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Pennsylvania Reduces Psychotropic Medication Use Among Medicaid-Enrolled Foster Children - DHS, CHOP Announce Changes to Further Reduce Inappropriate Use

Philadelphia, PA – The Department of Human Services (DHS) and PolicyLab at The Children’s Hospital of Philadelphia (CHOP) today announced several new initiatives that will further reduce the use of psychotropic medication among Medicaid-enrolled Pennsylvania children.

Over two years, DHS was able to realize a 75 percent reduction in psychotropic medication use for children served through the Medicaid fee-for-service program administered by DHS. These decreases were achieved by requiring prior authorization from DHS prior to prescribing these powerful medications for children. 

“The inappropriate use of these powerful medications for children in the foster care system compounds the trauma experienced by children who have been the victim of abuse and neglect and is simply unacceptable,” said DHS Secretary Ted Dallas. “The recommendations and analysis from PolicyLab provide Pennsylvania with an invaluable roadmap to improve the safety and quality of life for foster children served by the Medicaid system.” 

A state-commissioned PolicyLab study found that in 2012, the use of psychotropic medications was nearly three times higher among 6-18 year olds in foster care than among youth in Medicaid overall (prescribed at 43 percent versus 16 percent).

“Our research points to the importance of investing in non-pharmacological behavioral health interventions and evidence-based treatments for childhood trauma,” said Dr. David Rubin, CHOP Pediatrician and PolicyLab Director. “Alternative solutions should be used in addition to medications, and in some cases, in place of medications.”

In response to PolicyLab’s research and analysis, DHS and the Administrative Office of Pennsylvania Courts convened workgroups, including a Psychotropic Medication Subcommittee that offered a series of recommendations to DHS in June 2015. The recommendations and DHS’ response to the recommendations can be found here

"We’re proud of our long-standing commitment to research and our partnerships with the commonwealth,” said Doug Hock, Executive Vice President and Chief Operating Officer at CHOP. “It’s rewarding to see DHS and CHOP working together regarding psychotropic medication prescribing practices for children.”

DHS announced the following additional steps today to further reduce the use of psychotropic drugs among children in the foster care system:

  • Implemented prior authorization for all physical-health managed care organizations (PH-MCOs). PH-MCOs serves nearly 98 percent of the children in the foster care system. DHS worked with all MCOs in the Medicaid system to implement consistent policies regarding the authorization and reauthorization of antipsychotic medications. The new prior authorization policies mirror the changes that proved to be a vital part of the policies that reduced the use of psychotropic drugs in the Medicaid fee-for service program by 75 percent over two years and was finalized in January. DHS will continue to monitor prescribing patterns of psychotropic medications by PH-MCOs every six months;
  • Developed best practice guidelines for primary care physicians and psychiatrists. Working in partnership with the Pennsylvania Chapter of the American Academy of Pediatrics and the Pennsylvania Psychiatric Society, DHS created best practice guidelines regarding comprehensive assessments of behavior and treatment interventions; and
  • Deployed an electronic dashboard to improve care coordination for foster care children.

The electronic dashboard will allow state and county child welfare officials to monitor progress in reducing the inappropriate use of anti-psychotic and psychotropic medications for foster children in out-of-home placements and ensure children’s medical needs are met. The electronic dashboard will be used to monitor the use of antipsychotics in children and adolescents and their associated physical and behavioral health care services. The six-month pilot program began in February and includes eight counties. The pilot will be completed by August 15.

“We commend DHS for taking these important steps for our most vulnerable children, and we’re pleased to be partnered with them,” said Kathleen Noonan, member of the psychotropic subcommittee of the DHS Committee on Foster Care and Health and Associate Vice President of Board Relations at CHOP. “Addressing this issue is crucial to meeting the needs of the children we serve."

DHS also announced the following initiatives, which will be implemented in the next few months:

  • Creating a telephonic child psychiatric consultative service in April 2016. The new telephone hotline will assist prescribing physicians, physician assistants, and certified registered nurse practitioners to appropriately prescribe psychotropic medication for children. In August, the Department will add statistics about the use of the phone service to its electronic dashboard; and
  • Adopting a new psychotropic training module in July 2016. The Department is working with the University of Pittsburgh’s Child Welfare Resource Center to create a new training module regarding the appropriate use of psychotropic medication. When complete, the training will be offered to child welfare caseworkers, and birth, kindship, and foster parents.

“While we are making progress, there is still a great deal of work to be done,” Dallas said. “We must continue to build on this progress to ensure that children in the foster care system have the same opportunities that all Pennsylvania children enjoy no matter where they grow up.”

MEDIA CONTACT:    Kait Gillis, DHS, 717-425-7606

                                    Ashley Moore, CHOP, 215-630-4683

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