New Toolkit for Providers: Recommendations for Children and Adolescents on Antipsychotics

Date: October 1, 2024 
Attention: Behavioral Health Providers and Primary Care Providers

Call to Action

Texas Children Health Plan (TCHP) encourages providers to continue to take measures to ensure your patients, our members, receive excellent care. TCHP is committed to optimizing the quality of care provided to our members with behavioral health condition(s). TCHP would like to share information on metabolic monitoring recommendations for children and adolescents on antipsychotics. 

Why it matters?

Antipsychotic prescribing for children and adolescents has increased rapidly in recent decades. These medications can elevate a child’s risk for developing serious metabolic health complications associated with poor cardiometabolic outcomes in adulthood. Given these risks and the potential lifelong consequences, metabolic monitoring (blood glucose and cholesterol testing) is an important component of ensuring appropriate management of children and adolescents on antipsychotic medications.1

All patients treated with antipsychotic medications should receive yearly blood glucose and cholesterol testing. Consider the following when treating patients being treated with antipsychotics regardless if you are the prescribing provider. 

• Endorse the use of Care Everywhere to increase care coordination.
• Measure baseline lipid profiles, fasting blood glucose level, and body mass index.
• Use the lowest effective dose of antipsychotic medications.
• Avoid abrupt discontinuation of antipsychotic medications.
• Test blood glucose and cholesterol at a patient’s annual checkup or physical.
• Educate the parent/guardian about the:
  • Increased risk of metabolic health conditions from antipsychotic medications.
  • Appropriate health screening for antipsychotic medications.
• Behavioral health providers should consider ordering blood glucose and cholesterol screening tests for members who do not have regular contact with their PCP.
• If your patient does not have a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, other psychotic disorder, autism, or other developmental disorder then you will also need to adhere to the Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP) HEDIS measure requirements. This requirement identifies the need for psychosocial interventions as the first line treatment for nonpsychotic conditions.
• If your patient experiences a hospitalization for mental illness, please note that you will also need to adhere to the Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS measure requirements. This requirement identifies the need for both a 7 day and 30 day follow-up after discharge to ensure patient safety, medication adherence, and prevention of readmission.

Qualifying Medications

Next step for Providers: Providers are encouraged to share this communication with their staff. 

Resources:

• HEDIS toolkit on Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
• HEDIS toolkit on Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)
• HEDIS toolkit on Follow-Up After Hospitalization for Mental Illness (FUH)

• Texas Children’s Health Plan Psychotropic Medication Guide 

• Agency for Healthcare Research and Quality (AHRQ) Safe and Judicious Use of Antipsychotic Medications in Children and Adolescents Toolkit

References:

1 “Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM).” NCQA, 1 Jan. 2024, www.ncqa.org/hedis/measures/metabolic-monitoring-for-children-and-adolescents-on-antipsychotics/.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

For access to all provider alerts,log into: 
www.texaschildrenshealthplan.org/providers/provider-news/provider-alerts.