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Xu Y, Winters AM, Soto-Ramírez N, McCarthy L, Betz G, Liu M. Predisposing, Enabling, and Need Factors Associated with Psychotropic Medication and Mental Health Service Use among Children in Out-of-Home Care in the United States: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6769. [PMID: 37754629 PMCID: PMC10531290 DOI: 10.3390/ijerph20186769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
This scoping review aimed to identify predisposing, enabling, and need factors associated with the use of mental health services, including psychotropic medications, among children in out-of-home care in the United States. We searched the PsycInfo, SocINDEX, Medline, and Scopus databases, and 22 studies met inclusion criteria and were systematically analyzed. Among the included studies, 7 studies examined predictors associated with taking psychotropic medications, and 16 examined factors associated with using other mental health services. Significant predisposing, enabling, and need factors associated with greater use of mental health services, including psychotropic medications, were identified. The most frequently identified predisposing factors were child race/ethnicity, age, gender, and maltreatment. Important enabling factors were out-of-home placement type and length of care, and need factors included children's mental/behavioral problems. The results provide insight into maximizing factors facilitating children's use of mental health services to address mental health problems of children in out-of-home care. Further, the results imply the importance of the appropriate use of psychotropic medication (e.g., the type and dosage of medications) among children in out-of-home care. The identified factors can inform child welfare agencies and stakeholders on ways to improve access to mental health services and the appropriate use of psychotropic medications among children in out-of-home care in the United States.
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Affiliation(s)
- Yanfeng Xu
- College of Social Work, University of South Carolina, 1512 Pendleton St., Columbia, SC 29208, USA
| | - Andrew M. Winters
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY 40292, USA;
| | - Nelís Soto-Ramírez
- Center for Child and Family Studies, College of Social Work, University of South Carolina, Columbia, SC 29208, USA;
| | - Lauren McCarthy
- Children’s Hospital Colorado, University of Colorado, Aurora, CO 80045, USA;
| | - Gail Betz
- University of Maryland, Baltimore, MD 21201, USA;
| | - Meirong Liu
- School of Social Work, Howard University, Washington, DC 20059, USA;
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2
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McLeigh JD, Malthaner LQ, Tovar MC, Khan M. Mental Health Disorders and Psychotropic Medication: Prevalence and Related Characteristics Among Individuals in Foster Care. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:745-757. [PMID: 37593050 PMCID: PMC10427591 DOI: 10.1007/s40653-023-00547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 08/19/2023]
Abstract
This study sought to provide prevalence data for mental health (MH) diagnoses and psychotropic medication prescriptions among individuals in foster care and to examine their relationships with physical health status, maltreatment type, placement type, and demographic variables. Data were retrieved from electronic health records for 3,067 patients seen at integrated pediatric primary care clinics serving individuals in care. Descriptive and bivariate statistics for presence of MH diagnoses and psychotropic medication prescription were calculated. Multivariable zero-inflated negative binomial regressions were used to assess relationships. Half (50.0%) of patients had at least one MH diagnosis; trauma and stressor-related (31.5%) and attention deficit hyperactivity (22.6%) disorders were most common. 27.8% of patients were prescribed at least 1 psychotropic medication. Complex chronic physical health, having 1 and 2 or more maltreatment exposures, and being 6-11 and 12-20 years of age had significantly higher rates of having a MH diagnosis while being female, Black, Hispanic, and other race were significantly associated with lower rates. Patients with at least 1 MH diagnosis that had complex chronic physical health status, experienced sexual abuse, and were 6-11 and 12-20 years of age had significantly higher rates of psychotropic medication prescription while shelter and kinship placement and female gender were significantly associated with lower rates. Findings suggest that initial and ongoing MH screening is vital for individuals in care so that appropriate interventions can be offered. Results support implementing strategies designed to increase access to MH services for this population, such as integrated care and child psychiatry consult programs. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-023-00547-9.
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Affiliation(s)
- Jill D. McLeigh
- Rees-Jones Center for Foster Care Excellence, Children’s Health, 1935 Medical District Drive, Mailstop ST7.03, Dallas, TX 75235 USA
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, TX USA
| | - Lauren Q. Malthaner
- University of Texas Health Science Center School of Public Health, Dallas, TX USA
| | | | - Mohsin Khan
- Rees-Jones Center for Foster Care Excellence, Children’s Health, 1935 Medical District Drive, Mailstop ST7.03, Dallas, TX 75235 USA
- University of Texas Southwestern Medical Center, Dallas, TX USA
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3
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Chen BC, Lui JHL, Benson LA, Lin YJR, Ponce NA, Innes-Gomberg D, Lau AS. After the Crisis: Racial/Ethnic Disparities and Predictors of Care Use Following Youth Psychiatric Emergencies. JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY 2022; 52:360-375. [DOI: 10.1080/15374416.2022.2127103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
| | - Joyce H. L. Lui
- Department of Psychology, University of California
- Department of Psychology, University of Maryland
| | | | | | | | | | - Anna S. Lau
- Department of Psychology, University of California
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Morgan W, Schultz KV, Adiba A, Lohr WD. Promoting Resiliency and Eliminating Disparities-Best Practices when Working with Child Welfare Involved Youth of Color. Child Adolesc Psychiatr Clin N Am 2022; 31:631-648. [PMID: 36182215 DOI: 10.1016/j.chc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The US child welfare system has a long history of racial disproportionality and subsequent disparities. These disparities have been perpetuated by discriminatory laws and policies in our federal and state governments, coupled with a system of care that is fraught with the risk of biases in child welfare practices and procedures. Child psychiatrists should have a knowledge base of these inequities to help ensure culturally and trauma-informed care for child welfare involved youth and families. As physician leaders with knowledge of child development, child psychiatrists can also help inform inclusive legislation, policies, and programs.
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Affiliation(s)
- Wynne Morgan
- Division of Child & Adolescent Psychiatry, Department of Psychiatry, UMass Chan Medical School, 55 Lake Avenue North, Worcester MA 01655, USA.
| | - Kristie V Schultz
- Department of Pediatrics, University of Louisville School of Medicine, 200 East Chestnut Street, Louisville, KY 40202, USA
| | - Afifa Adiba
- Adolescent Mood Disorder Unit, Sheppard Pratt Health System, Towson, MD, USA; Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, 200 East Chestnut Street, Louisville, KY 40202, USA
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Mowbray O, Probert K, Jaramillo J, Kothari BH, McBeath B. Trajectories of mental health services for youth in foster care with attention deficit hyperactivity disorder. CHILDREN AND YOUTH SERVICES REVIEW 2022; 140:106599. [PMID: 35910531 PMCID: PMC9337625 DOI: 10.1016/j.childyouth.2022.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Youth in foster care with Attention Deficit Hyperactivity Disorder (ADHD) often have significant needs for mental health services. The degree to which youth taking medication for ADHD use mental health services in relation to sibling co-placement and their level of need over time is unclear. To examine these issues, caregivers (N = 54) provided information on youth mental health service use across an 18-month study period. Results show that siblings living apart had a higher probability of mental health service use. For youth with higher CBCL scores, probability of mental health service use was both high and stable over time. However, youth with lower CBCL scores showed a decrease in probability of mental health service use over time. The sustained commitment to receipt of mental health services among youth with ADHD is something all behavioral health providers who work with foster care involved youth can benefit from, as well as the youth themselves.
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Affiliation(s)
- Orion Mowbray
- University of Georgia, 279 Williams, St. Athens, GA 30677, United States
| | - Kylee Probert
- Oregon State University College of Public Health & Human Sciences, Human Development & Family Studies, Corvallis, OR 97331, United States
| | - Jamie Jaramillo
- Oregon State University College of Public Health & Human Sciences, Human Development & Family Studies, Corvallis, OR 97331, United States
| | - Brianne H. Kothari
- Oregon State University College of Public Health & Human Sciences, Human Development & Family Studies, Corvallis, OR 97331, United States
| | - Bowen McBeath
- Portland State University School of Social Work, 1800 SW 6th Ave, Portland, OR 97201, United States
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6
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Community Adversity and Utilization of Psychotropic Medications Among Children in Foster Care. J Behav Health Serv Res 2021; 49:231-239. [PMID: 34704173 DOI: 10.1007/s11414-021-09773-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
The objective of this study was to examine the association between community adversity and psychotropic use among children in foster care in one US state. This study uses a cross-sectional design integrated foster care and Medicaid administrative data with data from Kids Count, the US Census, and the Area Health Resource File. There were 4,334 children ages 5-18 in foster care in 2014. We used K-means cluster analysis grouped state counties using indicators of school performance, juvenile justice involvement, and food insecurity. Chi-square tests assessed significance between psychotropic medication and community adversity cluster. A generalized linear mixed model assessed the relationship between psychotropic use and community adversity cluster, accounting for individual-level and cluster-level factors. Children in foster care living in high adversity communities were significantly less likely to use psychotropic medication (p < .0001). Future research can investigate the specific community factor influencing judicious use of psychotropic medication and the impact on children outcomes.
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Oerbeck B, Overgaard KR, Hjellvik V, Lien L, Bramness JG. The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care. J Child Adolesc Psychopharmacol 2021; 31:350-357. [PMID: 33635152 PMCID: PMC8233215 DOI: 10.1089/cap.2020.0123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objectives: To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Methods: Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age- and gender-adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age, and gender. Results: One thousand eight hundred fifty-six children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥ 13 years. Among those, 423 or 23% used any of the 3 psychotropics, which was significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most of the people. Polypharmacy was not frequent in RC, as only 26% used ≥2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and although the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6-16-year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (95% confidence interval [95% CI]: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (95% CI: 0.9-1.0). Conclusion: The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.
