Psychotropic Polypharmacy Among Youths With Serious Emotional and Behavioral Disorders Receiving Coordinated Care Services.

OBJECTIVE: The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services. METHODS: A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy. RESULTS: In both groups, most youths were male, black, and 10-18 years old, with attention-deficit hyperactivity disorder (54%-55%), mood disorder (39%-42%), depression (26%-27%), and bipolar disorder (25%-26%). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28% for the CCS group and 29% for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample. CONCLUSIONS: Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.

A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities.

This article presents recommendations developed in 2001 by a committee of the Maryland Department of Health and Mental Hygiene that are used for managing acute aggressive behavior of youths in residential and inpatient treatment facilities in Maryland. The recommendations are highly similar to practice parameters published by the American Academy of Child and Adolescent Psychiatry, although they were developed independently. The recommendations are not prescriptive, nor are they based on an algorithm. Rather, they are based on a therapeutic process and designed to acknowledge the importance of professional and patient autonomy. The first step in the therapeutic process is to define the problem by addressing three issues: the target symptoms, the severity of those symptoms, and possible precipitants of the aggressive behavior. The next two steps are to select the goals of the intervention and to choose among three levels of immediate intervention, from least to most restrictive. The recommendations describe specific interventions, including medications that can be used at each level. The authors caution that the recommendations should be used in accordance with current regulations of the Center for Medicaid and Medicare Services and the Joint Commission on Accreditation of Healthcare Organizations.