Transcript Slide 1

Strengthening Psychotropic Medication
Management: Another Step in Improving
Well-Being for Children and Youth in
Foster Care
Bryan Samuels, Commissioner
Administration on Children, Youth and Families
Joining Forces: Federal and National
Collaboration
•
•
•
•
•
•
Administration for Children and Families
Centers for Medicare and Medicaid Services
Substance Abuse and Mental Health Services Administration
Agency for Healthcare Research and Quality
Food and Drug Administration
National Institute of Mental Health
• American Academy of Child and
Adolescent Psychiatrists
• American Association of Pediatrics
• Centers for Healthcare Strategies
• National Association of Mental
Health Program Directors
• National Association of Medicaid
Directors
August 27, 2012
• National Resource Center for Youth
Development
• PolicyLab at Children’s Hospital of
Philadelphia
• Rutgers University
• Tufts University
• Etc.
Because Minds Matter
2
HHS Activities to Support States
• Interagency Workgroup
• Communications:
– Tri-agency letter to State Directors
– Information Memorandum & Program Instruction
– CMS Information Bulletin
• Webinars
• Online Resources (www.childwelfare.gov)
• Alignment of ongoing activities
• Cross-system Summit, Because Minds Matter
August 27, 2012
Because Minds Matter
3
Other Opportunities and Resources
• CHCS Quality Improvement Collaborative
• MEDNET Consortium
• AHRQ Systematic Review of Interventions for Children
Exposed to Maltreatment and Family Violence
• Youth Guide for Talking about Psychotropic Medications
• APA/DOJ Training on Evidence-Based Practices for
Child Welfare
• T-MAY (Treatment of Maladaptive Aggression in Youth)
Guidelines
• Etc.
August 27, 2012
Because Minds Matter
4
Goals of the Summit: Collaborating
for Change
Enhance existing cross-system efforts and
collaborative work
Showcase collaborative projects and initiatives that
improve well-being for children and families
Present sound data and solid science on which to
base system changes
Develop plans to strengthen psychotropic medication
management
August 27, 2012
Because Minds Matter
5
Context: Caregiver Risk Factors for
Children Known to Child Welfare
Prior Reports of Maltreatment
High Stress in family
Poor Parenting Skills
Low Social Support
Trouble Paying for Basic Needs
History of Maltreatment of Caregiver
Child Special Needs or Behavior Problem
Mental Health Problems
Domestic Violence
Drug Abuse
Alcohol Abuse
0
August 27, 2012
10
Because Minds Matter
20
30
40
Percent
50
60
6
Children with Substantiated and
Unsubstantiated Reports of Maltreatment
Are at Similar Risk for Poor Outcomes
Substantiated
Unsubstantiated
45
40
42.3
38.8
Percent
35
30
31.7
33.4
25
20
20.7
23.3
15
20.8
19.4
10
5
0
Developmental Cognitive Problems
Emotional/
Problems (0-5 years)
(4-17 years)
Behavioral Problems
(1.5-17 years)
August 27, 2012
Because Minds Matter
Substance Use
Disorder (11-17
years)
7
Risk of Social-Emotional Problems and Use of Psychotropic
Medications among Children Known to Child Welfare, by Age
Group
Percent of Children Reported to Child Protective Services
Risk of Social-Emotional Problems
Current Use of Psychotropic Medication
70%
60%
57.2%
49.5%
50%
40%
30%
20%
20.5%
19.6%
16.0%
10%
1.5%
0%
1.5-5 Years
6-10 Years
11-17 Years
Age Group
August 27, 2012
Because Minds Matter
8
Risk of Social-Emotional Problems and Use of Psychotropic
Medications among Children Known to Child Welfare, by
Placement Type
Percent of Children Reported to Child Protective
Services
Risk of Social-Emotional Problems
Current Use of Psychotropic Medication
70%
61.2%
60%
48.2%
50%
40%
42.7%
40.9%
35.6%
30%
20%
10%
10.9%
13.6%
11.8%
0%
In-Home
Kin Care
Foster Care
Placement Setting
August 27, 2012
Because Minds Matter
Group Home or
Residential Home
9
Most Common Mental Health Diagnoses among Children in
Foster Care Receiving Psychotropic Medications
40%
Percent of Children in Foster Care Receiving
