One of our new workgroups for 2016 will look into how and when antipsychotic medications are prescribed for children, adolescents, and teens. Among the types of medications that can change brain function, antipsychotics have great potential for being prescribed too often or at too high a dose. These drugs are often prescribed for aggressive or impulsive behaviors rather than psychosis and are associated with harms in a developing brain and body.

Our workgroup will look at strategies to be sure that when antipsychotics are prescribing to pediatric patients they are being used appropriately, in an evidence-based way, and that children and their families are supported by behavioral health services. Right now we are developing our scope of work, which starts with deciding on the right questions to ask. So far, we want to know:

– Has there been an increase in the number of antipsychotics prescribed to kids in WA State?

– What are the important negative side effects, or key harms, that happen when antipsychotics are prescribed to children, adolescents, and teens?

– What are the important benefits?

– What causes a doctor to prescribe antipsychotics?

– Are there any alternatives to antipsychotics that might accomplish the same thing?

– What are the barriers to these alternatives? Is behavioral management really available and easy to access for all families in WA State?

– What are the costs associated with these drugs for patients? For our health care system?

– What are some creative solutions like telemedicine to increase access to care?


Building on Past Success

This isn’t the first time our State has wanted to improve the way that antipsychotics are prescribed. The Legislature made this a priority in 2007 by expanding behavioral health services for children who get their care through Medicaid. Part of this included creating a program called the Partnership Access Line (PAL) to give primary care clinicians the opportunity to talk to experts about different types of medication used to treat behavioral health issues including antipsychotics. This is a “telephone based child mental health consultation system for primary care providers funded by the Washington State legislature. PAL employs child psychiatrists and social workers affiliated with Seattle Children’s Hospital to deliver its consultation services…[and]  is available to primary care doctors, nurse practitioners and physician assistants throughout Washington State.”[i] You can find out more about this program here.

National Work 

The American Psychiatric Association has also weighed in through Choosing Wisely® saying, “Don’t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.”[ii] Our Federal Government is also looking at antipsychotics through the Agency for Healthcare Research and Quality which is part of our Department of Health and Human Services. They started updating their recommendations in late 2015. Read more about this process here. The New York Times has also covered this issue through their article: A Call for Caution on Antipsychotic Drugs.

Is this an issue that is important to you or your family? Let us know – email me at gweir@qualityhealth.org or come to our workgroup meeting – we are meeting this month on March 14th from 8:00 – 9:30am at Group Health Research Institute Metropolitan Park East and will discuss this topic again at our March 16th Bree Collaborative meeting from 12:30 – 4:30pm at the Waterfront Activities Center.

Ginny Weir, MPH
Bree Collaborative Program Director

[i] Partnership Access Line. Available: www.palforkids.org/index.html.
[ii] American Psychiatric Association. Five Things Physicians and Patients Should Question. Choosing Wisely. September 2013; August 2014; April 2015. Available: www.choosingwisely.org/societies/american-psychiatric-association/.