A Tuesday, February 10 congressional briefing entitled, Reducing Overreliance on Psychotropics and Increasing Use of Psychosocial Treatments for Children and Youth in Foster Care focused attention on the need for stronger treatment options for children in foster care. The briefing was cosponsored by First Focus, Voice for Adoption and the State Policy Advocacy Reform Center. As part of the discussion, Associate Commissioner for the Children’s Bureau, Joo Yeun Chang discussed the recent proposals included in the Administration budget to Congress to address the challenge.
The Administration is proposing funding for a joint project by the Administration for Children and Families (ACF) and the Centers for Medicare & Medicaid Services (CMS) to address the over use of psychotropic medications by promoting evidenced-based interventions. Under the budget request, for each of the next five years, $50 million a year would be provided through ACF and matched by $100 million a year through Medicaid. Through competitive demonstration projects, states would receive performance-based Medicaid incentive payments to improve care coordination. This would be paired with ACF funding to states that support state efforts to build provider and systems capacity. The capacity building through ACF would include: enhancing child welfare workforce; using reliable screening and assessment tools; better coordination between child welfare and Medicaid especially Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT); and training for foster parents, adoptive parents, guardians, and judges.
A series of the speakers focused on the needs of children in foster care with one of the common themes being the need to understand that one size or one solution will not fit all children in care and that there is no simple requirement to address the needs of children in foster care. Instead the best approaches include expanding the availability of non-pharmacological behavioral therapy through collaboration between Medicaid and the child welfare agency, improving the management in the use of data to identify at risk populations, targeting quality improvement efforts to youth most in need, and the need to develop and strengthen state level prescribing-monitoring guidelines. Underlying all of it is the need to have permanency for children in therapy so that there is a placement of reunification, adoption or kinship care.
The panelists provided different perspectives, comments by Kathleen Newnan, Co-director of Policy Lab of Children’s Hospital of Philadelphia provided an overview of the foster care population. Kevin George, Well-Being Program Manager from the state of Oregon, discussed what that state has done and the progress they have made in reducing the reliance of medications. Michael Naylor from the University of Illinois, Department of Psychiatry, talked about the needs of children in care and juvenile justice and highlighted the fact that many of these children are in need of the therapy and treatment services because of the underlying conditions including poor prenatal care, abuse and neglect, impaired attachment due to removal from the family of origin and the general impact of poverty on children.
Briefing sponsor Senator Tom Carper (D-DE) offered remarks that argued that if we were to make progress then we needed to address the underlying problems these children face.
