The effect of location on psychotropic treatment practices among pediatricians.

OBJECTIVE: The purpose of the study was to examine how access factors affect prescribing practices of psychotropic medications among pediatricians. More specifically, the aim of the current study was to examine differences in the treatment of mental and behavioral health problems among children and adolescents across small nonmetropolitan, regional, metropolitan, and urban settings across the United States. METHOD: A total of 516 pediatricians working in outpatient clinics located in 12 US states, 3 in each of the following regions: New England, the Plains, the Pacific Northwest, and the South completed surveys on their prescription practices for children and adolescents with mental and behavioral health needs. RESULTS: Findings indicate that pediatricians in small nonmetropolitan settings with populations of fewer than 20,000 prescribe antidepressants; antianxiety, antipanic, and antiobsessive medication; antipsychotics; and mood stabilizers significantly more frequently than their counterparts in urban, metropolitan, and regional settings. CONCLUSION: Implications of these findings for clinical practice and training are discussed.

Physician "costs" in providing behavioral health in primary care.

OBJECTIVE: To examine pediatricians time spent, and resulting reimbursement payments for, addressing behavioral health concerns in a rural primary care pediatric practice. METHODS: Research assistants observed 228 patient visits in a rural pediatric primary care office. The length of the visit (in minutes), content of visit, number and type of codes billed, and related insurance reimbursement amounts were recorded. Interrater reliability, scored for 22% of patient visits, was ≥90%. RESULTS: Medical only visits lasted, on average, 8 minutes as compared with behavioral only visits that required nearly 20 minutes of physician time. Pediatricians billed up to 10 different billing codes for medical only visits but only billed 1 code for behavioral only visits. Consequently, pediatricians were reimbursed significantly less, per minute, for behavioral only visits as compared with those sessions addressing medical only or a combination of medical and behavior concerns. CONCLUSION: Findings converge with previous research, demonstrating that behavioral health concerns dramatically affect the length of visit for primary care physicians. Moreover, this study is the first to document the specific impact of such concerns on pediatrician reimbursement for providing behavioral services. These results provide further support for integrating behavioral health services into pediatric primary care settings, thus allowing physicians to refer more difficult patients with behavioral issues to in-house collaborating behavioral health providers who can spend additional time necessary to address the behavioral health issue and who are licensed to receive mental health reimbursement.

A critical item analysis of the QABF: development of a short form assessment instrument.

Due to the relative inability of individuals with intellectual disabilities (ID) to provide an accurate and reliable self-report, assessment in this population is more difficult than with individuals in the general population. As a result, assessment procedures must be adjusted to compensate for the relative lack of information that the individual may be able to provide and rely more on the behavioral expression of communication. One method commonly used is the indirect functional assessment that utilizes behavior rating scales developed to gather behavioral data in a short time. One of the few empirically derived and psychometrically sound scales is the Questions About Behavioral Function (QABF), a 25-item questionnaire designed to rate specific behavioral functions and maintaining variables. The purpose of this study was to use both exploratory and confirmatory factor analytic procedures to examine the psychometric properties of the QABF, conduct an item analysis, and determine if a short form version could be developed that is both psychometrically valid and reliable, and clinically useful. Results of the item selection procedure indicated that the original 25 items could be reduced to 15. Evaluation of the 15-item short form showed that the QABF-SF maintained the original five-factor structure of the original form, while maintaining an equivalent degree of reliability and validity. The QABF-SF appears to be a useful tool to aid clinicians in the brief functional assessment of behavior in individuals with ID.

Behaviour problems in institutionalised people with intellectual disability and schizophrenia spectrum disorders.

BACKGROUND: Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledge of how schizophrenia spectrum disorders (SSD) manifest themselves in individuals with intellectual disability (ID). In addition, little is known about the relationship between behaviour problems and psychopathology in this population. METHOD: Utilising the Behavior Problems Inventory (BPI), three areas of problem behaviour (self-injurious, stereotyped, and aggressive/destructive) were assessed in 58 individuals with ID divided into three groups (with SSD, with a diagnosis of psychopathology other than SSD, and with ID only) and a total BPI score was calculated for each. RESULTS: The SSD group was unique when compared to the Control group (ID only) for frequency of stereotyped behaviours. Further, severity of stereotyped behaviours in the SSD group was unique compared to the Psychopathology and Control groups. CONCLUSION: The SSD group was unique compared to the other two groups, particularly for severity of stereotyped behaviours. Many specific behavioural differences were also related to either SSD or general psychopathology.

Assessing side effects of pharmacotherapy treatment of bipolar disorder: a 20-year review of the literature.

A substantial literature on the effective treatment of bipolar disorder has begun to appear, particularly in the last 20 years. The majority of treatments studied have employed medications, particularly mood stabilizers, atypical antipsychotics and antidepressants. Most treatments produce side effects and medications are no exception. A review of assessment methods used to evaluate side-effect profiles is presented, along with author interpretations of these data in terms of cost and benefits. Additionally, a discussion of the implications for side-effect monitoring and management during short-term versus more long-term treatments is presented with respect to the general and intellectual disability populations. Summaries of relevant drug side-effect assessment practices are presented and future research directions are suggested.