OVERVIEW OF STATE APPROACHES TO OVERSIGHT AND MONITORING OF PSYCHOTROPIC MEDICATIONSJoyce Pfennig, Ph.D.Kate Stepleton, MSW

Annual Progress and Services Reports (APSRs)

Child and Family Services Improvement and Innovation Act of 2011

Required Components of Psychotropic Oversight and Monitoring Plan

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

Required Components of Psychotropic Oversight and Monitoring Plan

Required Components of Psychotropic Oversight and Monitoring Plan

Required Components of Psychotropic Oversight and Monitoring Plan

Synthesis of State Plans

Caveats

Screening, Assessment and Treatment

Informed and Shared Decision-Making

Medication Monitoring

Mental Health Expertise and Consultation

Mechanisms for Sharing Accurate and Up-To-Date Information

Common Approaches and Innovative Ideas

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 agency-level protocols

Few States described procedures related to ALL FIVE components

Widespread adoption of AACAP guidelines

Screening, Assessment and Treatment Many States are using EPSDT as screening

and assessment mechanism Several States ensure that a trauma-

informed assessment is completed At entry Within 30 days of placement Within 45 days of placement

Integration with other screening and assessment activities

Innovative: Use of telemedicine – required initial screening completed over the phone using validated screening tools

Informed Consent and Shared Decision-Making Approaches emphasized assent as well

as consent – youth involvement in decision-making

Several States give birth parent decision-making authority until parental rights have been terminated

Some States describe protocols for contesting decisions

Medication Monitoring

Mix of retrospective and prospective approaches Many States are using red flags to trigger reviews

Prescription of antipsychotic to child under 6 Prescription of 2 or more antipsychotics for more

than 60 days Many States use Drug Utilization Review (DUR)

Programs to monitor psychotropic medication use Feedback reports to providers to address

prescribing that does not align with best practices

Direct links between SACWIS and Medicaid information system facilitate monitoring

Mental Health Expertise and Consultation Innovative: Trauma consultation in complex

cases Trauma specialist as part of review team for

consultation in cases where multiple medication changes have not resulted in improvements in symptoms

Trauma-informed technical assistance hotlines for providers

Innovative: Creative solutions to deal with shortage areas (provider consultation lines)

Mechanisms for Sharing Accurate and Up-To-Date Information Several States described use of medical

passports or use of electronic health records that incorporate behavioral health

Use of interagency linkages – such as MOUs for the development of shared records

Tools to ensure informed consent Guide and tools for youth Resources for foster parents Trainings for caseworkers