Investigating geographic variation in use of psychotropic medications among youth in child welfare

Objectives

Public Law (P.L.) 110-351, the “Fostering Connections to Success Act,” calls for state child welfare agencies to partner with Medicaid and pediatric experts to provide planning and oversight regarding the provision of health and mental health services, including medication, to children in state custody. Recent reports, media cases, and class action lawsuits suggest over-use of psychotropic medications to address the behavioral needs of children in the child welfare system. We examined geographic variability in psychotropic medication use across US child welfare agency catchment areas to determine how rates of psychotropic medication use vary in relation to child, community, child welfare, and health system-level factors.

Methods

Cross-sectional analysis of Wave 1 data for the 92 child welfare catchment areas participating in the National Survey of Child and Adolescent Well-being, a random probability sample of 2,504 children ages 2-15 years undergoing investigation for abuse and neglect. We employed multilevel regression modeling to examine the impact of catchment-level variables on medication use, controlling for child-level variables.

Results

Fifteen percent of children reported taking psychotropic medications. Rates of medication use across catchment areas ranged widely from 0 to 40%, a 40-fold difference. On multi-level logistic regression modeling, older age (p < .001), male gender (p < .001), emotional and behavioral problems (p < .001), and insurance (p = .05) were associated with psychotropic medication use at the child-level. At the catchment-level, stressful environment within the child welfare system was negatively associated with medication use. No other catchment-level variables examined were found to explain use.

Conclusions

Striking disparities in medication use exist across catchment areas in this national sample. Of the catchment variables examined, only stressful environment was related to medication use.

Practice implications

These findings highlight significant geographic variation in medication use that most likely reflect both under-use and over-reliance on psychotropic medication. The link between child welfare environment and medication use suggests the influence of systemic, as opposed to clinical, causes of variation in medication use. This requires greater implementation of organizational processes governing quality of care for this highly vulnerable population.     

大规模学生评估的影响力与重要性:德国视角

二十年来,大规模学生评估对教育研究、学校体系和教育政策产生了深远影响."国际中学生评估项目"(PISA)、"国际学生数学与科学能力动态项目"(TIMSS)和"国际学生阅读能力进步研究项目"(PIRLS)使各个国家学生成绩值具有一定可比性,由此,人们能更细致地从学校内部来观察不同国家学校工作的差异度.大规模学生评估还为学校发展、教育领导以及学生成绩的改进提供必要数据.本文以PIRLS为例,旨在从德国视角为中国今后开展大规模国际学生评估提供借鉴.     

Museums as Media in the Emergent Global Context

The papers, participants, presentations, and discussions that serve as the source of this special issue of Curator: The Museum Journal bear witness to the fact that museums are not only places to which something radical, even traumatic is currently happening. They are participants, and essentially agents of change, in the stressful, shifting ecology of globalization that has unmoored whole economies, regions and populations. Fundamentally, they are a form of media, in the sense defined by the Oxford English Dictionary. This article summarizes the challenges museums face in pursuing their mission as media, and ends with a few remarks about the need to turn some attention in the future to the topic of research.     

What Library Managers Should Know about Emotional Labor

This article presents emotional labor in a library context and offers library managers strategies to minimize the negative effects of emotional labor on both staff and users. The components of emotional labor are explained and a framework of response levels is presented with strategies targeted to each response level: incident, training, supervision, human resources, and organizational culture. The strategies offer library managers some ideas for effectively managing emotional labor in their organizations. Understanding the effects of emotional labor and developing the tools that can offset potential negative outcomes can create a more positive work climate and better customer service.     

Assessment of muscle fatigue after an ultra-endurance triathlon using tensiomyography (TMG)

In this study, we used tensiomyography (TMG) to assess muscle status immediately after an ultra-endurance triathlon. Maximal radial displacement or deformation of the muscle belly, contraction time, delay time, sustain time, and relaxation time were measured for both legs, and dependent t-tests were used to compare means between the beginning and end of the race. The 19 men assessed (age 37.9 ± 7.1 years; height 177.5 ± 4.6 cm; weight: 73.6 ± 6.5 kg) participated in the 2009 edition of the Lanzarote Ironman. Deterioration in the neural response was observed for contraction time (P = 0.008) and relaxation time (P = 0.011), with a moderate decrease in the response time (sustain time) and a loss in muscle stiffness (deformation of the muscle belly). The effect of muscle fatigue on the rectus femoris and biceps femoris was different. Barely any changes in contraction time, relaxation time, sustain time, and deformation of the muscle belly were observed, while only the contraction response time decreased to a significant extent (reduction in delay time; P = 0.003). The considerable loss in contractile capacity induced by a long-distance race was reflected in changes in the neuromuscular response and fluctuations in the contractile capacity of the muscle. These modifications, derived from a prolonged, exhausting effort, can be assessed in a simple, non-aggressive, non-invasive way using tensiomyography.