Best Practice Network

We get a fax or email as soon as children enter Department of Children's Services (DCS) custody. At that time, children and adolescents who aren't officially eligible for Medicaid get immediate coverage through TennCareSelect for 45 days. Those who are already enrolled in a managed care organization health plan will keep their current coverage until we get an eligibility file from the Division of TennCare.

Children and teens must have a medical screening exam within 72 hours of entering DCS custody. The purpose of the 72-hour screening is to identify, treat and provide caregivers with education about a child's acute or chronic medical or behavioral health conditions.

They should then have an EPSDT checkup within 30 days. The exam performed within the first 72 hours may serve as the EPSDT exam if it contains all necessary components. Following these exams, children and teens should continue getting preventive services according to the Bright Futures/American Academy of Pediatrics Periodicity Schedule.

Previously, most kids and adolescents in state custody got their initial and subsequent EPSDT screenings at local health departments. To help promote continuity of care, PCPs can now perform the 72-hour initial exam, 30-day EPSDT exam and any subsequent EPSDT screenings. If the PCP isn't available, children may visit a local health department for these services.

DCS facilitates the informed consent process for children and teens in state custody so they get appropriate health care. This means a child's DCS representative may consent to care or delegate consent to the person who cares for the child daily (foster parents, legal guardians). For more information about informed consent, see the Provider Administration Manual or related DCS policy.

Psychotropic medications affect how the brain works and cause changes in mood, awareness, thoughts and feelings. They're typically prescribed to children and teens to manage conditions such as attention-deficit/hyperactivity disorder, anxiety, depression and mood disorders.

Consider these tips when treating young patients with psychotropic medications:

• Develop a plan for short- and long-term monitoring. Consider the type of medication, risk of side effects, the patient's need for ongoing psychosocial support and other factors when developing this plan. Keep in mind children taking an antipsychotic medication need annual metabolic testing, including blood glucose and cholesterol testing.
• Work with DCS. After performing an evaluation and proposing a treatment plan, educate families about the diagnosis, medication, expected benefits, potential side effects and alternatives to medication to ensure they make an informed decision.
  Note: If your patient is in foster care, you must get consent from the child's regional nurse consultant before starting medication. Once treatment begins, DCS monitors the prescribing and drug use patterns of children in foster care to ensure these patients get safe and appropriate treatment. This may include working with DCS regional nurse consultants, the DCS chief medical officer or other personnel.

Our goal is to help promote the safe and appropriate use of psychotropic medications in children and teens with behavioral health disorders by sharing resources and best practices. If you have questions about psychotropic medication use, please call 1-800-367-3403 to speak with a board-certified psychiatrist or consult with an expert about treatment.