Trends in Psychotropic Medication Costs
for Children and Adolescents, 1997-2000
Andrés Martin, MD, MPH; Douglas Leslie, PhD
Objective: To examine trends in psychotropic medi-
cation utilization and costs for children and adolescents
between January 1, 1997, and December 31, 2000.
Methods: Pharmacy claims were analyzed for mental
health users 17 years and younger (N = 83 039) from a
national database covering 1.74 million privately in-
sured youths. Utilization rates and costs for dispensed
medications were compared across psychotropic drug cat-
egories and individual agents over time.
Results: Overall use of psychotropic drugs increased from
59.5% of mental health outpatients in 1997 (a 1-year
prevalence of 28.7 per 1000) to 62.3% in 2000 (33.7 per
1000), a 4.7% increase. The largest changes in utiliza-
tion were seen for atypical antipsychotics (138.4%), atypi-
cal antidepressants (42.8%), and selective serotonin re-
uptake inhibitors (18.8%). The average prescription price
increased by 17.6% ($7.90 per prescription), a change
in turn attributed to a shift toward costlier medications
within the same category (55.1% of the increase, or $4.35)
and to pure inflation (44.9% of the increase, or $3.55;
P for trend �.001 for all comparisons). Almost half
(46.7%) of the $2.7 million gross sales differential was
accounted for by only 3 of the 39 drugs identified (am-
phetamine compound, risperidone, and sertraline), and
75% was accounted for by 7 drugs (the previous 3 and
bupropion, paroxetine, venlafaxine, and citalopram).
Conclusions: Psychotropic drug expenditure increases
during the late 1990s resulted from more youths being
prescribed drugs, a preference for newer and costlier medi-
cations, and the net effects of inflation. The impact of man-
aged care and pharmaceutical marketing effects on these
trends warrants further study.
Arch Pediatr Adolesc Med. 2003;157:997-1004
T
HE USE of psychotropic
medications in children has
become a highly visible is-
sue, receiving regular at-
tention from academics (for
a recent summary, see Jensen et al1), poli-
cymakers,2,3 and the lay press alike.4-6 In
contrast to the controversial and at times
charged reactions that the topic can en-
gender, reliable national estimates of the
extent of pediatric use of psychotropic
drugs have only recently started to be-
come available.7-9 Previous studies10,11 have
documented that most psychotropic medi-
cations are not prescribed by mental health
specialists but rather by general practi-
tioners, a pattern that is certainly appli-
cable to stimulants, the most widely used
psychotropic drug class for children: in
1995, pediatricians prescribed 50% of
stimulants, family practitioners 20%, and
psychiatrists only 13%.8
The financial implications of pediat-
ric pharmacotherapy have gone largely un-
examined, an important shortcoming given
that in the US expenditures for prescrip-
tion drugs have continued to be the fastest
growing component of health care across
a ...
This is the summary text of a presentation at the Vatican addressing: "The Question of the Use of Pharmaceuticals in Pediatrics." This presentation covers the clinical trial evidence and offers prescription guidelines
This article applies a critical flaw analysis to psychiatric drugs for children and concludes the evidence does not support drugs as a first line choice.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
This is the summary text of a presentation at the Vatican addressing: "The Question of the Use of Pharmaceuticals in Pediatrics." This presentation covers the clinical trial evidence and offers prescription guidelines
This article applies a critical flaw analysis to psychiatric drugs for children and concludes the evidence does not support drugs as a first line choice.
The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This article calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. The authors assert that current prescribing practices are empirically unsound and unduly influenced by pharmaceutical company interests, resulting in unnecessary risks to patients. In the spirit of evidenced based medicine’s inclusion of patient values as well as the movement toward health home, we present a patient bill of rights for psychotropic prescription. We then offer guidelines to raise the bar of care equal to the available science for all prescribers of psychiatric medications.
BRP Pharmaceuticals is a leader in physician dispensing services that provides instant medication to patients located in Burbank, CA. Visit: http://www.brppharma.com/
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. ColTawnaDelatorrejs
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns, trends, and
correlates of mental health and substance use treatments among adults
with co-occurring disorders. Our data were from the 325,800 adults who
participated in the National Survey on Drug Use and Health in the period
2008–14. Approximately 3.3 percent of the US adult population, or
7.7 million adults, had co-occurring disorders during the twelve months
before the survey interview. Among them, 52.5 percent received neither
mental health care nor substance use treatment in the prior year. The
9.1 percent who received both types of care tended to have more serious
psychiatric problems and physical comorbidities and to be involved with
the criminal justice system. Rates of receiving care only for mental
health, receiving treatment only for substance use, and receiving both
types of care among adults with co-occurring disorders remained
unchanged during the study period. Low perceived need and barriers to
care access for both disorders likely contribute to low treatment rates of
co-occurring disorders. Future studies are needed to improve treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-
occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental he ...
