2. 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

3. 37% of the population has 2 or more

7. 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

8. Mean Health Expenditures for Children in Medicaid Using Behavioral Health Services, 2005 (what? Why it’s 2014?!!)

9. Behavioral Health Utilization for Traditional vs
Behavioral Health Utilization for Traditional vs. Promising Services among Children in Medicaid, 2005* STATEMENT OF VALUES

11. Help CW resource appropriately: Don’t pay for Grey

12. 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!)

13. 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:
Administration of health risk assessment instrument (e.g., health hazard appraisal)
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.

14. 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.
ƒCreate 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.
ƒInclude evidence-based practices that are relevant for the child welfare population in the array of covered services and supports.
ƒMonitor Medicaid claims data against the foster care population and measure service utilization and outcomes for this group of children

15. 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.

16. 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