Current Projects

Program Guidelines

The cornerstone of the program is the Florida Best Practice Psychotherapeutic Medication Guidelines for major mental health conditions affecting children, adolescents, and adults. The guidelines are updated on a rotating basis every other year. In fiscal year 2016-17, the Program updated the following guidelines:

• Florida Psychotherapeutic Medication Guidelines for Children and Adolescents
• Autism Spectrum Disorder and Intellectual Disability Disorder: Psychotropic Medication Recommendations for Target Symptoms in Children and Adolescents

To revise and update the guidelines, we convene a meeting of national and state experts in psychopharmacology, academia, primary care, pediatrics, psychiatry, nursing, managed care, and community health. The guidelines are available on our website.

Second Medical Review (SMR)

In collaboration with AHCA, the program has implemented the Second Medical Review Program (formerly known as the Prior Authorization Program) for the prescribing of antipsychotics and antidepressants in children. Specifically, the SMR Program reviews applications for: 1) Children who are prescribed an antipsychotic medication under the age of 6 years old; 2) Children over the age of 6 who receive antipsychotic polypharmacy prescriptions or antipsychotic prescriptions above maximum dosing recommendations; and 3) Children under the age of 6 years who receive an antidepressant prescription. More recently, a Second Medical Review was introduced for children under the age of 6 who receive a stimulant medication prescription. The SMR Program was created out of concern for the prescribing of antipsychotics and/or antidepressants to very young children for whom very few randomized control trials exist to demonstrate safety and efficacy. Since the SMR Program began in the second quarter of 2008, over 8,500 requests have been received and reviewed by child psychiatrists at the University of South Florida, Department of Psychiatry and Neurosciences. The SMR Program is intended to reduce the number of young children receiving inappropriate antipsychotic, antidepressant, and stimulant treatment, and children and adolescents receiving high dose medications and/or polypharmacy.

Tracking Antipsychotic Use

An important responsibility of the program is to track the use of antipsychotic medications for children and adults whose prescriptions hit a series of quality indicators designed to flag practices that are not well supported by evidence, may produce marginal benefit and/or increase clinical risk and can be applied to analysis of claims. We have been tracking trends of antipsychotic prescribing for the last eight years. We generate several types of analyses to identify practices which warrant greater review and scrutiny. These analyses also help us design the types of intervention used to communicate with prescribers. As a result of our analyses we found that a small number of high volume adult and child clinicians provide the greatest potential for impact. In addition there are many primary care physicians writing small numbers of antipsychotic medications. Our quality initiatives have targeted both groups. We report that the use of antipsychotic polypharmacy in both children and adults has substantially reduced.

Registry

From the information obtained through the prior authorization process we have created a database/registry of children who began antipsychotic treatment before the age of six years. The goals of this initiative are to provide an opportunity to generate data on the long-term outcomes of antipsychotic medications, report actual medical practice, track a broad variety of outcomes, monitor trends over time to understand the long- term effects of antipsychotic use in young children, identify analytic opportunities and ultimately make the registry available to the research community. To date we have 4,929 children in the registry for which we have collected demographic information, medical and behavioral diagnoses, and psychotherapeutic drug information.

Prescriber Education and Support

The Program hosts two hotlines for Florida Providers:

• The Florida Pediatric Psychiatry Hotline, 866-487-9507
• The Florida Clozapine Hotline, 727-562-6762 (providers can also email questions to )

The hotline services are available on non-holiday weekdays between 8:00 am and 5:00 pm. No registration is required and the services are free.
The Program provides educational opportunities for Florida providers through hosting webinars. In fiscal year 2015-16, the Program hosted the following webinars that are available for viewing on our website:

• Managing Pediatric Sleep Disorders
• Guidelines for Autism Spectrum Disorder and Intellectual Disability
• Perinatal Mood Disorders
• Monitoring Physical Health from the Consumer’s Perspective

In fiscal year 2016-17, the Program will host four (4) webinars on the following topics:

• Disruptive Mood Dysregulation Disorder
• Major Depressive Disorder or Bipolar Disorder with Mixed Features
• Medical Management in Autism Spectrum Disorder
• Day to Day Practice: Issues of Women of Reproductive Age with SMI and Substance Use Disorder

Throughout the year, the Program also sponsors meetings and speakers at Florida medical conferences that educate prescribers about the safe, efficient prescribing of psychotherapeutic medication, best practices in mental health treatment, and integrated care across physical and mental health settings. In fiscal year 2015-16, the Program hosted four (4) regional meetings for the Florida Chapter of the American Academy of Pediatrics (FCAAP) on children’s mental health and care integration.

Integration of Behavioral and Medical Health

The Substance Abuse and Mental Health Services Administration (SAMSHA) defines an integrated approach to care as “the systematic coordination” of mental health, substance abuse, and primary care services. Integrated care bridges the gap that often occurs between the medical and behavioral health care systems, and produces the best health outcomes for individuals with serious mental illness.

Every two years, the Program produces a set of guidelines for clinicians who treat patients with SMI to take an integrated approach to monitoring: 1) The physical health of their patients who are at increased risk of developing chronic medical conditions such as cardiovascular disease and diabetes; and 2) The side effects that often arise from patients taking psychotherapeutic medication. These guidelines were most recently updated in February 2016 and are available here.

Special Studies

During the year, the program conducts various evaluation studies on priority areas for the Agency. In fiscal year 2015-16, the Program reviewed:

• The causes of repeated psychiatric and physical health hospitalizations of Florida Medicaid recipients.
• The pregnancy and birth outcomes of women with serious mental illness compared to women without serious mental illness in the Florida Medicaid Program.
• The current status of Statewide Inpatient Psychiatric Program (SIPP) facilities and treatment outcomes in the MMA environment.

In fiscal year 2016-17, the Program will examine:

• The extent of care integration delivered to adults with serious mental illness (SMI) and children with serious emotional disturbance (SED) treated in various health care settings throughout the state.
• The long-term health outcomes of children prescribed antipsychotic medications versus those children not prescribed antipsychotic treatment.
• • The impact of treatment versus non-treatment of SMI in pregnant women on the health of children.