Epidemiology is the study of occurrence, distribution and determinants of health and
diseases or disorders in man and its application in controlling health problems.
Epidemiology has by tradition two major areas.
First is the study of infectious diseases that spread to large populations, i.e., epidemics.
The second is the study of chronic diseases.
Epidemiological studies help to solve such health problems and provide a basis for
improving living conditions of the people.
During its progress and development, epidemiology has made available precise and
strict methodologies for the study of diseases.
Pharmacology is the study of the effects of drugs.
Clinical Pharmacology is the study of the effects of drugs in humans, It is traditionally
divided into two basic areas namely:
1. Pharmacokinetics
2. Pharmacodynamics.
Pharmacokinetics is the study of the relationship between dose administered of a drug
and the serum or blood level achieved, it deals with absorption, distribution, metabolism
and excretion.
Epidemiology is the study of the distribution and determinants of diseases in
populations.
Epidemics is the study of chronic/ infectious diseases in large populations.
Pharmacoepidemiology is the study of the use of and the effects of drugs in large
number of people.
It involves the examination of a single individual or large groups of people followed for
many years.
It involves gathering & analysis of information in order to identify possible causation &
related factors, that can be applied in clinical practice to group of people & also to
individuals undergoing treatment.
Critical Response Rubric:
Category 0 1 1.5 2
Timeliness
late On time
Delivery of Critical
Response
Utilizes poor
spelling and
grammar; appear
“hasty”
Errors in
spelling and
grammar
evidenced
Few
grammatical or
spelling errors
are noted
Consistently uses
grammatically
correct response
with rare
misspellings
Organization
Unorganized. A
summary of the
chapter.
Unorganized in
ideas and
structure.
Some evidence
of organization.
Unorganized in
either ideas or
structure.
Primarily
organized with
occasional lack
of organization
in either ideas
or structure.
Clear
organization.
Ideas are clear
and follow a
logical
organization.
Structure of the
response is easy
to follow.
Relevance of
Response
(understanding the
chapter)
Lacks clear
understanding of
the chapter
Occasionally off
topic; short in
length and offer
no further
insight into the
topic. Lacking 2
or more of the
following: (1)
The text
assumptions (2)
implications of
the assumptions
(3) what the
author is
arguing for (4)
how the author
constructs their
argument
Related to
chapter
content; lacks
one of the
following: (1)
The text
assumptions (2)
implications of
the
assumptions (3)
what the author
is arguing for
(4) how the
author
constructs their
argument
Clear
understanding of
chapter content
and includes all of
the following:(1)
The text
assumptions (2)
implications of the
assumptions (3)
what the author is
arguing for (4)
how the author
constructs their
argument
Expression within
the response
(evidence of
critical thinking)
Does not express
opinions or ideas
about the topic
Unclear
connection to
topic evidenced
in minimal
expression of
opinions or
ideas
Opinions and
ideas are stated
with occasional
lack of
connection to
topic
Expresses
opinions and
ideas in a clear
and concise
manner with
obvious
connection to
topic
Story 2
Naming, walking and magic
By Carlos Gonzalez
The words you speak become the house you live in.—Hafiz (Ladinsky, 1999, p. 281)
Brazilian lyricist and novelist, Paulo Coelho, says that magic is a kind of bridge between the visible and invisible (2014). My work as a teacher and my students’ experiences in the learning spaces I help create sometimes reflect Coelho’s definition. In class, I often make the argument that language is the ultimate form of magic. Without it we don't really understand the world about us. It is that bridge between what is known and what wants to be known or is currently invisible.
In our sessions, because most of my students are familiar with and culturally rooted in the Bible, I mention a passage where God tells Adam to name the animals in the Garden of Eden. For me, this story works as a powerful reminder that the impulse to name is an integral part of what it means to be human. The naming of the animals implies that the way we relate to the world has something to do wi.
Critical Response Rubric- Please view the videos provided on Asha De.docxwillcoxjanay
Critical Response Rubric- Please view the videos provided on Asha Degree. The first, Trace Evidence, is a descriptive trace of the evidence in the case. The second video is the FBI clip hat includes Asha's parents. The Third clip is an experimental walk of the route Asha is claimed to have took that night. SAY HER NAME EXAMPLE- Simply provide a name an incident where violence was inflicted on a Black Female Body (since we've acknowledged Breonna Taylor, please research and find someone else that the class can be made aware of.
One page double space (thoughts)/response
.
https://www.youtube.com/watch?v=Ih5RUlzJjZI
https://www.youtube.com/watch?v=Y-9FtGTRWnk
https://www.youtube.com/watch?v=f30w54xfxiI
.
