Document guides care of youths prescribed antipsychotic medications

As pediatricians increasingly are called on to address the needs of children and adolescents with mental health concerns, a new document can shed light on evidence-informed strategies, including nonpharmacologic and pharmacologic interventions.

Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents, http://bit.ly/SAMHSArxguide, was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). The guidance is a result of a multimodal process, including insight from a steering committee, systematic evidence review, environmental scan and proceedings from an expert panel meeting that included participation by AAP members. Publicly available resources, evidence and principles that support best practice prescribing strategies are offered.

Antipsychotic medication use in children and youths in the United States is substantially higher than in most other developed countries. Safe and effective pharmacologic therapies are a critical issue in mental health and substance use treatment. As a site of care coordination for complex behavioral health needs, the medical home can help families and youths identify and decrease barriers to care.

The document describes practices for systems-level strategies to ensure safe, effective medication use, including:

• prior authorizations or mandatory peer reviews,
• drug utilization reviews,
• elective psychiatric consultations,
• shared decision‐making tools,
• quality improvement and learning collaboratives,
• trauma‐informed and evidence‐based systems of care,
• public reporting and quality indicators,
• intensive care coordination, and
• multimodal initiatives.

Engagement of families and youths in the process of prescribing antipsychotic medications also is emphasized.

SAMHSA encourages pediatricians, families and youths to use the document as a resource for information on risks and benefits associated with these medications; when developing a plan for identifying potential side effects; and as an aid when discussing possible nonpharmacological treatments.