Psychotropic Medication Consultation in Schools

Abstract

Assessing, consulting, and intervening with students being treated with psychotropic medications is an increasingly common activity for school psychologists. This article reviews some of the literature providing evidence for the greater need for training in school psychopharmacology. A legal and ethical case study is presented that highlights the complexity of medication issues for school psychologists. Training programs are encouraged to examine current curricular requirements to insure that graduates are exposed to evidenced-based treatments including pharmacological approaches. It is vital that school psychologists examine their own competencies as they work to ethically and legally consult with families and physicians to improve adaptive functioning in school-aged populations.     

Reducing Psychotropic Medications in an Intensive Residential Treatment Center

Medication rates in behaviorally disordered children and youth have greatly increased to current high levels and are very controversial. This study examined changes in psychotropic medication use, levels of behavioral disturbance, and use of personal restraint and seclusion in a population of youth with serious behavioral disorders receiving medically directed cognitive-behavioral treatment in an intensive residential setting. The hypothesis was that there would be significant reductions in medication rates, without the unintended consequences of increased rates of problem behavior or offsetting increases in the use of seclusion or personal restraint. Results showed significant reductions in both the number of youth on medication and the average number of psychotropic medications during the residential stay. There were also significant reductions in behavioral disturbance, seclusions, and personal restraints. These results demonstrate that psychotropic medication can be significantly reduced without increases in problem behavior or the use of seclusions or personal restraints. We conclude that it is possible to significantly reduce psychotropic medication rates to far more conservative levels within the context of a clinically directed cognitive-behavioral treatment milieu.     

Use of Psychotropic Medications Among Youth in Treatment Foster Care

We describe the use of psychotropic medications among youth in treatment foster care (TFC). Data from 240 youth were coded to examine rates of medication use, including polypharmacy and an indicator of “questionable polypharmacy.” Fifty-nine percent of youth in TFC had taken a psychotropic medication within the past 2 months. Of the youth taking psychotropics, 61 % took two or more and 22 % met criteria for questionable polypharmacy. The majority of youth taking psychotropics also received psychosocial mental health services and were more likely to receive such services than youth not taking medication. Use of psychotropic medication use was not significantly related to demographic factors, maltreatment history, or custody. However, youth with more severe symptoms were more likely to be on medications and to be on multiple medications. Youth with “questionable polypharmacy” were less likely than other youth on multiple medications to have a recent visit to a psychiatrist.     

Psychotropic Medication Practices for Youth in Systems of Care

Concerns have been raised about the quality and appropriateness of psychiatric medication treatment for youth treated in the child welfare or juvenile justice systems. Unfortunately there is a lack of empirical research to indicate whether there are indeed widespread problems related to psychopharmacologic treatment for youth served by public sector systems. This exploratory study utilized data from a national survey of social workers to examine differences in reports on medication type, processes, and perceived outcomes for adolescent clients in the juvenile justice and/or child welfare system (n = 90) versus non-systems clients (n = 305). Relevant clinical and demographic factors were controlled in hierarchical binary logistic and linear regression analyses. The results indicated that social workers referring to systems cases were more likely to report the use of highly potent medication (antipsychotics, mood-stabilizers, and poly-pharmacy), less likely to report that clients were receptive to or involved in the decision to utilize medication, and less likely to report beneficial medication outcomes. However, these reported differences, suggesting that medication treatment for systems youth tends to be less participatory and beneficial, were largely accounted for by differences in clients’ level of functional impairment and rate of disruptive behavior disorders. Implications for further research are discussed.     

NCCN成人临床癌痛指南中心理问题、精神症状和精神用药的解读

疼痛的体验是主观的,疼痛与痛苦相伴而行.NCCN成人癌痛指南对癌痛的评估和治疗中涉及大量的心理问题与干预、精神症状评估和精神药物应用,本文力求对这方面进行解读,以揭示癌痛治疗中对人的尊重和对"总疼痛"的理解.     