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Affiliation(s)
- Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Address correspondence to: Beate Oerbeck, PhD, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959 Nydalen, Oslo 0424, Norway
| | | | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Faculty of Health and Social Science, Inland University College of Applied Science, Elverum, Norway
| | - Jørgen G Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway.,Institute of Clinical Medicine, UiT—The Arctic University of Norway, Tromsø, Norway
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8
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Raman R, Jarrett RT, Cull MJ, Gracey K, Shaffer AM, Epstein RA. Psychopharmaceutical Prescription Monitoring for Children in the Child Welfare System. Psychiatr Serv 2021; 72:295-301. [PMID: 33467871 DOI: 10.1176/appi.ps.202000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Children in the child welfare system are more likely to receive psychotropic medication prescriptions than children in the general population. The authors used prescription- and administrative-level data to quantify variability in prescribing practices among prescribers for the child welfare population in a southern U.S. state. METHODS Using administrative- and prescription-level child data and Administration on Children, Youth and Families guidelines, the authors defined the primary outcome, potentially inappropriate psychotropic prescriptions (i.e., red-flagged prescriptions). A hierarchical-logistic regression model was fit to account for case complexity and estimate the adjusted probability of a prescription being red-flagged. A funnel plot was used to visualize standardized prescribing rates for every prescriber and identify outlying prescribers. RESULTS From May 2016 to September 2017, 506 prescribers issued 64,923 prescriptions for 4,093 children with a median (interquartile range) age of 14 (10-16) years. Most prescribers (76.9%) issued at least one red-flagged prescription, 1,263 (30.9%) children received at least one red-flagged prescription, and 14,806 (22.8%) prescriptions were red-flagged. The standardized prescribing rate for each prescriber was compared with a benchmark of 22.8%, defined a priori as the proportion of red-flagged prescriptions in the overall sample. Forty-seven prescribers (9%) prescribed red-flagged prescriptions between two and three standard deviations above the benchmark, and 72 prescribers (14%) more than three standard deviations above the benchmark. CONCLUSIONS It is vital to monitor psychotropic prescriptions for children in the child welfare system. Quantifying variability in prescribing practices among prescribers for these children might be used to guide oversight.
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Affiliation(s)
- Rameela Raman
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee (Raman, Jarrett); Center for Innovation in Population Health, University of Kentucky, Lexington (Cull); Center of Excellence for Children in State Custody, Vanderbilt University Medical Center, Nashville, Tennessee (Gracey, Shaffer); Chapin Hall at the University of Chicago, Chicago (Epstein)
| | - Ryan T Jarrett
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee (Raman, Jarrett); Center for Innovation in Population Health, University of Kentucky, Lexington (Cull); Center of Excellence for Children in State Custody, Vanderbilt University Medical Center, Nashville, Tennessee (Gracey, Shaffer); Chapin Hall at the University of Chicago, Chicago (Epstein)
| | - Michael J Cull
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee (Raman, Jarrett); Center for Innovation in Population Health, University of Kentucky, Lexington (Cull); Center of Excellence for Children in State Custody, Vanderbilt University Medical Center, Nashville, Tennessee (Gracey, Shaffer); Chapin Hall at the University of Chicago, Chicago (Epstein)
| | - Kathy Gracey
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee (Raman, Jarrett); Center for Innovation in Population Health, University of Kentucky, Lexington (Cull); Center of Excellence for Children in State Custody, Vanderbilt University Medical Center, Nashville, Tennessee (Gracey, Shaffer); Chapin Hall at the University of Chicago, Chicago (Epstein)
| | - April M Shaffer
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee (Raman, Jarrett); Center for Innovation in Population Health, University of Kentucky, Lexington (Cull); Center of Excellence for Children in State Custody, Vanderbilt University Medical Center, Nashville, Tennessee (Gracey, Shaffer); Chapin Hall at the University of Chicago, Chicago (Epstein)
| | - Richard A Epstein
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee (Raman, Jarrett); Center for Innovation in Population Health, University of Kentucky, Lexington (Cull); Center of Excellence for Children in State Custody, Vanderbilt University Medical Center, Nashville, Tennessee (Gracey, Shaffer); Chapin Hall at the University of Chicago, Chicago (Epstein)
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9
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Practical opportunities for pharmacists to optimize psychotropic medication use among foster youth. J Am Pharm Assoc (2003) 2020; 60:S7-S10. [PMID: 32669218 DOI: 10.1016/j.japh.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Bring awareness of the health disparity of higher psychotropic medication use among foster youth, describe barriers to optimizing foster children's medication regimen from the perspective of people who work closely with them, and propose practical strategies to empower pharmacists to identify and care for this vulnerable population. SUMMARY A total of 11 focus groups with 72 participants were conducted. Although the discussion guide did not specifically address pharmacists or pharmacies, participants in 9 groups referenced them. The pharmacist-related comments fell under 2 main themes: (1) Pharmacists are recognized as medication experts and their expertise is valued. (2) Those caring for foster youth observe barriers to optimal medication therapy that are unique to children in the foster care system. Practical considerations include providing education to social workers, offering unit-dose packaging, offering delivery, and being a resource during transitions of care. CONCLUSION Higher rates of psychotropic medication use among foster youth in the United States have raised concern for several decades. Pharmacists are recognized as medication experts by the foster care team, creating an opportunity for pharmacists to become more involved in optimizing psychotropic medication use among foster youth.
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Harwick RM, Unruh D, Lindstrom L. Transition to adulthood for youth with disabilities who experienced foster care: An ecological approach. CHILD ABUSE & NEGLECT 2020; 99:104310. [PMID: 31838228 DOI: 10.1016/j.chiabu.2019.104310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 11/19/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Almost 21,000 youth, in the U.S., leave foster care due to "emancipation" each year. Although not well documented for this age group, nearly half of children/youth in foster care receive a disability diagnosis. There is a growing body of literature about the transition to adulthood for youth with disabilities. However, minimal research exists on the transition experiences of youth in foster care who also have a disability. This study intends to help fill this gap in the literature. OBJECTIVE The purpose of the study was to uncover challenges during the transition to adulthood for youth with disabilities who experienced foster care and elucidate the supports most beneficial in addressing these challenges. PARTICIPANTS AND SETTING All participants reside in the United States pacific northwest. Seven foster care alumni aged 19-23 and five professionals serving the target population participated in the study. METHODS We conducted semi-structured interviews with YDFC and a focus group with professionals to understand the process of the transition to adulthood for YDFC. Our findings generated an ecological model useful for transition planning prior to the youth leaving foster care. Within our model we focus on alterable factors to bring intervention points to light. RESULTS Barriers uncovered included lack of consistent high school graduation requirements, high quality Independent Living Programs, positive relationships and highly skilled professionals; frequent placement changes; and inappropriate disability or mental health diagnosis. CONCLUSIONS Recommendations include systems improvements; improved intra- and interagency collaboration; and helping youth build and maintain positive relationships.
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Affiliation(s)
- Robin Marie Harwick
- University of Washington, Alcohol and Drug Abuse Institute, 1107 NE 45th St Ste. 120, Seattle, WA, 98105, United States.
| | - Deanne Unruh
- University of Oregon, 212 Clinical Services Bldg. 5260, Eugene, OR, 97403, United States
| | - Lauren Lindstrom
- University of California Davis, One Shields Ave., Davis, CA, 95616, United States
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11
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Jacobson JH, Pullmann MD, Parker EM, Kerns SEU. Measurement Based Care in Child Welfare-Involved Children and Youth: Reliability and Validity of the PSC-17. Child Psychiatry Hum Dev 2019; 50:332-345. [PMID: 30264230 DOI: 10.1007/s10578-018-0845-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study evaluates whether the psychometric properties of the Pediatric Symptoms Checklist-17 (PSC-17), a common behavioral health measure typically used as a dichotomous screening tool for mental health needs, support its use as a continuous measure for tracking behavioral health over time. A total of 6492 foster parents of children and youth aged 5.5-17 completed the PSC-17. Convergent and discriminant validity was assessed by comparing raw PSC-17 subscale scores with associated outcomes (e.g. psychiatric diagnoses). Long-term test-retest reliability was assessed over 6 months. Scores on the PSC-17 demonstrated good convergent and divergent validity. PSC-17 subscale scores were most strongly associated with analogous diagnoses. Test-retest reliability was moderate, as expected for a time window of this length. This study provides moderate support for the psychometric qualities of the PSC-17 when used with children and youth in the child welfare system as a continuous measure of psychosocial functioning over time.
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Affiliation(s)
- Jedediah H Jacobson
- Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 358015, Seattle, WA, 98195, USA.
| | - Michael D Pullmann
- Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 358015, Seattle, WA, 98195, USA
| | - Elizabeth M Parker
- Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 358015, Seattle, WA, 98195, USA
| | - Suzanne E U Kerns
- Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Box 358015, Seattle, WA, 98195, USA.,University of Denver Graduate School of Social Work, 2148 S High St, Denver, CO, 80208, USA
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12
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Parker EM, Jacobson J, Pullmann MD, Kerns SEU. Identifying Psychosocial Problems Among Children and Youth in the Child Welfare System Using the PSC-17: Exploring Convergent and Discriminant Validity with Multiple Informants. Child Psychiatry Hum Dev 2019; 50:108-120. [PMID: 29961167 DOI: 10.1007/s10578-018-0824-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Youth who enter foster care are at risk of mental health need, but questions arise as to the validity of their self-reported symptomatology. This study examines the screening validity of the youth-report version of the Pediatric Symptom Checklist-17 (PSC-17) in a child welfare population. Data come from 2389 youth who completed a version of the PSC-17 adapted for youth report, and their biological and foster parents who completed the parent-report version. Youth also completed a shortened version of the Screen for Child Anxiety Related Disorders (SCARED). Convergent and discriminant validity of the PSC-17 was assessed using multi-trait multi-method matrices. The PSC-17's internalizing subscale was strongly correlated, attention subscale was moderately correlated, and externalizing subscale was weakly correlated with the SCARED's anxiety and PTSD subscales. Comparing youth and foster parent scores, the PSC-17 had moderate convergent validity and weak/fair discriminant validity. Comparing youth, foster parent, and biological parent scores, the PSC-17 had moderate convergent validity and weak/fair discriminant validity. The current study provides some support for the validity of the PSC-17 for the population of youth in foster care.
