In 2009, after years of taking a cocktail of psychotropic drugs including escitalopram, lisdexamfetamine dimesylate and fluoxetine/olanzapine, Gabriel Meyers took his own life in his Florida foster home. He was 7 years old.
Across the country, children living in foster care are given psychotropic medication at higher rates than their non-foster peers. A 2013 report estimates that 37 percent of children in the foster care system are on psychotropic medications; some states reported prescription rates as high as 52 percent of the foster population, compared to 4 percent of the general youth population. Approximately 20 percent of foster children on psychotropic medication are taking more than one prescription concurrently, and many of those drugs, like fluoxetine/olanzapine, are not intended for children. Several of the medications come with warnings concerning suicidal ideation.
These prescriptions are only part of the problem. Since many of these children do not have permanent residences, they may also be missing a sustained doctor-patient relationship with a primary care provider or behavioral health specialist who would understand their history and monitor their treatments. A pediatrician who sees the child infrequently or who may be seeing the child for the first time may not be fully aware of the patient’s current situation, his or her behavioral health history or current medication regimen.
“We found that there are a number of factors that contribute to potential medication-related problems among foster kids that needed to be addressed,” said Lauren Megargell, Pharm.D., Director of Drug Therapy Management (DTM) Programs & Outcomes for PerformRx. Megargell and the DTM team identified, through research and firsthand evidence while providing DTM services, a number of hurdles to providing care to the foster population: incomplete health records, inconsistent continuity of treatment, and a shortage of behavioral health specialists.
They also found some startling statistics: their research showed that Children in foster care were 4.5 times more likely to be prescribed psychotropic drugs and were often prescribed multiple drugs in the same year or simultaneously. “We were seeing patients who should not have been on these therapies in the first place,” Megargell said.
Working with its sister company PerformCare, a behavioral health managed care organization (MCO), PerformRx implemented a four-step management pilot to help address these issues for its members in Louisiana. Under this program, PerformRx first identifies cases where psychiatrist input is needed, and works with PerformCare’s Chief Medical Officer and Medical Informatics department to develop a comprehensive clinical profile of the identified members. Next, PerformCare coordinates a behavioral health consultation with the network medical director of AmeriHealth Caritas Louisiana. The third step is to determine, on a case-by-case basis, if and how the recommendation should be enacted, such as a referral to intensive care management or a consultation with the prescriber to discuss the patient’s case. Finally, the new course of action is implemented, and the patient’s therapy is changed, discontinued or maintained as appropriate, or the patient may be referred to a specialist for further consultation.
“This process was developed to ensure that these vulnerable members receive the care they need,” Dr. Cheryll Bowers-Stephens, Chief Medical Officer for PerformCare, said. “Each step was designed to put the members’ needs first. By connecting prescribers, primary caregivers and behavioral health professionals, we ensure there is a greater continuity of care with fewer chances for gaps or miscommunications. We aim to ensure that these members do not fall through the cracks.”
PerformRx’s foster care DTM program launched in September 2014, and in November, it was nominated for a 2014 eValue8 Innovations Awards by the National Business Coalition of Health. “The response from patients, providers, and the industry has been very encouraging,” Megargell said. “There is definite room in this population for improvement and education, and everyone we have spoken to wants to learn. We all want the same thing: to ensure that these children are getting the best care.”
Kyle Richardson is a copywriter for PerformRx. Before joining the company in 2014, he worked for 10 years covering business, technology, marketing and design for various publications. He is based in Philadelphia.