The Impact of Psychiatric Practice Guidelines on Medication Costs and Youth Aggression in a Juvenile Justice Residential Treatment Program

Lee, Terry G.; Walker, Sarah Cusworth; Bishop, Asia S.

doi:10.1176/appi.ps.201400544

Cited by 15 publications

(23 citation statements)

References 54 publications

(51 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Three studies focused on management staff and/or teams, with sample sizes ranging from 32 (teams) to 75 (staff) [21,31,35]. Eight studies measured EBP impact on the organization/ agency or system and had sample sizes ranging from 3-307 organizations [22,24,26,27,30,32,33,36].…”

Section: Resultsmentioning

confidence: 99%

“…The remainder were published in specialty journals related to public health (four articles [20][21][22][23]), children's services (one article [19]), or implementation science (one article [24]). Several studies focused on specific demographic groups [children with substance use disorders, mental health disorders, or trauma (six articles [19,[23][24][25][26][27]), adolescents/youth with mental health disorders (two articles [21,28]), justice-involved youth (two articles [29,30]), geriatric mental health (one article [20]), and veteran's mental health (one article [31]). Studies focusing on specific diagnoses included: alcohol use (one article [32]), addiction (one article [33]), co-occurring disorders (one article [34]), mental health disorders (two articles [22,35]), and serious mental illness (one article [36]).…”

Section: Data Extraction and Analysismentioning

confidence: 99%

See 1 more Smart Citation

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

2021

View full text Add to dashboard Cite

Background This study is a systematic literature review of cost analyses conducted within implementation studies on behavioral health services. Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Costing studies in this area are rare but necessary since cost can be a barrier to implementation and sustainment of EBP. Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and applied the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Key search terms included: (1) economics, (2) implementation, (3) EBP, and (4) behavioral health. Terms were searched within article title and abstracts in: EconLit, SocINDEX, Medline, and PsychINFO. A total of 464 abstracts were screened independently by two authors and reduced to 37 articles using inclusion and exclusion criteria. After a full-text review, 18 articles were included. Results Findings were used to classify costs into direct implementation, direct services, and indirect implementation. While all studies included phases of implementation as part of their design, only five studies examined resources across multiple phases of an implementation framework. Most studies reported direct service costs associated with adopting a new practice, usually summarized as total EBP cost, cost per client, cost per clinician, and/or cost per agency. For studies with detailed analysis, there were eleven direct cost categories represented. For five studies that reported costs per child served, direct implementation costs varied from $886 to $9470 per child, while indirect implementation costs ranged from $897 to $3805 per child. Conclusions This is the first systematic literature review to examine costs of implementing EBP in behavioral healthcare settings. Since 2000, 18 studies were identified that included a cost analysis. Given a wide variation in the study designs and economic methods, comparison across studies was challenging, which is a major limitation in the field, as it becomes difficult to replicate studies or to estimate future costs to inform policy decisions related to budgeting. We recommend future economic implementation studies to consider standard economic costing methods capturing costs across implementation framework phases to support comparisons and replicability.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Data Extraction and Analysismentioning

confidence: 99%

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

2021

View full text Add to dashboard Cite

show abstract

“…It seems to be especially common among children/youth who have experienced several changes of care environments (Bertram, Narendorf, & McMillen, ; McMillen, Fedoravicious, Rowe, Zima, & Ware, ; Narendorf et al, ). Results from several studies question the often alleged benefits of psychotropic medications on placement stability and rates of disruptive behaviour of children/youth in out‐of‐home care (Bellonci et al, ; Lee, Walker, & Bishop, ; Tai, Shaw, & dos Rheis, ). Two recent studies examined the effects of systematic re‐assessments on prescribed psycho‐pharmaceuticals for youth in residential care.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent studies examined the effects of systematic re‐assessments on prescribed psycho‐pharmaceuticals for youth in residential care. Both found that relatively radical reductions of such medications did not result in an increase of youths’ aggressive behaviour (Bellonci et al, ; Lee et al, ). In fact, Bellonci et al () reported substantial decreases in the number of assaultive incidences and in the use of physical restraints.…”

Section: Discussionmentioning

confidence: 99%

Health problems and healthcare needs among youth in Swedish secure residential care

2018

View full text Add to dashboard Cite

International research has consistently reported that youth in secure residential care have high rates of somatic/dental health problems. Here, we report results from the first such study in a Nordic country. An experienced paediatrician performed systematic somatic and rudimentary dental health assessments of 91 youths, age 13–17, recently admitted to four secure residential units in Sweden. Girls were oversampled. Participants were tested for sexually transmitted diseases (STD). We found large unmet needs of health/dental care, similar to reports from other countries: 75% of the girls and 53% of the boys had at least one previously known health problem that was poorly followed up or was unknown before the assessment. Over 40% of the girls had severe dental decay. Only two cases of STD were identified (Chlamydia). Some 91% of the girls and 64% of the boys were referred to a health or a dental care clinic.

show abstract

“…Preliminary studies within paediatric populations have demonstrated that psychotropic polypharmacy and antipsychotics can be safely reduced within residential treatment centres without re-emergence of challenging behaviours in children 28–33. Moreover, researchers observe reductions in adverse events and side effects,29 32 as well as substantial cost savings 10 34…”

Section: Introductionmentioning

confidence: 99%

Deprescribing psychotropic medications in children: results of a national qualitative study

et al. 2019

View full text Add to dashboard Cite

Background and ObjectivePrescriptions for psychotropic medications to children have risen dramatically in recent years despite few regulatory approvals and growing concerns about side effects. Government policy and numerous programmes are attempting to curb this problem. However, the perspectives of practising clinicians have not been explored. To characterise the perspectives and experiences of paediatric primary care clinicians and mental health specialists regarding overprescribing and deprescribing psychotropic medications in children.MethodsWe conducted 24 semistructured interviews with clinicians representing diverse geographic regions and practice settings in the USA. Interview questions focused on clinician perspectives surrounding overprescribing and experiences with deprescribing. We transcribed audio files verbatim and verified them for accuracy. We analysed transcripts using a grounded theory approach, identifying emergent themes and developing a conceptual model using axial coding.ResultsAnalysis yielded themes within four domains: social and clinical contextual factors contributing to overprescribing, opportunities for deprescribing, and facilitators and barriers to deprescribing in paediatric outpatient settings. Most participants recognised the problem of overprescribing, and they described complex clinical and social contextual factors, as well as internal and external pressures, that contribute to overprescribing. Opportunities for deprescribing included identification of high-risk medications, routine reassessment of medication needs and recognition of the broader social needs of vulnerable children. Facilitators and barriers to deprescribing were both internal (eg, providing psychoeducation to families) and external (eg, parent and child preferences) to clinicians.ConclusionOur findings highlight a discrepancy between clinicians’ concerns about overprescribing and a lack of resources to support deprescribing in outpatient paediatric settings. To successfully initiate deprescribing, clinicians will need practical tools and organisational supports, as well as social resources for vulnerable families.

show abstract

The Impact of Psychiatric Practice Guidelines on Medication Costs and Youth Aggression in a Juvenile Justice Residential Treatment Program

Cited by 15 publications

References 54 publications

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review

Health problems and healthcare needs among youth in Swedish secure residential care

Deprescribing psychotropic medications in children: results of a national qualitative study

Contact Info

Product

Resources

About