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Office of Mental Health



The PSYCKES Youth quality indicators project focus on issues of psychotropic prescribing in youth, often referred to as problems of "too much, too many, too young." Psychotropic medications offer both the promise of effective treatment for psychiatric disorders in youth and the risk for development of significant health concerns. In the past ten years there has been an increase in the number of psychotropic medications which are being prescribed to children and adolescents and an increase in the number of young children on psychotropic medications; many children are also prescribed higher than recommended doses of psychotropic medications. However, the growth of the scientific evidence regarding best practices for use of these medications in youth has been slow, with few randomized, controlled studies to guide use and document adverse effects. Given the growing scientific literature describing safety concerns, these prescribing practices should be carefully balanced with potential risks, particularly for long term use. The Youth indicator set identifies children under 18 on three or more psychotropics, children younger than six years on any psychotropic, and children under 18 on higher than recommended doses of psychotropic medication.

The Youth Reference Guide (289kb) provides:

  • brief definitions of each indicator within the Youth indicator set,
  • a summary of the scientific evidence regarding psychotropic prescribing for children and adolescents,
  • clinical recommendations for reducing psychotropic prescribing risk in youth, and
  • an annotated bibliography of key scientific articles.

Detailed information about the Youth indicators can be found in the Technical Specifications (125kb).

For QI teams wishing to identify psychotropic prescribing risk in youth outside of the Medicaid population, chart review forms are available. The Psychotropic Medication Reference Table (386kb) provides information on how medications are classified for the indicators that identify polypharmacy in youth and young children on psychotropic medications, and the maximum dose used to calculate the higher than recommended dose in youth.

OMH has developed several educational resources about psychotropic prescribing issues in youth, including:

Comments or questions about the information on this page can be directed to the PSYCKES Team.