1. © NCYL 0 Addressing the Over- Medication of Foster Youth What can we learn from state initiatives? March 15, 2016 Nathan Kamps-Hughes, Policy Researcher

2. © NCYL 1

3. 2 “At one point I was taking 4 different medications at the same time. This involved taking a total of 12 pills a day, 6 in the morning and 6 at night. As a result of taking these drugs I experienced weight gain, an irregular heartbeat. I failed classes because I couldn’t stay awake.”

4. © NCYL 3 Psychotropics Overview  Foster children are being prescribed psychotropics at rates 2.7 to 4.5 higher than non-foster youth (GAO Report 2011).  In California  Nearly 25% of youth in foster care are receiving psychotropics.  56% of CA foster youth in group homes are receiving psychotropics.  50% of foster children on psychotropics are receiving antipsychotics

5. © NCYL 4 Financial and Human Costs  Health Risks  Side effects  Chronic physical disabilities resulting from long- term psychotropic use  Financial Costs  Reimbursement rates for psychotropic prescriptions billed to Medi-Cal  Treatment of long-term psychotropic-related disabilities

6. © NCYL 5 What other states are doing to address the problem  Data Collection Mechanisms  Prior Authorization Processes  Second Opinion/Specialist Consultation  Provider Outreach, Feedback & Education  Enhancement of Psychosocial Interventions

7. © NCYL 6 Potential Data Indicators Type of Data CollectedWhere It Is Being Collected Number of Youth in Foster Care Receiving Psych Meds Florida, Illinois, Indiana, Maryland, Michigan, Ohio, New York, Vermont, Washington Polypharmacy Measures Florida, Illinois, Indiana, Michigan, Ohio, New York, Vermont, Washington Co-Pharmacy Measures Florida, Illinois, Indiana, Michigan, Ohio, Vermont, Washington Metabolic Monitoring Measures Illinois, New York, Maryland, Ohio Dosage Rates Florida, Illinois, Indiana, Maryland, Michigan, Virginia, Washington Prescription Rates By Age Florida, Illinois, Indiana, Maryland, Michigan, Ohio, Vermont, Washington Provision of Non-Pharma, Psychosocial First- Line Interventions Ohio, Vermont, Washington Emergency Medication Prescription Rates Illinois Drug Indication based on DSM Diagnosis Indiana, Maryland, Michigan, Virginia, Washington

8. © NCYL 7 What other states are doing to address the problem  Data Collection Mechanisms  Prior Authorization Processes  Second Opinion/Specialist Consultation  Provider Outreach, Feedback & Education  Enhancement of Psychosocial Interventions

9. © NCYL 8 State-Level Successes  Data Collection Mechanisms  New York has experienced a 25% reduction in antipsychotic polypharmacy  Ohio has demonstrated a 25% reduction in antipsychotic prescriptions to children under 6, antipsychotic co-pharmacy, and psychotropic polypharmacy  Second Opinion/Specialist Consultation  Washington state has seen a 53% reduction in high-dose prescriptions, a 23% reduction in psychotropic prescriptions among children under 5, and an annual savings of 1.2 million.

10. © NCYL 9 Recommendations Develop thorough data collection, analysis, and dissemination processes. Use this data to inform provider outreach and education programs, as well as triggers for specialist consultation/second opinions. Questions to consider 1.Who are the prescribers? 2.What resources do they need to prescribe appropriately? 3.How will these resources be provided and who will provide them?

11. © NCYL 10 Recommendations (Continued) Develop prior authorization, second opinion, and provider outreach processes independent of data collection mechanisms Identify creative and cost-effective means to expand access to and utility of psychosocial interventions among foster youth. Upcoming webinar on 3-24

12. © NCYL 11 California’s Approach State Workgroup Efforts 2012-Current Clinical, Data/Tech, Youth Family Education Legislative Package 2015 SB 238 (Mitchell) SB 319 (Beall) SB 484 (Beall) SB 253 (Monning) Legislative Package 2016 SB 1174 (McGuire) SB 1291 (Beall)

13. © NCYL 12

14. © NCYL 13 SB 1174 (McGuire) Scope of Package Oakland Tribune “The legislation may not be enough. But it’s a good start, even though it steers clear of imposing requirements directly on doctors who prescribe the drugs to foster kids.” ~Oakland Tribune Editorial

15. © NCYL 14 SB 1291 (Beall) Scope of Package Governing Magazine “The biggest challenge is how you increase the use of evidence-based therapies for kids in addition to the monitoring strategies” ~Shadi Houshyar, First Focus

16. © NCYL 15 California’s Approach State Workgroup Efforts 2012-Current Clinical, Data/Tech, Youth Family Education Legislative Package 2015 SB 238 (Mitchell) SB 319 (Beall) SB 484 (Beall) SB 253 (Monning) Legislative Package 2016 SB 1174 (McGuire) SB 1291 (Beall)

17. © NCYL 16 Additional Resources For additional resources, go to: http://youthlaw.org/issues/sp ecial-projects/psychdrugs- action/

18. © NCYL 17 Questions & Comments

19. © NCYL 18 For more information contact.... Anna Johnson, MPP ajohnson@youthlaw.org (510) 699-6567ajohnson@youthlaw.org ©NCYL 2016