More Related Content
Similar to Trends in Psychotropic Medication Costsfor Children and Adol.docx
BRP Pharmaceuticals is a leader in physician dispensing services that provides instant medication to patients located in Burbank, CA. Visit: http://www.brppharma.com/
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. ColTawnaDelatorrejs
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns, trends, and
correlates of mental health and substance use treatments among adults
with co-occurring disorders. Our data were from the 325,800 adults who
participated in the National Survey on Drug Use and Health in the period
2008–14. Approximately 3.3 percent of the US adult population, or
7.7 million adults, had co-occurring disorders during the twelve months
before the survey interview. Among them, 52.5 percent received neither
mental health care nor substance use treatment in the prior year. The
9.1 percent who received both types of care tended to have more serious
psychiatric problems and physical comorbidities and to be involved with
the criminal justice system. Rates of receiving care only for mental
health, receiving treatment only for substance use, and receiving both
types of care among adults with co-occurring disorders remained
unchanged during the study period. Low perceived need and barriers to
care access for both disorders likely contribute to low treatment rates of
co-occurring disorders. Future studies are needed to improve treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-
occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental he ...
Epidemiology is the study of occurrence, distribution and determinants of health and
diseases or disorders in man and its application in controlling health problems.
Epidemiology has by tradition two major areas.
First is the study of infectious diseases that spread to large populations, i.e., epidemics.
The second is the study of chronic diseases.
Epidemiological studies help to solve such health problems and provide a basis for
improving living conditions of the people.
During its progress and development, epidemiology has made available precise and
strict methodologies for the study of diseases.
Pharmacology is the study of the effects of drugs.
Clinical Pharmacology is the study of the effects of drugs in humans, It is traditionally
divided into two basic areas namely:
1. Pharmacokinetics
2. Pharmacodynamics.
Pharmacokinetics is the study of the relationship between dose administered of a drug
and the serum or blood level achieved, it deals with absorption, distribution, metabolism
and excretion.
Epidemiology is the study of the distribution and determinants of diseases in
populations.
Epidemics is the study of chronic/ infectious diseases in large populations.
Pharmacoepidemiology is the study of the use of and the effects of drugs in large
number of people.
It involves the examination of a single individual or large groups of people followed for
many years.
It involves gathering & analysis of information in order to identify possible causation &
related factors, that can be applied in clinical practice to group of people & also to
individuals undergoing treatment.
Critical Response Rubric:
Category 0 1 1.5 2
Timeliness
late On time
Delivery of Critical
Response
Utilizes poor
spelling and
grammar; appear
“hasty”
Errors in
spelling and
grammar
evidenced
Few
grammatical or
spelling errors
are noted
Consistently uses
grammatically
correct response
with rare
misspellings
Organization
Unorganized. A
summary of the
chapter.
Unorganized in
ideas and
structure.
Some evidence
of organization.
Unorganized in
either ideas or
structure.
Primarily
organized with
occasional lack
of organization
in either ideas
or structure.
Clear
organization.
Ideas are clear
and follow a
logical
organization.
Structure of the
response is easy
to follow.
Relevance of
Response
(understanding the
chapter)
Lacks clear
understanding of
the chapter
Occasionally off
topic; short in
length and offer
no further
insight into the
topic. Lacking 2
or more of the
following: (1)
The text
assumptions (2)
implications of
the assumptions
(3) what the
author is
arguing for (4)
how the author
constructs their
argument
Related to
chapter
content; lacks
one of the
following: (1)
The text
assumptions (2)
implications of
the
assumptions (3)
what the author
is arguing for
(4) how the
author
constructs their
argument
Clear
understanding of
chapter content
and includes all of
the following:(1)
The text
assumptions (2)
implications of the
assumptions (3)
what the author is
arguing for (4)
how the author
constructs their
argument
Expression within
the response
(evidence of
critical thinking)
Does not express
opinions or ideas
about the topic
Unclear
connection to
topic evidenced
in minimal
expression of
opinions or
ideas
Opinions and
ideas are stated
with occasional
lack of
connection to
topic
Expresses
opinions and
ideas in a clear
and concise
manner with
obvious
connection to
topic
Story 2
Naming, walking and magic
By Carlos Gonzalez
The words you speak become the house you live in.—Hafiz (Ladinsky, 1999, p. 281)
Brazilian lyricist and novelist, Paulo Coelho, says that magic is a kind of bridge between the visible and invisible (2014). My work as a teacher and my students’ experiences in the learning spaces I help create sometimes reflect Coelho’s definition. In class, I often make the argument that language is the ultimate form of magic. Without it we don't really understand the world about us. It is that bridge between what is known and what wants to be known or is currently invisible.
In our sessions, because most of my students are familiar with and culturally rooted in the Bible, I mention a passage where God tells Adam to name the animals in the Garden of Eden. For me, this story works as a powerful reminder that the impulse to name is an integral part of what it means to be human. The naming of the animals implies that the way we relate to the world has something to do wi.
