Medications aren’t always the best cure for kids with mental or behavioral issues.
Rather than continuing to treat her son’s anxiety with a prescription drug that caused side effects, Esther Hawkins worked with his doctor to find other options.
Jay, a 14-year-old from Wooster who also has autism and attention deficit hyperactivity disorder, now uses a handheld biofeedback device that gives him visual cues when he’s able to successfully calm himself down and lower his pulse.
“He was on an anxiety medication and it really did not go well,” she said. “We’re trying other things.”
An Akron agency is leading an effort to promote proper use of psychiatric medications for children and to reduce overuse, particularly for young patients covered by the Medicaid program.
Ohio Minds Matter launched about 1½ years ago to improve mental health treatment for children covered by Medicaid, the federally and state-funded public insurance program for low-income residents.
Dr. Steven Jewell, vice president and medical director of Child Guidance and Family Solutions in Akron, is chairing one of three regional Ohio Minds Matter pilot programs to educate primary-care doctors, parents and others about the best use of psychiatric medications.
The Northeast Ohio collaborative includes pediatricians, psychiatrists, court representatives, child welfare agencies, school officials, parent representatives and others from Summit, Portage, Trumbull and Stark counties.
Hawkins, regional coordinator for National Alliance on Mental Illness Ohio’s Parent Advocacy Connection, is among the participants.
Along with advocating for her own son, she’s helped numerous families who are struggling to get proper treatment for their children. Her son had been covered by Medicaid until the federal health reform law allowed his family to get private insurance coverage for his pre-existing health conditions.
“When you’re talking about families who are struggling to hold it together, how do you manage multiple medications?” she said. “What Minds Matter is about is giving families and kids the opportunity to really participate.”
Medications can be extremely helpful when used properly for depression, attention deficit hyperactivity disorder, anxiety and other conditions, Jewell said. “There is no doubt these medications can be lifesaving is certain circumstances.”
However, he said, they should only be used when truly needed because “we really don’t know the impact of these medicines on a developing mind.”
Other treatment options, such as therapy, also can be considered.
Focus on antipsychotics
The statewide program is developing online tools to help parents, caregivers and physicians better understand mental health conditions and the best uses among children of “psychotropic” medications, or those prescribed to manage a psychiatric symptom or challenging behavior.
Part of the focus includes a subset of psychotropic drugs known as atypical antipsychotics, such as Risperdal and Abilify, initially developed for schizophrenia.
They can also be used to effectively treat severe aggressiveness or as a mood stabilizer but carry risks, including weight gain that can lead to diabetes, cardiovascular problems and other health problems, Jewell said.
“Awareness is a piece of the puzzle,” he said.
Ohio decided to launch the Minds Matter program based on national concerns about rising use of atypical antipsychotics among children covered by Medicaid, especially those in foster care, said Dr. Mary Applegate, medical director of the Ohio Department of Medicaid.
“We want to make sure all the people involved in the care of the youth, including the youth themselves, are informed,” she said.
Number of medicated
An average of 6.2 percent of children nationwide covered by the Medicaid program take one or more psychotropic medications, according to a report from the Medicaid Medical Directors Learning Network and the Rutgers Center for Education and Research on Mental Health Therapeutics. Among children covered by private insurance, about 4.8 percent took one or more psychiatric drugs.
The percentage of privately insured children who take antipsychotic medications is about half a percent, compared to 1.3 percent of children covered by Medicaid, the researchers found.
The estimated 12,000 Ohio children in foster care who are covered by the Medicaid program are much more likely to be prescribed one or more medications to treat mental health issues. National studies have shown as many as 22 percent of children in foster care take at least one psychiatric medication — a percentage that officials say is similar in Ohio.
Children in foster care often have faced life traumas, which are associated with depression and other psychiatric conditions, said Dr. Mark Hurst, medical director of the Ohio Department of Mental Health and Addiction Services. But proper treatment can be a challenge because their care might not be coordinated.
Reducing drug use
The initial goals of the Ohio Minds Matter project include achieving a 25 percent reduction among children on Medicaid by July 30 in the following target areas:
• Use of atypical antipsychotic medications in children younger than 6.
• Use of two or more atypical antipsychotic drugs for more than two months.
• Use of four or more psychotropic medicines in children and adolescents.
As part of the initiative, Medicaid is working with participating doctors to report their prescribing habits so potential issues can be identified and discussed, Jewell said.
Through the project, primary-care doctors are being encouraged to use new online tools for guidance on managing patients.
Pediatricians and family medicine doctors also can get assistance through an existing Pediatric Psychiatry Network, which links primary-care doctors throughout Ohio with pediatric psychiatrists who can answer patients’ care questions around the clock.
For more information about the initiative or to download the informational tools, visit www.ohiomindsmatter.org.
Cheryl Powell can be reached at 330-996-3902 or cpowell@thebeaconjournal.com. Follow Powell on Twitter at twitter.com/CherylPowellABJ.