Using incentives for training participation.

TOPIC: This column describes how public partners can help incentivize participation in training. Specifically, a state mental health agency and its implementation center applied financial and nonfinancial incentives to encourage participation in training and implementation supports. PURPOSE: Although training is not sufficient to change practice, it is a necessary first step in implementing evidence-based treatments. Finding ways to incentivize participation, particularly strategies with minimal resource involvement, is important for the psychiatric rehabilitation workforce and cash-strapped public systems. SOURCES USED: This description draws from published material and experiences from New York State. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Engaging public partners to incentivize training can significantly increase participation in training. Incentive programs exist that do not require additional funding-an important consideration, given the fiscal climate for most public payers.

Scaling up evidence-based behavioral health care practices in New York state.

This column describes the Center for Practice Innovations (CPI), which was created in 2007 by the New York State Office of Mental Health and the Department of Psychiatry at Columbia University. CPI uses innovative approaches to build stakeholder collaborations, develop and maintain practitioners' expertise, and build agency infrastructures that support implementing and sustaining evidence-based practices. CPI's five core initiatives provide training in co-occurring mental and substance use disorders, assertive community treatment, supported employment and education, wellness self-management, and treatment of first-episode psychosis. Central to CPI's activities are award-winning training modules, statewide learning collaboratives, and use of a learning management system.

Psychotropic medications prescribing patterns for children and adolescents in New York's public mental health system.

CONTEXT: Breakthroughs in the development of effective medications for a number of psychiatric disorders have led to increased use of these compounds in the treatment of children. OBJECTIVES: To understand the use of psychotropic medications in the treatment of children, a state-wide study was undertaken based on the data collected in a large planning study. DATA AND SETTING: A stratified random sample of 10 different program types in New York State produced data on children served in different specialty mental health services. PARTICIPANTS: Randomly selected cases were reviewed at a randomly selected sites to generate a sample of 1592 cases on which data were collected on clinical presentation and service use, including psychotropic medication prescriptions. MAIN OUTCOME MEASURES: The Child and Adolescent Needs and Strengths (CANS-MH) tool was used to provide a reliable review of clinical indicators. RESULTS: Psychotropic medication use is common in the children's public mental health service system in New York. Most children served in high intensity settings receive medication as a part of their treatment. It appears that most prescriptions for stimulants and antidepressants are consistent with either diagnostic or symptom indications. Many children with these indications are not on medications. On the other hand, a large number of children without evidence of psychosis receive antipsychotic medications. CONCLUSION: The evidence suggests that stimulant and antidepressant are not over-prescribed. However, the use of antipsychotic medications for other indications is a priority for further research.