Clinical Update: Child and Adolescent Behavioral Health Care in Community Systems of Care

Larson, Justine; Kazura, Allesandra; Fortuna, Lisa R.; French, William P.; Hodas, Gordon R.; Metz, P; McGinty, Kaye L.; Bellonci, Christopher; Lee, Terry; Lohr, William David; Sharma, Pravesh; Zachik, Al; Varma, Chinedu; Kamarauche, Asuzu; Adade, Otema A.; Bender, Edward A.; Brown, Kurt Anthony; Concepcion, Milangel; Naylor, Michael W.; Pandhi, Shashwat; Ugorji, Onyi; Abright, A. Reese; Becker, Ted; Diamond, John; Hayek, Munya; Keable, Hélène; Ripperger-Suhler, Jane; Vasa, Roma A.; Bukstein, Oscar G.; Rockhill, Carol; Walter, Heather J.

doi:10.1016/j.jaac.2022.06.001

Cited by 12 publications

(4 citation statements)

References 93 publications

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“…Working alongside leaders in community mental health, School Mental Health Ontario has helped to lead an initiative designed to build coherence in the system of care for child and youth mental health service delivery, which culminated in a vision document, Right Time, Right Care: Strengthening Ontario’s mental health and addictions system of care for children and young people (School & Community System of Care Collaborative, 2022 ). This consensus document builds on a MTSS model and an updated version of the system of care framework (American Academy of Child and Adolescent Psychiatry, 2022 ; Stroul et al, 2021 ), to further articulate the relative roles for school and community mental health partners, with a view to maximizing efficiencies, optimizing role-specific expertise and setting benefits, and centering identity affirming mental health care for children, youth, and families. The aspirational vision articulated for the Ontario context emphasizes the critical upstream role that schools play in mental health promotion, prevention, early identification, and early intervention, and the need for strong bridging to, from, and through more intensive treatment supports delivered within the community mental health setting.…”

Section: Advancing Smh Policy and Practicementioning

confidence: 99%

“…The United States (U.S.) Substance Abuse and Mental Health Services Administration (SAMHSA) recently emphasized that the COVID-19 pandemic only intensified what was already a significant youth mental health concern. The report underscored calls from national leaders in the United States, including the U.S. President, the U.S. Office of the Surgeon General ( 2021 ), and the American Academy of Child and Adolescent Psychiatry ( 2022 ) to escalate efforts to address child and youth mental health concerns with a sense of urgency. The SAMHSA ( 2022 ) report highlighted significant unmet mental health and substance-related needs for children and youth prior to the pandemic (Centers for Disease Control and Prevention, 2021 ; Perou et al, 2013 ; Welsh et al, 2020), with problems including higher numbers of youth screening positive for suicidal ideation and increasing rates of anxiety and depression since the pandemic (Lantos et al, 2022 ; Mayne, 2021 ; Office of the Surgeon General, 2021 ).…”

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confidence: 99%

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Propelling the Global Advancement of School Mental Health

Weist

Hoover

Daly

et al. 2023

Clin Child Fam Psychol Rev

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Rates of mental health problems and disorders in children and youth have been increasing for at least three decades, and these have escalated due to the pandemic and multiple other societal stressors. It is increasingly recognized that students and families frequently struggle to receive needed care through traditional locations such as specialty mental health centers. Upstream mental health promotion and prevention strategies are gaining support as a public health approach to supporting overall population well-being, better utilizing a limited specialty workforce, and reducing illness. Based on these recognitions, there has been a progressive and escalating movement toward the delivery of mental health support to children and youth “where they are,” with a prominent and more ecologically valid environment being schools. This paper will provide a brief review of the escalating mental health needs of children and youth, advantages of school mental health (SMH) programs in better meeting these needs, example model SMH programs from the United States and Canada, and national and international SMH centers/networks. We conclude with strategies for further propelling the global advancement of the SMH field through interconnected practice, policy, and research.

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Section: Advancing Smh Policy and Practicementioning

confidence: 99%

mentioning

confidence: 99%

Propelling the Global Advancement of School Mental Health

Weist

Hoover

Daly

et al. 2023

Clin Child Fam Psychol Rev

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“…Furthermore, psychotropic medication use in pediatric populations has significantly increased over the past decade, especially off-label use of atypical antipsychotic medications ( 6 , 7 ). Psychotropic medications may be necessary as part of a patient’s care, in conjunction with psychotherapy and other evidence-based psychosocial interventions ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Prescribed psychotropic medication patterns among treated Foster Care enrollees: a single institution study

Cosme,

Rudig,

Borsellino

et al. 2024

Front. Psychiatry

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BackgroundWhile several state-based studies have shown that children in foster care are more likely to be prescribed psychotropic medications and experience concomitant medication use both within and among medication class, these patterns have not been explored in the state of Nevada, which lacks state mandated oversight of psychotropic prescribing for foster care enrolled youth.MethodsData from an electronic medical record system from a single institution were analyzed to examine the prevalence of psychotropic prescribing and concomitant medication use in children ages 2 to 19 who were enrolled and received psychotropic prescriptions between July 2019 to June 2022.ResultsOut of 569 distinct psychotropic medication treatment episodes within this cohort, the most frequent psychotropic classes prescribed were non-stimulant ADHD medications (alpha-agonists and atomoxetine, 31.5%), atypical antipsychotics (22.1%), antidepressants (20.6%), and stimulants (16.0%). The use of stimulants and non-stimulant ADHD medications decreased in older age groups while the use of antidepressants and antipsychotics increased in older age groups. During the three-year period studied, 24.0% of psychotropic medications prescriptions increased in dosage. Treatments were prescribed for only one month in 43.8% of youth. In children prescribed psychotropic medications, concomitant medication use for at least 60 days occurred in 28.0% of children who had any psychotropic medication prescribed.ConclusionWithin the cohort of 273 foster care enrolled subjects aged 2 to 19 years old who received psychotropic medication prescriptions, non-stimulant ADHD medications (both alpha-agonists and atomoxetine) and atypical antipsychotics were more commonly co-prescribed additional psychotropic medication compared to other co-prescribed medication categories. This study illustrates prescribing patterns in a community mental health clinic focused on judicious prescribing of psychotropic medications in foster care enrolled youth. Despite this, 41% of the youth treated in this clinic received at least one prescription for psychotropic medication, and of those, 27.8% were prescribed more than one psychotropic medication at the same time. More studies are necessary to understand the underlying causes of high prevalence of concomitant medication use and prescribing practices of psychotropic medications use in foster care involved pediatric populations.

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“…For example, using the System-of-Care Practice Review tool, Stephens and colleagues found that youths’ whose care experiences were more consistent with system-of-care principles experienced greater improvement in symptoms one year after their baseline assessment even after controlling for several important potential confounds (Stephens et al, 2004 ). Given these findings, stakeholders have argued that the extent to which families experience system-of-care principles at the point of service interaction is an important component of mental health service quality for youths (Kutash et al, 2011 ; Larson et al, 2022 ; Stroul & Blau, 2008 ).…”

Section: Introductionmentioning

confidence: 99%