Psychotropic Medication Use and Clinical Outcomes Among Children and Adolescents Receiving System of Care Services

Objective: Few studies of psychotropic medication use among children and adolescents address the effectiveness of this medication, as it is typically used in naturalistic treatment settings. The objective of this study was to investigate psychotropic medication use among children and adolescents treated in system of care communities, to identify subject characteristics associated with psychotropic medication use, and determine whether psychotropic medication use is associated with reduced symptom severity. Methods: Data were collected through the National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. For this evaluation, 27 system of care communities reported data on medication use and clinical ratings at intake and 6-month follow-up on children and adolescents 6-18 years of age receiving mental health services between 2006 and 2009. We used mixed-effects logistic regression to determine associations between patient characteristics and medication use, and mixed-effects linear regression to determine whether subjects taking medication and those not taking medication experienced different changes in symptom severity between intake and 6 months. Results: Subject characteristics associated with psychotropic medication use, when controlling for other characteristics, included having more severe emotional and behavioral symptoms at intake, having more co-occurring diagnoses, and receiving more than one type of service. Those both taking and not taking medication showed symptom reduction at 6 months, although symptom severity among subjects taking medication remained in the clinical range. When controlling for covariates, symptom reduction was associated with medication use. Conclusion: Taking psychotropic medication was more strongly associated with measures of illness severity-greater symptom severity at intake, more co-occurring diagnoses, and more service intensity-than with other demographic characteristics. Subjects who took medication showed more symptom reduction at 6 months than those not taking medication, although this reduction was not sufficient to normalize symptoms among those taking medication.