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Young AS, Findling RL, Riehm KE, Seegan P, Crum RM, Mojtabai R, Chiappini EA, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Horwitz SM. Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics. Psychiatr Serv 2023; 74:1218-1226. [PMID: 37287230 PMCID: PMC10983772 DOI: 10.1176/appi.ps.20220375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. METHODS Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment. RESULTS Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy. CONCLUSIONS The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.
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Affiliation(s)
- Andrea S Young
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Kira E Riehm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Paige Seegan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Rosa M Crum
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Erika A Chiappini
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Eric A Youngstrom
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Mary A Fristad
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Boris Birmaher
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
| | - Sarah M Horwitz
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Young, Seegan, Crum, Mojtabai, Chiappini); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (Young, Riehm, Crum, Mojtabai); Department of Psychiatry, Virginia Commonwealth University, Richmond (Findling); Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Riehm); Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, and Helping Give Away Psychological Science, Chapel Hill, North Carolina (Youngstrom); Department of Psychiatry & Behavioral Health, Ohio State University, Columbus (Fristad, Arnold); Division of Child & Family Psychiatry and Big Lots Behavioral Health Services, Nationwide Children's Hospital, Columbus, Ohio (Fristad); Department of Psychiatry, University of Pittsburgh, Pittsburgh (Birmaher); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Horwitz)
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