Patterns of Psychotropic Medication Prescription in Youth Prison: Part 1: CHAID Analysis

2.50
Hdl Handle:
http://hdl.handle.net/10755/157695
Type:
Presentation
Title:
Patterns of Psychotropic Medication Prescription in Youth Prison: Part 1: CHAID Analysis
Abstract:
Patterns of Psychotropic Medication Prescription in Youth Prison: Part 1: CHAID Analysis
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Cloyes, Kristin G., PhD, RN
P.I. Institution Name:University of Utah, College of Nursing
Title:Assistant Professor
Contact Address:6523 SE 41st Ave, Portland, OR, 97202, USA
Contact Telephone:801-557-3808
Background and Significance: The number of children and adolescents serving time in secure juvenile facilities (youth prisons) has increased 44% in twenty years. In Utah, an average of 190 youth resides in secure facilities daily. Many of these youth have clinically significant symptoms of mental health disorders, and roughly 30-50% of them are prescribed psychotropic medications. Youth prisons have become a critical site for mental health intervention for at-risk youth. The primary mode of treatment in these settings is psychopharmacology, and the use of psychotropic medications has become a key point of political and clinical contention. Nevertheless, there is a remarkable lack of empirical data related to psychopharmacologic practice in these settings. Purpose: This study was conducted in cooperation with the Utah Division of Juvenile Justice Services (JJS). This state agency administers 6 secure care facilities, where youth up to 18 years of age are incarcerated long term. The study had two primary aims: 1) To describe patterns of prescription and use of psychotropic medication in and across the six facilities; 2) To explore provider and staff practices, attitudes and beliefs related to psychopharmacological treatment. A long term aim is to contribute empirical data to a best practices approach to mental health treatment for youth in these facilities across the US. Methods: This mixed methods study combined retrospective clinical data and interviews with psychiatric providers and staff working at each facility. Here we report on the analysis of chart data, interpreted within the context of interview findings. Systematic chart reviews were conducted for all youth residing in the 6 JJS secure care facilities June-August 2007 who were also prescribed psychotropic medications (N = 75). Categorical and ordinal data related to patterns of medication use were collected, as well as descriptive demographic and clinical data for each case. To examine patterns of psychotropic medication prescription, understood as the effect of a set of complex clinically and culturally derived decisions, we used Chi-squared Automatic Interaction Detector (CHAID). This allowed us to explore these data for significant interactions among variables that predict antipsychotic prescription, an event that emerged as statistically and qualitatively significant. Results: Atypical antipsychotics were the second most frequently prescribed class of medications (N = 42, 56%) and quitiapine (Seroquel) was the most common specific medication (N = 27, 39%). This is despite the fact only 23% of our sample had a recorded history of diagnosis with psychotic features (such as schizophrenia, bipolar disorder, mood disorder NOS or psychosis NOS) and 13% had recorded histories of psychotic symptoms, all conditions conventionally associated with antipsychotic treatment. The variables most predictive of antipsychotic use were whether youth were prescribed multiple meds concurrently, Chi squared (1, N=42) = 15.49, p<.001, followed by whether youth had a diagnosis of ADD/ADHD, Chi squared = (1, N=34) =6.3171, p<.01. Further, antipsychotics were significantly correlated with ADD/ADHD diagnosis, p=.002. Implications: Patterns of antipsychotic medication use indicate that antipsychotics are used in this sample primarily to manage ADD/ADHD and behavioral symptoms. Overall medication dosages, both stimulant and non-stimulant, are quite low compared with typical dosing found in community practice. While the prescription of adjunctive medications is conventional practice in the psychopharmacologic treatment of youth and adults, the correlation of antipsychotic use and ADD/ADHD is not common. Interviews with providers and staff described a prevailing stigma attached to prescribing stimulants for ADD/ADHD treatment in prison. Findings suggest that psychopharmacological practices are informed as much by culture and context as scientific theory and standards of practice.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePatterns of Psychotropic Medication Prescription in Youth Prison: Part 1: CHAID Analysisen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157695-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Patterns of Psychotropic Medication Prescription in Youth Prison: Part 1: CHAID Analysis</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Cloyes, Kristin G., PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Utah, College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6523 SE 41st Ave, Portland, OR, 97202, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">801-557-3808</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kristin.cloyes@nurs.utah.edu</td></tr><tr><td colspan="2" class="item-abstract">Background and Significance: The number of children and adolescents serving time in secure juvenile facilities (youth prisons) has increased 44% in twenty years. In Utah, an average of 190 youth resides in secure facilities daily. Many of these youth have clinically significant symptoms of mental health disorders, and roughly 30-50% of them are prescribed psychotropic medications. Youth prisons have become a critical site for mental health intervention for at-risk youth. The primary mode of treatment in these settings is psychopharmacology, and the use of psychotropic medications has become a key point of political and clinical contention. Nevertheless, there is a remarkable lack of empirical data related to psychopharmacologic practice in these settings. Purpose: This study was conducted in cooperation with the Utah Division of Juvenile Justice Services (JJS). This state agency administers 6 secure care facilities, where youth up to 18 years of age are incarcerated long term. The study had two primary aims: 1) To describe patterns of prescription and use of psychotropic medication in and across the six facilities; 2) To explore provider and staff practices, attitudes and beliefs related to psychopharmacological treatment. A long term aim is to contribute empirical data to a best practices approach to mental health treatment for youth in these facilities across the US. Methods: This mixed methods study combined retrospective clinical data and interviews with psychiatric providers and staff working at each facility. Here we report on the analysis of chart data, interpreted within the context of interview findings. Systematic chart reviews were conducted for all youth residing in the 6 JJS secure care facilities June-August 2007 who were also prescribed psychotropic medications (N = 75). Categorical and ordinal data related to patterns of medication use were collected, as well as descriptive demographic and clinical data for each case. To examine patterns of psychotropic medication prescription, understood as the effect of a set of complex clinically and culturally derived decisions, we used Chi-squared Automatic Interaction Detector (CHAID). This allowed us to explore these data for significant interactions among variables that predict antipsychotic prescription, an event that emerged as statistically and qualitatively significant. Results: Atypical antipsychotics were the second most frequently prescribed class of medications (N = 42, 56%) and quitiapine (Seroquel) was the most common specific medication (N = 27, 39%). This is despite the fact only 23% of our sample had a recorded history of diagnosis with psychotic features (such as schizophrenia, bipolar disorder, mood disorder NOS or psychosis NOS) and 13% had recorded histories of psychotic symptoms, all conditions conventionally associated with antipsychotic treatment. The variables most predictive of antipsychotic use were whether youth were prescribed multiple meds concurrently, Chi squared (1, N=42) = 15.49, p&lt;.001, followed by whether youth had a diagnosis of ADD/ADHD, Chi squared = (1, N=34) =6.3171, p&lt;.01. Further, antipsychotics were significantly correlated with ADD/ADHD diagnosis, p=.002. Implications: Patterns of antipsychotic medication use indicate that antipsychotics are used in this sample primarily to manage ADD/ADHD and behavioral symptoms. Overall medication dosages, both stimulant and non-stimulant, are quite low compared with typical dosing found in community practice. While the prescription of adjunctive medications is conventional practice in the psychopharmacologic treatment of youth and adults, the correlation of antipsychotic use and ADD/ADHD is not common. Interviews with providers and staff described a prevailing stigma attached to prescribing stimulants for ADD/ADHD treatment in prison. Findings suggest that psychopharmacological practices are informed as much by culture and context as scientific theory and standards of practice.</td></tr></table>en_GB
dc.date.available2011-10-26T20:06:59Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:06:59Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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