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Children's Services

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This week the Pennsylvania Department of Human Services (DHS) announced several new initiatives to reduce the use of psychotropic medication among our state’s most vulnerable children. Speaking at The Children’s Hospital of Philadelphia, DHS Secretary Ted Dallas reported on the partnership of DHS with the Pennsylvania Chapter of the American Academy of Pediatrics and the Pennsylvania Psychiatric Society. A state-commissioned PolicyLab study that found that in 2012 in Pennsylvania, the use of psychotropic medications was nearly three times higher among 6-18 year olds in foster care than among youth in Medicaid overall. Based on this study and the collaborative effort mentioned above, Pennsylvania has initiated the following:

  • Best practice guidelines are being developed for clinicians regarding comprehensive assessments of behavior and treatment interventions;
  • Managed care organizations will be required to give prior authorization for antipsychotic medications for children;
  • A new electronic dashboard will make it easier for DHS to monitor what medications children are taking and improve care coordination;
  • In April, DHS will open a telephonic child psychiatric consultative service to help prescribing physicians, physician assistants, and nurse practitioners appropriately prescribe psychotropic medication for children; and
  • In July, the department will begin training child welfare caseworkers and caregivers on the appropriate use of psychotropic medication.

“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,” Dallas said, “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.”

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The presentation materials, handouts, and recordings of the February 3 joint meeting of the RCPA Children’s and Mental Health Committees, as well as the Children’s Committee meeting, are now available. Materials include documents relating to the panel presentation on the needs and opportunities in early childhood services, and other documents referenced in the committee meeting discussions.

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Last Friday, at the state’s Act 62 External Work Group meeting, the Office of Mental Health and Substance Abuse Services (OMHSAS) released and reviewed the data collected by HealthChoices contractors during the April 2015 survey of autism spectrum disorder (ASD) service capacity. This point-in-time survey reflects what was at that time the level of ASD service capacity for the delivery of behavior specialist consultant and applied behavior analysis services.

Among the highlights in this data are service access trends as of April 2015, showing:

  • A 19% level of service access delays of more than 31 days, with delays ranging by managed care organizations from 14% to 30% for children that had been accepted, evaluated, and authorized for services.
  • The level and reasons given for staff recruitment challenges, showing a significant level of hiring challenges among providers, with the predominant reasons being the licensure requirements of
    • At least one year of experience involving functional behavior assessments of individuals under 21 years of age; and
    • At least 1,000 hours of in-person clinical experience with individuals with behavioral challenges or experience in a related field with individuals with an ASD.

During review and discussion of the data, OMHSAS Deputy Secretary Marion indicated that OMHSAS will begin to meet with the managed care organizations, to more closely analyze the data, and discuss approaches and solutions to the service access and professional labor pool challenges in provider networks.

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The Department of Human Services/Bureau of Adult Protective Services is offering trainings/webinars for Adult Protective Services. 

Complete online registration at the Survey Monkey LINK below.
Please feel free to share this information with other staff and providers.

With new webinar software we have twice as many logins available and will hopefully be able to accommodate all requests.

Adult Protective Services and Mandatory Reporting Requirements

How: Webinar and In-Person Attendance available
Where: Clothes Tree Building, DGS Complex (former Harrisburg State Hospital Campus)
What: Overview of Act 70, Adult Protective Services Law, eligibility criteria, DHS and Liberty Healthcare Responsibilities; the process for reporting,  mandatory reporting requirements, and statutory definitions.

When:

  • Thursday, February 25 at 1:00 pm
  • Tuesday, March 15 at 10:00 am

Complete the online registration survey at https://www.surveymonkey.com/r/DHS_APS_Training

Information and webinar link will be sent prior to the presentation. Contact Deborah Bender at [email protected] with any questions or concerns.

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On January 27, 2016, a letter was sent to Department of Human Services (DHS) Secretary Ted Dallas, requesting reconsideration of DHS’ decision to raise the minimum age of eligibility for Community HealthChoices (CHC). RCPA was one of more than 35 organizations and individuals that signed this letter of support.

Currently, the minimum age of eligibility for the Attendant Care, Independence, and OBRA waivers is 18. However, the CHC Request for Proposal (RFP) states, “CHC will serve adults age 21 or older who require Medicaid Long-Term Services and Supports (MLTSS) (whether in the community or in private or county nursing facilities)…. and current participants in DHS’ (Office of Long-Term Living) waiver programs who are 18-to 21 years old.” This would change the minimum age for home and community-based services administered by OLTL to age 21.

Concern was noted in the letter of how raising the minimum age of eligibility for CHC will create large gaps in services. Many examples were elaborated on the services that keep young adults in their homes and communities and out of institutional care, including home modifications, vehicle modifications, assistive technology, respite, and residential habilitation. The letter urges DHS to fix this critical problem before the CHC RFP is finalized.

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In an effort to promote “Government that Works,” the Office of Child Development and Early Learning (OCDEL) has made it a priority to integrate early childhood education services, so that providers can offer multiple OCDEL services to families without duplicating paperwork, and families can more easily access the services they need. To lead and promote this approach to improving and streamlining bureaucratic and operational challenges faced by providers and families, OCDEL has produced a short video overview with Deputy Secretary Michelle Figlar.

Providers are also being asked to share their experiences with OCDEL programs to help shape this work. It is critical for the RCPA Children’s Steering Committee and work groups to hear how OCDEL programs work for providers and families. Input from providers of early childhood care will significantly inform and influence this work. For RCPA members, it will be vital that providers of early childhood mental health, behavioral consultation, autism, and pediatric rehabilitation services, that need to be delivered in a coordinated and collaborative manner, help to inform this process. RCPA members who serve young children are encouraged to complete a short survey by Monday, February 8. The survey includes five pages of questions and should take an average of five minutes to complete. For more information, visit the PA Keys website.

OCDEL has made stakeholder engagement one of its priorities to assure high quality services for children and families. For a listing of all open stakeholder engagement opportunities, please visit the PA Keys website.

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The Physical Health Managed Care Organizations (PH-MCOs) serving Pennsylvania’s HealthChoices Medicaid program are now inviting psychiatric service providers to submit a response for the Telephonic Psychiatric Service (TiPS) Request for Proposals (RFP). The PH-MCOs will contract for TiPS that will provide real time telephonic consultative services to primary care providers (PCPs), and other prescribers of psychotropic medications, for children under the age of 21. A TiPS provider is responsible for establishing and maintaining a team of behavioral health professionals who will be available to respond to inquiries from PCPs seeking assistance in providing pediatric behavioral health care. Qualified applicants must have a TiPS staff which includes one full-time equivalent child psychiatrist, one full-time equivalent behavioral health therapist, and one full-time equivalent care coordinator. Now available are the RFP, and supplemental information, including pediatric membership by plan/zone, and a 2014 Health Affairs article on a similar program in Massachusetts. A vendor fair for interested respondents is being held on Tuesday, January 26 in Mechanicsburg. See the RFP for additional details. All questions should be directed to MCO Coalition Consultant, Emily Katz.

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