Access to Psychosocial Services Prior to Starting Antipsychotic Treatment Among Medicaid-Insured Youth

Finnerty, Molly; Neese-Todd, Sheree; Pritam, Riti; Leckman‐Westin, Emily; Bilder, Scott; Byron, Sepheen C.; Scholle, Sarah Hudson; Crystal, Stephen; Olfson, Mark

doi:10.1016/j.jaac.2015.09.020

Cited by 30 publications

(20 citation statements)

References 40 publications

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“…Most young children receiving care for ADHD (65%) were in utilization profiles characterized by low or no probability of psychological services and high probability of receiving ADHD medication. These results are consistent with previous research that showed that less than one-half of young children received any psychosocial treatment before being treated with antipsychotic medications (15). The variation in treatment receipt across these seven states is also consistent with previous studies showing differences in state-level estimates of medication and behavioral treatment among children with ADHD (14, 18).…”

Section: Discussionsupporting

confidence: 93%

“…The misalignment between clinical guidance and utilization could be the result of a number of factors. Provider availability may be a key driver, because few trained professionals are available to deliver evidence-based psychosocial treatments for children (15). There may be differences by physician type in care of children with ADHD (30).…”

Section: Discussionmentioning

confidence: 99%

“…There may be differences by physician type in care of children with ADHD (30). Physicians may prescribe medication while families are placed on waiting lists for psychological services (15, 31, 32). Providers may also be influenced by other considerations in the clinical decision-making process for initiating ADHD treatment, such as physical safety and educational concerns (32).…”

Section: Discussionmentioning

confidence: 99%

“…However, that study took a cross-sectional approach and did not examine sequencing of treatment, specifically how many children received behavioral treatment before medication. Previous research has used Medicaid claims data to define treatment trajectories for children with mental disorders (15, 16) but has not focused on whether treatment patterns for young children with ADHD conform to clinical guidelines.…”

mentioning

confidence: 99%

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Adherence to Recommended Care Guidelines in the Treatment of Preschool-Age Medicaid-Enrolled Children With a Diagnosis of ADHD

Morán

Serban

Danielson

et al. 2019

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Objective: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder of childhood. Clinical guidelines recommend behavior therapy as the first-line treatment for preschool-age children with ADHD. This study evaluated longitudinal patterns of services received by Medicaid-enrolled children ages 2 to 5 with ADHD in seven southeastern states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina). Methods: A discrete sequence clustering analysis was used with 2005–2012 Medicaid Analytic eXtract data to profile patient-level utilization for each state, with a focus on receipt of psychological services and medication. The model output was used to assess utilization behaviors longitudinally relative to recommended care guidelines and to characterize sources of variation in utilization patterns by demographic and ecological factors. Results: Five states had a utilization profile with a high probability of receipt of psychological services before medication among children with ADHD, covering 16% of the total study population. Most young children’s ADHD care experience in the seven states (65%) fit utilization profiles characterized by a high probability of receiving any ADHD medication. Black race was significantly associated with higher utilization of psychological services in three states. Conclusions: About 16% of Medicaid-enrolled preschool-age children with ADHD received care during 2005–2012 that appeared to be consistent with 2011 recommended care guidelines. State-level and subpopulation variations in utilization for ADHD-related clinical care were found. The findings indicate that there were major gaps in treatment for ADHD among young children and that the gaps are wider for some states and subpopulations of children.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Adherence to Recommended Care Guidelines in the Treatment of Preschool-Age Medicaid-Enrolled Children With a Diagnosis of ADHD

Morán

Serban

Danielson

et al. 2019

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“…Other similarities to their study are the low incidence of prior treatment with cognitive behavioral interventions and the fact that younger children were less likely to have received prior treatment. In contrast to our findings, in over half of a sample of Medicaid insured children, there was no prior psychosocial treatment in the 3 months before the antipsychotic had been prescribed [32,38]. However, our study, as well as the study by Rettew et al [7] assessed all prior lifetime treatments, which might explain this difference.…”

Section: Discussioncontrasting

confidence: 95%

Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence

Dinnissen

Dietrich

Molen

et al. 2020

Eur Child Adolesc Psychiatry

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Antipsychotics are often prescribed to children and adolescents, mostly off-label. We aimed to assess adherence to recommendations of guidelines for antipsychotic prescription. We reviewed 436 medical records from 155 clinicians from 26 clinics within three Dutch child and adolescent psychiatry organizations (n = 398 outpatient, n = 38 inpatient care). We assessed target symptoms, diagnostic process, prior and concomitant treatment, and consideration of contra-indications. Multiple logistic regression assessed the role of age, sex, and psychiatric diagnosis on adherence to three main recommendations: to (1) prescribe antipsychotics only after other treatments proved insufficient, (2) always combine antipsychotics with psychosocial interventions, and (3) not prescribe multiple antipsychotics simultaneously. Most patients received off-label antipsychotics. Main target symptoms were inattention/hyperactivity (25%), aggression (24%), and other disruptive behaviors (41%). Most patients underwent diagnostic evaluation before the first prescription; however, screening of contra-indications was low (0.2-19%). About 84% had previously received psychosocial treatment and 48% other psychoactive medication, but 9% had not received any treatment. Notably, only 37% continuously received concomitant psychosocial treatment. Simultaneous use of multiple antipsychotics occurred in 3.2%. Younger children were at higher risk of non-adherence to guideline recommendations regarding prior and concomitant treatment, children with autism spectrum disorder or attention-deficit/ hyperactivity disorder more likely not to receive concomitant psychosocial treatment. Sex did not significantly affect adherence. Our findings implicate insufficient adherence to important recommendations regarding antipsychotic use in children and adolescents. Especially younger children are at higher risk of receiving suboptimal care. There is an urgency to consistently offer psychosocial interventions during antipsychotic treatment.

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Cultural Considerations in the Treatment of African American Youth with Attenuated Psychosis Syndromes: The Importance of Socio-contextual and Clinical Factors

Novacek

LoPilato

Goines

et al. 2019

Handbook of Attenuated Psychosis Syndrome Across Cultures

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Access to Psychosocial Services Prior to Starting Antipsychotic Treatment Among Medicaid-Insured Youth

Abstract: A majority of Medicaid-insured youth initiating antipsychotic treatment have not received a psychosocial service in the preceding 3 months. This service pattern highlights a critical gap in access to psychosocial services.

Cited by 30 publications

References 40 publications

Adherence to Recommended Care Guidelines in the Treatment of Preschool-Age Medicaid-Enrolled Children With a Diagnosis of ADHD

Adherence to Recommended Care Guidelines in the Treatment of Preschool-Age Medicaid-Enrolled Children With a Diagnosis of ADHD

Prescribing antipsychotics in child and adolescent psychiatry: guideline adherence

Cultural Considerations in the Treatment of African American Youth with Attenuated Psychosis Syndromes: The Importance of Socio-contextual and Clinical Factors

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