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Kentucky's Child Medicaid Recipients Prescribed Psychotropic Drugs at Double the National Rate

Credit Melanie Tata/Creative Commons

Kentucky children who receive Medicaid are prescribed medications to treat mental illness and behavioral issues at double the rate of the national average, according to research from the Child and Adolescent Health Research Design and Support Unit at the University of Louisville.
Of the almost 600,000 children receiving Medicaid in Kentucky, 14 percent have been prescribed at least one psychotropic medication, such as Ritalin or Zoloft, the researchers found. Also, 42 percent of the children in Kentucky's foster care system has been prescribed at least one of these drugs.

Nationally, 7.4 percent of kids receiving Medicaid and 26.6 percent of kids in the foster care system have been prescribed a psychotropic medication.

Psychotropic medications alter chemical levels in the brain that impact mood and behavior. They include anti-psychotics, anti-depressants, attention deficit hyperactivity disorder drugs, anti-anxiety medications and mood stabilizers.

Dr. Gilbert Liu, along with other CAHRDS researchers, have begun a study to examine why these drugs are given to Kentucky children at such a high rate. He said more and more primary care providers are seeing families express concerns about behavioral problems among children.

"Is it a question of we're getting better at screening for these things and so we're just detecting them more effectively, or are children, for whatever reason, having more mental health problems? It's probably a combination of the two," Liu said.

The team has been awarded a $75,000 Improved Health Outcomes Program grant from Passport Health Plan, which administers Kentucky Medicaid to more than 200,00 people statewide.

The study is an extension of work Kentucky Medicaid recently began on the use of psychotropic medicationin people 21 and younger.

Dr. John Langefeld, chief medical officer for the Department of Medicaid Services, said although medication use can reflect diagnosis, it's not always a direct correlation.

"It's our belief that the best kind of care includes therapy, family counseling, working with schools to develop specialized services and programs, and engaging kids with lots of natural support." - Dr. Allen Brenzel

"Understanding the degree of mental illness or mental health conditions is something that takes a broader focus than just looking at medications," Langefeld said.

The state Department for Behavioral Health and Developmental and Intellectual Disabilities is concerned that children may be only receiving medication, instead of or without additional appropriate mental health services, said Dr. Allen Brenzel, medical director for the agency.

"It's our belief that the best kind of care includes therapy, family counseling, working with schools to develop specialized services and programs, and engaging kids with lots of natural support," Brenzel said.

Brenzel said the higher rate of psychotropic medication use may be because there is a lack of access to alternatives to medication.

Kentucky has had a shortage of mental health providers, which leaves many families going to their child's primary care provider for treatment options, Lui said.

"This may be a bridge strategy so that the family is just not left without any attempt at help or intervention," Liu said.

In 2013 there were 577,604 Kentucky Medicaid/KCHIP members. Of those, 82,564 had a prescription for some sort of psychotropic medication that they took on a regular basis. The cost was more than $87 million; the figure does not include any medical services. Primary care physicians, pediatricians and family practice physicians were responsible for majority of the prescriptions.

"It's very difficult in those settings to make an accurate diagnosis and to have the time it takes to fully investigate and assess the child and be sure the diagnosis is appropriate," Brenzel said.

Brenzel said they hope to build a system where evaluations can be completed in settings where there are trained child and adolescent psychiatrist.

Earlier this year, the state Cabinet for Health and Family Services began allowing independently licensed behavioral health professionals such as clinical social workers, Ph.D. psychologist, and marital and family therapist, to provide services to Medicaid enrollees.

They also created a new licensure category called the Behavioral Health Service Organization so that providers could join with others in their field to create mental health clinics for children and families.

The three-phased year-long study will assess Kentucky Medicaid claims data for geographic patterns as well as differences of racial, ethnic, gender and socioeconomic class. It will also examine what type of providers are prescribing psychotropic medication to children.

The second phase of the study will interview providers who have higher-than-average rates of prescribing psychotropic medication. The last phase will develop approaches to correcting overuse of psychotropic medication in children.