{"id":19056,"date":"2012-02-02T10:02:39","date_gmt":"2012-02-02T15:02:39","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=19056"},"modified":"2012-02-02T10:54:36","modified_gmt":"2012-02-02T15:54:36","slug":"sooner-or-later","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/02\/02\/sooner-or-later\/","title":{"rendered":"sooner or later&#8230;"},"content":{"rendered":"\n<p align=\"justify\">In response to a request from Senator Grassley, the Government Accountability Office did a <a target=\"_blank\" href=\"http:\/\/www.gao.gov\/assets\/590\/586570.pdf\"><u><strong><font color=\"#200020\">survey<\/font><\/strong><\/u><\/a> [12\/01\/2011] of the medication of Medicaid covered children with psychotropic drugs in five States [Florida, Texas, Oregon, Michigan, and Massachusetts], separating Foster Children and non-Foster Children:<\/p>\n<p>                  &nbsp;&nbsp;                 <\/p>\n<table align=\"center\" width=\"60%\" cellspacing=\"2\" cellpadding=\"0\" border=\"0\">\n<tr>\n<td align=\"center\" colspan=\"6\"><strong><font color=\"#200020\">Medicaid &ndash; Foster Children<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"center\">Age          <\/td>\n<td align=\"center\"><strong><font color=\"#200020\">FL<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">TX<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">OR<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MI<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MA<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td align=\"center\" colspan=\"5\">\n<hr size=\"1\" \/>   <\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">0-5<\/font><\/strong><\/td>\n<td align=\"right\">5.3%<\/td>\n<td align=\"right\">9.1%<\/td>\n<td align=\"right\">2.5%<\/td>\n<td align=\"right\">4.4%<\/td>\n<td align=\"right\">4.9%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">6-12<\/font><\/strong><\/td>\n<td align=\"right\">31.2%<\/td>\n<td align=\"right\">45.8%<\/td>\n<td align=\"right\">23.4%<\/td>\n<td align=\"right\">26.7%<\/td>\n<td align=\"right\">44.8%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">13-17<\/font><\/strong><\/td>\n<td align=\"right\">36.8%<\/td>\n<td align=\"right\">58.2%<\/td>\n<td align=\"right\">43.3%<\/td>\n<td align=\"right\">35.0%<\/td>\n<td align=\"right\">53.4%<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td align=\"right\" colspan=\"5\">\n<hr size=\"1\" \/>   <\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">1-17<\/font><\/strong><\/td>\n<td align=\"right\">22.0%<\/td>\n<td align=\"right\">32.2%<\/td>\n<td align=\"right\">19.7%<\/td>\n<td align=\"right\">21.0%<\/td>\n<td align=\"right\">39.1%<\/td>\n<\/tr>\n<\/table>\n<p>                                   <\/p>\n<table align=\"center\" width=\"60%\" cellspacing=\"2\" cellpadding=\"0\" border=\"0\">\n<tr>\n<td align=\"center\" colspan=\"6\"><strong><font color=\"#200020\">Medicaid &ndash; non&ndash;Foster Children<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"center\">Age          <\/td>\n<td align=\"center\"><strong><font color=\"#200020\">FL<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">TX<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">OR<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MI<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MA<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td align=\"center\" colspan=\"5\">\n<hr size=\"1\" \/>   <\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">0-5<\/font><\/strong><\/td>\n<td align=\"right\">3.3%<\/td>\n<td align=\"right\">3.1%<\/td>\n<td align=\"right\">0.5%<\/td>\n<td align=\"right\">1.1%<\/td>\n<td align=\"right\">2.2%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">6-12<\/font><\/strong><\/td>\n<td align=\"right\">12.3%<\/td>\n<td align=\"right\">10.6%<\/td>\n<td align=\"right\">6.2%<\/td>\n<td align=\"right\">11.5%<\/td>\n<td align=\"right\">12.1%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">13-17<\/font><\/strong><\/td>\n<td align=\"right\">11.9%<\/td>\n<td align=\"right\">11.4%<\/td>\n<td align=\"right\">12.0%<\/td>\n<td align=\"right\">13.1%<\/td>\n<td align=\"right\">14.7%<\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td align=\"right\" colspan=\"5\">\n<hr size=\"1\" \/>   <\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">1-17<\/font><\/strong><\/td>\n<td align=\"right\">8.2%<\/td>\n<td align=\"right\">7.1%<\/td>\n<td align=\"right\">4.8%<\/td>\n<td