Experts Share Best Practices for Serving Youth in Florida's Statewide Inpatient Psychiatric Programs
Medicaid supports three out-of-home treatment programs for children and youth with serious emotional disturbance: Therapeutic Foster Care; Therapeutic Group Care; and for those who struggle with severe mental illness and/or emotional problems and require placement in a psychiatric residential setting, they are referred (through a Medicaid Waiver) to one of the 15 Florida Statewide Inpatient Psychiatric Programs (SIPPs). The waiver process allows the State to selectively contract with a limited number of providers and monitor their services thoroughly and consistently.
Before admission, qualified examiners are required to certify that youth referred for SIPP treatment are expected to benefit from residential treatment, and that appropriate treatment in less restrictive settings is not available. SIPP services include crisis intervention; bio-social and or psychiatric evaluation; close monitoring by staff; medication management; individual, family, and group therapy; and connection to community based services. These services are expected to be relatively short-term – six months or less.
To ensure SIPPs provide the most appropriate psychotropic medication management and psychosocial interventions for children and adolescents, a recent meeting held July 15 - 16, 2011 and organized by faculty from the College of Behavioral & Community Sciences (CBCS) and leaders in Florida, brought together experts in psychiatry, nursing, pharmacy, and research to discuss best practices.
During the opening forum, Dr. Bob Constantine from CBCS’s Department of Mental Health Law & Policy provided an overview of the Medicaid Drug Therapy Management Program (MDTMP). The program goal is to improve the quality and efficiency of the prescribing of mental health drugs, and to improve the health outcomes of Medicaid beneficiaries with a mental illness. The MDTMP website offers recent updates on guidelines for children.
Lodi Rohrer, MSPH and Dr. Norin Dollard from the CBCS Department of Child & Family Studies presented data on the mental health diagnoses and psychotropic medications for youth at admission and discharge from SIPPs in 2010. According to their data, 669 youth were admitted in 2010 with the most common diagnoses of mood and affective disorders, disruptive behavior disorders and attention deficit hyperactivity disorder (ADHD). At the time of discharge, the two most common categories of medications prescribed (n=817) were atypical antipsychotics, used to treat multiple psychiatric conditions, and medications used to treat ADHD and mood disorders, such as bipolar disorders and depression.
On the second day, Drs. Peter Jensen and Lisa Hunter-Romanelli from the REACH Institute facilitated small group exercises designed to solve real-world problems and foster implementation of evidence-based practices in inpatient and residential child psychiatric settings. Discussions were based on the Mental Health Practices in Child Welfare Guidelines Toolkit (pdf).
The meeting concluded with a presentation by Dr. Bhagirathy Sahasranaman about the SIPP process from a community provider perspective, including goals of treatment and challenges faced by providers and families. Dr. Sahasranaman is currently Medical Director at Henderson Behavioral Health Center, which is the oldest and largest behavioral healthcare provider in Broward County, Florida.
“A highlight of the expert panel meeting for me was the facilitators’ ability to create an atmosphere where the SIPP child psychiatrists felt comfortable discussing both effective strategies and challenges in playing a leadership role in the implementation of evidence-based therapeutic and psychopharmacologic interventions,” said Dr. Mary Armstrong, an invited guest from CFS, and long-time evaluator of Florida’s Medicaid programs. “One result of this open climate was a sharing of specific techniques and activities that promote effective practices. My hope is that we can continue this sharing and dialogue through web-supported strategies.”
Meeting Partners:
USF College of Behavioral & Community Sciences
The Florida Medicaid Drug Therapy Management Program for Behavioral Health (MDTMP)
Agency for Health Care Administration
Florida Department of Children & Families’ Substance Abuse and Mental Health Program Office