Psychiatric Annals

Feature Articles 

Promoting Access to Quality Psychopharmacology Services for Youths

Abigail Boden Schlesinger, MD; John V. Campo, MD

Abstract

Mental health treatment has been transformed by the widespread use of psychopharmacologic medications. This transformation has been found to be increasingly true in the care of youths with mental disorders. An armamentarium of medications has become available to treat a growing number of childhood mental health problems. What was once a meager evidence base has experienced modest growth. In the midst of this transformation, understandable concerns about access to safe and effective psychopharmacologic treatment have arisen. Research demonstrating the efficacy of a variety of psychopharmacologic treatments has made it increasingly important to translate advances in treatment efficacy into practical effectiveness strategies to maximize public health benefits. Unfortunately, as in other branches of medicine, there is a gap between what science recommends and usual clinical practices, with “real-world” management often failing to meet recommended standards for treatment content, intensity, and follow-up. Barriers exist to treatment access and include stigma, a limited supply of well-trained providers, reimbursement problems, and segregated systems of care for presumed “physical” and “mental” disorders. This “quality chasm” between treatments delivered in “white-tower” efficacy studies and those available in the community is similar to other chronic health conditions, such as diabetes and asthma. The pediatric psychopharmacology quality chasm was documented in the Multimodal Treatment of ADHD (MTA) study, which found that “expert” psychopharmacologic management was superior to “treatment as usual” in the community, despite the fact that treatment was almost exclusively psychopharmacologic.

ABOUT THE AUTHORS

Abigail Boden Schlesinger, MD, is with the University of Pittsburgh, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

John V. Campo, MD, is with Ohio State University/ Columbus Children’s Hospital OSU Harding Hospital, Columbus, Ohio.

Address correspondence to: Abigail Boden Schlesinger, MD, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara St, 464 BT, Pittsburgh, PA 15213.

Dr. Schlesinger and Dr. Campo have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Analyze the need for novel methods for providing access to psychopharmacologic services to youths.
  2. Explain the qualitative models designed to improve access to mental health treatment by altering the delivery of care for youths with mental illness.
  3. Describe the quantitative models designed to improve access to mental health treatment by increasing the number of providers who can provide these services.

Abstract

Mental health treatment has been transformed by the widespread use of psychopharmacologic medications. This transformation has been found to be increasingly true in the care of youths with mental disorders. An armamentarium of medications has become available to treat a growing number of childhood mental health problems. What was once a meager evidence base has experienced modest growth. In the midst of this transformation, understandable concerns about access to safe and effective psychopharmacologic treatment have arisen. Research demonstrating the efficacy of a variety of psychopharmacologic treatments has made it increasingly important to translate advances in treatment efficacy into practical effectiveness strategies to maximize public health benefits. Unfortunately, as in other branches of medicine, there is a gap between what science recommends and usual clinical practices, with “real-world” management often failing to meet recommended standards for treatment content, intensity, and follow-up. Barriers exist to treatment access and include stigma, a limited supply of well-trained providers, reimbursement problems, and segregated systems of care for presumed “physical” and “mental” disorders. This “quality chasm” between treatments delivered in “white-tower” efficacy studies and those available in the community is similar to other chronic health conditions, such as diabetes and asthma. The pediatric psychopharmacology quality chasm was documented in the Multimodal Treatment of ADHD (MTA) study, which found that “expert” psychopharmacologic management was superior to “treatment as usual” in the community, despite the fact that treatment was almost exclusively psychopharmacologic.

ABOUT THE AUTHORS

Abigail Boden Schlesinger, MD, is with the University of Pittsburgh, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

John V. Campo, MD, is with Ohio State University/ Columbus Children’s Hospital OSU Harding Hospital, Columbus, Ohio.

Address correspondence to: Abigail Boden Schlesinger, MD, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara St, 464 BT, Pittsburgh, PA 15213.

Dr. Schlesinger and Dr. Campo have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Analyze the need for novel methods for providing access to psychopharmacologic services to youths.
  2. Explain the qualitative models designed to improve access to mental health treatment by altering the delivery of care for youths with mental illness.
  3. Describe the quantitative models designed to improve access to mental health treatment by increasing the number of providers who can provide these services.

Mental health treatment has been transformed by the widespread use of psychopharmacologic medications. This transformation has been found to be increasingly true in the care of youths with mental disorders. An armamentarium of medications has become available to treat a growing number of childhood mental health problems. What was once a meager evidence base has experienced modest growth. In the midst of this transformation, understandable concerns about access to safe and effective psychopharmacologic treatment have arisen. Research demonstrating the efficacy of a variety of psychopharmacologic treatments has made it increasingly important to translate advances in treatment efficacy into practical effectiveness strategies to maximize public health benefits. Unfortunately, as in other branches of medicine, there is a gap between what science recommends and usual clinical practices, with “real-world” management often failing to meet recommended standards for treatment content, intensity, and follow-up. Barriers exist to treatment access and include stigma, a limited supply of well-trained providers, reimbursement problems, and segregated systems of care for presumed “physical” and “mental” disorders. This “quality chasm” between treatments delivered in “white-tower” efficacy studies and those available in the community is similar to other chronic health conditions, such as diabetes and asthma. The pediatric psychopharmacology quality chasm was documented in the Multimodal Treatment of ADHD (MTA) study, which found that “expert” psychopharmacologic management was superior to “treatment as usual” in the community, despite the fact that treatment was almost exclusively psychopharmacologic.

ABOUT THE AUTHORS

Abigail Boden Schlesinger, MD, is with the University of Pittsburgh, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

John V. Campo, MD, is with Ohio State University/ Columbus Children’s Hospital OSU Harding Hospital, Columbus, Ohio.

Address correspondence to: Abigail Boden Schlesinger, MD, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara St, 464 BT, Pittsburgh, PA 15213.

Dr. Schlesinger and Dr. Campo have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

  1. Analyze the need for novel methods for providing access to psychopharmacologic services to youths.
  2. Explain the qualitative models designed to improve access to mental health treatment by altering the delivery of care for youths with mental illness.
  3. Describe the quantitative models designed to improve access to mental health treatment by increasing the number of providers who can provide these services.

10.3928/00485713-20070701-01

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