align=\"right\">7.9%<\/td>\n<td align=\"right\">10.2%<\/td>\n<\/tr>\n<\/table>\n<p>They also looked at some parameters that would be indicators of irrational medication:        <\/p>\n<table align=\"center\" width=\"60%\" cellspacing=\"2\" cellpadding=\"0\" border=\"0\">\n<tr>\n<td align=\"center\" colspan=\"6\"><strong><font color=\"#200020\">Medicaid &ndash; Foster Children<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"center\">Age          <\/td>\n<td align=\"center\"><strong><font color=\"#200020\">FL<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">TX<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">OR<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MI<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MA<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td align=\"center\" colspan=\"5\">\n<hr size=\"1\" \/>   <\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">&gt;5 meds<br \/>        <\/font><\/strong><\/td>\n<td align=\"right\">0.11%<\/td>\n<td align=\"right\">1.05%<\/td>\n<td align=\"right\">0.13%<\/td>\n<td align=\"right\">0.29%<\/td>\n<td align=\"right\">1.33%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">&gt; max dose<\/font><\/strong><\/td>\n<td align=\"right\">1.50%<\/td>\n<td align=\"right\">3.27%<\/td>\n<td align=\"right\">1.12%<\/td>\n<td align=\"right\">1.67%<\/td>\n<td align=\"right\">2.21%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">&lt;1 year old<br \/>        <\/font><\/strong><\/td>\n<td align=\"right\">2.10%<\/td>\n<td align=\"right\">1.20%<\/td>\n<td align=\"right\">0.30%<\/td>\n<td align=\"right\">1.50%<\/td>\n<td align=\"right\">0.70%<\/td>\n<\/tr>\n<\/table>\n<p>                                   <\/p>\n<table align=\"center\" width=\"60%\" cellspacing=\"2\" cellpadding=\"0\" border=\"0\">\n<tr>\n<td align=\"center\" colspan=\"6\"><strong><font color=\"#200020\">Medicaid &ndash; non&ndash;Foster Children<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td align=\"center\">Age          <\/td>\n<td align=\"center\"><strong><font color=\"#200020\">FL<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">TX<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">OR<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MI<\/font><\/strong><\/td>\n<td align=\"center\"><strong><font color=\"#200020\">MA<\/font><\/strong><\/td>\n<\/tr>\n<tr>\n<td>&nbsp;<\/td>\n<td align=\"center\" colspan=\"5\">\n<hr size=\"1\" \/>   <\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">&gt;5 meds<br \/>        <\/font><\/strong><\/td>\n<td align=\"right\">0.03%<\/td>\n<td align=\"right\">0.02%<\/td>\n<td align=\"right\">0.01%<\/td>\n<td align=\"right\">0.02%<\/td>\n<td align=\"right\">1.33%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">&gt;max dose<br \/>        <\/font><\/strong><\/td>\n<td align=\"right\">0.44%<\/td>\n<td align=\"right\">0.37%<\/td>\n<td align=\"right\">0.16%<\/td>\n<td align=\"right\">0.49%<\/td>\n<td align=\"right\">0.56%<\/td>\n<\/tr>\n<tr>\n<td><strong><font color=\"#990000\">&lt;1 year old<br \/>        <\/font><\/strong><\/td>\n<td align=\"right\">1.20%<\/td>\n<td align=\"right\">1.00%<\/td>\n<td align=\"right\">0.10%<\/td>\n<td align=\"right\">0.30%<\/td>\n<td align=\"right\">0.70%<\/td>\n<\/tr>\n<\/table>\n<ul>\n<div><strong><font color=\"#200020\">Conclusions<\/font><\/strong>:      <\/p>\n<div align=\"justify\"><sup>The higher rates of psychotropic drug prescriptions among foster children may be explained by their greater mental health needs and the challenges inherent to the foster care system. However, thousands of foster and nonfoster children in the five states we analyzed were found to have prescriptions that carry potential health risks. While doctors are permitted to prescribe these drugs under current laws, increasing the number of drugs used concurrently and exceeding the maximum recommended dosages for certain psychotropic drugs have been shown to increase the risk of adverse side effects in adults. Prescriptions for<\/sup><sup> infants are also of concern, due to the potential for serious adverse effects even when these drugs are used for non-mental health purposes. Comprehensive oversight programs would help states identify these and other potential health risks and provide caregivers and prescribers with the information necessary to weigh drug risks and benefits. The recently enacted Child and Family Services Improvement and Innovation Act requires states to establish protocols for monitoring psychotropic drugs prescribed to foster children. Under the act, each state is authorized to develop its own monitoring protocols, but HHS-endorsed, nationwide guidelines for consent, oversight, consultation, and information sharing would help states close the oversight gaps we identified and increase protections for this vulnerable population.