michael w. naylor, m.d. university of illinois at chicago
DESCRIPTION
Psychiatric Consultation in a Psychotropic Medication Oversight Program for Foster Children: The Illinois Model. Michael W. Naylor, M.D. University of Illinois at Chicago Director, Clinical Services in Psychopharmacology. Background. Historical context - PowerPoint PPT PresentationTRANSCRIPT
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Psychiatric Consultation in a Psychotropic Medication
Oversight Program for Foster Children: The Illinois Model
Michael W. Naylor, M.D.University of Illinois at Chicago
Director, Clinical Services in Psychopharmacology
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Background
• Historical context– DCFS challenged by federal courts, DOJ
and ACLU• inadequate casework• chaotic and dangerous placements• substandard care
– Illinois violating constitutional rights of children
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Background
• Historical context– Chicago Tribune 1995 editorial series:
• DCFS called “the worst child welfare system in America…” and “a cruel, indifferent bureaucracy that harms kids.”
• “system of shame”
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Background
• Historical context– Federal court-approved consent decree
(B.H. v Suter, 1991)• DCFS and ACLU agree to collaborate on
system reform plan
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State Context
• Psychotropic medication consent– DCFS Rule 325– Clinicians wishing to start a foster child on
a psychotropic medication must obtain consent from the DCFS Guardian
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State Context
• DCFS Psychotropic Medication Consent Program– Two components:
• Centralized Psychotropic Medication Consent Line
– Office of the DCFS Guardian• Clinical Services in Psychopharmacology
– University of Illinois at Chicago
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State Context
• Centralized Psychotropic Medication Consent Line– Office of the DCFS Guardian
• legal guardian for children committed to the Department
• responsible for providing consent for medical, surgical, and psychiatric treatment
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State Context
• Clinical Services in Psychopharmacology– provide independent review for all
psychotropic medication requests– monitor utilization of psychotropic
medications– provide consultation on particularly
complicated cases
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State Context
• Clinical Services in Psychopharmacology– notify the Guardian where provider patterns
warrant review– conduct training for DCFS, foster parents and
childcare providers on psychotropic medications
– disseminate information regarding new pharmaceutical developments and alerts
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Consent ProcessPrescribing
Clinician
UIC Research Team
UIC Psychiatric Nurse
UIC Psychiatric Consultant MD
UIC Psychiatric Nurse
DCFS Authorized
Agent
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Psychotropic MedicationRequest Form
– name– DCFS ID
Number– date of birth– sex
– race– weight and
height– placement – physician’s
name and specialty
• Demographic information
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Psychotropic MedicationRequest Form
• Clinical information– diagnosis– current medications and dosage– symptoms/rationale– requested medication
• dosage and frequency
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Consultation
• Three main providers of consultation for clinicians treating foster children:– Clinical Services in Psychopharmacology– DocAssist– Consult for Kids
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CSP
Consent
Oversight
Clinical
Prior Authorization
Systemic
Monitoring/QI
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Clinical Services in Psychopharmacology
• Consultation– consent process
• independent review of the appropriateness of the psychotropic medication consent request
• recommend action to DCFS– approve– deny– modify
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Clinical Services in Psychopharmacology
• Consultation– oversight
• formal– high risk prescribers– emergency medication utilization
• informal– feedback from Administrative Case Reviews– concerns expressed by caseworkers, regional nurses,
guardian ad litem, Court Appointed Special Advocates, judges, Office of the DCFS Guardian
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Clinical Services in Psychopharmacology
• Consultation– clinical
• clinical concerns that arise in the course of the independent medication review
• MD:MD• review of consent history• chart review• face-to-face
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Clinical Services in Psychopharmacology
• Consultation– prior authorization
• provided consultation to HFS vis-à-vis prior authorization for antipsychotic medications and stimulants for children
• DCFS consent for a medication serves as prior authorization for foster children
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Clinical Services in Psychopharmacology
• Consultation– systemic
• consult on development of policies, best practice guidelines re: mental health care for foster children
• co-write legislation
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Clinical Services in Psychopharmacology
• Consultation– monitoring/QI
• medication utilization patterns– rate of copharmacy with two or more antipsychotics– rate of polypharmacy by age group
• timeliness of consent process• compliance with Rule 325
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Impact of Consultation
0 20 40 60 80 100
0.00
0.05
0.10
0.15
0.20
Months
% R
eque
sts
ParoxetineFluoxetineOther SSRIs
Paroxetine WarningCSP InterventionBlack Box Warning
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Consultation
• Illinois DocAssist– established through the joint efforts of the
Department of Healthcare and Family Services, the Department of Human Services – Mental Health, and the University of Illinois at Chicago
– funding support by the Illinois Children’s Mental Health Partnership
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Consultation
• Illinois DocAssist– clinical
• quality of treatment for Medicaid funded children with mental illness in the primary care setting
– client – Medicaid funded providers with a focus on primary care
– purpose – improve the identification, diagnosis and treatment of children and youth with mental health issues through consultation, education and referral services
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Consultation
• Consult for Kids Program– established by DCFS to provide primary
care clinicians participating in HealthWorks with resources to evaluate foster children in their care for mental health and behavioral concerns
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Consultation
• Consult for Kids Program– clinical
• address questions and concerns about a foster child’s emotional, interpersonal, behavioral or cognitive problems
– client – primary care providers– purpose – help primary care providers navigate a
challenging child through the child welfare system
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Consultation
• Challenges to effective consultation– “silo-ization”
• duplication of services• lack of coordination
– informing stakeholders of the services– meeting demand for services
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Consultation
“The Curse of Unwelcome Oversight
and Unrequested Consultation.”