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Affiliation(s)
- Elizabeth M Parker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA.
| | - Jedediah Jacobson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA
| | - Suzanne E U Kerns
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA.,University of Denver Graduate School of Social Work, 2148 S High St, Denver, CO, 80208, USA
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13
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Verd S, Aguiló G, Kraemer M, Fernández M, Servera C, Colom M, Palmer P, López-Sureda M, Juan M, Ripoll J, Llobera J. Past medical history: A comparison between children at the point of entry into the care system and children at home. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/15379418.2018.1521761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sergio Verd
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Gloria Aguiló
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Milanka Kraemer
- Family Medicine Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Mercedes Fernández
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Catalina Servera
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Marina Colom
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Patricia Palmer
- Family Medicine Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Mar López-Sureda
- Pediatric Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Marta Juan
- Child Protection Department, Majorcan Local Authority, Palma de Mallorca, Spain
| | - Joana Ripoll
- Research Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
| | - Juan Llobera
- Research Unit, Department of Primary Care, Balearic Health Authority, Palma de Mallorca, Spain
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14
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Brain structural covariance network centrality in maltreated youth with PTSD and in maltreated youth resilient to PTSD. Dev Psychopathol 2018; 31:557-571. [PMID: 29633688 DOI: 10.1017/s0954579418000093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Child maltreatment is a major cause of pediatric posttraumatic stress disorder (PTSD). Previous studies have not investigated potential differences in network architecture in maltreated youth with PTSD and those resilient to PTSD. High-resolution magnetic resonance imaging brain scans at 3 T were completed in maltreated youth with PTSD (n = 31), without PTSD (n = 32), and nonmaltreated controls (n = 57). Structural covariance network architecture was derived from between-subject intraregional correlations in measures of cortical thickness in 148 cortical regions (nodes). Interregional positive partial correlations controlling for demographic variables were assessed, and those correlations that exceeded specified thresholds constituted connections in cortical brain networks. Four measures of network centrality characterized topology, and the importance of cortical regions (nodes) within the network architecture were calculated for each group. Permutation testing and principle component analysis method were employed to calculate between-group differences. Principle component analysis is a methodological improvement to methods used in previous brain structural covariance network studies. Differences in centrality were observed between groups. Larger centrality was found in maltreated youth with PTSD in the right posterior cingulate cortex; smaller centrality was detected in the right inferior frontal cortex compared to youth resilient to PTSD and controls, demonstrating network characteristics unique to pediatric maltreatment-related PTSD. Larger centrality was detected in right frontal pole in maltreated youth resilient to PTSD compared to youth with PTSD and controls, demonstrating structural covariance network differences in youth resilience to PTSD following maltreatment. Smaller centrality was found in the left posterior cingulate cortex and in the right inferior frontal cortex in maltreated youth compared to controls, demonstrating attributes of structural covariance network topology that is unique to experiencing maltreatment. This work is the first to identify cortical thickness-based structural covariance network differences between maltreated youth with and without PTSD. We demonstrated network differences in both networks unique to maltreated youth with PTSD and those resilient to PTSD. The networks identified are important for the successful attainment of age-appropriate social cognition, attention, emotional processing, and inhibitory control. Our findings in maltreated youth with PTSD versus those without PTSD suggest vulnerability mechanisms for developing PTSD.
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Glesener D, Anderson G, Li X, Brown J, Amell J, Regal R, Ferguson D. Psychotropic Medication Patterns for American Indian Children in Foster Care. J Child Adolesc Psychopharmacol 2018; 28:225-231. [PMID: 29425063 DOI: 10.1089/cap.2017.0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study assesses the effects of race, age, sex, and time spent in foster care on rates of psychotropic medication use for children in foster care in 2012. METHODS Using existing electronic records through county Social Service and Minnesota Medical Assistance databases, 626 children were identified using the inclusion criteria of having been in foster care for at least 30 days during 2012 in St. Louis County, Minnesota. All prescriptions for dispensed psychotropic medications were identified into the following classes: antidepressants, attention-deficit/hyperactivity disorder (ADHD) medications, antipsychotics, alpha-agonists, and other (including anticonvulsants/mood stabilizers, lithium, benzodiazepines, and sedative hypnotics). RESULTS Overall, 26% of children were dispensed at least one psychotropic medication during the year with the percentage of children on medication for each race as follows: American Indian (AI) 23.3%, European American (EA) 29.2%, and African American (AA) 18.3%. AI children were significantly less likely to be dispensed any psychotropic medication and ADHD medication. EA children, males, and older children received psychotropic medications from significantly more classes than AI or AA children, females, and younger children. Males were significantly more likely to be dispensed alpha-agonists, antipsychotics, and ADHD medications. Increased time since placement into foster care was also significantly associated with increased dispensing rates of antidepressants, ADHD medication, and multiple medication classes. CONCLUSIONS The results of this study show that non-EA children, in particular AI children, were dispensed psychotropics both overall and across different medication classes less often compared to other racial groups. While the reasons for this difference are not known, future studies are needed to address whether mental health needs of all children in foster care are being appropriately addressed, accounting for need and patient preference.
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Affiliation(s)
- David Glesener
- 1 Department of Social Work, University of Minnesota , St. Paul, Minnesota
| | - Gwendolyn Anderson
- 2 Department of Social Work, University of Minnesota Duluth , Duluth, Minnesota
| | - Xuan Li
- 3 Department of Mathematics and Statistics, University of Minnesota Duluth , Duluth, Minnesota
| | - Jacob Brown
- 4 College of Pharmacy, University of Minnesota , Duluth, Minnesota
| | - James Amell
- 2 Department of Social Work, University of Minnesota Duluth , Duluth, Minnesota
| | - Ronald Regal
- 3 Department of Mathematics and Statistics, University of Minnesota Duluth , Duluth, Minnesota
| | - Donald Ferguson
- 5 St. Louis County Public Health and Human Services Department , Duluth, Minnesota
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McLaren JL, Barnett ER, Concepcion Zayas MT, Lichtenstein J, Acquilano SC, Schwartz LM, Woloshin S, Drake RE. Psychotropic medications for highly vulnerable children. Expert Opin Pharmacother 2018; 19:547-560. [PMID: 29596008 DOI: 10.1080/14656566.2018.1445720] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION At least 20% of children in the U.S. are highly vulnerable because they lack healthcare and protection. Several factors produce vulnerability: trauma, disruptions of parenting, poverty, involvement in the juvenile justice and/or child welfare systems, residence in restrictive settings, and problems related to developmental disabilities. These children receive psychotropic medications at high rates, raising numerous concerns. AREAS COVERED The authors begin this review with a description of the population of highly vulnerable children. They then follow this with a review of the effectiveness and side effects of psychotropic medications for their most common diagnoses, using the highest-quality systematic reviews identified by multiple database searches. EXPERT OPINION Highly vulnerable children receive numerous psychotropic medications with high rates of polypharmacy, off-label use, and long-term use, typically in the absence of adjunctive psychosocial interventions. The current evidence contravenes these trends. Future studies of psychotropic medications in vulnerable children should include long-term effectiveness trials and polypharmacy in conjunction with evidence-based, family-centered, psychosocial treatments.
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Affiliation(s)
- Jennifer L McLaren
- a Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,b Dartmouth Hitchcock Medical Center , Lebanon , NH , USA.,c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | - Erin R Barnett
- a Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,b Dartmouth Hitchcock Medical Center , Lebanon , NH , USA.,c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,d Dartmouth Trauma Interventions Research Center , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | | | - Jonathan Lichtenstein
- a Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,b Dartmouth Hitchcock Medical Center , Lebanon , NH , USA.,c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | - Stephanie C Acquilano
- c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | - Lisa M Schwartz
- c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,e Department of Medicine , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,f Department of Community & Family Medicine , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,g Medicine and the Media Programs , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | - Steven Woloshin
- c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,e Department of Medicine , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,f Department of Community & Family Medicine , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.,g Medicine and the Media Programs , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
| | - Robert E Drake
- c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA
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Hambrick EP, Rubens SL, Brawner TW, Taussig HN. Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care? J Child Psychol Psychiatry 2018; 59:140-149. [PMID: 28862324 PMCID: PMC5775045 DOI: 10.1111/jcpp.12802] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with multiple mental and physical health problems. Yet, mechanisms by which ACEs confer risk for specific problems are largely unknown. Children in foster care typically have multiple ACEs and high rates of negative sequelae, including delinquent behaviors. Mechanisms explaining this link have not been explored in this population. Impaired sleep has been identified as a potential mechanism by which ACEs lead to delinquency in adolescents, because inadequate sleep may lead to poor executive function and cognitive control - known risk factors for delinquency. METHODS Interviews were conducted with 516 maltreated children in foster care, ages 9-11 years, and their caregivers regarding child exposure to ACEs, sleep problems, engagement in delinquent acts, symptoms of posttraumatic stress disorder, and current psychotropic medication use. ACEs data were also obtained from child welfare case records. RESULTS After controlling for age, gender, race/ethnicity, placement type (residential, kin, foster), length of time in placement, posttraumatic stress symptoms, and current psychotropic medication use, sleep partially mediated the association between ACEs and delinquency. CONCLUSIONS Although delinquency is likely multiply determined in this population, improving sleep may be one important strategy to reduce delinquency.
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Affiliation(s)
- Erin P. Hambrick
- Department of Psychology, University of Missouri–Kansas City,The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine
| | | | | | - Heather N. Taussig
- The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine,Graduate School of Social Work, University of Denver
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Willis R, Dhakras S, Cortese S. Attention-Deficit/Hyperactivity Disorder in Looked-After Children: a Systematic Review of the Literature. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2017; 4:78-84. [PMID: 28932648 PMCID: PMC5574951 DOI: 10.1007/s40474-017-0116-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To systematically review the literature on the prevalence and pharmacological treatment of ADHD in looked-after children (LAC). RECENT FINDINGS LAC are a very challenging population from a clinical and psychosocial standpoint, with higher mental health needs compared to non LAC. To date, no systematic review on the prevalence of ADHD, and its treatment, in LAC is available. SUMMARY We searched Pubmed, PsycInfo EMBASE + EMBASE CLASSIC, OVID Medline and Web of Science up to November 9 th, 2016. We found 24 papers meeting our criteria. The vast majority of the retained studies are from the USA and show rates of ADHD and of its pharmacological treatment substantially higher in LAC than those reported in national estimates. Future studies from countries other than the USA, aiming to understand the most cost-effective strategies, in the short as well as long term, to manage symptoms of ADHD in LAC are needed.
