1. Thomas I. Mackie, MA, MPH Tufts Clinical and Translational Science Institute Tufts University Boston, MA

2.  Child welfare agency, acting as in loco parentis or “in place of the parent,” assumes legal responsibilities and functions of the parent when child enters custody  Informed consent and shared decision-making:  A process, both at time of initiation and ongoing, by which the child welfare agency or its designee consents to the use of mental health services, including psychotropic medications, for children in custody.

3.  Consent: The process of a:  Clinician providing information to the child, family, and state- assigned decision maker about the treatment options, targeted symptoms, and course of treatment; and  State-assigned decision-maker provides an informed decision regarding which treatments are in the best interest of the child. (Romanelli et al, 2009)  Assent: A 3-part process that includes the youth:  Understanding (to the best of his/her developmental abilities) treatment options,  Voluntarily choosing to undergo treatment options, and  Communicating this choice. (Bartholome, 1995)

4.  2 national studies:  2009-2010 (Charles H. Hood Foundation) ▪ Examine state policies and best practices and disseminate to child welfare agencies  2011-2012 (William T. Grant Foundation) ▪ Identify types of information states using to develop plans ▪ Investigate monitoring approaches  1 state study:  2010-2011 (Court Improvement Program Fund) ▪ Conduct a multi-stakeholder examination of the informed consent approach employed by a state child welfare agency.

5. INFORMAUTHORIZENOTIFYMAKE (Leslie et al., 2010)

7. Access to Up- to-date Information and Training Mental Health Consultant with Child Welfare Experience Contracted Academic Medical Unit with Mental Health Expertise (Leslie et al., 2010)

8.  American Academy of Child and Adolescent Psychiatry (2011). AACAP position statement on oversight of psychotropic medication use for children in state custody: A best principles guideline. Available at: http://www.aacap.org/galleries/PracticeInformation/FosterCare_BestPrinciples_FINAL.pdf. http://www.aacap.org/galleries/PracticeInformation/FosterCare_BestPrinciples_FINAL.pdf  Bartholome, W. G. (1995). Informed consent, parental permission, and assent in pediatric practice. Pediatrics, 96(5), 981-982.  Leslie, L. K., Mackie, T. I., Dawson, E. H., Bellonci, C., Schoonover, D. R., Rodday, A. M. et al. (2010). Multi-state study on psychotropic medication oversight in foster care. Available at: http://www.tuftsctsi.org/About-Us/News/Archive/Landmark-Report-on-Psychotropic-Medication- Oversight-in-Foster-Care.aspx http://www.tuftsctsi.org/About-Us/News/Archive/Landmark-Report-on-Psychotropic-Medication- Oversight-in-Foster-Care.aspx  Leslie, L. K., Mackie, T. I., Mulé, C., Wade, R., Rubin, C. L., Dawson, E. H. et al. (2011). Examination of the Rogers process for youth in the custody of the Massachusetts Department of Children and Families. Study report and appendix. Available at: http://www.tuftsctsi.org/About-Us/News/Archive/Examination-of- the-Rogers-Process.aspxhttp://www.tuftsctsi.org/About-Us/News/Archive/Examination-of- the-Rogers-Process.aspx  Romanelli, L. H., Landsverk, J., Levitt, J. M., Leslie, L. K., Hurley, M. M., Bellonci, C., et al. Child Welfare- Mental Health Best Practices Group. (2009). Best practices for mental health in child welfare: Screening, assessment, and treatment guidelines. [Consensus Development Conference Practice Guideline]. Child Welfare, 88(1), 163-188.

9.  Lesley Siegel, MD Chief of Psychiatry Connecticut Department of Children and Families  Kathy Teutsch, RN, LMSW, MMSW Division Administrator for Medical Services Texas Department of Family and Protective Services  James. F. Bush, MD, FACP Wyoming Medicaid Medical Officer Governor, Wyoming Chapter ACP Wyoming Department of Health

10. INFORMAUTHORIZENOTIFYMAKE Youth; Worker; Foster family; PCP; Centralized Medication Consent Unit Shared decision-making CMCU Child Psychiatrist or Advanced Practice Nurse CMCU enters information in SACWIS and emails worker, regional nurse, and regional clinical manager of details Connecticut Youth, Child Welfare Agency, Caregiver, Regional Nurse Consultants Court most often designates child welfare to consent; 16 or 17 year old youth consent Foster care agency, child welfare agency, caregiver Texas Youth; Worker; Caregivers; PCP; Primary Care Support Program (PAL) Initial psychiatric evaluation & recommend required treatment plan at MDT hearing Contracted psychiatrist provides second opinion when indicated by parameters/ “thresholds” Multiple stake-holders involved in team meetings, including caseworker, caregiver, Gaurdian ad-Litem Wyoming Psychotropic Medication Utilization Review conducted by STAR health

11.  Please let us know your name and agency.  If the question is directed to a particular panel member, please indicate this.