<\/sup>     <\/div>\n<div align=\"justify\"><strong><font color=\"#200020\">Recommendations for Executive Action<\/font><\/strong>:<br \/>      <sup>In our draft report, we recommended that the Secretary of HHS evaluate our findings and consider endorsing guidance to state Medicaid and child welfare agencies on best practices for monitoring psychotropic drug prescriptions for foster children, including guidance that addresses, at minimum, informed consent, oversight, consultation, and information sharing. We have received written comments on our draft report from HHS and relevant agencies in 6 states. In written comments, HHS agreed with our recommendation and provided technical comments, which we incorporated as appropriate. In written comments and exit conferences, staff from state Medicaid and foster care agencies provided comments on key facts from the report. Agency comments will be incorporated and addressed in a written report that will be issued in December 2011.<\/sup><\/div>\n<\/div>\n<\/ul>\n<div align=\"justify\">No matter what your beliefs about ADHD or your thoughts that there are high rates of mental disorder in Foster Children or Medicaid Children, it&#8217;s inconceivable that the figures in those tables are justified by any rational medical <em>rationale<\/em> &#8211; particularly those second tables [which should be filled with zeros]. So there&#8217;s no question that the GAO findings are consistent with anything that has to do with the practice of sensible medicine. My impression is that this kind of over-medication of kids is largely the result of a subgroup of doctors who prey on Medicaid by seeing tons of these patients. But I don&#8217;t really know that in any real way. And those Call-Notes in the Janssen Trial gave me the willies about over-prescribing Atypicals.  <\/div>\n<p align=\"justify\"><img decoding=\"async\" align=\"right\" width=\"180\" hspace=\"4\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/feather.gif\" \/>But it&#8217;s the APA response that bugs me [below]. This statement, &quot;<em>New research on alleged overuse of  psychotropic medications in both  nursing-home and foster-care settings  signals a need for better  training of nonpsychiatric physicians and  increased funding to bolster  the mental health workforce<\/em>&quot; puts the blame on others. I expect that there&#8217;s plenty of blame to go around but that we psychiatrists and child psychiatrists own a significant share in our own right. And I didn&#8217;t care much for this one either, &quot;<em>While APA acknowledged in its statement in  conjunction with the Senate  hearing that children in foster-care  systems experience high rates of  mental illness, it voiced support for  the GAO&rsquo;s recommendation that HHS  issue formal guidance to state  Medicaid and child-welfare agencies on  best practices for monitoring the  prescription of psychotropic  medications for foster children.<\/em>&quot; Medicine has been traditionally self regulating. I don&#8217;t hear the APA&#8217;s response as having any acknowledgement of that function. It&#8217;s a politically correct response with all the forcefulness of a feather.  <\/p>\n<div align=\"justify\"><img decoding=\"async\" align=\"left\" width=\"180\" hspace=\"4\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/feather-1.gif\" \/>The problem here is not that people need just &quot;<em>formal guidance to state  Medicaid and child-welfare agencies on best  practices for monitoring the  prescription of psychotropic medications  for foster children.