Improving the quality and cost-effectiveness of publicly financed health care
Improving Outcomes for Children Involved in Child Welfare
Addressing physical and behavioral health problems is a critical issue in the child welfare population. As many as two-thirds of children entering foster care have behavioral or emotional problems. Access to physical and behavioral health services for children in foster care varies drastically across the country, with some youth receiving too much and disjointed care and others receiving too little care. Furthermore, Medicaid's costs for physical and behavioral health services for these high-needs children are disproportionately large relative to the population's share of Medicaid enrollment.
The Center for Health Care Strategies (CHCS) worked to improve the delivery of physical and mental health care for children in child welfare through a three-year national collaborative that included nine managed care organizations:
- CareOregon
- Connecticut Behavioral Health Partnership
- Magellan of Florida, Magellan Public Sector Solutions, Magellan Health Services
- The Massachusetts Behavioral Health Partnership
- Mid Rogue, IPA (Oregon)
- Priority Partners MCO (Maryland)
- University of Pittsburgh Medical Center Health Plan (Pennsylvania)
- Volunteer State Health Plan (Tennessee)
- Wraparound Milwaukee (Wisconsin)
These organizations developed and piloted promising approaches to meet the health and behavioral care needs of children and youth in the child welfare system. The project also provided participants with access to expert technical assistance and a peer-learning network.
CareOregon worked to improve medical record documentation of pharmacotherapy for children in the Child Welfare system diagnosed with ADHD and reviewed their poly-pharmaceutical use. Additionally they assured that overall treatment, including psychosocial and pharmaceutical use, was appropriate. CareOregon engaged providers to help families to support therapeutic medication use by providing them with tools to use to appropriately reduce the need for poly-pharmaceutical use. [top]
Connecticut Behavioral Health Partnership and Value Options improved behavioral health treatment for target children and supports for their families. The team worked with Foster Care Clinics in two local areas to examine rates of behavioral health screening and behavioral health referrals among children referred by The Department of Children and Families (DCF). Subsequent interventions with DCF, primary care providers, and managed care organizations focused on improving rates of appropriate behavioral health treatment. [top]
Magellan of Florida provided kinship care families with experienced foster families as mentors to help them negotiate the multiple systems involved with the provision of behavioral health care services to children in the child welfare system and prevent placement disruption related to behavioral health problems. [top]
The Massachusetts Behavioral Health Partnership systematically monitored prescribing patterns of behavioral health care providers and implemented strategies to ensure appropriate use of psychotropic medications. [top]
Mid Rogue, IPA ensured/provided a medical home and continuity of care for children removed from their homes. They also worked to improve coordination of behavioral and physical health care through improved communication among Mid Rogue, the child welfare agency, and foster families. [top]
Priority Partners, MCO and Johns Hopkins HealthCare (JHHC) worked with foster families in order to better assess, coordination, and comprehensive medical and mental health treatment for foster children. A "Coordination of Care Workgroup" was being established with partners from multiple relevant agencies and youth and family representatives. [top]
UPMC for You, Inc. worked to ensure that children coming into foster care are assessed and treated for medical and behavioral health care needs. A process for effectively communicating among primary care providers, behavioral health care providers, child welfare workers, and families was developed to include child welfare workers' access to an electronic health record to support the children's continuity of care. [top]
Volunteer State Health Plan and BCBS of Tennessee worked to increase the use of an electronic "Shared Community Health Record" to provide timely and complete medical information to providers in the VSHP Best Practice network, who are responsible for the child's Medical Home. [top]
Wraparound Milwaukee, MCO implemented systematic communication procedures between Wraparound Milwaukee's child psychiatrists and primary care physicians in the community, particularly those serving children through Federally Qualified Health Centers. They also worked to integrate information related to medical and behavioral health for children in child welfare into their data system, including information related to medications use. [top]