The context Child welfare New World order Safety, Permanency, Well-Being Parameters and imperatives Business rules and procurement history New World order Performance or results based contracting Data driven practice The science of well-being ACES
37% of the population has 2 or more
Child Welfare is the state agency tasked with attending to this: Emotional Abuse Physical Abuse Sexual Abuse Neglect Emotional Neglect Physical Neglect Household Dysfunction Mother Treated Violently Household Substance Abuse Household Mental Illness Parental Separation or Divorce Incarcerated Household Member
Mean Health Expenditures for Children in Medicaid Using Behavioral Health Services, 2005 (what? Why 2005..it’s 2014?!!)
Behavioral Health Utilization for Traditional vs Behavioral Health Utilization for Traditional vs. Promising Services among Children in Medicaid, 2005* STATEMENT OF VALUES
http://www.chcs.org/usr_doc/Making_Medicaid_Work.pdf
Help CW resource appropriately: Don’t pay for Grey
Get Shoulder to Shoulder: MH, CW, and MA to improve care National examples Find Partners Resources Use the data you have (it’s the best there is!)
Bind Screening to EPSDT: SC example The South Carolina Department of Health and Human Services (SCDHHS) is expanding the availability of behavioral health pediatric screening tools and providing guidance on the utilization of these tools. Best practice indicates that standardized screenings of this type are recommended to be done during the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) visits or as dictated by clinical need. This recommendation is in alignment with the American Academy of Pediatrics (AAP) recommendations regarding screening and surveillance of family and social environment for risk factors and mental health screening of children and adolescents in primary care settings. Effective January 1, 2013, SCDHHS updated its policy to cover Current Procedural Terminology (CPT) Codes: 99420 - Administration of health risk assessment instrument (e.g., health hazard appraisal) 96110 - Developmental screening with interpretation per standardized instrument The code can be used for a standardized screening tool to assess for trauma exposure and/or to update the child and family’s psychosocial history. Standardized screening tools can be used to assess for such issues as postpartum depression, parental distress, domestic violence, parental substance abuse or mental illness, youth and family social support, grief, and loss.
ADVICE FROM MICHIGAN Cover a broad array of services and supports under the state Medicaid plan to ensure that they are adequately financed and sustainable. Create an administrative structure at the state level, with both a core operational team and a policy leadership team across child welfare, Medicaid, behavioral health, and other key agencies. Demonstrate with data that the Medicaid behavioral health system can deliver the services needed by the child welfare population and achieve good outcomes. Incorporate behavioral health staff at the front line to help child welfare staff assess the need for behavioral health intervention, determine appropriate services, and link with providers. Incorporate child welfare liaison staff with expertise in Medicaid to facilitate enrollment when a child enters foster care, ensure that children are linked with primary care providers, and provide feedback to policy makers about needed improvements in access to physical health and behavioral health services. Ensure that the partnership includes state and local stakeholders, both of which are needed to implement strategies to improve services, particularly in a county-run system. Include evidence-based practices that are relevant for the child welfare population in the array of covered services and supports. Monitor Medicaid claims data against the foster care population and measure service utilization and outcomes for this group of children http://www.chcs.org/usr_doc/Making_Medicaid_Work.pdf
Quality Binds: some ideas • Reduction in the number of children with a clinical level of need receiving no services; • Increase in the number of children receiving evidence-based screening, assessment and treatment; • Reduction in the use of “deep-end” services, including emergency department visits for acute crisis stabilization and residential treatment for extended periods; • Reduction in the use of psychotropic medication prescribing practices that do not conform with the American Academy of Child and Adolescent Psychiatrists Practice Parameters; • Reduction in the number of psychotropic medications prescribed and a reduction in the total number of youth with prescriptions for psychotropic medications; • Reduction in the use of foster home placements to include re-entries into care; • Net increase of Medicaid-participating EBP-trained clinicians; and • Improvements in child functioning across well-being domains and reductions in trauma symptoms.
A Conversation Starter In Foster Care Rank Not in Foster Care Abilify 1 Amoxil Concerta 2 Ventolin Catapres 3 Zithromax Risperdal 4 Polymox Seroquel 5 Proventil Adderall 6 Singulair Zoloft 7 Keflex Vyvanse 8 Augmentin Depakote 9 Mycostatin 10