Clinical Update: Child and Adolescent Behavioral Health Care in Community Systems of Care

Creating an Equitable System of Care for Minoritized Youth and Addressing Systemic and Structural Barriers

We provide an overview of the systems of care and the barriers faced by minoritized youth. We discuss ways to address barriers by forging alliances, improving communication with cultural humility, and a nonjudgmental approach. We underscore the importance of a holistic evaluation of minoritized children while leveraging their resilience to create a comprehensive and multipronged plan of action.

Strengthening Support for Community Mental Health Programs Through Partnership and Collective Impact

Effective partnerships can profoundly impact outcomes for youth with behavioral health concerns. Partnerships occur at multiple levels - at the individual, organizational, state, and national levels. The Systems of Care (SOC) framework helps to conceptualize and articulate the skills necessary for forming partnerships in youth's mental health. This article explores values in the SOC framework and makes the case that the framework can help develop a "road map" to develop the skills needed to achieve successful partnerships. Impediments to effective partnerships are also discussed. Several case examples are given to illustrate the principles and impediments to partnership formation.

Prescribed psychotropic medication patterns among treated Foster Care enrollees: a single institution study

Background

While several state-based studies have shown that children in foster care are more likely to be prescribed psychotropic medications and experience concomitant medication use both within and among medication class, these patterns have not been explored in the state of Nevada, which lacks state mandated oversight of psychotropic prescribing for foster care enrolled youth.

Methods

Data from an electronic medical record system from a single institution were analyzed to examine the prevalence of psychotropic prescribing and concomitant medication use in children ages 2 to 19 who were enrolled and received psychotropic prescriptions between July 2019 to June 2022.

Results

Out of 569 distinct psychotropic medication treatment episodes within this cohort, the most frequent psychotropic classes prescribed were non-stimulant ADHD medications (alpha-agonists and atomoxetine, 31.5%), atypical antipsychotics (22.1%), antidepressants (20.6%), and stimulants (16.0%). The use of stimulants and non-stimulant ADHD medications decreased in older age groups while the use of antidepressants and antipsychotics increased in older age groups. During the three-year period studied, 24.0% of psychotropic medications prescriptions increased in dosage. Treatments were prescribed for only one month in 43.8% of youth. In children prescribed psychotropic medications, concomitant medication use for at least 60 days occurred in 28.0% of children who had any psychotropic medication prescribed.

Conclusion

Within the cohort of 273 foster care enrolled subjects aged 2 to 19 years old who received psychotropic medication prescriptions, non-stimulant ADHD medications (both alpha-agonists and atomoxetine) and atypical antipsychotics were more commonly co-prescribed additional psychotropic medication compared to other co-prescribed medication categories. This study illustrates prescribing patterns in a community mental health clinic focused on judicious prescribing of psychotropic medications in foster care enrolled youth. Despite this, 41% of the youth treated in this clinic received at least one prescription for psychotropic medication, and of those, 27.8% were prescribed more than one psychotropic medication at the same time. More studies are necessary to understand the underlying causes of high prevalence of concomitant medication use and prescribing practices of psychotropic medications use in foster care involved pediatric populations.

Editorial: Can Mobile Crisis Response Help Mitigate Racialized Disparities in Acute Child Mental Health Care?

Mobile crisis response (MCR) is a community-based intervention designed to provide de-escalation and relief to individuals experiencing a behavioral health or substance use-related crisis wherever they are, including at home, at work, at school, or in the community. Often it is the first, or only, option for youth who experience barriers to accessing traditional mental health care in the community. Elevated rates of mental health needs and suicidality among children and adolescents in the United States make availability of quality MCR increasingly important. Studies suggest that an estimated 70% to 80% of children with mental health disorders do not receive care, and minoritized children are even less likely to access community-based behavioral health care services.1 MCR can act as a bridge for securing treatment for children in acute distress. However, until recently, few studies have demonstrated the outcomes of MCR services for children and adolescents or more specifically for minoritized youth.

Propelling the Global Advancement of School Mental Health

Rates of mental health problems and disorders in children and youth have been increasing for at least three decades, and these have escalated due to the pandemic and multiple other societal stressors. It is increasingly recognized that students and families frequently struggle to receive needed care through traditional locations such as specialty mental health centers. Upstream mental health promotion and prevention strategies are gaining support as a public health approach to supporting overall population well-being, better utilizing a limited specialty workforce, and reducing illness. Based on these recognitions, there has been a progressive and escalating movement toward the delivery of mental health support to children and youth "where they are," with a prominent and more ecologically valid environment being schools. This paper will provide a brief review of the escalating mental health needs of children and youth, advantages of school mental health (SMH) programs in better meeting these needs, example model SMH programs from the United States and Canada, and national and international SMH centers/networks. We conclude with strategies for further propelling the global advancement of the SMH field through interconnected practice, policy, and research.

Disparities in Youth and Family Experiences of System-of-Care Principles by Level of Youth Need

The extent to which mental health services for youths embody system-of-care (SOC) principles is an important quality indicator. This study tested whether youth and family experiences of SOC principles varied depending on youths' level of need after adjusting for sociodemographic and treatment factors. The relationship to caregiver-reported clinical outcomes was also examined. Using administrative data and cross-sectional surveys from a stratified random sample of 1124 caregivers of youths ages 5-20 within a statewide system, adjusted analyses indicated caregivers of youths with the most intensive needs were significantly less likely to report receiving care that embodied SOC principles, with deficits on six of nine items. Youths whose services embodied SOC principles experienced significantly greater improvement in caregiver-reported functioning even after adjusting for level of need. Results highlight disparities in SOC principles for youths with intensive needs and the need for policy and intervention development to improve care for this population.