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STARLIGHT ADOLESCENT CENTER: UTILIZATION REPORT 2003
Introduction to Starlight: Starlight Adolescent Center --California’s first Community Treatment
Facility for children and adolescents with severe emotional disturbances- opened in October
2000. The initial mission of Starlight was to provide local and cost-effective treatment as an
alternative to expensive state hospitalization. This mission was accomplished as state hospital
populations declined and youth moved into community treatment. Subsequently, Starlight began
to play a unique and vital role in the continuum of services available throughout the state,
providing care to the most troubled of all youth in a safe, structured and secure treatment
environment. A recent report issued by the California State Department of Mental Health
documents that “CTFs are serving the youth they were designed to serve and CTFs fill a gap in

the system, providing services to the most troubled youth”.^
In the children’s system of care. Community Treatment Facilities such as Starlight are a step-up
for clients who are unable to succeed within an RCL Level 14 Group Home. CTFs also offer
treatment - as distinct from detention - to juvenile offenders with mental illness. Additionally,
CTFs provide step-down and sustained treatment focus for youth coming from acute or sub
acute psychiatric facilities. In addition to providing safety, structure and treatment, CTFs run
Non-Public Schools to meet the educational needs of enrolled youth.
The opportunities and challenges of CTF programming stem directly from the unique role CTFs
fulfill in the system of care - and from the overtly collaborative nature of the CTF model (which
was jointly developed by DMH and CDSS and now increasingly serves a juvenile offender
population). Each public system stakeholder, family, and youth contributes an array of needs
and requirements that must be melded into a coordinated, seamless, and individualized plan of
care for each client. Both the social and environmental risks surrounding the client’s life and the
client’s high risk behaviors must be reduced significantly to enable a successful transition back
to home and community. This is the current mission of Starlight Adolescent Center.
Starlight Client Demographics: In the past three years since opening. Starlight has served a
total of 92 clients. During the most recent year of operation (October 2002-0ctober 2003), 61
clients were served. The clients ranged in age from 12 to 18 years with an average age of 15.1
(±1.4), and there were slightly more males than females(57% vs. 43%).
Sex Distribution

Ages of Clients Served (October 2002-0ctober
2003)
30%

^6%

26%-

25%
20%

15%

15%
10%

5%

boys
3%

0%

12yrs

57%

I
13

17yrs

Jordan, Patricia, LCSW & Abbott, Beverly, LCSW,(2004) Study of Community Treatment Facilities, 22
pgs., ayailable at http://www.dmh.ca.goy/press/doc/2003/CTF/CTF.pdf.

Starlight Utilization Report For 2003: Page #1

The racial/ethnic backgrounds of the clients were, in
order of prevalence: Caucasian, Hispanic, African

Client Ethnicity

American, and Asian/Pacific Islander.

Starlight’s clients came from Santa Clara County
(57%), Alameda County (30%), and five other
counties throughout California. Almost half of the
youngsters (48%) were referred by the Probation
Department; 31% were referred by the Social
Services Department; and 25% were referred by the
Mental Health Department.
□ Caucasian □ Hispanic □ Black □ Asian
Referring Agencies
50%

44%

40%
31%
30%

25%

20%
10%

0%
Social Services

MH/3632

Probation

Starlight Client Acuity — Prior History Data: The youngsters referred to Starlight all had very
high levels of acuity. Previous history information (illustrated in the next three charts) indicated
high rates of past psychiatric hospitalizations, high rates of previous Group Home placement
failures, and admissions typically coming directly from Juvenile Hall or an acute psychiatric
hospital. In short, these were youngsters who had not been successfully served in other
programs.

About half of the youngsters were
living in Juvenile Hall immediately
prior to admission to Starlight.
Another

16%

psychiatric

were

hospital.

in

an

Ten

acute

percent

Placement Immediately Prior to Admission
60%
50%

Adolescent

40%

Center—on their high level locked
Psychiatric Health Facility unit. The
youngsters admitted directly from a
psychiatric hospital were previously
at home (5%), in Group Homes
(7%), at STARS (2%), and in an
unknown location (2%)

30%

were

at

STARS

20%

16%
10%

10%

7%

10%

7%

0%
Home

Shelter

STARS

Starlight Utilization Report For 2003; Page #2

Juv. Hall

Psych.