Psychotropic Medications
36%
34%
30%
21%
20%
17%
10%
0%
ADHD
Depression
Conduct/Oppositional
Defiant Disorder
Bipolar Disorder
Mental Health Diagnosis
August 27, 2012
Because Minds Matter
10
Psychotropic Medication and
Behavioral Health Service Use
Use of specialty mental health services separately and in combination with
psychotropic medications among children meeting clinical criteria for mental
health need
Out-of-Home
In-Home
No services
21.5
30
33.1
Meds only
58.2
18.5
1.8
August 27, 2012
Specialty MH
services only
Meds + Specialty
MH services
Because Minds Matter
9.4
27.5
11
Feeling safe and
stable in the
living
environment
Able to manage
emotions and
regain
equilibrium
when upset
Belonging and
social
connectedness
(permanency)
WELLBEING
Able to sustain
positive
interpersonal
relationships
Self-efficacy
based on
developing
competencies
Adapted from Impact Youth Services, 2011;
http://impactyouthservices.com/goals.htm
Has a positive
self image
August 27, 2012
Promoting
Well-Being in
the Context of
Maltreatment
ACYF-CB-IM-12-04:
http://www.acf.hhs.gov/programs/cb/laws_p
olicies/policy/im/2012/im1204.pdf
Because Minds Matter
12
ACYF-CB-IM-12-04: Promoting Social and
Emotional Well-Being for Children and
Youth Receiving Child Welfare Services
1.
Focus on child & family level outcomes
2.
Progress monitor for reduced symptoms and improved
child/youth functioning
3.
Proactive approach to social and emotional needs
4.
Developmentally specific approach
5.
Promotion of healthy relationships
6.
Build capacity to deliver EBPs
http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf
August 27, 2012
Because Minds Matter
13
“…although children who have been maltreated face
immense challenges, they are incredibly resilient. We
also know that even among children who do develop
social-emotional, behavioral, and mental health
problems, healing and recovery are possible. With
the right tools and capacity, child welfare systems can
identify the complex needs of children who have
experienced maltreatment and deliver targeted,
evidence-based services that help young people
overcome the social and emotional impact of
abuse and neglect. By addressing these needs, we
increase the likelihood that children in foster care will
exit to positive, permanent settings, with the skills
and resources they need to be successful in life.”
August 27, 2012
Because Minds Matter
Testimony of Bryan
Samuels, Commissioner,
Administration on
Children, Youth and
Families, to the U.S.
Senate Committee on
Homeland Security and
Governmental Affairs,
Subcommittee on Federal
Financial Management,
Government
Information, Federal
Services, and
International Security,
December 1, 2011.
14
Strengthening Management of
Psychotropic Medications
August 27, 2012
Cross-system
collaboration
Screening and
assessment
Access to
evidence-based
treatments
Informed and
shared decisionmaking
Medication
monitoring
Mental health
expertise
Integrated data
Information
sharing
Youth
engagement and
empowerment
Because Minds Matter
15
Emerging Opportunity: NCINQ
• The National Collaborative for Innovation in Quality Measurement
(NCINQ) is one of 7 AHRQ/CMS Centers of Excellence in
Pediatric Quality Measures Program.
• NCINQ is developing performance measures in a variety of areas,
including care for children in child welfare. Data sources may
include administrative data, health insurance claims, medical
records, and surveys.
• NCINQ is actively seeking State input into these measures. States
are invited to participate in focus groups to inform their
development.
• States are also invited to implement the measures using their data
systems to test their feasibility, with support from NCINQ. Fall
2012 into 2013.
August 27, 2012
Because Minds Matter
16
Moving Forward Together
• Ongoing Enhancement of APSRs
• Upcoming GAO Report
• Engagement of Stakeholders
• Facilitation of Communication for Future
Directions
August 27, 2012
Because Minds Matter
17