GETTING PRACTICAL: DEVELOPING YOUR STATE PLAN FOR PSYCHOTROPIC MEDICATION

MANAGEMENT – PART 3

T U E S D A Y , J U N E 5 T H A T 3 : 0 0 P M ( E T )

C A L L - I N N U M B E R : 1 - 8 0 0 - 8 3 2 - 0 7 3 6 C O N F E R E N C E R O O M : 8 4 6 6 3 3 9

P L E A S E C A L L : 2 0 2 - 6 8 7 - 0 3 0 8 O R E M A I L M N 3 4 4 @ G E O R G E T O W N . E D U

I F Y O U N E E D A N Y A S S I S T A N C E D U R I N G T H E C A L L .

© 2010 GEORGETOWN UNIVERSITY

The work of Georgetown University's National Technical Assistance Center for Children's Mental Health and American Institutes for Research’s Technical Assistance Partnership for Child and Family Mental Health is supported through an intra-agency Agreement between

ACF/ACYF and SAMHSA/CMHS.

FITTING IT ALL TOGETHER: PSYCHOTROPIC MEDICATIONS, TRAUMA AND SOCIAL-EMOTIONAL WELL-BEING

Bryan SamuelsCommissionerAdministration on Children, Youth and FamiliesAdministration for Children and Families

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HHS Activities

• Establishment of Interagency Workgroup (August, 2011)

• Updating Resources on the Child Welfare Information Gateway – www.childwelfare.gov(ongoing)

• Letter to Child Welfare, Medicaid, and Mental Health Directors (November, 2011)

• Testimony at Senate Hearing (December, 2011)• Technical Assistance Webinar Series (January, 2012-

June, 2012)

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New Psychotropic Medication Management RequirementsAccording to the Child and Family Services Improvement and Innovation Act of 2011, States are required to submit descriptions of protocols planned or in place to oversee and monitor psychotropic medication use among children and youth in foster care. The Children’s Bureau has instructed States to address the following areas:

1. 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);

2. Informed and shared decision-making (consent and assent) and methods for on-going communication between the prescriber, the child, his/her caregivers, other healthcare providers, the child welfare worker, and other key stakeholders;

3. Effective medication monitoring at both the client and agency level;

4. 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); and

5. Mechanisms for accessing and sharing accurate and up-to-date information and educational materialsrelated to mental health and trauma-related interventions (including information about psychotropics) to clinicians, child welfare staff, and consumers.

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ACYF-CB-IM-12-03: http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1203.pdfACYF-CB-PI-12-05: http://www.acf.hhs.gov/programs/cb/laws_policies/policy/pi/2012/pi1205.pdfACYF-CB-PI-12-06 (Tribal): http://www.acf.hhs.gov/programs/cb/laws_policies/policy/pi/2012/pi1206.pdf

June 5, 2012

Strengthening management of psychotropic medications is just one of the building blocks of better outcomes for children and youth.

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http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdfhttp://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf

Trauma Screening and Functional AssessmentInitiative to Improve Access to Needs-Driven Evidence-Based/Evidence-Informed Mental and Behavioral Health Services in Child Welfare

• Improve adoption outcomes by creating a flexible service array that provides early access to effective mental and behavioral health services that match the needs of children, youth, and families in the service population

• Support the implementation of evidence-based or evidence-informed screening, assessment, case planning, and service array reconfiguration practices in child welfare systems while simultaneously targeting and de-scaling practices and services that: 1) are not effective; and/or 2) do not meet the assessed needs of the target population

• Identify factors and strategies associated with successful installation, implementation, and sustainability of service system changes

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Title IV-E Child Welfare Waiver Demonstration Projects• May 14: Release of Information Memorandum

• Technical assistance provided through application

• June 4: Letters of Intent due (optional, but not required)

• July 9: Proposals due (may be submitted earlier)

• Federal review begins promptly upon receipt of proposals

• Negotiation with States

• September 28: Waiver terms and conditions signed

See ACYF-CB-IM-12-05: Child Welfare Waiver Demonstration Projects for Fiscal Years (FYs) 2012-2014http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1205.pdf

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Title IV-E Waiver Demonstration Projects: Areas of Priority• Produce positive well-being outcomes for children, youth and their

families, with particular attention to addressing the trauma experienced by children who have been abused and/or neglected;

• Enhance the social and emotional well-being of children and youthwho are available for adoption, as well as those who have been adopted, with a particular emphasis on those children who have been waiting the longest or are hardest to place in order to achieve and sustain successful adoptions;

• Yield more than modest improvements in the lives of children and families and contribute to the evidence base; and/or

• Leverage the involvement of other resources and partners to make improvements concurrently through child welfare and related program areas, including proposals to establish financial incentives based on the achievement of positive child outcomes.

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Alignment with other opportunities, including Medicaid waivers• “Title IV-E agencies are encouraged to engage in a dialogue with State

Medicaid and mental health agencies and consider new and existing opportunities in Medicaid and/or other program areas to complement Medicaid’s efforts to serve children with special needs. Several opportunities may exist to link with Medicaid, such as technical assistance available through the Centers for Medicare & Medicaid Services (CMS) for health homes.”

• “Proposals that involve projects of other relevant Federal initiatives (e.g. title XIX (Medicaid) State Plan Amendments and/or waivers in Medicaid or other programs) will be strongly considered. Some examples of strategies for aligning a title IV-E waiver project with a Medicaid waiver include allowing for a behavioral health intervention to be provided in a Home and Community Based setting; parents to participate in an evidence-based intervention with their child; or targeting a particular part of a State without implementing statewide.”

