Figure 1
The title of Figure 1 is Statewide Number and Proportion of Children in Foster Care With Prescriptions for Psychotropic Medications Paid for by Medi-Cal During Fiscal Year 2014–15.
Figure 1 depicts the statewide number and proportion of children in foster care with psychotropic medication prescriptions paid by Medi-Cal during fiscal year 2014-15. The left side of the figure is a pie chart showing that 79,166 children in foster care statewide in fiscal year 2014-15, of which 9,317 (12 percent) had at least one Medi-Cal paid prescription for psychotropic medications. The right side of the figure is a second pie chart showing that Medi-Cal paid for 95,748 prescriptions for psychotropic medications to foster children in the same year. Of these prescriptions, 34,586 (36 percent) were for antidepressants, 33,303 (35%) were for antipsychotics, and 25,109 (26 percent) were for stimulants. The remaining 3 percent of prescriptions were for mood stabilizers and antianxiety medications.
Figure 2
The title of Figure 2 is A Child in Foster Care’s Path to Mental Health Services in California.
Figure 2 depicts the channels through which children enter foster care and the types of entities providing mental health care to foster children. Children can enter the foster care system through one of two channels. The actions of adults can lead children to enter the foster care system through child welfare departments, while children’s own actions may lead them to enter foster care through county probation departments.
Foster children can then be placed in out-of-home care, such as a relative’s home, a foster family home, or a group home.
Once placed in out-of-home care, foster children can access mental health care services through four types of entities. Within Medi-Cal, mental health plans can provide services to foster children with “moderate to severe” mental health needs, and either managed care plans or the state’s fee-for-service Medi-Cal plan can provide services to foster children with “mild to moderate” mental health needs . Outside of Medi-cal, providers such as community health centers, community-based organizations, free clinics, or with individual providers paid for by county child welfare departments can provide services to foster children with varying mental health needs.
Figure 3
The title of Figure 3 is Psychotropic Medication Oversight of Children in Foster Care.
Figure 3 is a flow chart summarizing the oversight of psychotropic medications prescribed to children in foster care. The key participants in the process are the foster child, the foster child’s caregiver, a prescribing physician, a pharmacist, and county staff. A caregiver generally works with a county social worker or a public health nurse to coordinate the foster child’s health care services, which can include medical appointments with a physician to evaluate the need for psychotropic medications. If a physician prescribes psychotropic medications for a foster child, the physician must submit an authorization request for court approval. County coordinators include social workers, probation officers, public health nurses or other county staff who coordinate gathering necessary documents to provide to the courts. The courts may approve or deny the request, or delegate authority to administer psychotropic medications to the foster child’s parents. If the court authorizes the request, the county coordinators then forward the authorization to the foster child’s caregivers. While the court authorization process is taking place, the physician can submit the prescription to a pharmacy electronically or manually through the foster child’s caregiver. In certain situations, the pharmacist must receive approval of a treatment authorization request from the Department of Health Care Services before dispensing psychotropic medications. The pharmacist then dispenses the psychotropic medication to the caregiver. After receiving either court or parental approval, the caregiver can then administer the medication for the foster child.
Figure 4
The title of Figure 4 is Flow of Information to Update the California Department of Social Services’ Child Welfare Services/Case Management System and to Populate Health and Education Passports for Children in Foster Care.
Figure 4 is a flow chart summarizing how a foster child’s Health and Education Passport (passport) is updated with new information. A foster child’s caregiver should have a hardcopy passport, which is created from the California Department of Social Services’ Child Welfare Services/Case Management System (data system). At each healthcare appointment, the caregiver should provide the passport to the provider, who should then manually update the passport’s information and return it to the caregiver. The caregiver should then forward the updated passport to the foster child’s social worker or probation officer, who in turn should forward the updated passport to a public health nurse. The public health nurse is responsible for entering the passport’s new information into the data system so that an updated passport can be provided to the caregiver.
Figure 5
The title of Figure 5 is Gaps in the State’s Data Related to the Prescription of Psychotropic Medications to Children in Foster Care.
Figure 5 is a graphic summarizing the gaps in the State’s data related to psychotropic medications prescribed to foster children. The California Department of Social Services’ Child Welfare Services/Case Management System should contain information about foster children’s court authorizations or parental consents for the use of psychotropic medications and foster children’s psychosocial services. The Department of Health Care Services’ Medi-Cal data systems should contain information about paid Medi-Cal claims for psychotropic medication prescriptions and psychosocial services provided to foster children. Together, the information from the data systems for these two departments comprises the State’s data for psychotropic medications and psychosocial services. However, other health care providers can provide psychotropic medication prescriptions and psychosocial services to foster children that Medi-Cal does not reimburse. Information from these providers can exist outside of the State’s data systems, which from the State’s perspective, results in incomplete information regarding foster children’s psychotropic medications and psychosocial services.