Psychotropic Medications in Child Welfare

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Psychotropic Medications in Child Welfare

OVERSIGHT AND

MONITORING OF

PSYCHOTROPIC

MEDICATIONS IN CHILD

WELFARE

Joyce Pfennig, Ph.D.


Child and Family Services Improvement

and Innovation Act of 2011


Annual Progress and Services Reports

(APSRs)

Since 1994, agencies receiving

funding from title IV-B have been

required to submit Child and

Family Services Plans (CFSPs) to

the Children’s Bureau (HHS)

The CFSP is a five-year strategic

plan that sets forth the vision

and goals to be accomplished to

strengthen each agency’s overall

child welfare system

The APSR provides annual

updates on progress made

towards accomplishing the goals

and objectives of the CFSP


Required Components of Psychotropic

Oversight and Monitoring Plan

Comprehensive and

coordinated

screening,

assessment, and

treatment planning

Mechanisms to

identify children’s

mental health and

trauma-treatment

needs

Including a

psychiatric

evaluation, as

necessary, to

identify needs for

psychotropic

medication

Program Instruction ACYF-CB-PI-12-05:

http://www.acf.hhs.gov/programs/cb/laws_policies/policy/pi/2012/pi1205.pdf


Required Components of Psychotropic

Oversight and Monitoring Plan

Informed and shared

decision-making

(consent and assent)

Methods for ongoing

communication between

the prescriber, the child,

his/her caregivers,

other healthcare

providers, the child

welfare worker, and

other key stakeholders


Shared decision-making


How will we…

Engage youth

• Consent/Assent

• Handbook

Engage foster and kin caregivers

Engage biological parents, whenever

appropriate

Use information systems to support

decision-making

Resource: NRCPFC: Handbooks for Youth in Foster Care

Children’s Bureau/ ACF


Required Components of Psychotropic

Oversight and Monitoring Plan

Effective

medication

monitoring

both the

client and

agency

level


Medication Monitoring Approaches

Prospective

Consultation

Prior Authorization

Mandatory Second Opinion

Retrospective

Court Hearings

Drug Utilization Review

Data Trends


Required Components of Psychotropic

Oversight and Monitoring Plan

Availability of mental

health expertise and

consultation

regarding:

Both consent and

monitoring issues by a

board-certified or

board-eligible Child

and Adolescent

Psychiatrist (at both

the agency and

individual case level)


Required Components of Psychotropic

Oversight and Monitoring Plan

Mechanisms for

sharing accurate and

up-to-date

information related to

psychotropics to

clinicians, child welfare

staff, and consumers

This should include

both data sharing

mechanisms (e.g.,

integrated information

systems) and methods

for sharing educational

materials


Synthesis of State Plans


Caveats

APSRs may not be

fully reflective of

policies and

procedures that

are in place

Other information

may be found in

CFSP Health Care

Services Plan or

elsewhere in APSR

Five components

are not always

distinct (e.g.,

overlap between

ensuring informed

consent and

information

sharing)


General Observations

There is significant variation in approaches across

States

States describe a mix of current and proposed

approaches

States rarely addressed both client- AND agencylevel

protocols

Few States described procedures related to ALL

FIVE components

Widespread adoption of AACAP guidelines


Number of States

Screening, Assessment and Treatment

18

16

14

16

16

12

10

11

8

9

6

4

2

0

No Mention

Mentioned, No

Detail

Minimal Detail

Procedures

Described


Number of States

Informed and Shared Decision-Making

25

20

20

15

17

10

5

7

8

0

No Mention

Mentioned, No

Detail

Minimal Detail

Procedures

Described


Number of States

Medication Monitoring

20

18

16

18

14

15

12

10

11

8

6

8

4

2

0

No Mention

Mentioned, No

Detail

Minimal Detail

Procedures

Described


Number of States

Mental Health Expertise and

Consultation

25

20

23

15

10

10

9

10

5

0

No Mention

Mentioned, No

Detail

Minimal Detail

Procedures

Described


Number of States

Mechanisms for Sharing Accurate and

Up-To-Date Information

25

20

21

15

10

11

13

5

7

0

No Mention

Mentioned, No

Detail

Minimal Detail

Procedures

Described


Psychotropic Summit

Six-person State teams, comprised of two

representatives each from child welfare, mental

health, and Medicaid, have been invited to

attend the meeting.


Summit Purpose

Provide an opportunity for State leaders to enhance existing

cross-system efforts to ensure appropriate use of psychotropic

medications;

Showcase collaborative projects and initiatives at State- and

local-levels;

Offer state-of-the-art information on cross-system approaches

to improving mental health and well-being for children and their

families;

Encourage participants to think in a deep and nuanced way

about strategies for addressing the mental health and traumarelated

needs of children in foster care with evidence-based and

evidence-informed interventions; and

Facilitate each State’s development of action steps to improve

on and implement their existing oversight plans


Need for Innovative Ideas


Want More Background?

Child Welfare Information Gateway

ACYF Information Memorandum on Psychotropics:

http://www.acf.hhs.gov/programs/cb/laws_policies

/policy/im/2012/im1203.pdf

NSCAW brief on psychotropics for children known

to child welfare:

http://www.acf.hhs.gov/programs/opre/abuse_ne

glect/nscaw/reports/psychotropic-meds/NSCAW-

Psychotropic-Meds-Brief-No-17.pdf


Questions

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