Effectiveness of a Children’s Home and Community-based
Services Waiver Program
Ramon Solhkhah, M.D. Æ Cathryn L. Passman, C.S.W. Æ Glenn Lavezzi, B.A. Æ
Rachel J. Zoffness, M.A. Æ Raul R. Silva, M.D.
Published online: 12 June 2007
Ó Springer Science+Business Media, LLC 2007
Objective Limited alternatives exist to residential treatment or hospitalization for children
with the most serious emotional disturbances. Community-based interventions are intended
to offer less restrictive and expensive options than traditional treatment. One such program is
New York State’s Home and Community-Based Services (HCBS) Waiver Program.
Methods From 1996 to 2002, 169 children were enrolled in the Manhattan HCBS. All spent
at least one month on the wait list prior to admission to the waiver program. We used our
wait list as a control group (WLC), allowing for comparison of the HCBS intervention.
Results Sample consisted of 169 children between the ages of ﬁve and eighteen. The ethnic
composition was 46.8% Hispanic (N = 79), 47.9% African-American (N = 81), and 5.3%
Caucasian (N = 9). Average stay was 12 months in the HCBS program and 3.5 months for
the WLC. Only 30% of children in the WLC were maintained in the community, while 81%
of children in the HCBS were similarly maintained (P < 0.001). Also, the rate of hospital-
ization for the HCBS group was signiﬁcantly lower (3 versus 41%; P < 0.001). There was
also a trend for the WLC group to have had substantially higher rates of removal by the
Administration for Children’s Services (New York City’s protective service agency) (8.3
versus 1.8%) and to more frequently require residential treatment (13.0 versus 8.9%).
Conclusions It would seem that the HCBS program appears to be a clinically and cost-
effective method of maintaining children in their community.
Keywords Home-Base Community Service Á HBCS Á Psychopathology Á
Presented in part at the 50th annual meeting of the American Academy of Child and Adolescent Psychiatry,
Miami, FL Oct. 14-19, 2003.
R. Solhkhah, M.D. (&) Á C. L. Passman, C.S.W. Á G. Lavezzi, B.A. Á
R. J. Zoffness, M.A. Á R. R. Silva, M.D.
The Child and Family Institute at St. Luke’s and Roosevelt Hospitals, 411 West 114th Street, Suite 5C,
New York, NY 10025, USA
Psychiatr Q (2007) 78:211–218