Massachusetts Child Psychiatry Access Project: MCPAP

Two New Blogs Seek Your Input on Child Mental Health Services

The REACH ( The Resource for Advancing Children's Health) Institute has set up two new children's mental health blogs.  The first blog explores the time delay between when proven interventions are found and when children and families in need actually receive these proven interventions.  This blog can be found at:

http://thereachinstitute.wordpress.com

The second blog discusses the children's mental health system as it is today, and how the system cannot serve the nation's children without some drastic reorganizational changes.  This blog can be found at:

http://catchservices.wordpress.com

CDC Findings on Use of Mental Health Services:Children Aged 4-17

In September 2008, the Centers for Disease Control (CDC) released key findings from the National Health Interview Study ( NHIS) regarding the use of mental health services in the past 12 months by children aged 4-17 years in the United States, 2005-2006.

Key findings include:

• In 2005-2006, 15% of US children aged 4-17 had parents who talked to a health care provider or school staff about their child's emotional or behavioral difficulties.  This included 18% of boys and 11% of girls.
• Approximately 5% of children were prescribed medication for difficulties with emotions or behavior.  A large majority of these children (89%) were prescribed medications for difficulties with concentration, hyperactivity, or impulsivity, which are symptoms of attention deficit-hyperactivity disorder (ADHD).
• Approximately 5% of children received "treatment other than medication" for emotional or behavioral difficulties.  Most of these children - 60% -received this treatment from a mental health private practice, clinic, or center.

To view the entire report, click here.

Research Article Confirms Lack of Association between Measles Virus Vaccine and Autism

A September 2008 research article based on a case-control study confirms a lack of association between the measles virus vaccine and autism with enteropathy.

Click here to link to the PLoS One research article.

Dr. W. Ian Lipkin of Columbia University College of Physicians and Surgeons, who led the work on this article, was interviewed for a related Associated Press article.  Dr. Lipkin stated that no one knows just how many autism patients suffer from gastrointestinal disorders and the associated pain that they might not be able to communicate.  Dr. Lipkin went on to say that by some estimates, up to a quarter may be affected.

Click here to link to the Associated Press story on the MMR/autism study.

MassHealth Screening Initiative: Updated EOHHS Website

EOHHS has recently posted updated information regarding the mental health screening initiative on its site.  It appears to be a quite user-friendly resource which should be useful for getting answers and clarification regarding many aspects of this initiative including: 1) information regarding the screening instruments, 2) billing guidelines, 3) resources for helping to figure out what do after behavioral health needs are identified (including MCPAP!).  It also has some interesting discussion regarding why screening is important, and strategies for overcoming barriers to implementation.  Definitely worth taking a look and bookmarking the site.  BDS

Medications and Choices: The Perspective of Families and Youth - What Parents Tell Us about Psychiatric Medications

The Parent/Professional Advocacy League (PAL) and the Institute for Community Health (ICH) published a June 4, 2008 online report summarizing results of Massachusetts parent and youth surveys and focus groups on the perspective of families with regards to psychotropic medication choices.  The parents surveyed had a child age 19 or under who was currently taking psychotropic medication(s).  The children of those parents surveyed were invited to participate in related focus groups and online youth surveys.

Click here to link to a copy of this report.

MassHealth Information on Screening Tools Mandate Now Available on Website

Information on MassHealth's Children's Behavioral Health Initiative is now available at the Executive Office of Health and Human Services (EOHHS) website at www.mass.gov/masshealth under "News and Updates".

On December 31, 2007 MassHealth required primary care physicians to use standardized behavioral and devleopmental screening tools to screen children under 21 years of age.

The new information on the state website includes early periodic screening, diagnosis and treatment ( EPSDT) regulations, medical protocol and periodicity schedule, laboratory service codes, and billing guidelines.

Click below for a grid describing the eight MassHealth approved behavioral health screening tools.  The grid includes links to the screening tools' websites:

Download rosie_d_screening_tool.pdf

Massachusetts Children’s Autism Medicaid Waiver Program Applications

The Massachusetts DMR/Autism division will be accepting applications for a new children’s autism Medicaid waiver program between  November 5, 2007 and November 16, 2007.  Due to a limited amount of slots, the DMR/Autism division will only be accepting applications during this time period. The applications may be returned to a local autism support center or mailed directly to the DMR/Autism division.

This waiver program will help eighty (80) low income children under the age of nine (9) with a diagnosis of autism spectrum disorder. The waiver program provides up to $25,000 worth of services and supports to each child. These services may include  ABA  (Applied Behavior Analysis)  treatment

Download the message to families of young children with autism from the DMR/Autism division:

In English:

Download family_notice_for_autism_waiver_program_101107.doc

In Spanish:

Download spanish_family_notice_2_pages_final.doc

Download the Autism Waiver Program Eligibility Request Form:

In English:

Download eligibility_request_form_for_autism_waiver_program_101107.doc

In Spanish:

Download spanish_autism_waiver_p_elig_request_form_final.doc

CDC Data on Suicide Increase and Clinical Report in September 2007 Issue of "Pediatrics"

The Centers for Disease Control has recently released disturbing data regarding a sharp spike of suicides in the US among teenagers and particulary among teenage girls.  This 8% increase occurred from 2003 to 2004.  The 8% increase in suicides is the largest single increase in 15 years.

In 2003, some studies suggested that SSRIs used to treat depression may increase suicidal ideation in some children.  The FDA required a black box warning on SSRIs in early 2005.  The increase in suicide rates during 2003 to 2004 coincides with the decreases in prescriptions for SSRIs during the same time period.

Suicide is the third leading cause of death among people ages 10 to 24.

A clinical report in the September 2007 issue of Pediatrics authored by Benjamin Shain, MD, PhD, and the Committee on Adolescents explains what pediatricians can do to reduce the incidence of adolescent suicide by screening for depression and suicidal thoughts.  The report contains detailed advice for pediatricians regarding screening and management of depression and suicidal ideation.  The report also discusses the use of antidepressant medication.

The Massachusetts Child Psychiatry Access Project (MCPAP) urges all of our MCPAP enrolled primary care clinicians to follow the guidelines set in this clinical report.

Click here to link to this important report.

Strattera suicide warning

The FDA last week issued a warning regarding risk of suicidal ideation associated with Strattera after the manufactured reported data from clinical trials suggesting an extremely small percentage of children on the medication had reported suicidal ideation.  5 children among 1,357 children(0.4%) receiving the drug  reported suicidal ideation.  In comparison, none of the 851 who received placebo reported suicidal ideation.  The FDA advisory can be reviewed here.  At this time, clinical recommendations include the importance of communicating carefully with families regarding this risk, making a plan for close monitoring for mental status changes such as agitation, irritability, unusual changes in behavior and/or expressions of actual suicidal ideation, and more frequent follow-up with the provider.  Notably, FDA did not make specific recommendations about frequency of follow-up visits as in the case of SSRI's.