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Affiliation(s)
- Renece Willis
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | | | - Samuele Cortese
- Academic Unit of Psychology, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- The Child Study Center, New York University Langone Medical Center, New York, NY 10016 USA
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Hyde JK, Mackie TI, Palinkas LA, Niemi E, Leslie LK. Evidence Use in Mental Health Policy Making for Children in Foster Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:52-66. [PMID: 25711392 DOI: 10.1007/s10488-015-0633-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Considerable attention is being given to the use of research evidence to inform public policy making. Building upon Weiss's model of research utilization, we examined the types and uses of evidence that child welfare administrators used in response to federal policy reforms requiring psychotropic medications oversight for children in foster care. Participants relied on a range of "global" and "local" evidence types throughout the policy development phase. Global research evidence was used to raise awareness about problems associated with psychotropic medication use. Local evidence helped to contextualize concerns and had problem-solving and political uses. In most states, policy actions were informed by a combination of evidence types.
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Affiliation(s)
- Justeen K Hyde
- Institute for Community Health, 163 Gore Street, Cambridge, MA, 02141, USA.
| | | | - Lawrence A Palinkas
- School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Emily Niemi
- Tufts University School of Medicine, Boston, MA, USA
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Coke SP, Moore LC. Factors Influencing Female Caregivers' Appraisals of Their Preschoolers' Behaviors. J Pediatr Health Care 2017; 31:46-56. [PMID: 26874456 DOI: 10.1016/j.pedhc.2016.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION This study used the Resiliency Model of Family Stress, Adjustment, and Adaptation to explore family factors associated with primary female caregivers' appraisals of children's behaviors, distortion of their appraisals, and children's risk of having behavioral problems. METHOD A cross-sectional, correlational design was used. Data were collected from female caregivers of preschoolers. Instruments measured demographic characteristics, comfort in parenting, appraisal of behaviors, daily and parenting stress, depressive symptoms, social support, ratings of children's behaviors, and distortion in ratings. Analyses included χ2 and simultaneous linear regression. RESULTS Greater parenting discomfort and daily stress were associated with lower appraisals of children's behaviors. Caucasian race and higher distortion in behavioral ratings were associated with higher risk of behavioral problems. Caregiver's appraisal was associated with daily stress level and parenting comfort. DISCUSSION Additional research is needed regarding how these factors affect children's behavior and causes of distorted parental views of children's behaviors.
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Allaire BT, Raghavan R, Brown DS. Morbid Obesity and Use of Second Generation Antipsychotics among Adolescents in Foster Care: Evidence from Medicaid. CHILDREN AND YOUTH SERVICES REVIEW 2016; 67:27-31. [PMID: 27990038 PMCID: PMC5157933 DOI: 10.1016/j.childyouth.2016.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Many adolescents enter foster care with high body mass index (BMI), and patterns of treatment further exacerbate the risk of morbid obesity. A principal risk factor for such exacerbation is the use of second generation antipsychotics (SGAs). We examine the association between receiving a morbid obesity diagnosis and SGA prescriptions among adolescents in foster care. METHODS We analyzed claims from 36 states' Medicaid Analytic Extract (MAX) files for 2000 through 2003. Obesity diagnoses were ascertained through a primary or secondary diagnosis claim of morbid obesity. Covariates included gender, race/ethnicity. age, insurance status, state obesity rate, and state fixed effects. We calculated relative risks of a diagnosis based upon four SGAs (clozapine, olanzapine, quetiapine, and risperidone) associated with obesity and a polypharmacy indicator. RESULTS Of the 1,261,806 foster care adolescent-years in the MAX files, 6,517 were diagnosed with morbid obesity, an annual prevalence of 0.5%. The risk of a morbid obesity diagnosis is much higher for female and non-white adolescents. The risk increases with age. Quetiapine and clozapine increased the risk of a morbid obesity diagnosis more than 2.5 times, and two or more psychotropic drugs (polypharmacy) increased the risk fivefold. CONCLUSIONS Adolescents in foster care are much more likely to be on SGA medications, and therefore may be more susceptible to weight gain and obesity. Given that SGA prescribing for younger populations has only expanded since these data were released, our study may actually understate the magnitude of the problem. Care is needed when prescribing SGAs for foster care adolescents.
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Affiliation(s)
- Benjamin T. Allaire
- RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC 27709, United States
| | - Ramesh Raghavan
- Washington University in St. Louis, Campus Box 1196, Goldfarb Hall, Room 229C, One Brookings Drive, St. Louis, MO 63130, United States
| | - Derek S. Brown
- Washington University in St. Louis, Campus Box 1196, Goldfarb Hall, Room 229C, One Brookings Drive, St. Louis, MO 63130, United States
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22
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Posterior structural brain volumes differ in maltreated youth with and without chronic posttraumatic stress disorder. Dev Psychopathol 2016; 27:1555-76. [PMID: 26535944 DOI: 10.1017/s0954579415000942] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Magnetic resonance imaging studies of maltreated children with posttraumatic stress disorder (PTSD) suggest that maltreatment-related PTSD is associated with adverse brain development. Maltreated youth resilient to chronic PTSD were not previously investigated and may elucidate neuromechanisms of the stress diathesis that leads to resilience to chronic PTSD. In this cross-sectional study, anatomical volumetric and corpus callosum diffusion tensor imaging measures were examined using magnetic resonance imaging in maltreated youth with chronic PTSD (N = 38), without PTSD (N = 35), and nonmaltreated participants (n = 59). Groups were sociodemographically similar. Participants underwent assessments for strict inclusion/exclusion criteria and psychopathology. Maltreated youth with PTSD were psychobiologically different from maltreated youth without PTSD and nonmaltreated controls. Maltreated youth with PTSD had smaller posterior cerebral and cerebellar gray matter volumes than did maltreated youth without PTSD and nonmaltreated participants. Cerebral and cerebellar gray matter volumes inversely correlated with PTSD symptoms. Posterior corpus callosum microstructure in pediatric maltreatment-related PTSD differed compared to maltreated youth without PTSD and controls. The group differences remained significant when controlling for psychopathology, numbers of Axis I disorders, and trauma load. Alterations of these posterior brain structures may result from a shared trauma-related mechanism or an inherent vulnerability that mediates the pathway from chronic PTSD to comorbidity.
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Mayne SL, Ross ME, Song L, McCarn B, Steffes J, Liu W, Margolis B, Azuine R, Gotlieb E, Grundmeier RW, Leslie LK, Localio R, Wasserman R, Fiks AG. Variations in Mental Health Diagnosis and Prescribing Across Pediatric Primary Care Practices. Pediatrics 2016; 137:e20152974. [PMID: 27244791 PMCID: PMC4845867 DOI: 10.1542/peds.2015-2974] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary care pediatricians increasingly care for children's mental health problems, but little is known about practice-level variation in diagnosis and psychotropic medication prescribing practices. METHODS This retrospective review of electronic heath records from 43 US primary care practices included children aged 4 to 18 years with ≥1 office visit from January 1, 2009, to June 30, 2014. We examined variability in diagnosis and psychotropic prescribing across practices using logistic regression with practice fixed effects and evaluated associations of the availability of colocated or community-based mental health providers or the proportion of children in foster care with diagnosis and prescribing using generalized linear mixed models. RESULTS Among 294 748 children, 40 932 (15%) received a mental health diagnosis and 39 695 (14%) were prescribed psychotropic medication. Attention deficit/hyperactivity disorder was most commonly diagnosed (1%-16% per practice). The proportion of children receiving any psychotropic medication (4%-26%) and the proportion receiving ≥2 medication classes (1%-12%) varied across practices. Prescribing of specific medication classes also varied (stimulants, 3%-18%; antidepressants, 1%-12%; α-agonists, 0%-8%; second-generation antipsychotics, 0%-5%). Variability was partially explained by community availability of psychiatrists (significantly higher odds of a diagnosis or prescription when not available) but not by colocation of mental health professionals or percentage of children in foster care. CONCLUSIONS The prevalence of mental health diagnosis and psychotropic medication prescribing varies substantially across practices and is only partially explained by psychiatrist availability. Research is needed to better define the causes of variable practice-level diagnosis and prescribing and implications for child mental health outcomes.
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Affiliation(s)
| | | | - Lihai Song
- Center for Pediatric Clinical Effectiveness, PolicyLab
| | - Banita McCarn
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Jennifer Steffes
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Weiwei Liu
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Benyamin Margolis
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Romuladus Azuine
- Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland
| | - Edward Gotlieb
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Robert W Grundmeier
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laurel K Leslie
- American Board of Pediatrics, Chapel Hill, North Carolina; and
| | | | - Richard Wasserman
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois; Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
| | - Alexander G Fiks
- Center for Pediatric Clinical Effectiveness, PolicyLab, Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois; Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Pediatric Research Consortium, and
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Anderson LE, Chen ML, Perrin JM, Van Cleave J. Outpatient Visits and Medication Prescribing for US Children With Mental Health Conditions. Pediatrics 2015; 136:e1178-85. [PMID: 26459647 PMCID: PMC4621795 DOI: 10.1542/peds.2015-0807] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the mental health care US children receive from primary care providers (PCPs) and other mental health care providers. METHODS Using nationally representative data from the Medical Expenditure Panel Survey (MEPS) from 2008 to 2011, we determined whether children and youth aged 2 to 21 years with outpatient visits for mental health problems in the past year saw PCPs, psychiatrists, and/or psychologists/social workers for these conditions. We compared the proportion of children prescribed psychotropic medications by provider type. Using logistic regression, we examined associations of provider type seen and medication prescribing with race/ethnicity, household income, insurance status, geographical area, and language at home. RESULTS One-third (34.8%) of children receiving outpatient care for mental health conditions saw PCPs only, 26.2% saw psychiatrists only, and 15.2% saw psychologists/social workers only. Nearly a quarter (23.8%) of children saw multiple providers. A greater proportion of children with attention-deficit/hyperactivity disorder (ADHD) versus children with anxiety/mood disorders saw a PCP only (41.8% vs 17.2%). PCPs prescribed medications to a higher percentage of children than did psychiatrists. Children seeing a PCP for ADHD were more likely to receive stimulants or α-agonists than children with ADHD seeing psychiatrists (73.7% vs 61.4%). We found only limited associations of sociodemographic characteristics with provider type or medication use. CONCLUSIONS PCPs appear to be sole physician managers for care of 4 in 10 US children with ADHD, and one-third with mental health conditions overall. Efforts supporting mental health in primary care will reach a substantial portion of children receiving mental health services.
