Children
and Youth Services
Best
Practice Guidelines
Chronology
of Development of Current BPGs
2000
The Best Practice Guidelines for children and adolescents were completed
and presented to the child and adolescent committee for additional commentary.
The children’s guidelines address Anxiety Disorders, Bipolar Disorder,
Depression, Co-occurring Mental Retardation, PTSD, and Schizophrenia and
are based upon guideline materials published by the American Academy of
Child and Adolescent Psychiatry and The Expert Consensus Guideline Series,
LLC. Each organization granted permission to TDMHDD for the selected use
of original source material.
2001
The Best Practice Guidelines for adults were completed and submitted
to the adult committee for additional commentary. The adult guidelines
address Anxiety Disorders, Bipolar Disorder, Dissociative Disorder,
Major Depression, and Schizophrenia and are based on guidelines
published by the American Psychiatric Association and on the Surgeon
General’s Report on Mental Health.
TDMHDD had completed a license agreement with the APA for use of their
source materials in the summary guidelines. The draft guidelines had also
been presented to the EPSDT Remedial Plan Steering Panel of the Remedial
Plan under the John B consent decree, which involved TennCare, DCS, and
provider and beneficiary stakeholders for consideration. The Office of
the Medical Director began work toward organizing a conference on Best
Practices to be held later that year. Funding in the form of educational
grants from pharmaceutical manufacturers directly and through UT College
of Pharmacy was identified. The conference was planned as a one-day program
offering seminars along the major topical divisions of the guidelines.
TDMHDD received the Tennessee Alcohol and Drug Abuse Best Practice Guidelines
from the Tennessee Department of Health (TDOH) Bureau of Alcohol and Drug
Abuse Services, for incorporation in TDMHDD’s Best Practice Guidelines.
These guidelines include recommendations on the integration of mental
health and substance abuse services for persons with co-occurring disorders.
These guidelines were forwarded to the Advisory Panel for any additional
consideration or action to adopt.
TDMHDD convened the Child and Adolescent Services Committee to begin work
toward adding consideration of level of care utilization to the practice
guidelines for children. Level of care utilization, as an element of practice
guidelines, would entail assessment of individual behavior and circumstances
to indicate a probable need for a given intensity of service. Committee
deliberation focused upon adoption of the Child and Adolescent Level of
Care Utilization System (CALOCUS), developed cooperatively between the
Academy of Child and Adolescent Psychiatry, and the American Association
of Community Psychiatrists. However the Committee took no definitive actions.
TDMHDD completed final edits and presented its recommendations for the
Best Practice Guidelines to the TennCare Bureau.
2002
Approval of the TDMHDD guidelines by the EPSDT Remedial Plan Steering
Panel was received and initial training on the Best Practices Guidelines,was
completed via conference on May 15, 2002. Initial baseline data for the
Adult BPGs regarding Schizophrenia, Bipolar Disorders, and Depression
was collected by June 2002.
2003
The Best Practices Guidelines were finalized with the APA as was
indicated in their prospective licensing agreement. Copies of
the Adult BPGs were distributed to all RMHIs and CMHAs as well
as to individual providers. Initial baseline data was collected
for the Child BPGs regarding Conduct Disorders and Depression.
When the Best Practice Guidelines system was fully developed, it
was recommended for application through the BHO and was adopted
by the Department of Children’s Services and the Department
of Corrections. Copies of the Children’s BPG were distributed
to all RMHIs and CMHAs, individual BHO providers, and the Department
of Children’s services. Copies of the Adult BPGs were distributed
to the Department of Corrections.
TDMHDD began distributing the Children’s Best Practice Guidelines
on CDs in October 2003 and they are available on the TDMHDD website. Data
collection on both the Adult and Children’s version has been ongoing.
Distribution of all BPGs continues upon request.
Other Efforts
TMAP
2000
Inquires regarding TMAP began at the urging of the Advisory Panel
on Best Practices. The Office of Medical Director established
contacts with the Texas Department of Mental Health and Mental
Retardation regarding possible replication of the Texas Medication
Algorithm Project (TMAP). TMAP is a collaborative outcomes research
undertaken between Texas MHMR, the University of Texas Southwestern
and four other Texas medical schools. TMAP offers some evidence-based
pharmacy protocol for treatment of major depression disorder,
bipolar disorder and schizophrenia and includes physician education,
consumer education and strengthened quality standards. Through
funding support from CMHS and the Robert Wood Johnson Foundation,
TMAP officials are extending direct assistance to other State
Medicaid programs to replicate the TMAP design.
2001
The Texas program agreed to provide replication assistance to Tennessee,
beginning in early 2001, should Tennessee determine to go forward with
replication. TDMHDD guidelines were presented in narrative outline form
and were intended for interim application, pending further development
toward algorithmic design. TDMHDD remained interested in implementation
of the Texas Medication Algorithms (TMAP) for Bipolar disorder, Major
Depression, and Schizophrenia, and TMAP officials remained prepared to
facilitate at such time that Tennessee is prepared to go forward. TDMHDD
awaited response from TennCare regarding the Bureau’s willingness
to implement TMAP treatment and quality measurement protocols.
TDMHDD facilitated a presentation by representatives from the Texas Department
of Mental Health and Mental Retardation and allied programs, concerning
prospective implementation of the Texas Medication Algorithms (TMAP) as
an element of TDMHDD’s best practice guidelines. TennCare however,
chose not to adopt TMAP at this time. Technical assistance from the TMAP
program remains available to TDMHDD and TennCare, should Tennessee determine
to make use of the algorithms. TMAP representatives recommended the development
of a pilot project of relatively modest scale, should Tennessee elect
to pursue implementation. TDMHDD and TennCare continued to review additional
information regarding TMAP.
2004
TMAP officials were again contacted by TDMHDD regarding possible implementation
of the guidelines. Training with TMAP was scheduled which included discussions
of their future use for Tennessee. |
