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AACAP 2002 research forum: placebo and alternatives to placebo in randomized controlled trials in pediatric psychopharmacology [Meeting Abstract]

March, John; Kratochvil, Christopher; Clarke, Gregory; Beardslee, William; Derivan, Albert; Emslie, Graham; Green, Evelyn P; Heiligenstein, John; Hinshaw, Stephen; Hoagwood, Kimberly; Jensen, Peter; Lavori, Philip; Leonard, Henrietta; McNulty, James; Michaels, M Alex; Mossholder, Andrew; Osher, Trina; Petti, Theodore; Prentice, Ernest; Vitiello, Benedetto; Wells, Karen
OBJECTIVE: The use of placebo in the pediatric age group has come under increasing scrutiny. At the 2002 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Academy's Workgroup on Research conducted a research forum. The purpose was to identify challenges and their solutions regarding the use of placebo in randomized controlled trials in pediatric psychopharmacology. METHOD: Workgroups focused on problems and solutions in five areas: ethics and human subjects, research design and statistics, partnering with consumers, U.S. Food and Drug Administration and pharmaceutical industry perspectives, and psychosocial treatments. RESULTS: In many but not all circumstances, inclusion of a placebo control is essential to meet the scientific goals of treatment outcome research. Innovative research designs; involvement of consumers in planning and implementing research; flexibility by industry, academia, the National Institutes of Health, and regulatory agencies acting in partnership; and concomitant use of evidence-based psychosocial services can and should assist in making placebo-controlled trials acceptable. CONCLUSIONS: Properly designed placebo-controlled trials remain necessary, ethical, and feasible.
PMID: 15266201
ISSN: 0890-8567
CID: 167937

National trends in concomitant psychotropic medication with stimulants in pediatric visits: practice versus knowledge

Bhatara, Vinod; Feil, Michael; Hoagwood, Kimberly; Vitiello, Benedetto; Zima, Bonnie
OBJECTIVES: (1) To examine U.S. national trends in the use of concomitant pharmacotherapy with the stimulant class of psychotropic drugs in youth; and (2) to present these trends in the context of (a) extant safety and efficacy data, and (b) overall trends in concomitant pharmacotherapy with psychotropic drugs for youth. METHODS: Prescribing data for youths under age 18 years from National Ambulatory Medical Surveys from 1993 to 1998 were analyzed. The visits were categorized into monotherapy (only one psychotropic prescribed) and concomitant pharmacotherapy (>1 psychotropic prescribed). The proportions of these groups were computed as a percentage of all visits during which a psychotropic medication was prescribed. Differences in proportions between surveys were analyzed to determine trends. RESULTS: Between 1993--94 and 1997--98, the proportions of visits for concomitant pharmacotherapy in association with the stimulant class increased nearly five-fold. This increase paralleled an overall increase in the proportion of visits involving prescription of more than one psychotropic medication among youth. CONCLUSIONS: The growth in concomitant pharmacotherapy with the stimulants class has out-paced the increase in safety/efficacy data to inform the use of this practice, resulting in a mismatch between trends in prescribing and growth in knowledge. A simultaneous trend of note is the overall increase in the use of concomitant pharmacotherapy with all psychotropic drugs in youth. Controlled trials are particularly needed to support commonly used combinations of stimulants with antidepressants in youth. In the absence of definitive data, clinical guidelines based on expert consensus and limited data are available and are useful.
PMID: 15487478
ISSN: 1087-0547
CID: 167938

Integrating Evidence-Based Engagement Interventions Into "Real World" Child Mental Health Settings

McKay, Mary M; Hibbert, Richard; Hoagwood, Kimberly; Rodriguez, James; Murray, Laura; Legerski, Joanna; Fernandez, David
This article focuses on an attempt to integrate evidence-based engagement interventions into "real world" outpatient child mental health settings in order to increase access to care for urban youth and their families. More specifically, empirical support for introducing engagement interventions into child clinical settings will be reviewed. Then, specific engagement interventions that are delivered during the initial telephone contact with a child's adult caregiver or during the first face-to-face contact with a child and family are described with attention paid to the training necessary to assist service providers in adopting this change in practice. Factors that serve to facilitate or impede adoption of evidence-based engagement interventions are also reviewed. Finally, preliminary evidence for the effectiveness of integrating such evidence-supported approaches is presented.
PSYCH:2004-15536-007
ISSN: 1474-3329
CID: 169212

Research progress on effectiveness, transportability, and dissemination of empirically supported treatments: Integrating theory and research [Comment]

Silverman, Wendy K; Kurtines, William M; Hoagwood, Kimberly
Herschell, McNeil, and McNeil's (see record 2004-15972-007) documentation of the lag in the dissemination of child empirically supported treatments (ESTs) relative to adult ESTs highlights an important issue that needs to be addressed if progress is to be made in helping children who suffer from debilitating behavioral and emotional disorders. The Herschell et al. article brings to the foreground a myriad of other issues, however, that need to be addressed in order that the profession may achieve the long-term goal of widespread deployment of ESTs. In this commentary, we use Herschell et al. as a point of departure for highlighting one issue that we believe is particularly critical. Namely, we highlight the importance of balancing Herschell et al.'s current call for more basic research on dissemination with a call for more basic theory on effectiveness, transportability, and dissemination, and, more significantly, the integration of theory and research.
PSYCH:2004-15972-009
ISSN: 1468-2850
CID: 169211

