IMPROVING THE USE OF PSYCHOTROPIC MEDICATIONS IN CHILDREN AND YOUTH

IN FOSTER CARE

Oregon CHCS team Advisory Committee

June 15, 2013

PROPOSED STRATEGIES AND NEXT STEPS

►INFORMATION►CONSENT►CLINICAL PRACTICE

Information

►Youth in foster care (YOUTH ADVOCACY GROUPS) What to expect in foster care and rights

►Need a pamphlet to adopt ►Need a method to distribute and help

comprehend with a supportive adult (or peer for older youth).

Review of Psychiatric Medications►Alternatives to guide to healthy choices pamphlet►Need a method to distribute and help

comprehend with a supportive adult (or peer for older youth).

Information

►Foster Parents: Trauma training

►Involve the AMH trauma sub committee ►Involve PSU training

Establish a curriculum Establish a method of consistent training

CPS training►Work with OHSU CPS advisory committee to

develop curriculum and strategy for implementation

Medication / health care training►In place, need to improve process and materials

Information

►DHS Staff Trauma training

►Involve the AMH trauma sub committee ►Involve PSU training

Establish a curriculum Establish a method of consistent training

CPS training►Work with OHSU CPS advisory committee to

develop curriculum and strategy for implementation

Medication / health care training►In place, need to improve process and materials►Implement consultation and second opinion

strategies.

Information

►Providers:►Dashboards►Trauma informed clinics and clinicians

AMH trauma sub committee

►Evidence Based Guidelines OPAL K guidelines reviewed by OCCAP Process for provider buy-in Data can help providers manage their programs

Consent ► Current:

Clinician PARC (informs) with child and possibly the caregiver

Clinician fax form 173C to DHS Caregiver notifies caseworker of prescription Caseworker reviews information with supervisor to

authorize beginning of medication► Proposed new process

Clinician PARC (informs) with child and caregiver Caregiver provides information to

caseworker/supervisor (verbal and written 173C) Supervisor and caseworker reviews information

(department protocols) Caseworker notifies caregiver when and if to proceed

with medication regime

Subject to Legal review

Clinical Practice

►Disseminate Prescribing Flags Poly pharmacy greater than 4 Medication without an assessment Medication without a diagnosis Medication for children under six Antipsychotics

►Under six►Multiple►Longer than 6 months without a diagnosis

Clinical Practice

►Oversight Initiate a process for oversight of requests

for new antipsychotic for any child and any psychotropic for a child under the age of 6►Initiate a process for providing and receiving

feedback Dashboards to providers Dashboards to CCOs TED When flags triggered

►Communicate with provider►Peer review through DHS MD or via OPAL K

Next Steps

►Training and education workgroup Treatment of Aggression workgroup

►Legal and practical review of consent process►Trauma training: coordination with CSAC

Trauma Committee initiatives. PSU foster parent training program

►Building CPS capacity to serve Foster families►Building connections with CCOs►What happens if OPAL K is a no go?