Critical Response Rubric- Please view the videos provided on Asha De.docxwillcoxjanay
Critical Response Rubric- Please view the videos provided on Asha Degree. The first, Trace Evidence, is a descriptive trace of the evidence in the case. The second video is the FBI clip hat includes Asha's parents. The Third clip is an experimental walk of the route Asha is claimed to have took that night. SAY HER NAME EXAMPLE- Simply provide a name an incident where violence was inflicted on a Black Female Body (since we've acknowledged Breonna Taylor, please research and find someone else that the class can be made aware of.
One page double space (thoughts)/response
.
https://www.youtube.com/watch?v=Ih5RUlzJjZI
https://www.youtube.com/watch?v=Y-9FtGTRWnk
https://www.youtube.com/watch?v=f30w54xfxiI
.
Critical Reflective AnalysisIn developing your genogram and learni.docxwillcoxjanay
Critical Reflective Analysis
In developing your genogram and learning plan you were required to collect significant personal data that has influenced your lifestyle and consequently your personal health and wellness. Looking at this information and your personal learning plan a meaningful event must have come to mind. This event would have been an incident that probably impacted your lifestyle in a negative fashion; as an example a divorce, an accident or a sudden death of a family member from familial links. How did this affect your overall health using the six dimensions of wellness? How does the research support the findings? What does this mean for you? With the knowledge you have gained how has this changed your perspective? Why? What changes will you make?Using the LEARN
headings
write a critical analyses highlighting the abstract ideas underlying your reflection. Use specific details and at least
three references
to defend your conclusions.
Criteria for Evaluation and GradingFormat:
5 pages (excluding title and reference page)
12 font Arial or Times New Roman
Double spaced
Minimum of 3-4 references
APA format (link)
Submit in a Word.doc document
LEARN HEADINGS
Look Back
Present a meaningful event
Outline event concisely
Elaborate
Summarize event in detail (what happened, who was involved, where the event occurred, your involvement)
Describe personal feelings and perceptions of self and others
Analyze
Identify
one key
issue to analyze
Use literature as a guide with at least 3 evidence based journal articles
Compare and contrast the event with knowledge acquired in reading
Discuss the new perspective (view) you have acquired through the literature
Revise
Refer back to your acquired knowledge and analysis
Explain how you would preserve or change your perspective
Discuss rationale for considering the change in your life
Suggest alternative strategies you are presently using as a result of this analysis
New Perspective
Identify recommendations for future revision of your lifestyle
Guidelines to assist reflective writing:
Occasion for reflection: (an experience – seen, read, heard)
Presents experience through use of concrete, sensory language, quotations and narrative accounts
Shows depth of thought
Indicates creativity
Reflection ( exploration and analyzes)
Reveals feelings and thoughts through presentation of the experience
Conveys evidence of a personal response to the experience
Enables reader to understand the abstract ideas underlying the reflection through use of specific detail
Demonstrates good meta-cognition
Writing Strategies
Uses convincing language and scenarios to detail reflection
Uses comparison and imagery
Enhances reflection through contrasting and explaining possibilities
Makes inferences
Develops new ways of reflecting upon nursing and nursing practice
Coherence and style:
Demonstrates insight through natural flow of ideas
P.
Critical Reflection Project
z
z
z
z
Major parts
Orient the reader
Identify the focus/purpose of the book
Outline the scope of your paper
Topic sentence 1
Discuses the theme (theme 1) with supporting details
Concluding sentence
Topic sentence 2
Discuses the theme (theme 2) with supporting details
Concluding sentence
Conclude by restating the thesis, summarizing the argument, and making application
Address the themes from biblical point of view
Paragraphs
Outline
Introduction
Body
Conclusion
z
Introduction (Example)
I am a White privileged, American, who is loved, and who is attending the college of her dreams. I live with three younger siblings who do not fit that description. We live in the same house; they are American, loved, attending an amazing high school, privileged, but what is missing? The answer is the color of their skin; I am White and they are Black. My three youngest siblings are adopted from various parts of the United States as well as Africa, and their lives are worlds apart from mine; yet, we live feet apart. I am never afraid to walk home from school or get arrested by the cops, and yet I will be walking home with my 6’0, line man sized, African American little brother and people will cross to the other side of the street. Whole families have crossed in the middle of the road to avoid passing next to us. I know for a fact most of my friends do not worry about their little brother coming home safe because he has the build of the boys you hear about on television being beaten to death—because he has the skin color of the boys on television.
