Oklahoma agencies develop child, teen medication guide

BY STAFF REPORTS
12/03/2020 11:00 AM
TULSA – The use of medications such as antidepressants, anti-anxiety agents, mood stabilizers and antipsychotics – also known as psychotropic medications – to treat children and teens with emotional and behavioral issues has dramatically increased in recent years.

“Oftentimes youth with the most significant emotional and behavioral needs are prescribed the most medications, and yet are less likely to have seen a child and adolescent psychiatrist,” said Dr. Sara Coffey, assistant clinical professor of Psychiatry and Behavioral Sciences at OSU Center for Health Sciences.

According to a 2015 study in the New England Journal of Medicine, there has been a 600% increase in use of atypical antipsychotic medications in the past 25 years compared to just a 70% increase in psychotherapy during that same time.

And in another study of Medicaid claims, up to 67%of youth prescribed atypical antipsychotic medications also reported quality of care concerns.

“With this overprescribing and at times imprudent use of medications, we put youth at risk for serious side effects and miss the opportunity to employ more evidence-based care,” Coffey said.

The majority of youth who do receive treatment get it from their primary care physician. In fact, the American Academy of Pediatrics estimates that in the next 10 years, 40% of patient visits to pediatricians will involve long-term chronic disease management of physical and psychological or behavioral conditions.

“With the severe shortage in child and adolescent psychiatrists and limited access to evidence-based therapy, clinicians are doing what they can with the information they know to treat the symptoms of often devastating and destructive mental health symptoms in our youth,” Coffey said. “It’s imperative that up-to-date, evidence-based resources and collaboration is available to our clinicians on the front line of what at times can feel like a mental illness epidemic.”

To meet this growing need, the Oklahoma Health Care Authority and the Department of Human Services’ Division of Child Welfare assembled a task force to develop the Oklahoma Pediatric Psychotropic Medication Resource Guide, a collection of resources for Oklahoma physicians and health care professionals caring for youth with mental illness. Telligen Community Initiative also provided additional funding to aid in the creation and distribution of the guide.

Dr. Deborah Shropshire, director of Child Welfare Services in the Oklahoma Department of Human Services, said children who have experienced high rates of trauma are much more likely than other children to be treated at some point with psychotropic medications.

“Unfortunately, Oklahoma has a high rate of adverse childhood experiences (ACEs), the kinds of trauma that can result in behavioral health symptoms that often prompt families to seek health care solutions,” Shropshire said. “While reducing trauma is and should be a priority, it’s also critical that there is clear, evidence-informed guidance for providers on how to safely and effectively treat children with behavioral health needs. And that is what prompted the creation of the guide.”

Clinicians from the University of Oklahoma Center for Health Sciences and the OSU Center for Health Sciences, including Coffey, lead the core team that invited child and adolescent psychiatrists, pediatricians and pharmacists to join the task force in drafting the guide. The task force reviewed and compiled up-to-date information on best prescribing practices.

“I want to thank our amazing task force members who came together voluntarily to work on this important project, and Telligen Community Initiative that helped support this endeavor,” Coffey said.

The comprehensive document is for any clinician managing psychiatric medications in children and adolescents such as pediatricians, family physicians, psychiatrists, physician assistants and nurse practitioners. In the future, revisions to the guide will be made to ensure treatment recommendations are evidence based and current.

“Although this resource is meant to aid in the diagnosis and treatment of children and adolescents, it is important to note that ultimately the care of patients is a partnership with the patient, their family and the treating clinician,” Coffey said. “Our goal was to provide evidence-based information to support youth with psychiatric illness and the judicious use of medication to support psychiatric care.”

View the Oklahoma Pediatric Psychotropic Medication Guide at okla.st/okpedpsychotropicmed or order a copy by calling 1-877-283-4113 and reference publication number 20-27.

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