The Role of Formal Policy to Promote Informed Consent of Psychotropic Medications for Youth in Child Welfare Custody: A National Examination.

Active participation of youth and surrogate decision-makers in providing informed consent and assent for mental health treatment is critical. However, the procedural elements of an informed consent process, particularly for youth in child welfare custody, are not well defined. Given calls for psychotropic medication oversight for youth in child welfare custody, this study proposes a taxonomy for the procedural elements of informed consent policies based upon formal and informal child welfare policies and then examines whether enacted state formal policies across the United States endorsed these elements. A sequential multi-method study design included: (1) semi-structured interviews with key informants (n = 58) primarily from state child welfare agencies to identify a taxonomy of procedural elements for informed consent of psychotropic medications and then (2) a legislative review of the 50 states and D.C. to characterize whether formal policies endorsed each procedural element through February 2022. Key informants reported five procedural elements in policy, including how to: (1) gather social and medical history, (2) prescribe the medication, (3) authorize its use through consent and youth assent, (4) notify relevant stakeholders, and (5) routinely review the consenting decision. Twenty-three states endorsed relevant legislation; however, only two states specified all five procedural elements. Additionally, the content of a procedural element, when included, varied substantively across policies. Further research and expert consensus are needed to set best practices and guide policymakers in setting policies to advance transparency and accountability for informed consent of mental health treatment among youth in child welfare custody.

Systematic Review: System-wide Interventions to Monitor Pediatric Antipsychotic Prescribing and Promote Best Practice.

OBJECTIVE: Rapid growth of antipsychotic use among children and adolescents at the turn of the 21st century led Medicaid programs to implement 3 types of system-wide interventions: antipsychotic monitoring programs, clinician prescribing supports, and delivery system enhancements. This systematic review assessed the available evidence base for and relative merits of these system-wide interventions that aim to improve antipsychotic treatment and management. METHOD: Using PRISMA guidelines, eligible studies were written in English and evaluated system-wide interventions to monitor antipsychotic treatment or promote antipsychotic management among children and adolescents (0-21 years of age). Studies were identified through Ovid MEDLINE and PsychInfo (years 1990-2018) and an environmental scan. From an initial review of 824 publications, 17 studies met eligibility criteria. Two authors independently conducted quality assessments using the Crowe Critical Appraisal Tool. Findings were summarized descriptively. RESULTS: Identified studies (n = 17) evaluated prior authorization programs (n = 10), drug utilization reviews (n = 2), quality improvement (n = 4), care coordination programs (n = 1), and multimodal initiatives (n = 2). Studies were predominantly pre-post analyses, without a comparison group. With the exception of care coordination and drug utilization reviews, more than half of the interventions in each category were associated with significant reduction in antipsychotic treatment or promotion of best practice parameters. CONCLUSION: This evidence review concludes that evaluations of prior authorization programs demonstrate reductions in antipsychotic treatment, though evidence of impact of other system-wide interventions and other outcomes is limited. Additional research is necessary to investigate whether interventions influenced antipsychotic prescribing independent of secular trends, the comparative effectiveness and cost-effectiveness of interventions, the effect on functional outcomes, and the potential for unintended consequences.

Online maternity information seeking among lesbian, bisexual, and queer women.

OBJECTIVE: recent research has concluded that barriers to maternity health care exist for lesbian, bisexual, and queer women. This mixed methods study aims to understand patterns in seeking and sharing online health information for LBQ women attempting conception. DESIGN: researchers performed a qualitative content analysis of 400 discussions in lesbian-oriented Facebook groups, containing 1764 total instances of text. 400 discussions from heterosexual-oriented conception and parenting Facebook groups were examined for comparison purposes, though they will not be the focus of this analysis. This paper also presents descriptive statistics on posts observed. SETTING: posts were drawn from a representative sample of lesbian-oriented conception, pregnancy, and parenting Facebook groups. Posts examined for comparison purposes were drawn from groups that appeared to primarily serve heterosexual women. MEASUREMENTS AND FINDINGS: many participants in lesbian-oriented Facebook groups sought and provided medical information. Their queries focused on the insemination process, and frequently related to posters' specific situations, while heterosexual women tended to seek general advice about the conception and pregnancy process. The accuracy of the content of responses varied, and group members seemed to view the prevalence of contradictory information as positive evidence of diverse perspectives. Even when information was technically correct, posters did not always apply it properly to the question at hand. KEY CONCLUSIONS: barriers to maternity care, or a lack of education and initiative among primary care providers, may drive lesbian, bisexual, and queer women to seek health information from peers on the Internet when trying to become pregnant. These exchanges may contribute to misinformation, which may negatively affect lesbian, bisexual, and queer women's fertility outcomes and overall health. IMPLICATIONS FOR PRACTICE: clinicians should be conscious of online health information seeking as both a symptom of and cause of sexuality-based disparities.