Psychotropic Medication Use and Polypharmacy Among Children and Adolescents Initiating Intensive Behavioral Therapy for Severe Challenging Behavior.

OBJECTIVE: To evaluate the prevalence, trends, and factors associated with psychotropic medication use and polypharmacy among children and adolescents initiating intensive behavioral therapy for severe challenging behavior over a 10-year period. STUDY DESIGN: In this retrospective observational study, we examined data from caregiver interviews and patient medical records on the number and types of psychotropic medications prescribed to patients initiating intensive behavioral therapy between January 1, 2013, and December 31, 2022. Trends in medication use and polypharmacy across the 10-year period were analyzed using regression analysis, while differences in demographics and clinical factors for patients with use and polypharmacy were analyzed using nonparametric statistical analysis with odds ratios presented for significant factors. RESULTS: Data from all 302 pediatric patients initiating intensive behavioral therapy across the 10-year period were analyzed. Among all patients and all years, 83.8% were taking at least 1 psychotropic medication and 68.2% experienced polypharmacy. There were no changes in the prevalence of use, mean number of medications taken, or polypharmacy across the 10-year period. Patients diagnosed with attention-deficit/hyperactivity disorder or anxiety disorder, as well as those exhibiting self-injurious behavior had higher use of psychotropic medication and polypharmacy and were taking more medications overall. CONCLUSIONS: Psychotropic medication use and polypharmacy were extremely high for children and adolescents with severe challenging behavior, but use and polypharmacy did not change over the 10-year period of data collection. Further research is needed to establish the generality of these findings to other regions of the US.

Connecting soil health and water quality in agricultural landscapes.

As soil plays an integral role in the water cycle, the dynamic and inherent attributes of soil are important drivers of the amount and quality of water in streams, lakes, and groundwater. Studies have demonstrated links between agricultural soil management and water movement in soil, to the edge of fields, and across entire watersheds that feed water bodies of interest. Still, not enough is known about linkages between soil management, soil health, and watershed water quality to adequately predict impacts of land use changes and to effectively use soil management as a tool for water resource management. We describe here the mechanisms connecting soil health and water quality, the state of the science at the nexus of the two fields of study, and an overview of recent studies on the topic. A fundamental challenge is measuring and elucidating connections between processes working at different temporal and spatial scales. Research needs include expansion of field-scale data and analysis of combined datasets, greater understanding of the mechanisms that explain observed associations between management practices and water quality, ensuring that hydrologic models and decision-support tools more effectively reflect these soil-water mechanisms, and greater use of systems-based research designs.

Cover crop management practices to promote soil health and climate adaptation: Grappling with varied success from farmer and researcher observations.

Soil health is a pathway through which farm and environmental outcomes can be improved together on agricultural landscapes, and management to improve soil health is increasingly recognized as a strategy for agricultural producers to adapt to climate change-related impacts such as erosion and flooding. Many incentive programs exist or are in development to support the adoption of practices that promote soil health for these reasons, but few on-farm trials have compared the intersections of farmer versus researcher observations of soil health or of soil health compared with climate adaptation. The purpose of our study was to assess soil health outcomes and adaptation to simulated climate change in response to cover cropping on working farms enrolled in a Minnesota Natural Resources Conservation Service (NRCS)-funded Environmental Quality Incentives Program. This incentive program required the inclusion of diverse cover crop mixtures into existing farm crop rotations. We conducted farmer surveys, NRCS protocol field soil assessments, and NRCS-recommended laboratory assays on farms from across the state of Minnesota in a paired design comparing fields on the same or adjacent farms of the same soil mapping unit. Although 85% of farmers reported improvements in soil attributes or productivity, most field and laboratory assessments produced a high amount of variability in responsiveness to cover cropping. Despite this variability, we saw a significant decrease in bare ground and significant increases in earthworm counts, cellobiohydrolase microbial activity, and the Visual Evaluation of Soil Structure (VESS). Although researcher measurements did not show improvement in physical characteristics or infiltration other than the VESS field assessment, 67% of farmers reported improvements to the physical structure of the soil, associated with improved outcomes such as earlier planting dates and consistent crop growth across fields. When more than five species of cover crops were present, the percentage of reported improvements increased to >80%. We also found no significant improvement to climate change adaptation measured by nutrient or sediment loss after a simulated storm event. Together, our results suggest that adding a diverse annual cover crop mix to increase continuous cover can improve characteristics associated with soil health and that there needs to be a stronger focus in understanding variation in realized soil health outcomes on farms, including more co-creation of research with farmer partners.