10.12 Psychological and Behavioral Health Needs | CWS

The Social Services Case Manager (SSCM) will:

The SSCM will:

The SSCM will:

Psychotropic medications are drugs that affect the central nervous system by changing how the brain processes information. They can alter a person’s mood, thoughts, perceptions, emotions and behaviors. It is important to remember that although medications can play a role in treating several behavioral health disorders and conditions, treatment may also include psychotherapy (also called “talk therapy”) and brain stimulation therapies (less common). In some cases, psychotherapy alone may be the best treatment option. Choosing the right treatment plan should be based on a person’s individual needs and medical situation. Treatment should always be provided under the care of a licensed behavioral health professional.

When children enter care with behavioral health needs that warrant the use of psychotropic medication, the parents are usually aware of the child’s condition. Nevertheless, there should be a discussion with them as well as the child and the caregiver prior to authorizing the use of psychotropic medication for a child in DFCS custody. Even though DFCS may have the legal authority to authorize the use of psychotropic medication as part of a child’s treatment plan, having the support of the parent, child and caregiver will contribute to the success of the treatment plan. Since there may be strong feelings for or against the use of psychotropic medication, skill must be exercised to build a consensus. If no consensus can be reached, respectfully inform all parties that DFCS must take the course of action determined to be in the best interest of the child.

When children are in a Crisis Stabilization Unit (CSU) or Psychiatric Residential Treatment Facility (PRTF), decisions regarding consent for the use of psychotropic medication must be made very quickly to avoid impeding a child’s treatment. Therefore, consent should not be delayed by an inability to locate a parent or an inability to build a consensus with the parent, child and foster caregiver. Ideally, the discussion with the parent, child and caregiver should occur before the child requires in-patient treatment.

When a child enters foster care, it is extremely important to assess the child’s psychological and behavioral health needs. There are various types of behavioral health assessments including Trauma Assessments, Psychological Evaluations, Psychiatric Evaluations, Psychosocial Evaluations, Substance Abuse Evaluation, etc. Each of these assessments must be completed by a licensed behavioral health provider. The Trauma Assessment serves as the baseline assessment for children five years or older entering foster care and can help identify whether other types of assessments are appropriate to meet the needs of a child.

Trauma can affect many aspects of a child’s life and may lead to secondary problems that negatively impact safety, permanency, and well-being (e.g., peer relationships, problems in school, health related problems). The Administration for Children and Families (ACF), a federal agency in the Department of Health and Human Services, has informed state child welfare agencies of the need to implement trauma-focused screening, assessment and treatment for children in foster care. The emotional well-being of our children is of the utmost importance and is directly correlated to their ongoing safety and success of permanency plans. The trauma assessment identifies all forms of traumatic events experienced directly or witnessed by a child to determine the best type of treatment for that specific child. In addition to the trauma history, trauma-specific evidence-based clinical tools assist in identifying the types and severity of symptoms the child is experiencing. Examples of evidence-based, trauma-specific clinical tools include:

The trauma assessment must provide recommendations and actions to be taken by DFCS to coordinate services and meet a child’s needs. Behavioral health providers who conduct a trauma assessment will provide a report which includes:

The inclusion of a trauma assessment as part of the CCFA does not mean there will not be situations in which other specialized assessment (e.g., psychological evaluations, psycho-sexual evaluations, psychiatric evaluations, neuropsychological evaluations, substance abuse assessments, psycho-educational evaluations, etc.) will be warranted. The decision to refer a child for additional assessments must be made on a case-by-case basis in coordination with the CCT after an overall assessment of the child’s needs has been completed. If it is determined that a psychological evaluation is needed, prior authorization must be obtained from Amerigroup for Medicaid to pay for it.

Psychological evaluations are not required for every child who enters care. However, the results of the trauma assessment may recommend a psychological evaluation. If so, the SSCM should collaborate with the Amerigroup CCT to refer a child to a licensed psychologist in-network. Amerigroup must provide prior authorization for any psychological evaluation; otherwise, Medicaid cannot be used to pay for the evaluation. Amerigroup will evaluate the medical necessity for the psychological evaluation based on the needs of the child and information already available. The Amerigroup CCT will coordinate any evaluation deemed necessary. For 24 Hour Emergency Assistance regarding behavioral health or addictive disease services, call 1-800-715-4225.

