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Four State Medicaid programs have benefited from either their participation in or review of "Antipsychotic Medication Use in Medicaid Children and Adolescents: Report and Resource Guide From a 16-State Study," which reviews State-specific programs and policies to improve the use of antipsychotic medications.

The publication summarizes a 16-State study conducted by members of AHRQ's Medicaid Medical Directors Learning Network in partnership with the AHRQ-funded Center for Education and Research on Therapeutics at Rutgers University, which focuses on mental health therapeutics. Learning Network members, representing a combined enrollment of 12 million children and adolescents in Medicaid, developed a set of preliminary safety, quality, and appropriate use indicators for the analysis and monitoring of antipsychotic medication use.

The report notes that from 2004 to 2007, there was a 10 percent relative increase in antipsychotic medication use among children and adolescents younger than age 19 years in the Medicaid fee-for-service population. Using findings from the study, many States addressed antipsychotic medication use in children enrolled in Medicaid and have implemented policies for improving the quality of mental health care, including consultation services and psychiatric second-opinion statutes.

Washington Health and Recovery Services Administration funded a Partnership Access Line (PAL) to provide free, telephone-based mental health consultation to support primary care providers. Providers can call PAL to speak with a child psychiatrist for mental health treatment advice for any child. From May 2008 to December 2009, 23 percent of PAL calls were related to children enrolled in Medicaid's fee-for-service. The majority of the children had multiple diagnoses, with 41 percent having four or more diagnoses. "I think it has been a very effective program for actually trying to help the providers deal with these very complex kids," says Jeffery Thompson, MD, MPH, Chief Medical Officer for Washington State Medicaid and the project lead. According to Thompson, the rates of very young children and children receiving high doses of mental health medications have declined every year by sharing data, sharing quality strategies, and working with the community.

Wyoming Department of Health set up a PAL and adopted a mandatory second-opinion program for patients who exceed certain parameters, such as children receiving more than five antipsychotic medications concomitantly after 60 days. From January through June 2011, the Wyoming PAL conducted 42 consults for children. James Bush, MD, Medicaid Medical Health Officer with the Wyoming Department of Health, notes, "Clearly, we were able to develop this project based on information I acquired through the Learning Network."

New Hampshire Department of Health and Human Services continues to work with Dartmouth Medical School to develop a program that has a child psychiatrist provide "just in time" reviews for primary care practitioners managing mental health and drug interventions for children ages 18 years and younger. The State engaged in securing funding for the program to perform behavioral health drug reviews.

Minnesota Department of Human Services, although not a member of the original 16-State study, used the study findings to inform a 2010 legislative initiative that provides for a Medicaid pediatric psychiatry consultation, according to Jeffrey Schiff, MD, MBA, Medical Director with Minnesota Health Care Programs. "The collaborative nature of the Learning Network gives critical momentum to States to accelerate quality improvement efforts that might not otherwise be pursued, especially with regards to this study," Schiff notes. "The efforts of other States provide examples for me to share with people in my State to describe what other States are doing. It gives us the opportunity to share details and allows us to accelerate change, which is what the knowledge transfer approach was designed to do."

The Learning Network provided a forum to discuss policies to optimize prescribing. Thompson explains, "Having a network where we can not only work with our peers among the Medicaid medical directors and mental health directors but also benchmark to find out whether we're doing a good job or we need improvement is something that I think had been lacking for a long time. And, it has been within AHRQ's strategy to try to develop not only metrics that show where you are on quality and access but also to develop evidence-based tools or information that will inform you on how to become a best in class."