JUNE2002

Is psychotropic medication management an issue for youth and parents within a system of care (SOC)?

Approximately half (47%) of all caregivers interviewed during the 1997-1998 funding cycle of the System-Of-Care grant communities indicated that their youth had been or were on at least one psychotropic medication. The medications were primarily anti-depressant/mood stabilizers (e.g. Paxil, Depakote and Wellbutrin) and stimulants (e.g. Ritalin and Adderall). Males were almost twice as likely to use medications as females. Besides gender, other risk factors associated with medication use were a history of abuse (especially sexual and physical), running way, and attempting suicide. Youth who were diagnosed with psychotic disorders, pervasive development disorders, and attention deficit/ hyperactivity were most likely to have used medication six months before entering the grant community.

However, despite the widespread use of medication within the SOC, many family members, youth and clinicians continue to have ambivalent to negative feelings about the use of medication. The Surgeon General's Report on Mental Health confirmed for many consumers and providers their worst fears about the widespread use of psychotropic medication. The Report stated that the use of medication for children has outpaced the research on its safety and efficacy. Of the six documented studies on various classes of medications on children and adolescents, only two have demonstrated consistent positive results. Selective serotonin reuptake inhibitors (SSRIs) have been shown to have consistent positive results for adolescent obsessive-compulsive disorder, and stimulants (e.g. Ritalin) are consistently effective for childhood ADHD.

Besides issues of research and efficacy, there are other challenges to the appropriate use of medication that must be acknowledged and resolved if children are to benefit from what can be an effective form of treatment. These include:

A. Child/Family's concerns and challenges such as:

• inadequate /misinformation about addictive properties of psychotropic medications

• conflicting values and beliefs about any medication o mistrust of clinicians - especially by minorities

• compliance with prescribed medication regimen

• community stigma associated with psychotropic medications

B. Clinician's concerns and/challenges such as

• racial/ethnic/gender/class/sexual orientation bias, stereotyping and discrimination

• inadequate training in diagnostic assessments or ethnopharmacology 

• inadequate/misinformation about non-medication effective, evidence-based interventions

• limited and/or poor communication skills

C. Systemic concerns and challenges such as

• inadequate access to pharmaceuticals

• racial/ethnic/gender/class bias and discrimination

•  inadequate integration of mental health and primary care in training and practice settings

• insufficient number of well trained, culturally competent providers

• inadequate analysis of racial/ethnic differences on treatment efficacy

Responding appropriately to the concerns and challenges of consumers, providers, and the system is a formidable task. However, a strategy that has proven effectiveness is the Learn Model. It consists of the following component: o Listen with sympathy and understanding to the patient's perception of the problem o Explain your perceptions of the problem o Acknowledge and discuss the differences and similarities o Recommend treatment o Negotiate treatment

For more information, see:

National Evaluation Team. (2001). Medication use for children entering systems of care. System-of-Care Evaluation Brief, 2(8). Information is provided on the medication histories of children in the SOC. Demographic and diagnostic information is given. Impact and differential use of medication is compared between SOC and non-SOC communities.

Berlin, E.A., & Fowkes, W. C., Jr. (1983) A teaching framework for cross-cultural care: application in family practice. Western Journal of Medicine, 139, 934-938. Provides guidelines for increasing cultural competence - especially in the health arena. The LEARN model has been used in various settings with multicultural populations. It is recommended as a supplement to the history-taking component of a structured interview in various community settings