Early Childhood Mental Health Consultation: An Evaluation Toolkit
Mental Health Consultation within State Child Agency
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P.K. Leebens, 2012 Mental Health Consultation within State Child Agency Patricia K. Leebens, MD Clinical Assistant Professor Yale Child Study Center Former Director of Psychiatry Department of Children & Families State of Connecticut
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Mental Health Consultation within State Child Agency. Patricia K. Leebens, MD Clinical Assistant Professor Yale Child Study Center Former Director of Psychiatry Department of Children & Families State of Connecticut. Conflict of Interest. None. Overview of Presentation. - PowerPoint PPT Presentation
Transcript of Mental Health Consultation within State Child Agency
P.K. Leebens, 2012
Mental Health Consultation within State
Child AgencyPatricia K. Leebens, MDClinical Assistant Professor
Yale Child Study CenterFormer Director of Psychiatry
Department of Children & FamiliesState of Connecticut
P.K. Leebens, 2012
Conflict of Interest
None
P.K. Leebens, 2012
Overview of Presentation
Background Information of Connecticut Department of Children & Families
Behavioral Health Resources within DCF
Evolution of Psychotropic Medication Oversight and Mental Health Consultation with Foster Children
Pros and Cons of Role of Child Psychiatry Chief Within State Child Agency
P.K. Leebens, 2012
Educational Objectives Increase awareness of policy
issues unique to psychiatric consultation with children in state care
Become familiar with AACAP Position Statement on Oversight of Psychotropic Medication Use for Children in State Custody: A Best Principles Guideline
P.K. Leebens, 2012
Educational Objectives Increase understanding of process to
establish a centralized psychotropic medication consent process and psychiatric consultation and medication oversight process within a state children’s agency
Increase knowledge of role of child psychiatrist working within a state agency, including pros and cons
P.K. Leebens, 2012
Connecticut Department of Children & Families (DCF)
Consolidated State Agency for Children’s Services with Four Mandated Areas: Child Welfare, Juvenile Justice, Behavioral Health, Prevention Services
Operated under Federal Consent Decrees (“Juan F” and “Emily J” ) since 1991 after suits by ACLU
93,000 Hotline calls/year; 6800 substantiated DCF provides services for 36,000 children/yr DCF legal guardian for 5000 children/youth
P.K. Leebens, 2012
Behavioral Health Resources: Important Focus at DCF
Centralized Administration---Directors of Psychiatry (child psychiatrist), Medicine (pediatrician), Behavioral Health (PhD), Licensing of Mental Health Services (LCSW), Substance Abuse (LCSW), Juvenile Services (PhD), Child Welfare (LCSW), Prevention (PhD)
Regional Support---Regional Medical Director (child psychiatrist), LCSW, Mental Health Program Director
Juvenile Services--- Connecticut Juvenile Training School (child psychiatrist and pediatrician full-time)
Psychiatric Hospital---Albert J. Solnit Psychiatric Center (8 child psychiatrists; Yale Child Study Center Training Site)
P.K. Leebens, 2012
DCF Director of Psychiatry Not a political appointment -- Manager
(DCF MD’s unionized -- Local #1199) Consultant -- Child Fatality Review; Foster
Parent “Exception” Committee; individual case consultation; Training Academy; Medical Review Board & Institutional Review Board; CJTS & Al Solnit Center; inservices with regional nurses; leadership meetings
Mental Health Liaison -- “I’ll do that.” Oversees---Centralized Medication Consent
Unit (CMCU), Psychotropic Medication Advisory Committee (PMAC), and Regional Medical Directors
P.K. Leebens, 2012
Evolution of Increased Mental Health Consultation and Psychotropic
Medication Oversight October, 1999 -- Dr. Leebens hired as
DCF Director of Psychiatry – an “empty” position from 1992 to 1999. Quickly apparent that : Oversight of mental health needs of children
in state care was inadequate. Psychotropic medication use for children in
state care was excessive with little medical oversight.
Medication permission process was lengthy, confusing, and not medically informed.
P.K. Leebens, 2012
Evolution of Increased Mental Health Consultation and Psychotropic
Medication Oversight 2000 – Statewide Advisory
Committee Psychotropic Medication Advisory
Committee (PMAC) meets monthly; minutes public Volunteer members, public and private
sector: APRN’s, child psychiatrists, pediatricians, clinical pharmacists, parents, Medicaid and policy wonks
Headed by DCF Director of Psychiatry Review “best practices” for evaluation and
treatment of foster care children, and psychotropic medication monitoring and consent process
P.K. Leebens, 2012
Evolution of Increased Mental Health Consultation and
Psychotropic Medication Oversight
2001-2002 DCF Director of Psychiatry participated in the development of AACAP Position Statement on Oversight of Psychotropic Medication Use for Children in State Custody.