Group

Hosp.

home

The
vast
majority
of
youngsters (85%) had at
least one acute psychiatric
hospitalization
prior
to
admission to Starlight, and
the youngsters averaged 3.2
such hospitalizations. Almost
one third (31%) of the
youngsters had five or more
such hospitalizations.

Number of Acute Psychiatric Hospitalizations Prior
to Admission to Starlight
40%

15%

20%

UJ

10%
0%

one or two

none

About 80% of the youngsters
had prior Group Home
placement failures. More
than a quarter of the
youngsters (28%) had two
such

failures

and

30%
25%

another

19%
20%

four

15%

failures.

One

youngster had 24 Group
Home failures. The average
number of Group Home
stays was 2.5.

three or four five or more

Group Home Placement Failures Prior to Admission

quarter (25%) had three or
such

31%

29%
30%

10%

7%

5%

I

0%
none

one

16%

118%J
two

7%

I

three

four

I
five-

5%

nine +

eight

Starlight Client Acuity — Diagnostic Data: Starlight’s youth all had very severe psychiatric
disorders. The data on number of psychiatric diagnoses, types of diagnoses, specific diagnoses,
and functional levels are presented below.
Number of Concurrent DSM Psychiatric

All of the youngsters at Starlight had a
serious DSM-IV psychiatric diagnosis, and
75% had more than one such diagnosis.
The youngsters averaged 2.0 concurrent
diagnoses.

Diagnoses
54%

60%
50%
40%
30%

25%

20%
10%
0%

1 diagnosis

I

18%
3%.

-

2 diagnoses 3 diagnoses 4 diagnoses

Starlight Utilization Report For 2003: Page #3

Most(72%) of the youngsters had some
type of Emotional or “Internalizing”
Disorder (e.g., PTSD, Major Depression,
Bipolar Disorder). About half (52%) had
some type of Behavioral or “Acting Out”
Disorder (e.g., Conduct Disorder,
Intermittent Explosive Disorder). And
one fifth of the youngsters had some
type of Psychotic disorder (e.g..
Schizoaffective Disorder and Psychosis
Not Otherwise Specified).

Types of Psychiatric Disorders in the Starlight
Population
72%

80%

52%

60%
40%

20%

20%
0%
Emotional

Behavioral

Psychotic

disorders

disorders

disorders

The most common specific diagnoses were Major Depression (36%), Posttraumatic Stress
Disorder (21%), ADHD (20%), Conduct Disorder (20%), Bipolar Disorder (18%), and
Oppositional Disorder (16%).
All of the youngsters had serious impairments in adaptive functioning as measured by the
Children’s Global Assessment Scale (CGAS). At admission, 25% were unable to function in
almost all areas (CGAS score below 30); 47% were unable to function in at least one area
(CGAS 31-40); and 18% had severe impairments in one area (CGAS 41-50). The average
CGAS score for the youngsters was 37.7 (± 10.2).
CGAS Ratings
Functional Assessment(CGAS)Scores

51 to 60: moderate impairments in several but
not all areas

47%.

50%

41 to 50: severe impairments in one area or
moderate impairment in most areas
31 to 40: major impairments in several areas
(e.g., markedly withdrawn and
isolated)
21 to 30: serious impairment in almost all areas
(e.g., stays in bed all day)
below 21: needs considerable supervision to
prevent hurting self/others

40%
30%
22%
18%
20%
10%
10%

3%

0%

rzi
below 21

21-30

31 to 40 41 to 50 above 50

Starlight Client Acuity — Need for High Level Interventions During Treatment: Starlight’s
youngsters are among the most severely disturbed and most difficult-to-place in California.
Other placements have proven unsuccessful for these youth who have histories of dangerous
symptoms such as running away, physically assaulting others, and engaging in self-destructive
behaviors and/or suicide attempts. Starlight has tried to keep an appropriate balance between
not rejecting needy youngsters on the one hand and ensuring safety by screening out teens with
predatory and dangerous behaviors on the other hand.
As evidence of the high degree of olient acuity, during the 2003 calendar year Starlight
experienced: 26 transfers to acute psychiatric hospitals; 35 AWOLs (some returned); 49
worker’s comp claims; 394 client to client assaults; 418 client to staff assaults; 118 client self-

