IMPROVING THE USE OF PSYCHOTROPIC MEDICATIONS IN CHILDREN AND YOUTH IN FOSTER CARE Oregon CHCS team...

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?