ACYF-CB-IM-12-05: Child Welfare Waiver Demonstration Projects for Fiscal Years (FYs) 2012-2014 http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1205.pdf

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Important Role Medicaid Plays in Serving Children and Youth in Foster Care

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7%

34%

40%34%

48%55%

36%

52%

60%

0%

10%

20%

30%

40%

50%

60%

70%

Ages 0-5 Ages 6-11 Ages 12+

MH Prescriptions MH Services Any MH Use

Data source: HHS, 2010

Partnerships across HHS

• Exploring Continuous Eligibility for Children and Youth Who Have Been in Foster Care

• Identifying Opportunities to Ensure That Children Receive the Right Treatment Through Medicaid’s EPSDT Benefit and New Affordable Care Act Authorities

• Encouraging States to Take Advantage of Waiver Opportunities to Leverage Resources

• IPA Splitting Time between ACYF and CMS

• Psychotropic Medications

• Departmental High Priority Goal around Children and Youth in Child Welfare Who have Experienced Trauma

• Joint Communications

• Linking NCTSN with ACYF Integrating Trauma in Child Welfare Grantees

• Departmental High Priority Goal around Children and Youth in Child Welfare Who have Experienced Trauma

• Psychotropic Medications• Treatment/Therapeutic Foster Care Technical

Experts Panel• Behavioral Health Coordinating Council• National Center for Substance Abuse and

Child Welfare• Interagency Work Groups (Youth Programs,

Child Abuse and Maltreatment, Early Childhood)

• Joint Communications

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CENTERS FOR MEDICARE & MEDICAID SERVICES

Jean CloseTechnical Director, Division of Benefits & CoverageCenter for Medicaid and CHIPDisabled & Elderly Health Programs Group Centers for Medicare & Medicaid Services

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Medicaid Activities

• Sharing what is known

• Continuity of eligibility and care

• Working with States to enhance Drug Utilization Review (DUR)

• Health Homes

• Health Information Technology (HITECH)

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SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)

David DeVoursneySenior Policy AnalystOffice of Policy, Planning and InnovationSubstance Abuse and Mental Health Services Administration

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SAMHSA Activities

• Defining best practices• Developing resources• Infusing clinical expertise• Health homes• Addressing trauma

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CROSS-SYSTEM SUMMIT

Joyce PfennigProgram SpecialistChildren’s BureauAdministration on Children, Youth and FamiliesAdministration for Children and Families

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Because Minds Matter: Collaborating to Strengthen Management of Psychotropic Medication for Children and Youth in Foster Care

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Six-person teams from all 50 States, the District of Columbia, and Puerto Rico comprised of two representatives each from child welfare, mental health, and Medicaid are invited to participate in this working meeting. The purpose of the meeting is to:

• 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 trauma-related needs of children in foster care with evidence-based and evidence-informed interventions; and

• Facilitate each State’s development of action steps to improve upon and implement their existing oversight plans.

For more information, contact Kate Stepleton at kate.stepleton@acf.hhs.gov or your Regional Office.

August 27-28, 2012; Washington, D.C.

June 5, 2012

HEALTH CARE OVERSIGHT AND COORDINATION PLAN

Catherine HealthChild and Family Program SpecialistChildren’s BureauAdministration on Children, Youth and FamiliesAdministration for Children and Families

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Health Care Oversight and Coordination Plan• First required by the Fostering Connections to Success and

Increasing Adoptions Act of 2008

• Some delays were permitted, but majority submitted plan with 2010-2014 Child and Family Services Plan (CFSP)

• Original law required “the oversight of prescription medications” and Children’s Bureau added information that psychotropic medications should be included

• Law requires that the plan be developed in coordination with the State’s Medicaid agency and in consultation with pediatricians and experts

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Health Care Oversight and Coordination Plan• Annual Updates to the plan are expected in the Annual Progress and

Services Plan (APSR)

• Updated plan is due June 30, 2012 addressing the two new requirements:

– Protocol to monitor psychotropic medications

– How emotional trauma due to the removal is screened and treated

• Instructions for submission of the updated Health Care Oversight and Coordination Plan can be found at :

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

– Tribes: http://www.acf.hhs.gov/programs/cb/laws_policies/policy/pi/2012/pi1206.pdf

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THE REGIONAL PERSPECTIVE

Debra SamplesChildren’s Bureau, Region IXAdministration on Children, Youth and FamiliesAdministration for Children and Families

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Roles and Responsibilities of the Regional Office

• Receive, review, and recommend approval of the CFSPS and APSRs

• Conduct joint planning with states to ensure continuous improvements

• Ensure collaboration with stakeholders• Work with state to assess training and technical

assistance needs • Provide technical assistance• Approve onsite technical assistance from National

Resource Centers

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Technical Resources• National Resource Center for Youth Development (NRCYD)

http://www.nrcyd.ou.edu

• National Resource Center on Legal and Judicial Issues (NRCLJI) http://www.americanbar.org/groups/child_law/what_we_do/projects/rclji.html

• National Resource Center for Child Welfare Data and Technology (NRC-CWDT) http://www.nrccwdt.org

• National Child Welfare Resource Center for Organizational Improvement (NRCOI) http://www.nrcoi.org

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© 2010 GEORGETOWN UNIVERSITY

Q & A

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POLLING QUESTION

© 2010 GEORGETOWN UNIVERSITY

UPCOMING WEBINAROutcome Measurement and Management for Children and

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