1. IMPROVING THE USE OF PSYCHOTROPIC MEDICATIONS IN CHILDREN AND YOUTH IN FOSTER CARE Oregon CHCS team Advisory Committee June 15, 2013

2. PROPOSED STRATEGIES AND NEXT STEPS ► INFORMATION ► CONSENT ► CLINICAL PRACTICE

3. Information ► Youth in foster care (YOUTH ADVOCACY GROUPS)  What to expect in foster care and rights ► Need a pamphlet to adopt ► Need a method to distribute and help comprehend with a supportive adult (or peer for older youth).  Review of Psychiatric Medications ► Alternatives to guide to healthy choices pamphlet ► Need a method to distribute and help comprehend with a supportive adult (or peer for older youth).

4. Information ► Foster Parents:  Trauma training ► Involve the AMH trauma sub committee ► Involve PSU training  Establish a curriculum  Establish a method of consistent training  CPS training ► Work with OHSU CPS advisory committee to develop curriculum and strategy for implementation  Medication / health care training ► In place, need to improve process and materials

5. Information ► DHS Staff  Trauma training ► Involve the AMH trauma sub committee ► Involve PSU training  Establish a curriculum  Establish a method of consistent training  CPS training ► Work with OHSU CPS advisory committee to develop curriculum and strategy for implementation  Medication / health care training ► In place, need to improve process and materials ► Implement consultation and second opinion strategies.

6. Information ► Providers: ► Dashboards ► Trauma informed clinics and clinicians  AMH trauma sub committee ► Evidence Based Guidelines  OPAL K guidelines reviewed by OCCAP  Process for provider buy-in  Data can help providers manage their programs

7. Consent ► Current :  Clinician PARC (informs) with child and possibly the caregiver  Clinician fax form 173C to DHS  Caregiver notifies caseworker of prescription  Caseworker reviews information with supervisor to authorize beginning of medication ► Proposed new process  Clinician PARC (informs) with child and caregiver  Caregiver provides information to caseworker/supervisor (verbal and written 173C)  Supervisor and caseworker reviews information (department protocols)  Caseworker notifies caregiver when and if to proceed with medication regime Subject to Legal review

8. Clinical Practice ► Disseminate Prescribing Flags  Poly pharmacy greater than 4  Medication without an assessment  Medication without a diagnosis  Medication for children under six  Antipsychotics ► Under six ► Multiple ► Longer than 6 months without a diagnosis

9. Clinical Practice ► Oversight  Initiate a process for oversight of requests for new antipsychotic for any child and any psychotropic for a child under the age of 6 ► Initiate a process for providing and receiving feedback  Dashboards to providers  Dashboards to CCOs TED  When flags triggered ► Communicate with provider ► Peer review through DHS MD or via OPAL K

10. Next Steps ► Training and education workgroup Treatment of Aggression workgroup ► Legal and practical review of consent process ► Trauma training: coordination with CSAC Trauma Committee initiatives. PSU foster parent training program ► Building CPS capacity to serve Foster families ► Building connections with CCOs ► What happens if OPAL K is a no go?