Online Program

Psychopharmacologic Outcomes of Intensive Care Management for Youth with Serious Mental Health Needs

Tuesday, November 3, 2015 : 11:10 a.m. - 11:30 a.m.

Susan dosReis, PhD, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
Ming-Hui Tai, MS, MHPA, Pharmaceutical Health Services Research Program, University of Maryland, Baltimore, MD
Daniel Yi, School of Pharmacy, University of Maryland, Baltimore, MD
John Cosgrove, MSW, School of Social Work, University of Maryland, Baltimore, MD
Bethany Lee, PhD, School of Social Work, University of Maryland, Baltimore, MD
Ramesh Raghavan, MD, PhD, Brown School; and Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO
Benjamin Wu, BS, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD
Background/Purpose: Traditional high intensity child mental health services, such as inpatient treatment and residential services, are extremely costly and often inadequate for youth with significant mental health problems.  The wraparound practice model has been successful in stabilizing youth in a community setting and in coordinating care for youth with complex mental illness. These youth are likely to receive complex psychotropic regimens, yet little is known about the impact of intensive care coordination in reducing the complexity of medication treatment.                                    

Methods: Using a quasi-experimental design with matched intervention and controls, this study assesses psychotropic utilization before, during, and after receipt of wraparound services.  A sample of 5,000 youth, selected as 4 controls for each 1 intervention youth, are followed one-year pre, during, and up to one-year post discharge from intensive services.  Administrative claims data were used to identify psychotropic utilization patterns. Utilization was characterized by therapeutic class.  Polypharmacy was defined as more than two therapeutic classes used in the study period.  Data are analyzed with descriptive bivariate and multivariable regression models.

Findings: The majority of youth who received wrap-around services used psychotropic medication. The most common therapeutic class was antipsychotic medications followed by stimulants. Over half of the youth in the entire sample used more than one psychotropic medication.  There was a slight decrease in psychotropic use, overall and use of polypharmacy, among youth in the wraparound service model, compared with no change for the comparison group over the same time.

Implications: Intensive wraparound services have the potential for reducing the use of complex, multi-psychotropic regimens. This behavioral health model is sustainable over time and could be an effective approach for optimizing psychotropic treatment.

Learning Areas:

Public health or related public policy
Public health or related research

Learning Objectives:
Evaluate the rate of psychotropic medication use among youth with serious mental illness before and after receipt of high fidelity wraparound services Compare the rate of psychotropic medication use among youth who receive high fidelity wraparound services with youth who receive mental health services in usual care settings.

Keyword(s): Adolescents, Mental Health Treatment &Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have expertise in pharmacoepidemiology and children's mental health services research. I have conducted research involving psychotropic utilization patterns for youth in Medicaid and child welfare systems. I have several publications in the area that demonstrate my involvement in this field of research.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.