Preface. Evidence-Based Practice, Part I: Research Update

Burns, Barbara J [Ed]; Hoagwood, Kimberly Eaton [Ed]
One issue of "Child and Adolescent Psychiatric Clinics of North America" was planned to examine two questions: (1) What is the current state of the evidence?; and (2) What is the potential to move evidence into practice? Papers were invited around these two major themes. Authors responded enthusiastically, such that two issues were required to accomodate their contributions. The content divided naturally into "Part One: Evidence Update" and "Part Two: Effecting Change." Part Two will be released in the Spring of 2005. Part One provides an update on the status of recent studies examining the impact of specific treatment approaches (medication, psychosocial, and community- based services) on child and family outcomes. In Part Two, the voices and views of stakeholders about evidence-based practice, most critically those of family members and clinical practitioners, are echoed in several papers, along with theoretical and empirical data about attitudinal factors related to changing practitioner practice. In conclusion, the critical question seems to be whether or not the field has the confidence, forbearance, and strategic capability to effectively move the current evidence, albeit incomplete and steadily emerging, into practice.
PSYCH:2004-19632-002
ISSN: 1056-4993
CID: 169210

Evidence-based practice : Part I. Research update

Burns, Barbara J; Hoagwood, Kimberly
Philadelphia : Saunders, 2004
Extent: xiii, 717-959 p. ; 24 cm.
ISBN: n/a
CID: 169190

The policy context for child and adolescent mental health services: implications for systems reform and basic science development

Hoagwood, Kimberly
Significant state and national policy initiatives are focusing on strategies for financing and structuring the delivery of evidence-based services for children. These initiatives reflect, in part, an increased awareness of and respect for scientific standards about effective treatments and services. At the same time, major studies of system reform and organizational behavior are calling into question the effectiveness of current practices and identifying the complexities of taking science-based services to scale. Four major policy initiatives are described and the implications of scientific developments within the basic neurosciences for improving policy, practice, and service in children's mental health is discussed.
PMID: 14998880
ISSN: 0077-8923
CID: 167939

Developing strategies for psychopharmacological studies in preschool children

Greenhill, Laurence L; Jensen, Peter S; Abikoff, Howard; Blumer, Jeffery L; Deveaugh-Geiss, Joseph; Fisher, Celia; Hoagwood, Kimberly; Kratochvil, Christopher J; Lahey, Benjamin B; Laughren, Thomas; Leckman, James; Petti, Theodore A; Pope, Kayla; Shaffer, David; Vitiello, Beneditto; Zeanah, Charles
OBJECTIVE: To identify the obstacles and special challenges-ethical, practical, scientific, and regulatory-faced by investigators who attempt to conduct psychopharmacological studies in preschoolers. METHOD: In a workshop held at the 47th Annual Meeting of the American Academy of Child and Adolescent Psychiatry, featuring interactive sessions designed to elicit discussion of the theory and feasibility of research in this young population, several key domains were identified: diagnosis and assessment, ethics, research design, special considerations for preschoolers, regulatory/industry issues, and education/training. RESULTS: A Pediatric Psychopharmacology Initiative is needed to consolidate recommendations from this and other workshops and current federal, research, and regulatory committees. A scholarly review and a guide for institutional review boards and investigators should be prepared on issues related to preschoolers. Developmental specialists provide valuable expertise that can strengthen studies of pediatric psychopharmacology. 'N of 1' case studies can provide valuable information to clinicians. Only preschoolers with severe symptoms that occur in several interpersonal contexts should be entered into trials. Indications for the study of symptom complexes (e.g., aggression) rather than specific diagnoses should be examined and considered for regulatory activities. Psychopharmacology practice parameters for preschoolers are needed. CONCLUSIONS: With preschoolers being increasingly treated with psychopharmacological agents, the need for investigations to address the safety and efficacy of these medications is becoming a central issue for researchers from many disciplines
PMID: 12649627
ISSN: 0890-8567
CID: 34322

School psychology: A public health framework I. From evidence-based practices to evidence-based policies

Hoagwood, Kimberly; Johnson, Jacqueline
Describes current perspectives on evidence-based practices in psychology, medicine, and education. The paper also discusses challenges in the implementation and dissemination of research-based findings into schools and in particular understanding the fit between empirically validated interventions and organizational structures. Following that discussion, differences between current models of organizational behavior as studied in children's mental health services and in education are described and finally, the kinds of programmatic research models within school psychology that can move evidence-based practices towards system-wide policies are described. Implications for practice and policy are noted.
PSYCH:2003-04925-006
ISSN: 0022-4405
CID: 169216

School psychology--a public health perspective: Reply to comments [Comment]

Hoagwood, Kimberly
Replies to comments by H. S. Adelman and L. Taylor; S. R. Forness; R. M. Friedman; and M. D. Weist (see record 2003-04925-009, 2003-04925-010, 2003-04925-011, and 2003-04925-012, respectively) on the papers by K. Hoagwood and J. Johnson; W. Strein et al; and L. Hunter (see record 2003-04925-006, 2003-04925-007, and 2003-04925-008, respectively) regarding a public health perspective on or framework for school psychology and behavior problems. The author suggests that the 4 commentaries offer very thoughtful and nuanced perspectives on how to extend the revisionist approach to school psychology suggested in the special issue of the journal. Each commentary identifies important permutations to the public health framework described, and they articulate additional themes, roles, or perspectives that can be usefully added to it. The author addresses each commentary individually in her response.
PSYCH:2003-04925-013
ISSN: 0022-4405
CID: 169214