The New York Times best seller, “The New Jim Crow: Mass Incarceration in the Age of Colorblindness” by Michelle Alexander works to give an explanation for the phenomenon that has been splashed across the news left and right. This movement is known as the “Black Lives Matter” movement that has the purpose of fighting back against the racism in our society: the human rights and dignity many people of color feel they are denied. There is a problem in our society that needs to be addressed because lives are on the line; and, I feel that the Black Lives Matter movement is not effectively or gracefully working to solve this problem as God intended. My purpose for this paper is to argue that our society is not seeing the new racism that is running rampant; that God did not intend for any sort of racism; and, finally conclude with our society should be called into action, especially the believers. For this paper, it will be broken up into three different sections: Michelle Alexander’s book, the corresponding Bible passages, and concluded with the application section.
z
Body (example)
“The New Jim Crow: Mass Incarceration in the Age of Colorblindness” is a book by Michelle Alexander, whose main argument is “that mass incarceration is, metaphorically, the New Jim Crow.” Some background to explain this statement is Jim Crow laws were a set of laws that barred African Americans from ha.
Critical reflection on the reading from Who Speaks for Justice, .docxwillcoxjanay
Critical reflection on the reading from
Who Speaks for Justice,
Part 5: Culture pages 161-219.
Cultural and social foundations provide no clear answers or guidance in why things are the way they are and requires students to become mindful of beliefs and patterns of behavior. Some things to think about Why instead of the What and When. What culture do you practice? Where did it come from? Are you paying attention to how culture impacts your behavior, actions and thinking? How does your culture impact others around you? Cultural and social foundations provide no clear answers or guidance in why things are the way they are and requires students to become mindful of beliefs and patterns of behavior.
.
Critical Reflection ExerciseStudents are expected to have co.docxwillcoxjanay
Critical Reflection Exercise
Students are expected to have completed the assigned readings each week and be prepared to comment critically.
Rather than providing mere summaries of course readings, students will be asked to analyze and synthesize information from the assigned readings while reflecting on their own lived experiences using personal examples, situations they observe in organizations and within their communities, and current events.
Students will submit a
three
page, double-spaced critical reflection of the assigned readings.
Assigned Readings: *
For the Second Reading, just Chapter 1 & 2
.
Critical Reading StrategiesThe University of Minnesota published.docxwillcoxjanay
Critical Reading Strategies
The University of Minnesota published a guideline on critical reading, called Critical Reading Strategies.
Click here (Links to an external site.)Links to an external site. for the document.
These guidelines suggest reading in an active and engaged way in order to analyze, evaluate, and understand texts. They recommend:
1. Identifying what you're reading for. Answer the following questions:
1. Why am I reading this text? Is it for general content? To complete a written assignment? To research information?
2. Allowing yourself enough time to read. I recommend giving yourself about one hour for every 25 pages of reading.
1. Note: Get comfortable with the feeling of struggling to read. Many of the texts we encounter this semester are very old. These readings may be obscure, difficult to understand, while reflecting cultural values that may be alien to you. I recommend paying attention to these feelings of discomfort as you read, and then using them to investigate the text further.
1. Example: You notice there is a lot of repetition in the Epic of Gilgamesh so you decide to look into it. You find out that the translation history of Epic of Gilgamesh involves a great deal of transcription from fragmented cuneiform tablets into our written text system.
3. Previewing the text. Does the text have any headings or sub-headings? If so, what are they? Does it include an introduction? If so, what does the introduction have to say? What does the text look like on the page? Literally--does it take up a lot of space? Bigger/smaller margins? Use block writing or stanzas?
4. Engaging. I cannot stress it enough: get in the habit of reading with a pen or pencil in hand. Write in the margins. Circle things you find important. Develop a notation system that reflects your thoughts or feelings as you read.
1. You may draw an angry face next to the section where Gilgamesh insults the goddess Ishtar. You might underline the stanza in which Gilgamesh and Enkidu confront the monster, Humbaba.
2. What the texts says vs what it does. Take time to summarize the text says. What is the main idea? How is the main idea supported? Now ask yourself: how does it do that? Does it use imagery? Metaphor? Repetition? Simple or complicated language?
What is World Literature?
David Damrosch is known for his extensive work in world literature and comparative literature. He is also the director of Harvard's The Institute for World Literature (Links to an external site.)Links to an external site.. In "Introduction: Goethe Coins a Phrase," Damrosch provides a brief history of world literature as a literary field, and also defines world literature in terms of translation and circulation. See below for the PDF.
Damrosch, David (Introduction--Goethe Coins a Phrase).pdf
· The concept of "world literature" as a literary field comes into the Western World through Goethe's term, weltliteratur. It's important to note that Goethe was not the first to use weltlite.
Critical Qualitative Research Designpages 70–76Related to un.docxwillcoxjanay
Critical Qualitative Research Design
pages 70–76
Related to understanding your goals as a researcher is the development of the rationale of the study. A rationale is the reason or argument for why a study matters and why the approach is appropriate to the study. Rationales can range from improving your practice and the practice of colleagues (as in practitioner research), contributing to formal theory (e.g., where there may be a gap in or lack of research in an area), understanding existing research in a new context or with a new population, and/or contributing to the methodological literature and approach to an existing corpus of research in a specific area or field. Thinking about and answering the questions in Table 3.1 can aid in this process. Considering these kinds of questions is central to developing empirical studies, and it is important to understand that these rationales and goals will also lead you to conduct different types of research, guiding your many choices—from the theories used to frame the study to the selection of various methods to the actual research questions as well as designs chosen and implemented.
