeting, perceived impact of managed health care and their perception of funding stability. METHOD: Mailed survey of medically-oriented child protection teams throughout the United States using a questionnaire that contained 28 items focused on a variety of financial issues; 14 items were drawn from a similar study done 6 years earlier, which allowed for comparison over time. RESULTS: Responses were received from 320 out of 472 organizations, yielding a response rate of 68%. Inclusion criteria were met by 153 responses and were included in the analysis; 22 of these had also responded to the earlier survey. Median total budget was $300,000 and state and local government funding was the largest revenue source (Mdn = 30%, range: 0-100%), followed by patient care generated revenue (Mdn = 20%, range: 0-100%). The mean charge for an evaluation was $283 (SD = 196.11, range: $0-$800). Forty percent of teams indicated that managed care had no impact where as 49% saw a negative impact. Comparisons between the responses to this survey and the one done 1993 demonstrated that teams were seeing about the same number of patients and showed trends towards increased budget amounts and broader inclusion of various health care and non-health care disciplines on the teams. CONCLUSIONS: No single source of funds for such teams has emerged as the uniform solution for all teams. Creative patchworks composed of various funding sources remain the typical solution to the funding needs of medically-oriented child protection teams.