Medical Professional Publications

Many Community Mental Health Centers Don't Follow Pediatric Medication Guidelines

Despite the fact that medication guidelines can enhance mental health outcomes, many of the largest providers of behavioral services for low-income children and adolescents don’t routinely follow any.  These are the findings from the largest survey of U.S. child-serving mental health centers.

“Pediatric medication guidelines may result in greater standardization of care and enhanced clinical outcomes,” said Jack Stevens, PhD, principal investigator in the Center for Biobehavioral Health at The Research Institute and study author.  “Community mental health centers serve as an important safety net for impoverished youths with mental disorders. Yet, the quality of medication management in these clinics for this vulnerable population is poorly understood.”

To address these gaps in the mental health services literature, investigators from Nationwide Children’s Hospital and colleagues at Medical University of South Carolina, Columbia University and San Diego State University examined nationally representative survey data from child-serving community mental health centers across the United States.

Of the 152 community mental health center directors who answered whether or not pediatric medication guidelines or algorithms are used at their site, only 50 percent reported that prescribers follow any form of explicit medication guidelines. Roughly a third of clinic directors reported that their clinics followed medication guidelines for childhood attention deficit hyperactivity disorder or depression, even though pediatric practice parameters for these conditions were available years prior.  

“We learned that governmental agencies are the leading sources of information regarding which guidelines should be followed,” said Dr. Stevens.  “Centers that use standardized child outcome measures were more likely to follow medication guidelines. We were surprised to find that community mental health centers that employ child psychiatrists, the mental health professionals with the greatest training in pediatric psychopharmacology, were not more likely to follow medication guidelines.”

Dr. Stevens says further research should examine how Centers determine whether or not guidelines are used and whether these guidelines improve clinical outcomes in large child-serving community mental health centers.

“Overall, our findings underscore the need of disseminating evidence-based practices to inexperienced prescribers through child psychiatry training programs and seasoned clinicians from routine settings,” said Dr. Stevens.

Stevens J, Kelleher KJ, Wang W, Schoenwald SK, Hoagwood KE, Landsverk J; Research Network on Youth Mental Health. Use of Psychotropic Medication Guidelines at Child-Serving Community Mental Health Centers as Assessed by Clinic Directors. Community Ment Health J. 2010 Sep 29. [Epub ahead of print]   Disclosure: Dr. Stevens is a former shareholder in Wyeth

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