The DFCS Care Coordination Treatment Unit, formerly known as Placement Resource Operations (PRO), is one of eight units under the Placement and Permanency Section of DFCS. Requests for clinical services from the DFCS Care Coordination Treatment Unit may be submitted to cctu.support@dhs.ga.gov. The goals of the unit include:

The WPAC Unit provides practice support, consultation and quality monitoring of physical and moderate^[1] behavioral health needs of children and youth in foster care. Specific functions of intensive support and monitoring include:

A LIPT should be established on behalf of children in each community. The team may be single or multi-county teams depending upon the size of the community and geographic availability of needed resources. The purpose for the development of the LIPT is to improve and facilitate the coordination of services to children with severe emotional disorders (SEDs) and addictive disease. LIPTs have the following goals:

Georgia law requires permanent membership of the LIPT to include a local representative from each of the following agencies:

In addition to the permanent members, the local interagency committee reviewing the case of a child or adolescent may include, as ad hoc members, the special education administrator of the school district serving the child or adolescent, the parents of the child or adolescent, and caseworkers from any involved agencies.

“High risk” youth regarding behavioral health are those who have been designated as having a severe emotional disturbance or substance use/abuse. This would include:

About one fourth of youth between 10-17 years of age fall into the “moderate risk” category regarding behavioral health. They tend to be experimenters. They commit minor delinquent offenses and occasionally use illicit substances, but not hard drugs. They may also be one year behind in school.

About half of all young people fall into the “low risk” category regarding behavioral health. They do not commit any serious delinquent acts, do not use illicit substances, and are not yet sexually active. A small portion occasionally drink alcohol and a few are a year behind in school because of their birth dates or for developmental reasons. However, their risk for any significant negative consequences is minimal.

When children require short-term, specialized hospitalization services to manage critical or immediate behavioral health needs, it is extremely important that DFCS staff is available and responsive to the hospital and treatment staff providing care to the children. In some cases, family members are not available to participate in treatment and support activities. Consequently, DFCS has the responsibility to fill in the gaps and ensure full engagement in the treatment process. Hospitals are places where children go to receive treatment and must not be viewed as foster care placements. Therefore, discharge planning should begin as soon as a child is admitted to a hospital or treatment facility. DFCS must ensure an appropriate placement option is available upon the child’s release from the hospital so that the transition from the treatment facility to the placement occurs as smoothly as possible. Regardless of what day or time the discharge is scheduled to occur, a child should not be left in a hospital or facility after their treatment needs have been met.

On March 03, 2014, the Georgia Department of Community Health (DCH) transitioned from a standard fee-for-service Medicaid program to a statewide Medicaid Care Management Organization (CMO) through Amerigroup Georgia Managed Care Company. The transition impacted children in DFCS custody and children receiving AA as they became members of a new program called Georgia Families 360˚. The new program is separate from Georgia Families, the general Medicaid program administered by DCH. Georgia Families 360˚ is designed to provide coordinated care across multiple services and focus on the physical, dental, and behavioral health needs of member children. The program is designed to ensure each member has a medical and dental home, access to preventive care screenings, and timely assessments. It also seeks to ensure medical providers adhere to clinical practice guidelines and evidence-based medicine.

Each Georgia Families 360˚ member is assigned to a regional Care Coordination Team with a specified Care Manager. The Amerigroup CCT members are Masters level staff, most whom hold a professional license to practice in their respective field. The Amerigroup CCT completes a Health Risk Screening (HRS) on youth in care to identify medical and/or behavioral health needs. It ensures each child is assigned to a behavioral health services provider as needed. The Amerigroup CCT is responsible for coordinating the health components of the Comprehensive Child and Family Assessment (CCFA), including the initial physical, dental, and trauma assessment.

Care Managers are the primary partner of the SSCM for identifying and making referrals for needed services. Care Managers ensure each youth has an individualized care plan that addresses both physical and behavioral health needs. They work with community agencies to ensure appropriate services are provided. Any services not authorized by the Amerigroup CCT will not be paid for out of Medicaid. Therefore, it is imperative that all behavioral health and developmental care be coordinated with the Amerigroup CCT to avoid any uncovered expenses. If a child is ineligible for Medicaid, then the Department of Behavioral Health and Developmental Disabilities (DBHDD) will provide behavioral health services to the child.