AHRQ-Funded Studies Featured in Health Affairs’ Behavioral Health Issue

Four AHRQ-supported research projects are featured in the June issue of Health Affairs, which explores the topic of behavioral health, including racial and ethnic disparities in treatment, trends in financing of behavioral health and substance use disorder treatment, and the portrayal of mental health issues in the media. Access the abstracts for the AHRQ-supported articles:

Rapid Growth Of Antipsychotic Prescriptions For Children Who Are Publicly Insured Has Ceased, But Concerns Remain

+Author Affiliations

¹Stephen 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.
²Thomas 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.
³Miriam C. Fenton is research project manager at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
⁴Shahla Amin is senior data analyst at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
⁵Sheree Neese-Todd is director of public academic partnerships at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
⁶Mark 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.
⁷Scott Bilder is an associate research scientist at the Institute for Health, Health Care Policy and Aging Research at Rutgers University.

↵*Corresponding author

Abstract

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.