Clinical and Organizational Correlates of Medication for Youths in U.S. Mental Health Services

Warner, Lynn A.; Pottick, Kathleen J.; Bilder, Scott

doi:10.1086/430996

Cited by 14 publications

(11 citation statements)

References 68 publications

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“…Consistent with previous research (Warner et al 2005;Zito et al 2003), results of the analysis support the notion that either consistent (in the case of Medicaid participation) or adequate (in the case of higher family income) sources of fiscal resource play a role in the use of medication across system of care settings. Children who are Medicaid eligible are approximately 20% more likely to use medications than those who are not Medicaid eligible.…”

Section: Discussionsupporting

confidence: 85%

“…Females are more likely to be treated with antidepressant medication (Shireman et al 2002) and males more likely to be treated with stimulants (Guevera et al 2002). The relationship between medication use and age is not clear across studies (Warner et al 2005). Multiple studies indicate that children from minority populations are less likely to be treated using medications than Whites (Goodwin et al 2001;Leslie et al 2003;Martin et al 2003).…”

Section: Introductionmentioning

confidence: 99%

“…Multiple studies indicate that children from minority populations are less likely to be treated using medications than Whites (Goodwin et al 2001;Leslie et al 2003;Martin et al 2003). Generally, studies show that medication use increases for those having access to Medicaid (Warner et al 2005;Zito et al 2003) and also among those having private insurance (Hoagwood et al 2000). Research has also indicated that many youth involved in non-clinical youthserving systems (i.e., child welfare or juvenile justice) may be less likely to use medications (Zima et al 1999) than those who have extensive service histories in the mental health services system.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Pavkov

Walrath²

2008

J Child Fam Stud

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Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were selfreferred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Pavkov

Walrath²

2008

J Child Fam Stud

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“…Researchers conducting empirical studies of organizational-level interventions to increase the uptake of EBP approaches and improve client outcomes may help provide clinicians with needed agency support (Glisson et al 2016;Proctor et al 2011). Other researchers have found that organizational factors can influence the delivery of medication treatment, beyond clinical need factors of patients (Warner et al 2005). Our findings suggest that clinicians may be influenced by tradition, and organizational norms and routine practices in addition to their awareness of the empirical literature.…”

Section: Iqr Interquartile Rangementioning

confidence: 65%

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

Pottick

Tian

Kirk

et al. 2017

J Psychopathol Behav Assess

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Using a between-subject 3 × 3 design of an experimentally manipulated realistic case vignette of Black, White, and Hispanic youth in a survey mailed to 1540 experienced psychologists, psychiatrists, and social workers, the authors examined if clinicians alter their judgments about treatment for antisocially behaving youth based on the symptom's social context (e.g., life circumstances) and the youth's race or ethnicity, even among youth who are otherwise identical in terms of behavioral symptoms. Vignettes describe behaviors meeting DSM-IV criteria for conduct disorder, but contain contextual information suggesting either internal dysfunction (ID) or a normal response to a difficult environment [i.e., environmental-reaction (ER)]. Comparison was symptomonly (SO). Judgments of effectiveness of 14 treatments for youth exhibiting antisocial behavior were examined. Frequencies and median scores of perceived effectiveness level (1-9, Likert) were compared in bivariate analyses, stratifying context and youth's race or ethnicity. The context of the behavior was associated significantly with differences in effectiveness judgments in 13 of 14 treatments. Within ID and ER contexts, clinicians judged three different treatments as effective (median ≥ 7 of 9). In the SO condition, clinicians were less selective, judging six as effective. In the ID context, psychiatric medications, systems oriented family therapy, and residential care were judged more effective for White than for Black or Hispanic youth. Evidence-based practice research may be hampered by inattention to the social context of behavioral symptoms. Context may activate implicit racial assumptions about treatment effectiveness. Implications are for clinical training to improve service delivery, and future clinical research.

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“…The internal reliability for the scales used was good, but many of the measures utilized require further elaboration and testing. Finally, the small and disproportionate sample of systems relative to non-systems cases precluded analysis of other important factors that have been found to be related to medication experiences for systems cases (e.g., type of placement, placement history, history of abuse, length of time in the system, number of affiliations, provider type) (Raghavan et al 2005;Warner et al 2005;Zima et al 1999).…”

Section: Discussionmentioning

confidence: 99%

Psychotropic Medication Practices for Youth in Systems of Care

Moses

2007

J Child Fam Stud

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Concerns have been raised about the quality and appropriateness of psychiatric medication treatment for youth treated in the child welfare or juvenile justice systems. Unfortunately there is a lack of empirical research to indicate whether there are indeed widespread problems related to psychopharmacologic treatment for youth served by public sector systems. This exploratory study utilized data from a national survey of social workers to examine differences in reports on medication type, processes, and perceived outcomes for adolescent clients in the juvenile justice and/or child welfare system (n = 90) versus non-systems clients (n = 305). Relevant clinical and demographic factors were controlled in hierarchical binary logistic and linear regression analyses. The results indicated that social workers referring to systems cases were more likely to report the use of highly potent medication (antipsychotics, mood-stabilizers, and poly-pharmacy), less likely to report that clients were receptive to or involved in the decision to utilize medication, and less likely to report beneficial medication outcomes. However, these reported differences, suggesting that medication treatment for systems youth tends to be less participatory and beneficial, were largely accounted for by differences in clients' level of functional impairment and rate of disruptive behavior disorders. Implications for further research are discussed.

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Clinical and Organizational Correlates of Medication for Youths in U.S. Mental Health Services

Cited by 14 publications

References 68 publications

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

Psychotropic Medication Practices for Youth in Systems of Care

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