Children in Foster Care and Efforts to Provide Appropriate Behavioral Health Care Kamala D. Allen Director, Child Health

1. Children in Foster Care and Efforts to Provide Appropriate Behavioral Health CareKamala D. AllenDirector, Child Health Quality FFTA Public Policy Institute May 6, 2013 White House EOB Washington, DC

2. Presentation Overview • Rates of Behavioral Health Service Use • National Efforts to Address Psychotropic Medication Use for Children in Foster Care • Promising Approaches to Meet the Behavioral Health Needs of Children in Foster Care • The Role of EPSDT • Recommendations

3. Behavioral Health Service Use in Medicaid* • 10% of children in Medicaid use behavioral health services • They account for 38% of Medicaid’s behavioral health expenditures for children. * Findings from the forthcoming CHCS Medicaid Child Behavioral Health Utilization and Expenditure Study, 2013.

4. BH Services for Children in Foster Care* • Children in foster care account for: • 3% of the child Medicaid population • 15% of the behavioral health services used • 29% of the behavioral health service dollars • Children in foster care were more likely to be prescribed psychotropic medications. • 27% of children in foster care on psych medications • 23% of children with SSI/disabled-eligibility • 4% of children with TANF-eligibility * Findings from the forthcoming CHCS Medicaid Child Behavioral Health Utilization and Expenditure Study, 2013.

5. Children in Foster Care and Psych Meds* • Children in foster care were more likely to be prescribed psychotropic medications. • 27% of children in foster care on psych medications • 23% of children with SSI/disabled-eligibility • 4% of children with TANF-eligibility • More likely to receive multiple psychotropic medications • 40% received 2 or more; 20% received 3 or more • More likely to be prescribed antipsychotics • 42% of foster children and SSI children vs 18% TANF * Findings from the forthcoming CHCS Medicaid Child Behavioral Health Utilization and Expenditure Study, 2013.

6. Selected Efforts to Address Psychotropic Medication Use in Foster Care • Federal Technical Assistance and Guidance • AHRQ/CMS Measure Development Activities • Psychotropic Medication Quality Improvement Collaborative (CHCS) • PMQIC Data Subgroup • Psychotropic Medication Virtual Learning Community (CHCS) • AACAP Child Psychiatrist Listserv • AACAP Practice Parameters for Children in Child Welfare

7. Some Promising Approaches • Increasing access to evidence-based and evidence-informed practices • Adopting evidence-based/nationally endorsed practice parameters • Establishing meaningful and system-level consent (authorization) policies and practices • Establishing meaningful oversight and monitoring policies and practices • Embedding clinical expertise in the child welfare agency • Establishing data-sharing agreements among key agencies • Implementing effective care management approaches (e.g. Wraparound, Care Management Entities) • Engaging providers in practice change efforts • Engaging youth and families in treatment planning

8. The Role of EPSDT • Early and Periodic Screening, Diagnosis and Treatment • Children’s preventive care service under Medicaid • Requires provision of comprehensive health and developmental history, including assessment of physical and mental health development at specified intervals • Covered services vary across states according to their Medicaid State Plan • Medically necessary services are covered

9. State Foster Care Screening and Assessment Policies • Most child welfare agencies tie their screening requirements to their state EPSDT schedule. • • 38 states required a behavioral health screening. • Range: 1-90 days following removal. • 30 days was the most common requirement. • 27 states require a behavioral health assessment. • Range was 5-183 days following removal. • 30 days was the most common requirement. http://www.chcs.org/usr_doc/CHCS_CW_Foster_Care_Screening_and_Assessment_Issue_Brief_111910.pdf

10. Treatment: What Services are Provided?

11. Evidence-Based Practice Resources • SAMHSA’s National Registry of Evidence-based Programs and Practices • http://www.nrepp.samhsa.gov • CA Evidence-Based Practice Clearinghouse • www.cebc4cw.org

12. Recommendations to Improve Behavioral Health Outcomes in Foster Care • Look at your data on the needs and services for the foster care population • Look at benchmark and national outcomes data • Identify enabling legislation, regulation, and policy • Conduct financial mapping analysis to identify relevant funding streams • Engage system and community partners; families and youth • Garner support for evidence-based and evidence-informed practice • Use data to monitor trends and changes in indicators of well-being

13. Contact Information Kamala D. Allen, MHS Vice President Director, Child Health Quality Center for Health Care Strategies kallen@chcs.org