Management of Excessive Psychotropic Medication for Youth in Out-of-Home Care

描述（由申请人提供）：据估计，在美国有超过50万儿童被寄养，另有20万儿童接受住院治疗服务。这些家庭外安置的儿童中有许多有严重的情感和行为障碍，精神药物通常在他们的治疗中发挥重要作用。儿童精神药物治疗的研究，虽然必要和不断增长，其范围相对有限，并没有回答实际的研究需要，为这一高度脆弱的人群的日常实践。在接受家庭外护理的青少年中，有很高比例的人在服用药物，其中许多药物是标签外的，而且多种药物治疗很常见。标签外药物和多种药物都与儿童不良反应风险增加有关。许多研究人员认为，现有的经验证据不足以充分理解和支持目前青少年精神药物处方的水平。拟议的科学会议将允许家庭外药物治疗的专家形成合作并计划研究，为实践和政策提供信息。会议将有三个具体目标：(1)确定有希望的策略，以避免在治疗有行为和情绪问题的青少年时过度和不适当地使用精神药物；(2)促进基础研究人员和应用研究人员之间的合作研究联盟，并将其扩展到科学会议之外；(3)为联邦政府资助的研究制定一项长期计划，以研究和改善青少年在家外护理的药物治疗实践。会议将持续两天，有来自大学和供应商组织的24名与会者。所有的参与者都将有经验，目前的药物治疗研究和实践在家庭外的治疗设置。会议将在内布拉斯加州的男孩镇举行。预计这次会议将导致(1)建立一个网站，以促进该领域的研究和推进相关的公共政策努力；(2)在总体战略中建立一些相关的合作手稿，为未来成功申请NIMH研究经费奠定必要的基础；最终，(3)将提交给NIMH的机构间合作研究提案。

DESCRIPTION (provided by applicant): It is estimated that in the United States over 500,000 children are in foster care and another 200,000 receive residential treatment services. Many of these out-of-home placement children have severe emotional and behavioral impairments, with psychotropic medication often playing an important role in their treatment. Pediatric psychopharmacotherapy research, while essential and growing, has been relatively limited in its scope and does not answer the research needs presented by actual day-to- day practice for this highly vulnerable population. A high percentage of youth in out-of- home care are on medications, with many of the medications being off-label and polypharmacy being common. Off-label medications and polypharmacy are both linked to increased adverse effect risk in children. Many researchers have argued that the empirical evidence available is not adequate to fully understand and support the current level of psychotropic prescribing for youth. The proposed scientific meeting will allow experts in out-of-home pharmacotherapy to form collaborations and plan research that will inform practice and policy. The meeting will have three specific aims: (1) To identify promising strategies for avoiding excessive and inappropriate use of psychotropic medications in the treatment of youth with behavioral and emotional problems; (2) To promote collaborative research alliances between basic and applied researchers that will extend beyond the scientific meeting; and (3) To produce a long- term plan for federally-funded studies to research and improve pharmacotherapy practice for youth in out-of-home care. The meeting will occur over a two-day period, with 24 participants coming from both university and provider organizations. All participants will be experienced with current pharmacotherapeutic research and practice in out-of-home treatment settings. The meeting will be held at Boys Town, Nebraska. It is anticipated that this meeting will result in (1) a website being created to facilitate research and advance related public policy efforts in this area, (2) several related collaborative manuscripts within the overall strategy laying the groundwork necessary for successful future NIMH research grant applications, and ultimately, (3) inter-agency collaborative research proposals that will be submitted to the NIMH. PUBLIC HEALTH RELEVANCE: It is critical that behaviorally and emotionally troubled youth in out-of-home settings receive appropriate psychopharmacological care. The goal is for youth to receive the medications they need and no more, in order to maximize the therapeutic benefit and minimize the potential for adverse costs and consequences. To achieve this goal, this meeting will identify promising strategies for avoiding excessive and inappropriate use of psychotropic medications in the treatment of youth with behavioral and emotional problems.