Starlight Utilization Report For 2003: Page #4

injuries; and 22 other client injuries. A high level of intervention was needed to control and
safeguard youth with dangerous and assaultive behaviors. Among the interventions used at
Starlight during the 2003 calendar year were: 179 locked seclusions; 238 time-outs; 80 uses of
mechanical restraints; 343 containments; and 126 PRN STAT injections.
Given the high level of client acuity, SLAG management and staff focus quality improvement
efforts (policy, procedure, training, and programmatic refinements) on issues such as high risk
behavior management, client and staff safety, and preventative programming. Current quality
improvement projects include: upgrading emergency and disaster plans; teaching new methods
of managing dangerous behaviors to avoid the need for restraint and seclusion; and focusing on
school attendance and other positive forms of client engagement in the milieu.

Starlight Client Acuity — Subgroups: Differences were found among the Starlight youngsters
according to referral sources. The key differences are summarized in the Table below.
COMPARISON OF CLIENTS BY TO REFERRAL SOURCES
DMH Referrals

DSS Referrals

Probation Referrals

(n=15)

(n=19)

(n=27)

62%

31%

80%

14.8 (1.1)

15.0 (1.7)

15.5 (1.0)

African American

2%

25%

28%

Asian

0%

5%

77%
1%

38%
31%

4%
20%

5.6 (3.9)

1.4 (0.5)

2.0 (0.7)

17(1.7)

13(0.5)

3.0 (2.2)

Behavioral Disorders

54%

40%

88%

Emotional Disorders

85%

68%

68%

Psychotic Disorders

23%

0%

32%

36.6 (10.4)

38.6 (11.8)

37.9 (10.6)

Sex(% males)
Age (average & st. dev.)
Ethnic Distribution:

Caucasian

Hispanic
Prior Psychiatric
Hospitalizations
(average and st. dev.)
Prior Group Home
Placements

12%

(average & st. dev.)

C-GAS (mean & st. dev.)

Referrals from DMH tended to: be younger, be Caucasian, have a large number of prior
psychiatric hospitalizations, have high rates of Emotional Disorders, and have lower adaptive
functioning levels. Referrals from DSS tended to: be female, be Caucasian or Hispanic, have
lower rates of prior psychiatric hospitalizations and group home failures, have lower rates of
Behavioral Disorders, and be without Psychotic Disorders. Probation referrals were most often
males and tended to: be older, be African American, have higher rates of Group Home failures,
and have very high rates of Behavioral Disorders.

Starlight Utilization Report For 2003: Page #5

Comparison of Starlight CTF and Star View CTF Clients: Star View Adolescent Center is a
40-bed CTF located in Los Angeles County. Originally a RCL-14 Group Home, it converted to
CTF in December of 2001. Also operated by Stars Behavioral Health Group, Star View uses
many of the same treatment models as Starlight. A key difference between the two facilities is
the existence of an on-site Psychiatric Health Facility at Star View which reduces the need for
transfers to outside acute psychiatric hospitals.
The chart below summarizes key differences between Star View’s clients and those of Starlight
in terms of demographics, diagnostic information, and high-risk behaviors.

COMPARISON OF CLIENTS AT STARLIGHT CTF vs. STAR VIEW CTF
Star View CTF

Starlight CTF

Demographic and Referral Information
Sex(% males)
Age (average & st. dev.)