Psychotropic Medication Patterns in Medicaid-Insured Youth Based on Clinician-Reported Maltreatment Status

The main objective of this study is to explore the relationship of psychotropic medication use patterns and clinician-reported maltreatment status in Medicaid-insured youth. This cross-sectional study analyzed computerized outpatient claims for youth aged 2–17 years who were continuously enrolled for ≥10 months in a mid-Atlantic state Medicaid program in 2006. Bivariate analyses and multivariable logistic modeling were employed to assess patterns of any psychotropic drug use, and specifically for antipsychotics, antidepressants, and stimulants by clinician-reported maltreatment status and according to other study covariates. Child maltreatment status was assessed using ICD-9 codes for maltreatment. Other covariates included age group, gender, race/ethnicity, region, Medicaid-eligibility categories, and clinician-reported psychiatric diagnostic groups. Among 274,490 youth, 901 had a clinician-reported child maltreatment indicator for a prevalence of 3.3 per 1,000. These youth were more likely to be older, female, African American, and Medicaid eligible by foster care or disability. Youth with clinician-reported maltreatment compared to youth without identified maltreatment had a significantly higher prevalence of antipsychotic use (14.1 vs. 3.4 %), antidepressant use (12.1 vs. 3.4 %) and stimulant use (15.8 vs. 7.8 %). After adjusting for the study covariates, the odds of antipsychotic use (2.6 [2.0, 3.2]), antidepressant use (2.0 [1.6, 2.6]), and any psychotropic use (1.5 [1.3, 1.9]) were comparatively higher among youth with clinician-reported maltreatment. By contrast, the adjusted-odds of stimulant use was comparable between the groups. The findings from this exploratory study from one state’s Medicaid outpatient data suggest that youth with maltreatment indicators have an increased likelihood of antipsychotic and antidepressant medication dispensings.     

Pediatric Do-Not-Attempt-Resuscitation Orders and Public Schools: A National Assessment of Policies and Laws

Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored.     

Religion in Public Schools

If neutrality in religion is truly to be achieved in public schools, then more emphasis must be placed on providing nonbiased instruction on comparative religions and other similar topics.     

Medication and the Fragile Alliance: The Complex Meanings of Psychotropic Medication to Children,Adolescents, and Families

The past 10 years has seen a marked increase in the use of psychotropic medications to treat children and adolescents. Although there is considerable controversy about this trend, it seems inevitable that multimodal treatments including psychopharmacological interventions will need to be better understood and integrated if we are to provide effective treatment to the largest range of patients. In this article, we offer some observations from our clinical experience regarding the effects of medications on the alliance, transference, and family system. In particular, we examine some of the complex psychodynamic meanings of medication that can dramatically affect response to both medication and psychotherapy.     

Outpatient Psychotropic Medication Use in the US: A Comparison Based on Foster Care Status

Using data from the Client/Patient Sample Survey, a nationally representative study of outpatient mental health service utilization, the prevalence and correlates of psychotropic medication receipt for youth who live with families and in foster care are compared. The medication rate is similar for both groups, with slightly more than one-third of youth treated with medication. Additionally, when medication is prescribed, it is the sole intervention provided for close to one half of each group, and the distribution of other services received (such as clinical case management and collateral services) is similar, regardless of living situation. However, the predictors of medication use differ for the two groups. Among foster care youth, only presenting problems of depressed mood, being withdrawn, and suicidality significantly increase the odds of medication; among youth with families, sociodemographic characteristics (male gender), and a range of clinical factors (disruptive behavior disorder, presenting problems of hyperactivity and sleep disturbance, prior mental health service receipt, and inpatient or residential care referral sources) increase the likelihood of medication. The conclusion that distinct sets of factors predict medication for the two groups was reinforced by results of multivariate analyses; foster care status moderates the association between medication receipt and only one of the correlates examined (gender). Implications, limitations, and areas for future research are presented.     

Confidentiality Limits With Clients Who Have HIV: A Review of Ethical and Legal Guidelines and Professional Policies

The publication of the first counseling articles addressing confidentiality limits of clients who have HIV (human immunodeficiency virus) and continue to be sexually active with an uninformed partner occurred 4 years ago. Since that time, dialogue about whether a helping professional may ethically and legally breach confidentiality has not resolved the dilemma but instead has created more questions and controversy for counselors. In this article the authors highlight the barrage of ethical issues regarding HIV and Acquired Immune Deficiency Syndrome (AlDS), review ethical and legal guidelines pertaining to HIV and AIDS and confidentiality, summarize HIV and AIDS confidentiality policies of the major helping professional organizations, articulate questions that contribute to the confidentiality dilemmas, and challenge the American Counseling Association (ACA), formerly the American Association for Counseling and Development (AACD), to develop specific guidelines for counselors.     

