Clinicians' Experience with a Graduate Medical Education Implemented Child Psychiatry Access Program.

OBJECTIVE: The authors aim to measure differences in primary care clinicians' (PCC's) perceptions of managing pediatric mental health before and after launch of a child psychiatry access program (the access program) and identify the impact of engaging trainees from child psychiatry, pediatrics, and family medicine in administration and use of this program. METHODS: Child psychiatry fellows provide coverage of a grant-funded state-wide access program and engage trainee-peers in learning how to use the program. A survey measuring PCC's experience managing children's mental health conditions was administered before and after the child psychiatry access program launched. Rotation evaluations collect trainee's feedback. RESULTS: Statistically significant differences are identified before and after the program's launch in PCC's perception of access to child psychiatry (U = 294.5, p < 0.001) and between PCC's perceptions of the impact of behavioral health problems in their patients in those with less than 4 years post-residency training compared with those with 4 or more years post-residency (U = 524.5, p < .01). Trainee evaluation of the rotation is consistently positive (average 5:6 rating). CONCLUSION: The authors conclude that (1) the presence of a state-wide access program positively impacts PCC's reported access to child psychiatry; (2) child psychiatry fellows rate the clinical rotation experience favorably; and (3) there appears to be an association between less time out of primary care residency training and perception of improved access to child psychiatry and less clinical burden from behavioral health issues. Further research is required to understand the impact of a training in this model.

Re-Imagining Child Welfare to Support Children and Families.

Children and adolescents in foster care include many of the most severely traumatized victims of child abuse and neglect. They deserve the best possible care and treatment, yet their outcomes remain poor. The persistence of poor outcomes for youth in foster care reflects challenges of psychiatric diagnostic formulation and of service system design/access, both areas in which child and adolescent psychiatrists have a key role to improve care and outcomes.

Prescribed psychotropic medication patterns among treated Foster Care enrollees: a single institution study.

Background: While several state-based studies have shown that children in foster care are more likely to be prescribed psychotropic medications and experience concomitant medication use both within and among medication class, these patterns have not been explored in the state of Nevada, which lacks state mandated oversight of psychotropic prescribing for foster care enrolled youth. Methods: Data from an electronic medical record system from a single institution were analyzed to examine the prevalence of psychotropic prescribing and concomitant medication use in children ages 2 to 19 who were enrolled and received psychotropic prescriptions between July 2019 to June 2022. Results: Out of 569 distinct psychotropic medication treatment episodes within this cohort, the most frequent psychotropic classes prescribed were non-stimulant ADHD medications (alpha-agonists and atomoxetine, 31.5%), atypical antipsychotics (22.1%), antidepressants (20.6%), and stimulants (16.0%). The use of stimulants and non-stimulant ADHD medications decreased in older age groups while the use of antidepressants and antipsychotics increased in older age groups. During the three-year period studied, 24.0% of psychotropic medications prescriptions increased in dosage. Treatments were prescribed for only one month in 43.8% of youth. In children prescribed psychotropic medications, concomitant medication use for at least 60 days occurred in 28.0% of children who had any psychotropic medication prescribed. Conclusion: Within the cohort of 273 foster care enrolled subjects aged 2 to 19 years old who received psychotropic medication prescriptions, non-stimulant ADHD medications (both alpha-agonists and atomoxetine) and atypical antipsychotics were more commonly co-prescribed additional psychotropic medication compared to other co-prescribed medication categories. This study illustrates prescribing patterns in a community mental health clinic focused on judicious prescribing of psychotropic medications in foster care enrolled youth. Despite this, 41% of the youth treated in this clinic received at least one prescription for psychotropic medication, and of those, 27.8% were prescribed more than one psychotropic medication at the same time. More studies are necessary to understand the underlying causes of high prevalence of concomitant medication use and prescribing practices of psychotropic medications use in foster care involved pediatric populations.