57%

48%

15.1 (1.4)

15.0(1.5)

23%

35%

Ethnic Distribution:

African American
Asian

3%

2%

Caucasian

39%

26%

Hispanic

34%

36%

DSS(31%)

DSS (65%)

Referring Agency

Most Common Prior
Placement

DMH (25%)

DMH (0%)

Probation (44%)

Probation (35%)

Juvenile Hall (51%)

Juvenile Hall (26%)
Psychiatric Hospital (28%)
MacLaren Hall (27%)
(children’s shelter)

Psychiatric Hospital (26%)
(Incl. 10% from STARS PHF)
Diagnostic Information

Behavioral Disorders

52%

44%

Emotional Disorders

72%

81%

Psychotic Disorders

20%

17%

37.7 (10.2)

27.4 (4.2)

Major Depression (36%)
PTSD (21%)
Conduct Disorder(20%)

Bipolar Disorder(33%)
Major Depression (30%)

Bipolar Disorder(18%)

Conduct Disorder(22%)

C-GAS (average & st. dev.)

Most Common Diagnoses

PTSD (25%)

Starlight Utilization Report For 2003: Page #6

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COMPARISON OF CLIENTS AT STARLIGHT CTF vs. STAR VIEW CTF

Starlight CTF

Star View CTF

High-Risk Behaviors and Interventions
AWOLS (not permanent)

35

10

Worker’s Comp claims

49

11

Client to client assaults

394

141

Client to staff assaults

410

212

Client self-injuries

118

41

Other client injuries

22

51

Locked seclusions

179

0

Time-outs

238

278

80

0

Containments

343

497

PRN STAT injections

126

110

Uses of mechanical restraints

A chief difference between Star View and Starlight is that Star View serves only youngsters
referred by Probation or Social Services (no Mental Health referrals). The prevalence of Social
Services clients at Star View is almost double that at Starlight. Considering this referral pattern,
it is makes sense that fewer of Star View’s youngsters were admitted from Juvenile Hall and
more were admitted from psychiatric hospitals.
However, despite these referral differences and ethnic differences reflecting their local
communities, the clients at Star View and Starlight were very similar in their psychiatric profiles
(including specific diagnoses and types of diagnoses). Both of these CTFs seem to be serving
similar groups of youngsters.

Rates of most “high risk” behaviors and interventions were higher at Starlight than at Star View.
This may reflect the fact that most of Star View’s clients were stabilized to some extent on the
PHF unit before being admitted to the CTF.

Comparison of Starlight CTF and Star View CTF Outcome Data; The next below presents
the 2003 outcome data for Star View and Starlight. For Star View, the lengths of stay data
reported here are total stays in the CTF with intervening stays on the PHF unit not being
included in this figure. Starlight lengths of stay do not include any bedholds during which the
clients were in acute hospitals.

Starlight Utilization Report For 2003: Page #7

COMPARISON OF STARLIGHT CTF VS. STAR VIEW CTF: OUTCOMES DURING 2003

Starlight CTF

Star View CTF

Transfers to acute psychiatric hospitals

25

8

Transfers to on-site PHF Unit

NA

66

34

44

291 days

230 days

26%

14%

0%

3%

28%

38%

54%

55%

Psychiatric Hospitalizations:^

Discharge Statistics:

Number of discharges
Average length of stay
Placement At Discharge:
Family reunifications
Foster family placements
Group home placements
All lower level of care placements

Not surprisingly (considering Star View’s on-site PFIF), Starlight had many more transfers to
acute psychiatric hospitals than did Star View: There were 25 during the year for Starlight
versus only 8 during the year for Star View. Flowever, Star View had a substantial number of
transfers from the CTF to its PHF unit (66 during the 2003 year).
Average lengths of stay were greater at Starlight and show more range and variability. This may
be due to the higher percentage of Mental Health/Juvenile Probation youth served at Starlight:
the placement process for such youth can be protracted due to their combination of mental
illness and illegal or antisocial behavior.

Star View CTF and Starlight CTF had similar step-down rates with just over half of the clients
(54% for Starlight’s and 55% for Star View) being discharged to lower level of care settings.
Family reunifications were more common at Starlight (26% versus 14%) and Group Home
placements were more common at Star View (38% versus 28%).

^ The number of transfers are provided. The unduplicated client count is approximately 65% of this figure.
A subset of children experienced multiple psychiatric hospitalizations.

Starlight Utilization Report For 2003: Page #8