Main goal of position paper to improve psychiatric consultation and mental health care of children in state care, as well as medication oversight.
http://www.aacap.org/galleries/PracticeInformation/FosterCare_BestPrinciples_FINAL.pdf
P.K. Leebens, 2012
Evolution of Psychotropic Medication Oversight via Consultation
with Legislature 2003 DCF Legislative Liaison contacts Dr.
Leebens regarding proposed legislation to appoint a committee of legislators to oversee use of psychotropic medications with DCF children in state custody. (Yikes!)
Dr. Leebens and legislative liaison consulted with legislator to inform her about PMAC’s work and AACAP Guidelines.
Dr. Leebens and legislator propose new statute.
P.K. Leebens, 2012
Mental Health Consultation with Legislature – Impact on Public
Policy
2004 – Passage of Public Act No. 04-238 DCF shall within available resources and with
the assistance of the University of CT Health Center:
Establish guidelines for the use and management of psychotropic medications with children and youth in the care of DCF, and
Establish and maintain a database to track the use of psychotropic medications with children and youth committed to the care of DCF
P.K. Leebens, 2012
Evolution of Increased Mental Health Consultation and
Psychotropic Medication Oversight
2005 PMAC drafts practice guidelines, medication monitoring protocol, and medication permission process DCF Chief of Behavioral Health gets
commitment from legislature for $1.2 million to set up psychotropic consultation and oversight process
Request for Proposals process results in 2 unacceptable submissions
Behavioral Health drafts internal proposal
P.K. Leebens, 2012
Evolution of Increased Mental Health Consultation and
Psychotropic Medication Oversight
2007 – Under DCF Medical Director Janet Williams, statewide implementation of new Centralized Medication Consent Unit (CMCU) Centralized to handle all state-wide requests
by fax, phone, or email; manned by MD’s and APRN’s
Phone consultation often centerpiece of process
Response within 12 to 24 hours Provider education and child safety
paramount Med link data collected and aggregated
P.K. Leebens, 2012
DCF Psychotropic Medication Oversight
Materials Available at www.dcf.ct.gov Psychotropic Medication Treatment
Guidelines for children in state care Psychotropic Medication Protocol for
Laboratory Studies and Maximum Dosing
DCF Approved Medication List DCF 465 – Request for Psychotropic
Medication Consent Form . . . And more
P.K. Leebens, 2012
Additional Helpful Guidelines
A Guide for Community Child Serving Agencies on Psychotropic Medications for Children and Adolescents found on the AACAP website:
www.aacap.org/galleries/PracticeInformation/Psychopharm_in_SOC_Feb_2012.pdf
P.K. Leebens, 2012
Pros of Work as Child Psychiatrist Within State
Agency Statewide mandate to serve the needs
of children increases power of advocacy Access to expertise within and outside
of agency (statewide and nationally) Work is varied, challenging, with
opportunities to have positive impact on many children and families in need
Our training well-suited for complex “family” system issues in state government
P.K. Leebens, 2012
Cons of Work as Child Psychiatrist Within State
Agency Can be co-opted by political forces which
demand your sole allegiance to the state agency rather than to children and families that we serve
Commissioner political appointment – new governor may mean new direction to state agency
Can be professionally “contaminated” by ill-will against state agency
May have budgetary limitations which compromise your effectiveness and/or your professional standards
P.K. Leebens, 2012
Suggestions for Improved Effectiveness as State
Administrator Keep your eye on the prize: Improved
care for children and families that you serve.
Practice transparency in what you do and advocate.
Be collegial and respectful of other disciplines.
Know your field and stay connected to colleagues in other states, the private sector, med schools, and professional societies.
Slow and steady wins the race.
P.K. Leebens, 2012
Special Thanks: Lesley Siegel, MD, current DCF
Director of Psychiatry Janet Williams, MD, now deceased,
former DCF Director of Psychiatry Aurele Kamm, APRN, retired, tireless
developer of Central Med Consent Unit
Mike Naylor, MD – mentor and guide
P.K. Leebens, 2012
Contact InformationPatricia K. Leebens, MD
Consulting Child and Adolescent Psychiatrist
Family & Children’s Aid, Inc. 80 West Street
Danbury, CT [email protected]
203-748-5689 x104
