Overview
Children did not always receive recommended psychosocial services in conjunction with their prescriptions for psychotropic medications. Specifically, 17 of the 118 (14%) children who were prescribed at least one psychotropic medication in our FFS sample received no therapy during our audit period in conjunction with their psychotropic medications, according to MMIS data. In addition, 8 of the 50 (16%) children who were prescribed at least one psychotropic medication in our MCO sample receive no therapy during the audit period in conjunction with their psychotropic medications, according to MMIS data.
We also found that an additional 24 of the 118 children who were prescribed at least one psychotropic medication in our FFS sample and an additional 10 of the 50 children who were prescribed at least one psychotropic medication in our MCO sample did not receive therapy in conjunction with their psychotropic medications for over four months.
Additionally, we could not determine the frequency that children in residential facilities received therapy based on MMIS data, because therapy is not billed separately in a residential facility, as it was with the issues above.
Below is a table that summarizes the three issues we found related to children not receiving psychosocial services.
| Issue | Number of Children from FFS Sample | Number of Children from MCO Sample |
|---|---|---|
| No therapy at all | 17 out of 118 | 8 out of 50 |
| Did not receive therapy for over four months | 24 out of 118 | 10 out of 50 |
| Unable to determine frequency of therapy visits | 10 out of 118 | 3 out of 50 |
If children do not receive the recommended therapy and psychosocial services with psychotropic medications, treatment effectiveness can be negatively affected. Further DCF cannot monitor the effectiveness of these medications and cannot identify and mitigate any side effects that these children may experience. For example, 28 children from both our samples had suicidal ideations.
Authoritative Guidance
According to AACAP’s 2015 Recommendations about the Use of Psychotropic Medications for Children and Adolescents Involved in Child-Serving Systems,
All youth with complex behavioral needs, including youth in foster care, should receive a combination of evidence-based psychosocial interventions and psychotropic medication when indicated, not just psychotropic medication alone.
While DCF is not required to follow these recommendations, we consider them a best practice.
Reasons for Issues
DCF does not have sufficient monitoring controls in place to ensure that children in its protective custody who are prescribed psychotropic medications receive psychosocial services.
Recommendation
DCF should ensure that all children in its protective custody who are prescribed psychotropic medications receive psychosocial services and DCF should implement sufficient monitoring controls to ensure that these services are provided and that the efficacy of these services is evaluated.
Auditee’s Response
DCF agrees with this recommendation, in that we will continue to improve monitoring controls to document psychosocial services are provided.
DCF agrees that we are not consistent with documenting services in iFN when children receive psychosocial services at school and through Family Support Services. Many children receive services via Family Support Services (“FSS”) which is covered by Title IV E and will not be captured in MMIS claims. There are children who are stable on the ADHD medications, for example, who receive school supports through an IEP or 504, which also may not be clear in iFN. That child may not need additional outside support such as individual therapy.
Auditor’s Reply
We agree that DCF cannot rely solely on MassHealth claims to determine whether children in DCF custody received recommended psychosocial services. As stated in our reply above, we did not recommend that DCF do so. We instead recommend that DCF should ensure that all children in its protective custody who are prescribed psychotropic medications receive psychosocial services by implementing sufficient monitoring controls. Based on its response, DCF is addressing our concerns in this area.
| Date published: | November 7, 2024 |
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