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Affiliation(s)
| | - Minghua L. Chen
- Divisions of General Pediatrics, Center for Child and Adolescent Health Research and Policy, and
| | - James M. Perrin
- General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts; and,Department of Pediatrics, Harvard Medical School, Pediatrics, Boston, Massachusetts
| | - Jeanne Van Cleave
- General Academic Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts; and Department of Pediatrics, Harvard Medical School, Pediatrics, Boston, Massachusetts
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Accurso EC, Garland AF, Haine-Schlagel R, Brookman-Frazee L, Baker-Ericzén MJ. Factors contributing to reduced caregiver strain in a publicly-funded child mental health system. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2015; 23:131-143. [PMID: 26361434 PMCID: PMC4562689 DOI: 10.1177/1063426614532948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined caregiver strain in families who initiated mental health services for their child. Predictors of strain and the bidirectional relation between strain and child symptoms were examined. Participants included 218 children ages 4-13 with disruptive behavior problems and their caregivers, plus 96 psychotherapists, recruited from six publicly-funded clinics. Child disruptive behavior severity and caregiver strain were assessed at baseline, four, and eight months. Multilevel models were used to examine predictors of reduced caregiver strain, and autoregressive cross-lagged models were used to examine the bidirectional relations between change in caregiver strain and behavior problems over time. There were small to medium decreases in caregiver strain over the eight months after the initiation of mental health services, but few factors predicted change other than initial behavior problem severity. While more severe initial child symptoms predicted greater reductions in caregiver strain, greater child symptom severity sustained at four months predicted lesser improvements in caregiver strain. Simultaneously, greater caregiver strain predicted less improvement in child symptom severity, suggesting that child symptom severity and caregiver strain impact each other over time. These results suggest that attending to both child and caregiver factors may be important in maintaining improvements after initiating usual care.
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Affiliation(s)
- Erin C. Accurso
- The University of Chicago
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
| | - Ann F. Garland
- University of San Diego
- University of California, San Diego
- Child and Adolescent Services Research Center
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van den Ban EF, Souverein PC, van Engeland H, Swaab H, Egberts TCG, Heerdink ER. Differences in ADHD medication usage patterns in children and adolescents from different cultural backgrounds in the Netherlands. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1153-62. [PMID: 26017546 DOI: 10.1007/s00127-015-1068-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Differences in incidence and prevalence of ADHD medication use between ethnic groups have been reported. Goal of this study was to determine whether there are also differences in usage patterns of ADHD medication among native Dutch children and adolescents and those with a Moroccan, Turkish and Surinam cultural background in the Netherlands between 1999 and 2010. METHODS In a cohort of ADHD patients <19 years (N = 817) incident use and discontinuation of ADHD medication were measured for ethnicity and adjusted for age, gender and socio-economic status. RESULTS A significant higher proportion of ADHD-diagnosed patients from Moroccan (32 %) and Turkish (42 %) cultural background never used ADHD medication compared to Dutch natives (21 %). One-fifth of native Dutch and Turkish patients already used ADHD medication before the ADHD diagnosis date. Discontinuation of ADHD medication within 5 years was significantly higher in Moroccan [HR 2.4 (95 % CI 1.8-3.1)] and Turkish [HR 1.7 (95 % CI 1.1-2.6)] patients. A sensitivity analysis with a zip code-matched comparison between Dutch natives and non-natives showed similar results, suggesting this effect is probably not explained by socio-economic status (SES). CONCLUSION Differences are found in prescribing and use of ADHD medication between patients with a different cultural background. Native Dutch and Turkish patients start more frequently with ADHD medication before the ADHD diagnose date, which can be an indication of differences in either referral patterns and/or access to care. A higher percentage of patients with a Moroccan and Turkish cultural background never start using ADHD medication at all and discontinuation rate is higher compared to Dutch natives and Surinamese.
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Affiliation(s)
- Els F van den Ban
- Youth Division Altrecht, Institute for Mental Health, Nieuwe Houtenseweg 2, 3524 SH, Utrecht, The Netherlands,
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Lee T, Fouras G, Brown R. Practice parameter for the assessment and management of youth involved with the child welfare system. J Am Acad Child Adolesc Psychiatry 2015; 54:502-17. [PMID: 26004666 DOI: 10.1016/j.jaac.2015.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/01/2015] [Indexed: 11/27/2022]
Abstract
This Practice Parameter presents principles for the mental health assessment and management of youth involved with the child welfare system. Important definitions, background, history, epidemiology, mental health care use, and functional outcomes are described. Practical guidance regarding child welfare-related considerations for evaluation and management are discussed.
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Rundberg-Rivera EV, Townsend LD, Schneider J, Farmer CA, Molina BB, Findling RL, Gadow KD, Bukstein OG, Arnold LE, Kolko DJ, Buchan-Page KA, McNamara NK, Michel C, Austin A, Kipp H, Rice RR, Aman MG. Participant satisfaction in a study of stimulant, parent training, and risperidone in children with severe physical aggression. J Child Adolesc Psychopharmacol 2015; 25:225-33. [PMID: 25885012 PMCID: PMC4403019 DOI: 10.1089/cap.2014.0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the satisfaction of families who participated in the Treatment of Severe Childhood Aggression (TOSCA) study. METHODS TOSCA was a randomized clinical trial of psychostimulant plus parent training plus placebo (basic treatment) versus psychostimulant plus parent training plus risperidone (augmented treatment) for children with severe physical aggression, disruptive behavior disorder, and attention-deficit/hyperactivity disorder. Parents completed a standardized Parent Satisfaction Questionnaire (PSQ). RESULTS Of the 168 families randomized, 150 (89.3%) provided consumer satisfaction data. When they were asked if they would join the study again if they had the option to repeat, 136 (91%) said "yes," 11 (7%) said "maybe," and one (<1%) said "no." When asked if they would recommend the study to other parents with children having similar problems, 147 (98%) said "yes" and 3 (2%) said "maybe." Between 71% (rating one aspect of the Parent Training) and 96% (regarding the diagnostic interview) endorsed study procedures using the most positive response option. Asked if there were certain aspects of the study that they especially liked, 64 (43%) spontaneously reported parent training. Treatment assignment (basic vs. augmented) and responder status were not associated with reported satisfaction. However, responder status was strongly associated with parent confidence in managing present (p<0.001) and future (p<0.005) problem behaviors. CONCLUSIONS These findings indicate high levels of satisfaction with TOSCA study involvement and, taken together with previous pediatric psychopharmacology social validity studies, suggest high levels of support for the research experience. These findings may inform research bioethics and may have implications for deliberations of institutional review boards. TRIAL REGISTRY Treatment of Severe Childhood Aggression (The TOSCA Study), NCT00796302, clinicaltrials.gov .
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Affiliation(s)
| | - Lisa D. Townsend
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Psychiatry Kennedy Krieger Institute, Baltimore, Maryland
| | - Jayne Schneider
- Center for Psychiatry and Behavioral Medicine, Inc., Las Vegas, Nevada
| | | | - Brooke B.S.G. Molina
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert L. Findling
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenneth D. Gadow
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | | | - L. Eugene Arnold
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio.,Department of Psychiatry, Ohio State University School of Medicine, Columbus, Ohio
| | - David J. Kolko
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Nora K. McNamara
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | - Chenel Michel
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Adrienne Austin
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
| | - Heidi Kipp
- Departments of Psychiatry and Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert R. Rice
- Center for Clinical and Translational Science, Ohio State University Medical Center, Columbus, Ohio
| | - Michael G. Aman
- The Nisonger Center (UCEDD), Ohio State University, Columbus, Ohio
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Klein B, Damiani-Taraba G, Koster A, Campbell J, Scholz C. Diagnosing attention-deficit hyperactivity disorder (ADHD) in children involved with child protection services: are current diagnostic guidelines acceptable for vulnerable populations? Child Care Health Dev 2015; 41:178-85. [PMID: 24942100 DOI: 10.1111/cch.12168] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 11/29/2022]
Abstract
Children involved with child protection services (CPS) are diagnosed and treated for attention-deficit hyperactivity disorder (ADHD) at higher rates than the general population. Children with maltreatment histories are much more likely to have other factors contributing to behavioural and attentional regulation difficulties that may overlap with or mimic ADHD-like symptoms, including language and learning problems, post-traumatic stress disorder, attachment difficulties, mood disorders and anxiety disorders. A higher number of children in the child welfare system are diagnosed with ADHD and provided with psychotropic medications under a group care setting compared with family-based, foster care and kinship care settings. However, children's behavioural trajectories change over time while in care. A reassessment in the approach to ADHD-like symptoms in children exposed to confirmed (or suspected) maltreatment (e.g. neglect, abuse) is required. Diagnosis should be conducted within a multidisciplinary team and practice guidelines regarding ADHD diagnostic and management practices for children in CPS care are warranted both in the USA and in Canada. Increased education for caregivers, teachers and child welfare staff on the effects of maltreatment and often perplexing relationship with ADHD-like symptoms and co-morbid disorders is also necessary. Increased partnerships are needed to ensure the mental well-being of children with child protection involvement.
