Rapid Growth Of Antipsychotic Prescriptions For Children Who Are Publicly Insured Has Ceased, But Concerns Remain.
The rapid growth of antipsychotic medication use among publicly insured children in the early and mid-2000s spurred new state efforts to monitor and improve prescription behavior. A starting point for many oversight initiatives was the foster care system, where most of the children are insured publicly through Medicaid. To understand the context and the effects of these initiatives, we analyzed patterns and trends in antipsychotic treatment of Medicaid-insured children in foster care and those in Medicaid but not in foster care. We found that the trend of rapidly increasing use of antipsychotics appears to have ceased since 2008. Children in foster care treated with antipsychotic medications are now more likely than other Medicaid-insured children to receive psychosocial interventions and metabolic monitoring for the side effects of the medications. However, challenges persist in increasing safety monitoring and access to psychosocial treatment. Development of specialized managed care plans for children in foster care represents a promising policy opportunity. New national quality measures for safe and judicious antipsychotic medication use are also now available to guide improvement. Oversight policies developed for foster care appear to have potential for adaptation to the broader population of Medicaid-covered children.
Stephen Crystal (scrystal@rci.rutgers.edu) is director of the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes and the Center for Education and Research on Mental Health Therapeutics, as well as Board of Governors Professor and associate institute director for health services research at the Institute for Health, Health Care Policy and Aging Research at Rutgers University, all in New Brunswick, New Jersey.
Stephen
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Crystal
Thomas Mackie is an assistant professor in the Department of Health Systems and Policy at the Rutgers School of Public Health and at the Institute for Health, Health Care Policy and Aging Research, Rutgers University.
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Mackie
Miriam C. Fenton is research project manager at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
Miriam C
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Fenton
Shahla Amin is senior data analyst at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
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Amin
Sheree Neese-Todd is director of public academic partnerships at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
Sheree
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Neese-Todd
Mark Olfson is a professor of psychiatry in the Department of Psychiatry, College of Physicians and Surgeons, at Columbia University, and a research psychiatrist at the New York State Psychiatric Institute, both in New York City.
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Olfson
Scott Bilder is an associate research scientist at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
Scott
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D000293:Adolescent; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D002648:Child; D000073921:Child, Foster / Q000523:psychology; D002675:Child, Preschool; D005260:Female; D005581:Foster Home Care / Q000523:psychology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D014481:United States
D014150:Antipsychotic Agents
Children’s Health; Medicaid; Mental Health/Substance Abuse; Pharmaceuticals; Quality Of Care