1. Using Mental Health Expertise in Psychotropic Medication Monitoring Christopher Bellonci, M.D. Assistant Professor Tufts University School of Medicine cbellonci@tuftsmedicalcenter.org

2. Tufts Study Objectives Through a national study: 1)Examine state policies and best practices regarding psychotropic medication use; 2)Identify promising practices to disseminate to child welfare agencies; and 3)Determine implications for clinical care, research, and policy.

3. Results: Priority Scale of 1-10, with 10 being high Human resources: Medical Directors (n=16; 34%) Mental Health Directors (n=24; 51%) Other specialized mental health staff (n=32; 68%)

4. Use of Mental Health Expertise in an Oversight System 1.Recognition that psychotropic medication use is a systems problem 2.Collaboration among youth-serving organizations and stakeholders 3.Access to up-to-date guidelines on clinical practices 4.Mechanisms for identifying who needs psychotropic medication 5.Informed decision-making/consent and medication monitoring

5. Use of Mental Health Expertise in an Oversight System 6.Involvement of biological parents and youth in decision-making 7.Oversight program for monitoring population trends 8.Presence of a feasible and employable policy/guideline 9.Fiscal, human, and technological resources 10.National approach for psychotropic medication oversight

6. Mental Health Consultation Models External Agencies Internal to Child Welfare Agency Child Welfare Worker Child Welfare Admin- istrator Clinical Encounter Participants (Prescriber, Foster Parent, Youth) Child Welfare Unit with Mental Health Expertise Expert Review Unit (Univer- sity, Other) Court System

7. Questions to Consider What do you want the MH resources to do? What MH resources do you have available? What MH resources do you need (child psychiatrists, psychologists, social workers, nurses, etc…)? Do you want them within CW, contracted to CW from state MH agency, contracted from community or university, etc…? How can you pay for MH resources?