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Foster Family-based Treatment Association 11 th Annual Public Policy Institute

Foster Family-based Treatment Association 11 th Annual Public Policy Institute. Services, Gaps and Successes Kristin Kroeger Ptakowski Senior Deputy Executive Director Director of Government Affairs & Clinical Practice American Academy of Child and Adolescent Psychiatry May 6, 2013.

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Foster Family-based Treatment Association 11 th Annual Public Policy Institute

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  1. Foster Family-based Treatment Association11th Annual Public Policy Institute Services, Gaps and Successes Kristin Kroeger Ptakowski Senior Deputy Executive Director Director of Government Affairs & Clinical Practice American Academy of Child and Adolescent Psychiatry May 6, 2013

  2. Services • 60-85% of the children being served by the child welfare system meet criteria for a psychiatric diagnosis. • A wide range of service options must be available • Early identification, early intervention, planning for the long-term, normalizing lifestyles, and enhancing family unity and capabilities promote a healthier quality of life for those served. • Providing a full array of community-based services, care providers in partnership with the individual and family are able to customize plans to most effectively help the child and family reach their goals

  3. Services • CASII/ECSII • assesses the service intensity needs of children and adolescents presenting with psychiatric, substance use and/or developmental concerns. • takes into account family factors, cultural considerations, community supports, environmental concerns, medical and behavioral health co morbidities, safety concerns and responses to interventions - across 6 domains • Designed to facilitate an integrated service response by multiple systems (mental health, juvenile justice, child welfare etc. )

  4. Continuum of Services + Coordinated Care = Stability

  5. Treatment options • A comprehensive diagnostic assessment including biopsychosocial formulation in collaboration with the youth and the family. • A comprehensive assessment must include options for support and treatment that extend beyond just prescribing medications • Psychosocial Treatments – what types and how often are they used and reimbursed? • Lack of providers, training in EBP and reimbursement

  6. Treatment Options • Psychopharmacology • in Foster care and Medicaid population • Multiple medications • Stimulants, antidepressants • Antipsychotics – 2 fold increase from 2001-2010; represents largest expenditure for Medicaid in 2007 • BBW? • Why? • Increased recognition of MI • Expanded research and evidence base • Marketing to prescribers and consumers

  7. Additional Considerations • Most children taking medications did not receive psychosocial or medication follow up • PDL • FDA approval • Kids under 5 • Polypharmacy ***medication alone is rarely an adequate or appropriate intervention for children and adolescents with complex psychiatric disorders***

  8. Workforce • Children’s MH workforce is scarce • There are approximately 8,300 practicing child and adolescent psychiatrists in the country, of which 83 percent report their primary type of practice as direct patient care • severe maldistribution of child and adolescent psychiatric services in the U.S., The ratio of child and adolescent psychiatrists per 100,000 youth ranges from 4.9 in Idaho to 56.9 in the District of Columbia with a national average of 12.9 (AMA, 2012). • The Council on Graduate Medical Education (1990) reported that the nation would need more than 30,000 child and adolescent psychiatrists by 2000. • Other non MH clinicians with specific pediatric training/certification varies • 1,621 students per school psychologist

  9. Training • Little training in mental health for Primary Care/Pediatric residencies • CAP and other MH training programs are over extended and some do not have time for all of the therapeutic treatments

  10. Ways to Improve Access and Education • Collaborative Care Models • 28 states have programs to facilitate consultation between primary care providers and child psychiatrists • Partnership Access Line (PAL) – Washington State • Washington state’s Second Opinions program, psychiatrists review Medicaid psychotropic prescriptions that exceed certain safety thresholds. • Found consultations are cost-effective and resulted in an increase in referrals for psychosocial therapy and a decrease in prescribing of antipsychotic medications • MCPAP – • Gone from 8 - 63% PCP felt they were able to meet their patients needs

  11. Ways to Improve Access and Education • Services Research • NIMH covers most of the research • Mostly looking at medication and effects on the disorders • Some combined med and psychosocial • Some translational research going on • Training providers on EBP • Engage family, youth and all providers • Development of quality measures

  12. AACAP Education Efforts • Guidelines for States on Psychotropic Medication Oversight Programs (2005) • Guide for Service Providers on Psychotropic Medications (2012) • Education at our Annual Meeting • Listserv for AACAP members working in MH/CW state systems • Practice Parameter (coming soon)

  13. THANK YOU! kkroeger@aacap.org www.aacap.org

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