Antipsychotic Guidelines for Kids Not Followed
Antipsychotic prescribing rates for children in foster care and other Medicaid-insured children have finally leveled off following a period of rapid growth in the earlier 2000’s. Guideline practices are still not followed, research shows.
Details on the Antipsychotic Study
According to Medscape, current guidelines and treatment recommendations highlight the importance of the care processes. This includes the use of psychosocial mental health interventions as first line treatment.
The new study found that children treated with antipsychotics, more than one third of foster children and more than two thirds of other Medicaid children failed to receive the necessary psychosocial mental health interventions that should have happened during the 3 months proceeding the treatment.
Based on findings from an analysis of national and state level Medicaid data, as well as private health insurance companies, only 28% of foster children and 18% of other children received metabolic monitoring of blood glucose and serum cholesterol levels that is recommended.
Dr. Crystal, an author of the study claims that the new normal levels of prescribing represent a higher rate than what was previously seen. There is a safety concern about long term effects on brain development.
The study has also showed that these antipsychotics continue to be prescribed for mental disorders that are not indicated by the FDA. This includes ADHD, anxiety and depression.
According to Dr. Crystal, there is a long way to go before we can say that kids who are troubled enough to receive antispychotics are receiving the treatment appropriate to them. Major efforts need to be made to expand the supply, quality, and accessibility for these mental health services.
Encouraging Signs From the Study
According to Meredith Matone, DrPH, MHS, deputy director of Policy Lab atPhiladelphia’s Children’s Hospital, the decline in prescribing seen in this study is actually an encouraging sign. She states that it will be important to make sure we provide appropriate alternative therapies.
Dr. Matone states that children in foster care often have behavioral concerns, which is often from trauma exposure. Providers have few alternatives to medications due to psychotherapies being unavailable.
Antipsychotic use in children has expanded when it comes for the treatment of aggressive behaviors, which is above and beyond their approved uses.
When it comes to addressing this issue, provider education and expanded availability of medication alternatives are important, says Dr. Matone. Many state and local Medicaid and welfare systems are responding to this issue with the use of prescribing guidelines, oversight policies, such as the use of prior authorization.