<\/em>&quot; What&#8217;s needed is active censure of these practices with consequences from the APA on its members, the Certification Boards on their practitioners, and Licensing Boards on licensed physicians. Chronic, unjustified, overmedication of children is malpractice, not ignorance of guidelines. And, by the way, what is the APA for if not to set the tone for rational practice? If the APA doesn&#8217;t do it, sooner or later someone else will [and actually should]. There is outrageous information in this report that needs to be dealt with&#8230; <\/div>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/psychnews.psychiatryonline.org\/newsArticle.aspx?articleid=181254\" target=\"_blank\"><u><strong><font color=\"#200020\">APA Responds to Reports on Antipsychotic Prescribing<\/font><\/strong><\/u><\/a><br \/>    <strong><font color=\"#200020\"><sup>APA cites a need to use practice guidelines when prescribing antipsychotics in nursing homes and foster-care facilities.<\/sup><\/font><\/strong><br \/>    <strong><font color=\"#200020\">Psychiatric News<\/font><\/strong><br \/>  by Jonathan Wolfe<br \/>  January 6, 2012<\/div>\n<p>  <\/p>\n<div align=\"justify\"><sup>New research on alleged overuse of  psychotropic medications in both nursing-home and foster-care settings  signals a need for better training of nonpsychiatric physicians and  increased funding to bolster the mental health workforce, stated APA in  recently submitted congressional testimony. On November 30, 2011, the Senate Special  Committee on Aging held a hearing exploring an audit issued earlier in  the year by the Department of Health and Human Services&rsquo; (HHS) Office of  Inspector General (OIG). The report found that 14 percent of  nursing-home residents were prescribed an atypical antipsychotic during  the first six months of 2007. One day later, the Senate Homeland  Security and Government Affairs&rsquo; Subcommittee on Federal Financial  Management, Government Information, Federal Services, and International  Security heard testimony from the Government Accountability Office (GAO)  that foster children are prescribed psychotropic drugs at a  significantly higher rate than children not in foster care.<\/p>\n<p>    Conducted at the request of Sen. Charles  Grassley (R-Iowa), the OIG&rsquo;s report evaluated the extent to which  nursing-home residents over age 65 receive atypical antipsychotics, as  well as the cost to Medicare associated with these prescribing  practices. Grassley had voiced concern about prescription of these drugs  for off-label conditions and\/or in the presence of dementia&#8230;<\/p>\n<p>    <u><strong><font color=\"#200020\">Are Foster Children Overmedicated?<\/font><\/strong><\/u><br \/>    On another issue related to concerns about  use of antipsychotics, the GAO in recent congressional testimony  compared the number of foster children being prescribed psychotropic  medications in 2008 with the rate of prescriptions for nonfoster  children and examined state oversight of psychotropic prescriptions for  foster children through October 2011. While APA acknowledged in its statement in  conjunction with the Senate hearing that children in foster-care  systems experience high rates of mental illness, it voiced support for  the GAO&rsquo;s recommendation that HHS issue formal guidance to state  Medicaid and child-welfare agencies on best practices for monitoring the  prescription of psychotropic medications for foster children.<\/p>\n<p>    &ldquo;APA strongly believes psychotropic  medications must be prescribed only when appropriately deemed necessary,  and must form part of a larger customized treatment plan that includes  both psychopharmacologic and psychosocial interventions,&rdquo; Scully said in  his testimony.<\/sup><\/div>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>In response to a request from Senator Grassley, the Government Accountability Office did a survey [12\/01\/2011] of the medication of Medicaid covered children with psychotropic drugs in five States [Florida, Texas, Oregon, Michigan, and Massachusetts], separating Foster Children and non-Foster Children: &nbsp;&nbsp; Medicaid &ndash; Foster Children Age FL TX OR MI MA &nbsp; 0-5 5.3% [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-19056","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19056","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=19056"}],"version-history":[{"count":40,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19056\/revisions"}],"predecessor-version":[{"id":19097,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/19056\/revisions\/19097"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=19056"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=19056"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=19056"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}