Download Webinar Part 1: Psychotropic Medication Use Among Children Known to Child Welfare

Psychotropic Medication Use among
Children Known to Child Welfare
ISSUES AND ACTIVITIES
Bryan Samuels, Commissioner
Administration on Children, Youth and Families
Risk of Social-Emotional Problems and Use of Psychotropic
Medications among Children Known to CPS, by Age Group
Percent of Children Reported to Child Protective Services
Risk of Social-Emotional Problems
Current Use of Psychotropic Medication
70%
57.2%
60%
49.5%
50%
40%
30%
20%
20.5%
19.6%
16.0%
10%
0%
1.5%
1.5-5 Years
6-10 Years
Age Group
11-17 Years
Data Source: National Survey of Child and Adolescent Well-Being II (NSCAW II). NSCAW II is a Congressionally required study sponsored by the Office of Planning, Research and
Evaluation, Administration for Children and Families (ACF), U.S. Department of Health and Human Services (DHHS).
Risk of social-emotional problems was defined as scores in the clinical range on any of the following standardized measures: Internalizing, Externalizing or Total Problems scales
of the Child Behavior Checklist (CBCL: administered for children 1.5 to 18 years old), Youth Self Report (YSR; administered to children 11 years old and older), or the Teacher
Report From (TRF; administered for children 6 to 18 years old); the Child Depression Inventory (CDI; administered to children 7 years old and older); or the PTSD section
Intrusive Experiences and Dissociation subscales of the Trauma Symptoms Checklist (administered to children 8 years old and older).
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Risk of Social-Emotional Problems and Use of Psychotropic
Medications among Children Known to CPS, 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
Group Home or
Residential Home
Data Source: National Survey of Child and Adolescent Well-Being II (NSCAW II). NSCAW II is a Congressionally required study sponsored by the Office of Planning, Research
and Evaluation, Administration for Children and Families (ACF), U.S. Department of Health and Human Services (DHHS).
Risk of social-emotional problems was defined as scores in the clinical range on any of the following standardized measures: Internalizing, Externalizing or Total Problems
scales of the Child Behavior Checklist (CBCL: administered for children 1.5 to 18 years old), Youth Self Report (YSR; administered to children 11 years old and older), or the
Teacher Report From (TRF; administered for children 6 to 18 years old); the Child Depression Inventory (CDI; administered to children 7 years old and older); or the PTSD
section Intrusive Experiences and Dissociation subscales of the Trauma Symptoms Checklist (administered to children 8 years old and older).
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Psychotropic Medication Use and Polypharmacy among Children
Known to CPS, by Age Group
Percent of Children in Reported to Child Protective Services
Currently taking ONE psychotropic medication
Currently taking TWO OR MORE psychotropic medications
25%
20%
19.6%
15%
16.0%
TWO OR MORE
10%
TWO OR MORE
5%
1.5%
0%
1.5-5 Years
6-10 Years
11-17 Years
Age Group
Data Source: National Survey of Child and Adolescent Well-Being II (NSCAW II). NSCAW II is a Congressionally required study sponsored by the Office of Planning, Research and
Evaluation, Administration for Children and Families (ACF), U.S. Department of Health and Human Services (DHHS).
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Percent of Children in Foster Care Receiving
Psychotropic Medications
Most Common Mental Health Diagnoses among Children in Foster
Care Receiving Psychotropic Medications
40%
36%
34%
30%
21%
20%
17%
10%
0%
ADHD
Depression
Conduct/Oppositional
Defiant Disorder
Bipolar Disorder
Mental Health Diagnosis
Zito, JM; et al. (2008). Psychotropic medication patterns among youth in foster care. Pediatrics. 121(1): e157.
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HHS Workgroup
ACF convened an interagency workgroup to explore the use of
psychotropic medication among children in foster care and to develop
a commensurate response.
• Workgroup members represented 6 agencies:
• Agency for Healthcare Research and • Food and Drug Administration
Quality (AHRQ)
(FDA)
• Administration for Children and
Families (ACF)
• National Institute of Mental Health
(NIMH)
• Center for Medicare & Medicaid
Services (CMS)
• Substance Abuse and Mental Health
Administration (SAMHSA)
• Activities included reviewing published articles and reports,
convening a meeting of experts, gathering existing guidelines and
best practices and developing a plan for future activities
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Goals of Action Steps
• State child welfare agencies will know which psychotropic
medications are being used and their effectiveness/safety
• States will develop strategies for monitoring and oversight of
psychotropic medication
• Child welfare, Medicaid, and mental health entities at the State
level will collaborate on State Plan development and
implementation
• Better data that captures the mental health diagnoses and
psychotropic medication use among children in foster care
• To the extent possible, States will be able to provide a wider
array of supports/services to children with mental health and
behavioral problems
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Action Steps (1 of 2)
• Disseminate materials, including articles, studies, and guidelines
outlining the issue of psychotropic medication use among
children in foster care and explaining best practices in oversight
and monitoring; via listserves, Child Welfare Information
Gateway, webinars, meetings, etc.