There are many strategies for engaging in a structured inquiry process and through it an exploration of research goals and the overall rationale of a study. These strategies can include the writing of various kinds of memos, structured dialogic engagement processes, and reflective journaling. Across these strategies, creating the conditions and structures for regular dialogic engagement with a range of interlocutors is an absolutely vital and necessary part of refining your understanding of the goals and rationales for the research. We describe each of these strategies in the subsequent sections.
Memos on Study Goals and Rationale
Memos are important tools in qualitative research and tend to be written about a variety of different topics throughout the phases of a qualitative study. Memos are a way to capture and process, over time, your ongoing ideas and discoveries, challenges associated with fieldwork and design, and analytic sense-making. Depending on your research questions, memos can also become data sources for a study. There is no “wrong” way of writing memos, as their goal is to foster meaning making and serve as a chronicle of emerging learning and thinking. Memos tend to be informal and can be written in a variety of styles, including prose, bullet points, and/or outline form; they can include poetry, drawings, or other supporting imagery. The goals of memos are to help generate and clarify your thinking as well as to capture the development of your thinking, as a kind of phenomenological note taking that captures the meaning making of the researcher in real time and then provides data to refer back and consider the refinement of your thinking over time (Maxwell, 2013; Nakkula & Ravitch, 1998). While we find writing memos to be a useful and generative exercise, both when we write and share them in our indep.
Critical InfrastructuresThe U.S. Department of Homeland Security h.docxwillcoxjanay
Critical Infrastructures
The U.S. Department of Homeland Security has identified what is determined to be critical infrastructure assets that are designated as potentially being of terrorist interest. Although the final responsibility and mission for protecting those assets and sectors of each remains with the DHS, the initial accountability rests with local ownership and authorities.
The DHS has formulated a National Infrastructure Protection Plan to explain and describe the national responsibility. A very significant majority of the infrastructure elements are under private or corporate ownership and maintenance and must share the bulk of responsibility for protection and security under their own mission plans for security.
Assignment Guidelines
Address the following in 3–4 pages:
What is the National Infrastructure Protection Plan (NIPP)?
When was it created?
Who created it?
Why was it created? Explain.
How important is the private sector with regard to critical infrastructure protection? Why?
What types of strategies can be used for critical infrastructure protection (CIP)?
What strengths currently exist in the United States with regard to CIP? Explain.
What weaknesses still need to be addressed? Why?
How can federal agencies effectively cooperate with private sector organizations? Explain.
What types of information should be disseminated to private sector organizations that are responsible for key assets? Explain.
What types of information, if any, should be withheld from the private sector? Why?
ASSIGNMENT DUE TONIGHT 10/20/13 BY 12 CLOCK
.
Critical Infrastructure Protection
Discussion Questions: How has the federal government responded to possible terrorist attacks (mitigation) where civil liberties have not been endangered? Considering that so much of the nation’s critical infrastructure is privately owned, how has the government-regulated possible civil liberties issues related to private sector employers/employees? Can a balanced policy be implemented regarding critical infrastructure without eroding privacy, freedom of information or other civil liberties?
Minimum of 350 words
APA Style with quotation and references
.
Critical InfrastructuresIn terms of critical infrastructure and ke.docxwillcoxjanay
Critical Infrastructures
In terms of critical infrastructure and key resources (CIKR), an
asset
is a person, structure, facility, information, material, or a process that has value. For example, in the transportation sector, a bridge would be an asset.
A
network
is a group of related components that interact with each other or share information to perform a function. For example, a light rail system that crosses multiple jurisdictions in a large metropolitan area would be considered a network.
A
system
is any combination of facilities, personnel, equipment, procedures, and communications integrated for a specific purpose. For example, the U.S. interstate highways comprise a system within the transportation sector.
A
sector
consists of a logical collection of interconnected assets, systems, or networks that provide a common function to society, the economy, or the government. For example, the transportation sector consists of vast, open, accessible, interconnected systems, which include the aviation, maritime, pipeline, highway, freight rail, and mass-transit systems.
Address the following in 3–4 pages:
For each of the 18 CIKR sectors, identify 1
–
2 local examples of critical infrastructure.
Briefly describe the examples, and explain how they are operated and utilized.
Provide any information that you feel is unique to each sector.
In your local community, research the infrastructure, and identify one particular element that may be of particular interest to a terrorist or vulnerable to natural or manmade disaster.
Are there any protective measures in place to ensure its safety?
.