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Affiliation(s)
- B Klein
- Landsdowne Children's Centre, Brantford, ON, Canada; McMaster University, Hamilton, ON, Canada
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Geiger JM, Schelbe L, Hayes MJ, Kawam E, Katz CC, Klika JB. Intergenerational Transmission of Maltreatment: Ending a Family Tradition. ADVANCES IN CHILD ABUSE PREVENTION KNOWLEDGE 2015. [DOI: 10.1007/978-3-319-16327-7_4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Raghavan R, Brown DS, Allaire BT, Garfield LD, Ross RE. Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States. Psychiatr Serv 2014; 65:1445-51. [PMID: 25178250 PMCID: PMC4346518 DOI: 10.1176/appi.ps.201400028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Children with histories of abuse or neglect are the most expensive child population to insure for their mental health needs. This study aimed to quantify the magnitude of Medicaid expenditures incurred in the purchase of psychotropic drugs for these children. METHODS Children (N=4,445) participating in the National Survey of Child and Adolescent Well-Being (NSCAW) and from households under investigation for suspected child abuse and neglect were linked to their Medicaid claims from 36 states. Expenditures on psychotropic medications between the NSCAW sample and a propensity score-matched comparison sample of Medicaid-enrolled children were compared in a two-part regression of logistic and generalized linear models. RESULTS Children in the NSCAW sample had twice the odds of psychotropic drug use and $190 higher mean annual expenditures on psychotropic drugs than children in the comparison sample. Increased expenditures on antidepressants and antimanic drugs were the primary drivers of these increased expenditures. Male gender and white race-ethnicity were associated with significantly increased expenditures. Children in primary care case management had $325 lower expenditures than those in fee-for-service Medicaid. Among NSCAW children alone, male gender, older age, being in poorer health, and scoring in the clinical range of the Child Behavior Checklist (CBCL) all increased expenditures on psychotropic drugs. CONCLUSIONS Medicaid agencies should focus their cost containment strategies on antidepressants and antimanic drugs, consider expanding primary care case management arrangements, and expand use of instruments such as the CBCL to identify and treat high-need children.
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Affiliation(s)
- Ramesh Raghavan
- Dr. Raghavan, Dr. Brown, Dr. Garfield, and Ms. Ross are with the Brown School, Washington University in St. Louis, St. Louis, Missouri (e-mail: ). Dr. Raghavan is also with the Department of Psychiatry, Washington University in St. Louis. Mr. Allaire is with RTI International, Research Triangle Park, North Carolina
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Vinnerljung B, Hjern A. Consumption of psychotropic drugs among adults who were in societal care during their childhood-A Swedish national cohort study. Nord J Psychiatry 2014; 68:611-9. [PMID: 24754468 DOI: 10.3109/08039488.2014.902501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous studies have demonstrated greatly increased risks of severe psychiatric morbidity for former child welfare clients. We investigated psychotropic medication in this population as a proxy indicator of less severe mental health problems. METHODS This register-based cohort study comprises the Swedish birth cohorts between 1973 and 1981, 765,038, including 16,986 former children from societal care and 1296 national adoptees. Estimates of risk of retrieval of prescribed psychotropic medications during 2009 were calculated in four categories (any such drug, neuroleptics, antidepressants and anxiolytics/hypnotics) as hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox regression analysis, adjusting for birth parental background including psychiatric morbidity. RESULTS 17-25% of men and 25-32% of the women with childhood experiences of societal care retrieved at least one prescription of a psychotropic drug, equivalent to age-adjusted HRs of between 2.1 and 3.3, compared with the general population. Adjusting the analysis for birth parental confounders attenuated risks to between 1.5 and 2.7, depending on subgroup and sex. Men-especially those that entered care settings during their teens-tended to have higher risks of all outcomes. Adjusted HRs for national adoptees were similar to former children in care. CONCLUSIONS Former residents of societal care are a high-risk group for mental health problems well into mature adult age, demonstrating the need for systematic screening and implementation of effective prevention/treatment during time in care.
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Affiliation(s)
- Bo Vinnerljung
- Bo Vinnerljung, Ph.D., Department of Social Work, Stockholm University , 106 91 Stockholm , Sweden
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Growth in the concurrent use of antipsychotics with other psychotropic medications in Medicaid-enrolled children. J Am Acad Child Adolesc Psychiatry 2014; 53:960-970.e2. [PMID: 25151419 DOI: 10.1016/j.jaac.2014.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/16/2014] [Accepted: 06/16/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children; however, there is limited understanding of the frequency of concurrent SGA prescribing with other psychotropic medications. This study describes the epidemiology of concurrent SGA use with 4 psychotropic classes (stimulants, antidepressants, mood stabilizers, and α-agonists) among a national sample of Medicaid-enrolled children and adolescents 6 to 18 years old between 2004 and 2008. METHOD Repeated cross-sectional design was used, with national Medicaid Analytic eXtract data (10.6 million children annually). Logit and Poisson regression, standardized for year, demographics, and Medicaid eligibility group, estimated the probability and duration of concurrent SGA use with each medication class over time and examined concurrent SGAs in relation to clinical and demographic characteristics. RESULTS While SGA use overall increased by 22%, 85% of such use occurred concurrently. By 2008, the probability of concurrent SGA use ranged from 0.22 for stimulant users to 0.52 for mood stabilizer users. Concurrent SGA use occurred for long durations (69%-89% of annual medication days). Although the highest users of concurrent SGA were participants in foster care and disability Medicaid programs or those with behavioral hospitalizations, the most significant increases over time occurred among participants who were income-eligible for Medicaid (+13%), without comorbid ADHD (+15%), were not hospitalized (+13%), and did not have comorbid intellectual disability (+45%). CONCLUSION Concurrent SGA use with other psychotropic classes increased over time, and the duration of concurrent therapy was consistently long term. Concurrent SGA regimens will require further research to determine efficacy and potential drug-drug interactions, given a practice trend toward more complex regimens in less-impaired children/adolescents.
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Schneiderman JU, Arnold-Clark JS, Smith C, Duan L, Fuentes J. Demographic and placement variables associated with overweight and obesity in children in long-term foster care. Matern Child Health J 2014; 17:1673-9. [PMID: 23124799 DOI: 10.1007/s10995-012-1181-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Overweight and obesity is a growing problem for children in foster care. This study describes the prevalence of overweight and obesity in an urban, ethnic minority population of children ages 2-19 in long-term foster care (N = 312) in Los Angeles, California. It also investigates whether demographics or placement settings are related to high body mass index. The estimates of prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) were presented for gender, age, ethnicity, and placement type. Multiple logistic regression was used to examine potential associations between demographic and placement variables and weight status. The prevalence of overweight/obesity was almost 40 % and obesity was 23 % for the study population. Children placed in a group home had the highest prevalence of overweight/obesity (60 %) and obesity (43 %) compared to other types of placement. Within this study, older children (ages 12-19) were more likely to be overweight/obese than normal weight compared to children between 2 and 5 years old when controlling for gender, ethnicity and placement (OR = 2.10, CI = 1.14-3.87). These findings suggest that older age and long-term foster care in general may be risk factors for obesity. Child welfare agencies and health care providers need to work together to train caregivers with children in long-term foster care in obesity treatment interventions and obesity prevention strategies.
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Affiliation(s)
- Janet U Schneiderman
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA, 90089-0411, USA,
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Raghavan R, Brown DS, Allaire BT, Garfield LD, Ross RE, Snowden LR. Racial/ethnic differences in Medicaid expenditures on psychotropic medications among maltreated children. CHILD ABUSE & NEGLECT 2014; 38:1002-10. [PMID: 24646610 PMCID: PMC4061230 DOI: 10.1016/j.chiabu.2014.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/17/2014] [Accepted: 02/26/2014] [Indexed: 06/03/2023]
Abstract
This study quantifies racial/ethnic differences in Medicaid expenditures on psychotropic drugs among a national sample of children with suspected maltreatment. We linked 4,445 child participants in the National Survey of Child and Adolescent Well-Being (NSCAW) - consisting of children investigated for suspected abuse and neglect - to their Medicaid claims obtained from 36 states. We used propensity score matching to construct a comparison group of children without known child welfare involvement, and estimated two-part generalized linear models to examine differences in annual psychotropic drug expenditures per child between children of different races/ethnicities. When compared to a matched sample of children, African American and Latino children incur $292 and $144 less expenditures on psychotropic drugs, respectively, than white children. Among NSCAW children alone, African American children display $614 less spending on psychotropic drugs when compared to white children. Racial/ethnic differences in expenditures on psychotropic drugs occur among all children on Medicaid, but the differences are especially pronounced among African American children in contact with the child welfare system. These findings demonstrate that policymakers will need to pay special attention to the needs of children of color as Medicaid expansions proceed nationwide.
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Affiliation(s)
- Ramesh Raghavan
- Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, ; ;
| | - Derek S. Brown
- Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, ; ;
| | | | - Lauren D. Garfield
- Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, ; ;
| | - Raven E. Ross
- Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130, ; ;
| | - Lonnie R. Snowden
- University of California, Berkeley, School of Public Health, 50 University Hall, #7360, University of California, Berkeley, Berkeley, CA 94720-7360,
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Hilt R, Wolf C, Koprowicz K, Thomas E, Chandler M, Hao XL, Russell M, Le T, Hooks L, King B. Community child psychiatric medication experiences measured by an internet-based, prospective parent survey of retail pharmacy customers. Community Ment Health J 2014; 50:172-8. [PMID: 24323138 DOI: 10.1007/s10597-013-9671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 11/30/2013] [Indexed: 10/25/2022]
Abstract
One thousand five hundred parents filling a psychiatric prescription for their 6-18 year old child with a multi-state retail pharmacy chain received a single mailed invitation to complete a detailed online survey. 276 parents responded (18.4%). 60% of children on medications had a parent rated CBCL scale score in the clinically significant range at enrollment (T score ≥65), with a similar frequency of clinically significant CBCL scores through 15 months of survey followup. 47% of medication regimens were noted to be causing persistent side effects. This simple community based data collection method can offer a unique way to investigate naturalistic treatment outcomes.