• Identify and communicate strategies for ensuring continuous
Medicaid eligibility for children as they move in and out of foster
care and to new placements
• Identify existing Federal policies (e.g. ACA electronic health
records provision) that can be leveraged to ensure appropriate
prescription of psychotropic medication
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Action Steps (2 of 2)
• Develop and disseminate Information Memorandum and
Program Instruction detailing best practices in oversight and
monitoring and expectations for State Plan submissions
• Convene Summit of State child welfare, mental health, and
Medicaid authorities to enhance collaboration around response
to behavioral and mental health needs of children in foster care
• Review and approve State Health Care Plans; provide technical
assistance as needed
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Common Concerns & Evidence-Based Interventions (1 of 2)
Diagnosis/Concern/Activity
Evidence-Based Interventions
Identification of Mental Health
and Behavioral Health Issues
SCREENING
TOOLS
Screening Activities
•
•
•
•
Strengths and Difficulties Questionnaire
Pediatric Symptom Checklist
Child Behavior Checklist Behavior Assessment for Children
Etc.
Most Common Mental Health Diagnoses for Children in Foster Care
Conduct Disorder/Oppositional
Defiant Disorder
•
•
•
•
•
•
Attention Deficit Hyperactivity
Disorder
• Children’s Summer Treatment Program
Major Depression
• Adolescents Coping with Depression
• Cognitive Behavioral Therapy for Adolescent Depression
• Alternative for Families-Cognitive Behavioral Therapy (AF-CBT, formerly
known as Abuse-Focused-Cognitive Behavioral Therapy)
• Etc.
Post-Traumatic Stress Disorder
• See Next Slide
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Brief Strategic Family Therapy (BSFT)
Familias Unidas
Multisystemic Therapy (MST)
Parent-Child Interaction Therapy (PCIT)
Strengthening Families Program (SFP)
Early Risers – Skills for Success
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Common Concerns & Evidence-Based Interventions (2 of 2)
Diagnosis/Concern/Activity
Evidence-Based Interventions
Trauma
Actionable trauma symptoms
→ Posttraumatic Stress Disorder
• Cognitive Behavioral Intervention for Trauma in Schools (CBITS)
• Combined Parent-Child Cognitive Behavioral Therapy for Families at Risk for
Child Physical Abuse
• Prolonged Exposure Therapy
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
• SPARCS: Structured Psychotherapy for Adolescents Responding to Chronic
Stress
• TARGET-A: Trauma Affect Regulation: Guidelines for Education and
Therapy for Adolescents and Pre-Adolescents
• AF-CBT: Alternatives for Families/Abuse Focused Cognitive Behavioral
Therapy
• ARC: Attachment, self-regulation, and competency
• PCIT: Parent-Child Interaction Therapy
• Child Parent Psychotherapy
Behavioral Concerns
Internalizing/Externalizing
Behaviors: Behavioral Problems
and Relational Concerns
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•
•
•
•
•
•
•
•
Brief Strategic Family Therapy
Child Parent Psychotherapy
Functional Family Therapy
Nurturing Parenting Programs (NPP)
Parenting Wisely
Promoting Alternative Thinking Strategies
Triple P
Incredible Years
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Summary
&
Future Directions
• Bryan Samuels, Commissioner
Administration on Children, Youth and Families
Questions and Answers
Save the Dates
Part 2: January 30, 2012 3:30pm – 5:00pm ET
Part 3: February 13, 2012 3:30pm – 5:00pm ET
Resources
• GAO Report: HHS Guidance Could Help States Improve Oversight of
Psychotropic Prescriptions
http://www.gao.gov/products/GAO-12-270T
• Congressional testimony of Commissioner Bryan Samuels on reauthorization of
Promoting Safe and Stable Families:
http://waysandmeans.house.gov/UploadedFiles/Bryan_Samuels_Testimony.pdf
• Congressional testimony of Commissioner Bryan Samuels on psychotropic
medication use for children in foster care:
http://hsgac.senate.gov/public/index.cfm?FuseAction=Files.View&FileStore_id
=ceac2364-56ba-41e3-a301-149233540771
• NSCAW II Baseline Report: Children’s Services
http://www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/nscaw2
_baseline.pdf
http://www.childwelfare.gov