Critical Infrastructure Case StudyPower plants are an important .docxwillcoxjanay
Critical Infrastructure Case Study
Power plants are an important part of critical infrastructures and local, state, and national economies. Therefore, power plants need deep and multilayered access controls due to concerns over physical security. There are a number of sensitive areas that must be secured, and various employees need different levels of access to these locations. At a plant in the upper Midwest, this access is handled with identity badges that include images of the user and an RFID with their access rights. The RFID handles access through multiple levels. There is a security checkpoint at the entrance to the parking lot, and at the entrance. Both points require a badge to enter. From there the badge allows personnel to enter the facilities they are authorized to enter. It also acts as "something you have" for multipoint authentication onto secure systems. These are all standard functions for an RFID badge system. The badges also have an automatic deactivation feature, which is useful for certain personnel. Maintenance personnel, for example, do not have enhanced access and do not require access to secured areas of the site. However, the maintenance team may need access to any area of the facility regardless of its sensitivity, in the case of a breakdown or special project. To allow for this, the badges can be granted access rights that decay over time. This allows for temporary access to secure areas that is then automatically revoked over a number of hours or days. This lowers administrative time, and reduces the risk of human error in rights assignment.
.
Critical Infrastructure and a CyberattackPresidential Decisi.docxwillcoxjanay
Critical Infrastructure and a Cyberattack
Presidential Decision Directive 21 (PDD-21) identifies 16 critical infrastructures. PDD-21 lays out the national policy to maintain secure, functioning and resilient critical infrastructure. Select a critical infrastructure sector from the list below and discuss the impact that a cyberattack could have on that system or service:
Communication Sector (voice communications, digital communications, or navigation)
Energy Sector (electric power grid)
Water and Wastewater Systems Sector (water supply or sewage)
Healthcare and Public Health Sector (hospitals)
Transportation Systems Sector (rail or air)
Financial Services Sector (banking )
It is the third and fourth order effects from the cyberattack on the chosen critical infrastructure that shows the far reaching and devastating effect of a cyberattack. To demonstrate the interconnectedness of critical infrastructure, explain the cascading effects on other critical infrastructure. Then, discuss the measures DHS has taken to ensure resiliency of the selected infrastructure and the measures that need to be implemented in the future.
The Critical Infrastructure and a Cyberattack assignment
Must be three to four pages in length (excluding the title and reference pages) and formatted according to APA style as outlined in the
Ashford Writing Center (Links to an external site.)
.
Must include a
cover page (Links to an external site.)
with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must include an introductory paragraph with a succinct thesis statement. The thesis must be in both the introduction and the conclusion.
Must use at least three scholarly sources or official government sources in addition to the course text.
Must
document all sources in APA style (Links to an external site.)
as outlined in the Ashford Writing Center.
Must include a separate
references page that is formatted according to APA style (Links to an external site.)
as outlined in the Ashford Writing Center.
Carefully review the
Grading Rubric (Links to an external site.)
for the criteria that will be used to evaluate your assignment.
.
Critical Incident Protection (CIP)Plans need to have your name o.docxwillcoxjanay
Critical Incident Protection (CIP)
Plans need to have your name on them and need to include at least 2 pages describing:
•The importance of the document
•How it pertains to your residency company
•How your role in the company can help the plan be successful
Note:ASAP FORMAT
references and citations required
.
Critical Evaluation of Qualitative or Quantitative Research Stud.docxwillcoxjanay
Critical Evaluation of Qualitative or Quantitative Research Study
Read:
Stevens, K., (2013)
The impact of evidence-based practice in nursing and the next big ideas
.
OJIN: The Online Journal of Issues in Nursing
,
18
,(2), Manuscript 4. doi: 10.3912/OJIN.Vol18No02Man04
Critically evaluate either Study 3 or Study 4. Evaluate the credibility of professional citation, research design, and procedures in a research article. Include a discussion on how this study contributes to evidence-based practice.
Study 3 -
Patients’ and partners’ health-related quality of life before and 4 months after coronary artery bypass grafting surgery
Study 4 -
Striving for independence: a qualitative study of women living with vertebral fracture
Suggested Reading
Schreiber, M. L. (2016). Evidence-Based Practice.
Negative Pressure Wound Therapy
.
MEDSURG Nursing, 25
(6), 425-428.
Stevens, K., (2013)
The impact of evidence-based practice in nursing and the next big ideas
.
OJIN: The Online Journal of Issues in Nursing
,
18
,(2), Manuscript 4. doi: 10.3912/OJIN.Vol18No02Man04
Wakefield, A. (2014). Searching and critiquing the research literature.
Nursing Standard
,
28
(39), 49-57. doi:10.7748/ns.28.39.49.e8867
Chapter 6 (pp. 131-153), Chapter 7 (pp. 157-185), Chapter 8 (pp. 189-226) Chapter 12 (pp.323-350)& Chapter 13 (pp. 351-380) In Houser, J. (2018).
Nursing research: Readings, using & creating evidence
(4th ed.). Burlington, MA: Jones & Bartlett Learning
Qualitative Specific Resources
Houser, J. (2018).