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Affiliation(s)
- Robert Hilt
- Department of Psychiatry and Behavioral Health, Seattle Children's Hospital, University of Washington, M/S CPH, 4800 Sand Point Way NE, Seattle, WA, 98145, USA,
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Cohen D, Dillon FR, Gladwin H, De La Rosa M. American parents' willingness to prescribe psychoactive drugs to children: a test of cultural mediators. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1873-87. [PMID: 23715970 PMCID: PMC3833887 DOI: 10.1007/s00127-013-0710-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 05/10/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE In the USA, white children receive psychoactive drugs more often than black or Hispanic children. This study investigates whether cultural attitudes statistically mediate differences between American parents' self-identified racial-ethnic group membership and their willingness to medicate children for behavioral problems. METHODS Using data from telephone interviews with 1,145 parents in two Florida counties, structural models tested associations between each group compared with the other, in willingness to medicate children exhibiting different problematic behaviors and hypothesized cultural (familism, fatalism, attitude toward corporal punishment, religiosity, concern about treatment stigma, birth abroad, language of interview) and other mediators (views about medications and causes of children's problems). Respondent gender, age, socioeconomic status, parent-type household, taking psychoactive medication, and having a child with behavioral problems were used as covariates. RESULTS Race-ethnicity was strongly associated with specific cultural attitudes and views about medications and problems, but only Hispanics distinguished themselves significantly from whites in willingness to medicate children. Across groups, parents who viewed medication favorably and endorsed biomedical causes for problems were more willing to medicate. In Hispanic-white and Hispanic-black comparisons, being interviewed in Spanish was the sole but modest cultural mediator of willingness, and in black-white comparisons, only concern about treatment stigma weakly mediated differences in willingness. CONCLUSIONS These findings provide faint support for a parent-centered cultural explanation of reported prescription differences among youths of different racial-ethnic groups in the USA. However, structural and professional components of a broader cultural hypothesis for such differences, within the USA and between different countries, still require evaluation.
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Affiliation(s)
- David Cohen
- School of Social Work, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA,
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Bertram JE, Narendorf SC, McMillen JC. Pioneering the psychiatric nurse role in foster care. Arch Psychiatr Nurs 2013; 27:285-92. [PMID: 24238008 PMCID: PMC3844857 DOI: 10.1016/j.apnu.2013.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/27/2013] [Accepted: 09/01/2013] [Indexed: 11/27/2022]
Abstract
Older youth served in the foster care system have elevated rates of mental health disorders and are high users of mental health services, yet concerns have been raised about the quality of this care. This paper describes the details of a psychiatric nurse's work within a multidisciplinary team to address gaps in care for older youth with psychiatric disorders. We describe the process, outcomes, and lessons learned in developing and piloting a psychiatric nurse intervention for older youth in the foster care system as part of a multidimensional treatment foster care program. Our experiences support further work to develop a role for nursing to improve the quality of mental health treatment in foster care.
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Garland AF, Brookman-Frazee L, Gray E. The role of parent characteristics in community-based medication treatment for children with disruptive behavior problems. Community Ment Health J 2013; 49:507-14. [PMID: 22766691 PMCID: PMC3517686 DOI: 10.1007/s10597-012-9514-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/21/2012] [Indexed: 11/24/2022]
Abstract
Studies have documented increased psychoactive medication use rates among children, but little is known about what child and/or family characteristics predict medication treatment in community-based care. This study examines the role of parent characteristics in children's medication treatment, while accounting for other potential predictors. Participants included 213 children ages 4-13 with disruptive behavior problems. Medication treatment was assessed by parent report; potential predictors of medication treatment, including child characteristics and parent characteristics (e.g., education level, perceived strain and psychopathology) were assessed at service intake. Over 60 % of children used a psychoactive medication during the 16 month study period (most commonly stimulants). Parent education level and reported strain were significant predictors of children's medication treatment even when accounting for other significant predictors such as child diagnosis, age, race/ethnicity, etc. Results highlight the role that parent characteristics have in accessing community-based medication treatment for children with disruptive behavior problems.
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Affiliation(s)
- Ann F Garland
- Department of Psychiatry, University of California, San Diego, USA.
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Kowatch RA, Youngstrom EA, Horwitz S, Demeter C, Fristad MA, Birmaher B, Axelson D, Ryan N, Frazier TW, Arnold LE, Young AS, Gill M, Findling RL. Prescription of psychiatric medications and polypharmacy in the LAMS cohort. Psychiatr Serv 2013; 64:1026-34. [PMID: 23852186 PMCID: PMC3977739 DOI: 10.1176/appi.ps.201200507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study evaluated demographic and clinical correlates and predictors of polypharmacy at baseline assessment in the Longitudinal Assessment of Manic Symptoms (LAMS) sample, a cohort of children age six to 12 years at their first outpatient mental health visit at university-affiliated clinics. METHODS Use of medications in four classes (mood stabilizers, antidepressants, antipsychotics, and stimulants) was assessed, and the Service Assessment for Children and Adolescents classified lifetime and current use of various services. Analyses examined correlates of the number of medications prescribed and odds of polypharmacy, defined as use of two or more concurrent medications. RESULTS In the total sample, 201 of 698 participants (29%) were prescribed two or more medications. These participants had lower Children's Global Assessment Scale scores, more comorbid disorders, and higher baseline parent-reported mood symptoms than those prescribed no or one medication. White youths were three times as likely as nonwhite youths to be receiving two or more psychotropics, even after adjustment for other demographic and clinical characteristics. Of 262 participants (38% of sample) not being treated with medications, 252 (96%) had a diagnosis of at least one psychiatric disorder (74% had two or more). CONCLUSIONS Findings suggest that patients with greater severity and comorbidity were more likely to receive two or more medications. However, 38% of these children with serious disorders were not receiving psychotropic medication at the time of this assessment. Results counter findings suggesting overtreatment with medications of children with psychiatric disorders in the community.
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Affiliation(s)
- Robert A. Kowatch
- Department of Psychiatry, Ohio State Wexner Medical Center and Nationwide Children's Hospital, Department of Psychiatry, 700 Children's Dr., Columbus, OH 43205 ()
| | | | - Sarah Horwitz
- Department of Child Psychiatry, New York University School of Medicine, New York City
| | - Christine Demeter
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | - Mary A. Fristad
- Department of Psychiatry, Division of Child and Adolescent Psychiatry
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David Axelson
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh. Western Psychiatric Institute and Clinic, Pittsburgh
| | - Neal Ryan
- Western Psychiatric Institute and Clinic, Pittsburgh
| | | | - L. Eugene Arnold
- Department of Psychiatry, both at Ohio State University, Columbus
| | - Andrea S. Young
- Center for Pediatric Behavioral Health, Cleveland Clinic, Cleveland
| | - MaryKay Gill
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh. Western Psychiatric Institute and Clinic, Pittsburgh
| | - Robert L. Findling
- Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore
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Schneiderman JU, Smith C, Arnold-Clark JS, Fuentes J, Duan L. Weight changes in children in foster care for 1 year. CHILD ABUSE & NEGLECT 2013; 37:832-40. [PMID: 23499524 PMCID: PMC3713178 DOI: 10.1016/j.chiabu.2013.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 02/05/2013] [Accepted: 02/18/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The aims of this study of predominately racial/ethnic minority children in foster care (N=360, birth to 19 years old) in Los Angeles, CA were to examine the (1) prevalence of obesity (≥ 95 percentile) and overweight/obese (≥ 85 percentile) upon entrance to foster care (T1) and after 1 year in foster care (T2); (2) comparison of high weight categories to national statistics; (3) relationship of changes in weight status to age, reason for entry into foster care, and placement. METHODS Chi-square test and McNemar test comparing paired proportions were used to determine whether there were significant changes in the proportion of high weight categories between T1 and T2. Chi-square test or Fisher's exact test were used to evaluate the association between age, placement, and reason for foster care with the change in weight category. Changes in weight were categorized as (1) decreased in weight, (2) remained at overweight or obese, (3) increased in weight, or (4) remained normal. RESULTS The proportion of obese and obese/overweight children between ages 2 and 5 were significantly lower at T2 than T1. There were no significant changes in the prevalence of obesity for the total population at T2. Children age 6 or older had a higher prevalence of obesity and overweight/obesity compared to national statistics. Of children at all ages, 64.7% of children of all ages entered foster care with a normal weight and stayed in the normal range during their first year in foster care, 12.2% decreased their weight, 15.4% remained overweight or obese, and 7.7% increased their weight. Age and parental substance use was related to change in weight category from T1 to T2. CONCLUSION Children did not become more overweight or obese in foster care; however 28% of the children were obese or overweight upon entry into foster care. Children who are 6 years or older and obese upon entering foster care should be targeted for weight reduction. The pediatric community and child welfare system need to work together by including weight percentiles in the foster care file and training/monitoring child welfare caregivers in weight reduction interventions.
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Affiliation(s)
- Janet U Schneiderman
- School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA 90089-0411, USA.
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Lê Cook B, Barry CL, Busch SH. Racial/ethnic disparity trends in children's mental health care access and expenditures from 2002 to 2007. Health Serv Res 2013; 48:129-49. [PMID: 22716901 PMCID: PMC3449047 DOI: 10.1111/j.1475-6773.2012.01439.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine trends in disparities in children's mental health care. DATA 2002-2007 Medical Expenditure Panel Survey. STUDY DESIGN We used the Institute of Medicine (IOM) definition of health care disparities and estimated two-part expenditure models to examine disparity trends in any mental health care use, any outpatient care, and psychotropic drug use, as well as expenditures in these three categories, conditional on use. We used 2-year longitudinal panel data to determine disparities in care initiation among children with unmet need. PRINCIPAL FINDINGS Assessing trends over time between 2002 and 2007, we identified that disparities persist for blacks and Latinos in receipt of any mental health care, any outpatient care, and any psychotropic drug use. Among those with positive mental health care expenditures, Latino-white disparities in overall mental health care expenditures increased over time. Among children with unmet need, significant disparities in initiation of an episode of mental health care were found, with whites approximately twice as likely as blacks and Latinos to initiate care. CONCLUSIONS Disparities in children's mental health care use are persistent and driven by disparities in initiation, suggesting policies to improve detection or increase initial access to care may be critical to reducing disparities.
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Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Department of Psychiatry, Harvard Medical School, Somerville, MA 02143, USA.
