State of Texas Access Reform (Texas STAR) Health Program, www.fostercaretx.com/welcome-to-star-healthy, is a managed care plan for children and young adults who have aged out of the foster care system. The case titled “Statewide Managed Care Plan for Foster Care Children Features Care Coordination and a Central Database Leading to Improved Access and Mental Health Treatment” is featured in the AHRQ Innovations site http://innovations.ahrq.gov.
Children in the foster care system typically face a number of challenges that can negatively affect their physical, mental, and behavioral health. Frequent transitions make it difficult to maintain complete medical records for providers to use to identify the children’s health needs and for providers and children to understand the appropriate use of medications, especially psychotropic drugs.
In addition to medical and behavioral health services through Medicaid, STAR Health offers care coordination services, connections to community-based services, performs psychotropic drug utilization reviews, and helps caseworkers and foster patients understand the impact of trauma on children in the system.
If the Department of Family and Protective Services (DFPS) www.dfps.state.tx.us caseworkers need assistance with challenging cases, they can contact one of seven DFPS regional specialists who can offer more specific clinical advice.
In complex cases, the DFPS caseworker, service manager, specialist, and foster parents or facility caseworker, can hold telephone conference calls to coordinate care. A number of services not covered by Medicaid are provided such as explaining program benefits, arranging transportation to appointments, and setting up telemedicine consultations.
Children in foster care often have symptoms when they look back on past traumatic events that can mimic psychiatric disorders and can result in difficulties with attachment, mood regulation, behavioral control, plus other areas of functioning which may complicate diagnoses. As a result, children in foster care may be prescribed psychotropic medications inappropriately.
To remedy the problem, STAR Health behavioral health service managers conduct preliminary screenings on identified cases in which psychotropic medication regimens appear to be outside parameters.
After the case is reviewed and if indicated, the case is forwarded to a child psychiatry consultant for a formal review and then forwarded for peer-to-peer consultation with the prescribing physician. The child’s case is then tracked by STAR Health to ensure that the child’s psychotropic medication regimen is in compliance with the parameters.
To track additional medical information, the Health Passport database funded with $4 million from HHS, allows online access to medical histories. Information is automatically updated with data from providers and foster care caseworkers. It is also used by providers to identify health needs and to assess the appropriateness of care including psychotropic drug use.
As a result of the actions taken, the program has improved access to care over time and in comparison to national measures, has generated higher follow-up rates after mental illness hospitalization as compared to national rates. This has reduced the use of psychotropic drugs and polypharmacy (concurrent use of five or more medications) among foster care children.
For more information, email Rebecca Alejandro STAR Health Program Specialist Texas HHSC at rebecca.alejandro@hhsc.state.tx.us.