Disciplinary Practices in Nebraska's Public Schools

Increasing rates of youth violence and crime have exerted pressure on schools to maintain an orderly learning environment. Exclusionary measures, a common disciplinary procedure, however, have been under intense scrutiny. Our study examined disciplinary practices in elementary and secondary schools by surveying building administrators. Findings indicate strong correlation between level (secondary) and size of school, and socioeconomic status of students and rates of disciplinary actions; significant differences between school levels on disciplinary action for similar offenses and on availability of support programs; and differences in beliefs between elementary and secondary level administrators on the consequences of exclusionary actions.     

Professional Development Policies and Practices in Schools Affiliated with the Association of Christian Schools International

This is a report of survey research conducted among administrators of schools belonging to the Association of Christian Schools International (ACSI) regarding their professional development policies and practices. Schools from five states in the northwest region of the United States were included in the study. Three categories of policies and practices were identified: supporting individual growth, supporting group growth and those supporting both. We offer recommendations both for professional practice and further research.     

Use of Psychiatric Medications in Juvenile Detention Facilities and the Impact of State Placement Policy

The use of psychotropic medications is a significant factor in the overall effort to respond to detained youth with mental illness, yet there are very few studies of psychotropic medication use in juvenile detention settings. It is important to understand the factors that influence the use of mental health services and psychoactive medications in these settings since youth with emotional problems are overrepresented in them. This paper addresses the proportion of youth in these settings who receive mental health services and psychoactive medications. In addition, the impact of a major statewide policy change—the shift of juvenile placement responsibility from the state to local government—on these proportions was examined using 8 years of publicly available data from county probation departments. Multivariate regression analyses of 1,760 observations of quarterly reports from 55 counties showed that the use of both mental health services and psychoactive medications in detention facilities increased concurrently with the policy change. While these proportions had already been gradually increasing in these facilities, it appears that after the policy change they increased even more. This contradicts the aim of most juvenile justice planners—to divert non-violent youth offenders with emotional problems away from incarceration settings and towards community based treatment alternatives. If adequately available, these support services could provide diversion alternatives to prevent inappropriate detentions, and to provide post-detention treatment to prevent lapses in continuity of care and, ultimately, to prevent reoffending.     

我国公立医疗机构转型政策量化分析

分析我国城市一二级公立医院转型为康复医院、老年护理院等接续性医疗机构政策的内外部特征,为后续政策的制定与完善提供参考。通过构建政策工具、政策利益相关者、政策力度三维政策分析框架,对相关政策进行多维分类分析。得出相关政策发文量呈波动增长趋势;环境型政策工具使用过溢,供给型政策工具内部结构配置失衡,需求型政策工具应用匮乏;对不同政策利益相关方的关注度存在差异;政策顶层设计欠缺,整体政策效力不高。建议优化政策工具使用,平衡各利益相关方需求,完善政策体系内容。

     

Why Education in Public Schools Should Include Religious Ideals

This article aims to open a new line of debate about religion in public schools by focusing on religious ideals. The article begins with an elucidation of the concept ‘religious ideals’ and an explanation of the notion of reasonable pluralism, in order to be able to explore the dangers and positive contributions of religious ideals and their pursuit on a liberal democratic society. We draw our examples of religious ideals from Christianity and Islam, because these religions have most adherents in Western liberal democracies that are the focus of this article. The fifth and most important section “Reasonable pluralism and the inclusion of religious ideals in public secondary schools” provides three arguments for our claim that public schools should include religious ideals, namely that they are important to religious people, that they are conducive for the development of pupils into citizens of a liberal democracy, and that the flourishing of pupils as adults is advanced by encountering religious ideals. We also offer a more practical reason: religious ideals can more easily be included within public education than religious dogmas and rules.

The Question of Conscientiousness and Religious Engagement in Public Schools

In this paper, I examine the question of how to nurture and develop conscientiousness thinkers and future citizens of diverse liberal-democratic societies from the perspective of virtue epistemology (VE). More specifically, I examine this question in terms of how public schools might frame engagement with religious perspectives in the classroom. I begin by distinguishing between good and bad conscientiousness through an exploration of current work in the field of virtue epistemology. I then follow Kenneth Strike in his defense of the need for a more robust engagement with religious perspectives as a liberal educational imperative. I argue that basing a framework for engagement on VE, particularly the notion of subjective justification, has significant benefits. My main interest in developing a framework for what I deem to be a necessary supplemental dimension of citizenship education focused on religious engagement is in underlining the responsibility that liberal educators have in regulating what is often a highly contentious and unfortunately caddish debate surrounding religion and the religious. I conclude that by eschewing this responsibility educators are potentially missing out on significant resources for supporting the liberal-democratic educational agenda.