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Stimulant and atypical antipsychotic medications for children placed in foster homes. PLoS One 2013; 8:e54152. [PMID: 23326588 PMCID: PMC3541235 DOI: 10.1371/journal.pone.0054152] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 12/05/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives The purpose of this study is to examine the use of prescribed psychoactive medications in a prospective cohort of children shortly after they entered foster homes; and to identify demographics, maltreatment history, psychiatric diagnoses including ADHD comorbidity, and level of aggression that contribute to prescribed use of stimulant and atypical antipsychotic medication over time. Methods The sample included N = 252 children (nested in 95 sibling groups) followed for three years up to 4 yearly waves. Results Nearly all (89%) met criteria for at least one of eight psychiatric diagnoses and 31% (75/252) used one or more prescribed psychoactive medications. Over half (55%) were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); of these 38% used stimulants and 36% used atypical antipsychotics. Of the 75 medicated children, 19% received ≥3 different classes of drugs over the course of the study. Stimulants (69%) and atypical antipsychotics (65%) were the most frequently used drugs among medicated children. Adjusted odds ratios (AOR) showed that male gender (AOR = 3.2; 95% CI = 1.5–9.3), African American vs Latino ethnicity (AOR = 5.4; 95% CI = 2.1–14.2), ADHD regardless of Oppositional Defiant (ODD) or Conduct (CD) comorbidity (AOR = 6.0, 95% CI = 1.3–27.5), ODD or CD (AOR = 11.1, 95% CI = 2.1–58.6), and Separation Anxiety (AOR = 2.0, 95% CI = 1.0–4.0) psychiatric disorders were associated with the use of prescribed stimulants; while male gender (AOR = 3.8, 95% CI = 1.5–9.3), African American vs Latino (AOR = 5.1, 95% CI = 1.2–9.2) or Mixed/Other ethnicity (AOR = 3.3, 95% CI = 1.9–13.7), ADHD regardless of ODD or CD comorbidity (AOR = 5.8, 95% CI = 1.2–28.7), ODD or CD (AOR = 13.9, 95% CI = 3.3–58.5), Major Depression/Dysthymia (AOR = 2.8, 95% CI = 1.1–6.7) psychiatric disorders, and history of sexual abuse (AOR = 4.6, 95% CI = 1.3–18.4) were associated with the use of prescribed atypical antipsychotics. Conclusion The aggressive use of atypical antipsychotics, which has unknown metabolic risks, suggests that the efficacy and safety of such treatment strategies for psychiatrically ill children in foster care should be monitored.
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Epright MC, Waller S. When love hurts children: controlling the feelings of minors. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:28-29. [PMID: 24161176 DOI: 10.1080/15265161.2013.839754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Coke S, Spratling R, Minick P. Exploring the day-to-day life of mothers dealing with preschool children who have behavioral disorders. J Pediatr Health Care 2013; 27:23-32. [PMID: 23237613 DOI: 10.1016/j.pedhc.2011.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 06/14/2011] [Accepted: 06/17/2011] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study was to explore the day-to-day life of mothers dealing with preschool children who have behavioral disorders and to explore the mothers' experiences with their children's health care. METHOD A qualitative design was used to explore mothers' experiences in their day-to-day lives. A purposive sample of eight mothers was interviewed in their homes. A recorded face-to-face format was used that included open-ended, semi-structured questions. RESULTS Two major themes emerged from the day-to-day experiences of these mothers: "abandoning my other child" and "parenting in unsupportive environments". DISCUSSION The theme of "parenting in unsupportive environments" reflects the frustrations the mothers felt in their day-to-day lives while trying to find help for their children. The theme of "abandoning my other child" refers to the siblings of the children with behavioral disorders being overlooked by the mothers because so much of the mothers' attention and time was given to the child with the behavioral disorder.
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Affiliation(s)
- Sallie Coke
- Georgia College and State University, College of Health Sciences, Milledgeville, GA 31061, USA.
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Raghavan R, Brown DS, Thompson H, Ettner SL, Clements LM, Key W. Medicaid expenditures on psychotropic medications for children in the child welfare system. J Child Adolesc Psychopharmacol 2012; 22:182-9. [PMID: 22537361 PMCID: PMC3373221 DOI: 10.1089/cap.2011.0135] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Children in the child welfare system are the most expensive child population to insure for their mental health needs. The objective of this article is to estimate the amount of Medicaid expenditures incurred from the purchase of psychotropic drugs - the primary drivers of mental health expenditures - for these children. METHODS We linked a subsample of children interviewed in the first nationally representative survey of children coming into contact with U.S. child welfare agencies, the National Survey of Child and Adolescent Well-Being (NSCAW), to their Medicaid claims files obtained from the Medicaid Analytic Extract. Our data consist of children living in 14 states, and Medicaid claims for 4 years, adjusted to 2010 dollars. We compared expenditures on psychotropic medications in the NSCAW sample to a propensity score-matched comparison sample obtained from Medicaid files. RESULTS Children surveyed in NSCAW had over thrice the odds of any psychotropic drug use than the comparison sample. Each maltreated child increased Medicaid expenditures by between $237 and $840 per year, relative to comparison children also receiving medications. Increased expenditures on antidepressants and amphetamine-like stimulants were the primary drivers of these increased expenditures. On average, an African American child in NSCAW received $399 less expenditure than a white child, controlling for behavioral problems and other child and regional characteristics. Children scoring in the clinical range of the Child Behavior Checklist received, on average, $853 increased expenditure on psychotropic drugs. CONCLUSION Each child with child welfare involvement is likely to incur upwards of $1482 in psychotropic medication expenditures throughout his or her enrollment in Medicaid. Medicaid agencies should focus their cost-containment strategies on antidepressants and amphetamine-type stimulants, and expand use of instruments such as the Child Behavior Checklist to identify high-cost children. Both of these strategies can assist Medicaid agencies to better predict and plan for these expenditures.
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Affiliation(s)
- Ramesh Raghavan
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA.
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Brown DS, Fang X, Florence CS. Medical costs attributable to child maltreatment a systematic review of short- and long-term effects. Am J Prev Med 2011; 41:627-35. [PMID: 22099241 DOI: 10.1016/j.amepre.2011.08.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/14/2011] [Accepted: 08/05/2011] [Indexed: 11/24/2022]
Abstract
CONTEXT Child maltreatment is a serious and prevalent public health problem, which has been shown to be associated with numerous short- and long-term effects on mental and physical health. Few estimates of the medical costs of these effects have been published to date. To determine the range and quality of currently available estimates and identify the gaps and needs for future research, this article reviews research on medical costs of child maltreatment. EVIDENCE ACQUISITION Peer-reviewed literature on child maltreatment and medical costs was identified by searching major databases. Twelve articles on the medical costs of child maltreatment were identified. EVIDENCE SYNTHESIS Eight studies describe short-term costs among children; four describe adult, long-term costs. Most studies used convenience samples, captured a partial share of the total costs, and did not follow best practices for econometric analysis of medical costs. CONCLUSIONS Child maltreatment is associated with substantial medical costs in childhood and adulthood, but estimates vary widely because of differences in research designs, types of cost data, and study quality. Econometric estimates of the annual medical costs in adulthood range from zero to about $800. Per-episode estimates of child costs, based on mean comparisons, range from $0 to >$24,000.
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Affiliation(s)
- Derek S Brown
- Public Health Economics Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
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dosReis S, Yoon Y, Rubin DM, Riddle MA, Noll E, Rothbard A. Antipsychotic treatment among youth in foster care. Pediatrics 2011; 128:e1459-66. [PMID: 22106072 PMCID: PMC3387900 DOI: 10.1542/peds.2010-2970] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Despite national concerns over high rates of antipsychotic medication use among youth in foster care, concomitant antipsychotic use has not been examined. In this study, concomitant antipsychotic use among Medicaid-enrolled youth in foster care was compared with disabled or low-income Medicaid-enrolled youth. PATIENTS AND METHODS The sample included 16 969 youths younger than 20 years who were continuously enrolled in a Mid-Atlantic state Medicaid program and had ≥1 claim with a psychiatric diagnosis and ≥1 antipsychotic claim in 2003. Antipsychotic treatment was characterized by days of any use and concomitant use with ≥2 overlapping antipsychotics for >30 days. Medicaid program categories were foster care, disabled (Supplemental Security Income), and Temporary Assistance for Needy Families (TANF). Multicategory involvement for youths in foster care was classified as foster care/Supplemental Security Income, foster care/TANF, and foster care/adoption. We used multivariate analyses, adjusting for demographics, psychiatric comorbidities, and other psychotropic use, to assess associations between Medicaid program category and concomitant antipsychotic use. RESULTS Average antipsychotic use ranged from 222 ± 110 days in foster care to only 135 ± 101 days in TANF (P < .001). Concomitant use for ≥180 days was 19% in foster care only and 24% in foster care/adoption compared with <15% in the other categories. Conduct disorder and antidepressant or mood-stabilizer use was associated with a higher likelihood of concomitant antipsychotic use (P < .0001). CONCLUSIONS Additional study is needed to assess the clinical rationale, safety, and outcomes of concomitant antipsychotic use and to inform statewide policies for monitoring and oversight of antipsychotic use among youths in the foster care system.
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Affiliation(s)
- Susan dosReis
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Yesel Yoon
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David M. Rubin
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; and
| | - Mark A. Riddle
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth Noll
- Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aileen Rothbard
- Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania
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Morris J, Stone G. Children and psychotropic medication: a cautionary note. JOURNAL OF MARITAL AND FAMILY THERAPY 2011; 37:299-306. [PMID: 21745232 DOI: 10.1111/j.1752-0606.2009.00178.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This report addresses how the mental health field is organized in terms of the use of psychotropic medications with children and adolescents, and the ethical challenge this presents to marriage and family therapists.
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Affiliation(s)
- James Morris
- Marriage and Family Therapy Program, Texas Tech University,
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Leslie LK, Raghavan R, Hurley M, Zhang J, Landsverk J, Aarons G. Investigating geographic variation in use of psychotropic medications among youth in child welfare. CHILD ABUSE & NEGLECT 2011; 35:333-342. [PMID: 21620160 DOI: 10.1016/j.chiabu.2011.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 07/27/2010] [Accepted: 01/06/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Public Law (P.L.) 110-351, the "Fostering Connections to Success Act," calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors. METHODS Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables. RESULTS Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p<.001), male gender (p<.001), emotional and behavioral problems (p<.001), and insurance (p=.05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use. CONCLUSIONS Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use. PRACTICE IMPLICATIONS These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population.
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Affiliation(s)
- Laurel K Leslie
- Center on Child and Family Outcomes, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St., Tufts MC #345, Boston, MA 02111, USA
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