Caring for Children in State Custody and With Other Special Needs

Thank you for caring for our TennCareSelect members. Children in state custody or with other special needs often require complex care. So, we want to make it easy for you find the information you need.

Below, you’ll find a variety of resources and information specific to working with us and the Department of Children’s Services (DCS). We hope you find the information useful.

The Division of TennCare has also developed a list of tips for providers supporting children in state custody, which you can review here.

Resources to Support Providers

BlueCare Tennessee Provider Administration Manual

The Best Practice Network (BPN) Provider Manual section of our Provider Administration Manual contains details for our Best Practice Network. The Best Practice Network is a subset of the TennCareSelect network. It’s made up of primary care providers (PCPs) who serve children enrolled in SelectKids, our health care plan for children in DCS custody. PCPs in our Best Practice Network administer basic health care and coordinate all physical and behavioral health care for children assigned to their patient roster.

Health Care for Adults with Intellectual and Developmental Disabilities (IDD) Toolkit

Developed for PCPs by Vanderbilt University Medical Center and the Vanderbilt Kennedy Center, the IDD toolkit contains general information about caring for those with IDD, diagnosis-specific health watch tables, resources for meeting behavioral and mental health issues, and preventive care checklists.

While the toolkit is geared towards adult patients, it contains useful information for all PCPs, including those caring for teens and young adults.

Behavioral Healthcare in Pediatrics (BeHiP) Program Support for PCPs

We’re working with the Tennessee Chapter of the American Academy of Pediatrics (TNAAP) on the BeHiP training program. Through this program, pediatricians and other PCPs caring for children can get free training on tools and strategies for identifying, assessing, and managing patients with emotional, behavioral and substance use concerns.

Providers who are interested in BeHiP training have two options:

  • Office-based training – BeHiP faculty members are available to present 2-3 hour virtual or in-office education for provider offices. Topics can be tailored to meet specific practice needs and may include toxic stress, adverse childhood experiences, trauma-informed care, screening and office-based intervention, referrals for cognitive behavioral therapy, and more.
  • Online training modules – Providers can review these modules on the TNAAP website at their convenience and earn continuing education credits for completing them.

Providers in our BlueCare, TennCareSelect (including Best Practice Network) and CoverKids networks can also participate in the BeHiP Foster Care Learning Collaborative. This collaborative meets virtually each month and uses case-based learning to discuss the care of children who have behavioral health concerns and are currently in foster care.

For more information about the BeHiP resources available to PCPs, visit tnaap.org/programs/behip/behip-overview/.

BeHiP Program Support for Foster Care Medical Homes

We’re also working with TNAAP through the BeHiP program to help pediatric providers become Foster Care Medical Homes. Board-certified/board-eligible pediatricians, pediatric nurse practitioners or family practitioners in the BeHiP Foster Care Medical Home network receive referrals from DCS to care for children in state custody instead of the local health departments.

Tennessee Centers of Excellence

Centers of Excellence are tertiary care academic medical centers, provider agencies and other partners with expertise in children’s physical and behavioral health who focus on improving the well-being of children in or at risk of state custody. These centers provide clinical consultations, evaluations and limited direct services to children with complex needs.

Our state has five centers of excellence to serve children at risk of or in state custody. You can find a list of these centers, along with contact information, on the Division of TennCare website.

Connecting Children to Care

Immediate Eligibility

We get a fax or email as soon as children enter 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.

We follow up by fax with the DCS representative when children and teens get immediate TennCareSelect coverage within 48 hours of notification that they’ve entered state custody. This fax serves as proof of eligibility for TennCare-covered benefits until the child is approved for Medicaid. At that time, we’ll send a member ID card that includes the child’s assigned primary care provider.

72-Hour Initial Health Screening

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.

Children and teens should then have an Early and Periodic Screening, Diagnostic and Treatment (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 to receive preventive services according to the Bright Futures/American Academy of Pediatrics Periodicity Schedule.

Previously, most children and adolescents in state custody received 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 to get these services.

Obtaining Informed Consent

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 Guide or review the related DCS policy here.

Psychotropic Medication Monitoring in Children and Young Adults

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 that children taking an antipsychotic medication need annual metabolic testing, including blood glucose and cholesterol testing.
  • Work with the Department of Children’s Services (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 can 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 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.