Nursing research: Readings, using & creating evidence
(4th ed.). Burlington, MA: Jones & Bartlett Learning.
Chapter 9, p. 229-252
Chapter 14, p. 385-416
Chapter 15, p. 419-442
Additional Instructions:
All submissions should have a title page and reference page.
Utilize a minimum of two scholarly resources.
Adhere to grammar, spelling and punctuation criteria.
Adhere to APA compliance guidelines.
Adhere to the chosen Submission Option for Delivery of Activity guidelines.
Submission Options:
Choose One:
Instructions:
Paper
4 to 6-page paper. Include title and reference pages.
.
Critical Analysis of Phillips argument in her essay Zombie Studies.docxwillcoxjanay
Critical Analysis of Phillips' argument in her essay "Zombie Studies Gain Ground on College Campuses"
Compose a fully-developed paragraph to critically analyze Phillips' argument. Use the points you learned in the "Reading with a Critical Eye" text for your analysis. (500 words)
What are the main points Erica Phillips uses to support her argument that zombies are gaining ground on college campuses?
Who are the authorities that she presents to provide credibility to her argument.
Does she present you with facts or opinions? Is her information current?
Does her background give her any authority on the subject?
What are the strengths and weaknesses of her argument?
.
Critical Appraisal Process for Quantitative ResearchAs you cri.docxwillcoxjanay
Critical Appraisal Process for Quantitative Research
As you critically appraise studies, follow the steps of the critical appraisal process presented in Box 18-1. These steps occur in sequence, vary in depth, and presume accomplishment of the preceding steps. However, an individual with critical appraisal experience frequently performs multiple steps of this process simultaneously. This section includes the three steps of the research critical appraisal process applied to quantitative studies and provides relevant questions for each step. These questions are not comprehensive but have been selected as a means for stimulating the logical reasoning and analysis necessary for conducting a study review. Persons experienced in the critical appraisal process formulate additional questions as part of their reasoning processes. We cover the identification of the steps or elements of the research process separately because persons who are new to critical appraisal often only conduct this step. The questions for determining the study strengths and weaknesses are covered together because this process occurs simultaneously in the mind of the person conducting the critical appraisal. Evaluation is covered separately because of the increased expertise needed to perform this final step.
Step I: Identifying the Steps of the Quantitative Research Process in Studies
Initial attempts to comprehend research articles are often frustrating because the terminology and stylized manner of the report are unfamiliar. Identification of the steps of the research process in a quantitative study is the first step in critical appraisal. It involves understanding the terms and concepts in the report; identifying study elements; and grasping the nature, significance, and meaning of the study elements. The following guidelines are presented to direct
you in the initial critical appraisal of a quantitative study.
Guidelines for Identifying the Steps of the Quantitative Research Process
The first step involves reviewing the study title and abstract and reading the study from beginning to end (review the key principles in Box 18-2). As you read, address the following questions about the research report: Was the writing style of the report clear and concise? Were the different parts of the research report plainly identified (APA, 2010)? Were relevant terms defined?
You might underline the terms you do not understand and determine their meaning from the glossary at the end of this textbook. Read the article a second time and highlight or underline each step of the quantitative research process. An overview of these steps is presented in Chapter 3. To write a critical appraisal identifying the study steps, you need to identify each step concisely and respond briefly to the following guidelines and questions:
I. Introduction
A. Describe the qualifications of the authors to conduct the study, such as research expertise, clinical experience, and educational preparation. Doctoral .
Criteria
Excellent
Superior
Good
Work needed
Failing
Introduction
20 points
Engages reader's attenion. Strong, assertive stance. Gives title of story and author. Key points are presented in thesis. Has individual and creative slant
18 points
Clear thesis with key points. Gives title and author. Takes a stance on analysis of story.
16 points
Thesis general but analytical. Reader is aware from first paragraph of the author's perspective of the story.
14 points
Thesis too broad or not clear as analysis.
0 points
Needs thesis which will analyze story. Reader not clear about what to expect.
Body
20 points
Key points developed with details and examples from text. Refers to thesis concepts. Reflects authorial stance
18 points
Gives details and examples from text to analyze thesis concept.
16 points
Uses some examples from the story without much plot summary. Focuses on thesis concept.
14 points
Plot summary. Does not tie into thesis concept.
0 points
Plot summary or biography of author. Thesis not developed with details or key points.
Conclusion
15 points
Summarizes key points made in essay. Restates thesis concept in different words. Provides a sense of closure and unification.
13 points
Summarizes points made. Restates thesis concept.
11 points
Summarizes points made in body of essay. Unifies the essay without new topics introduced.
9 points
Ends abruptly. Introduces new topic into conclusion. Does not reflect information in introduction, thesis, and body.
0 points
Lacks summary of points or sense of unity in essay.
Academic tone
10 points
Semi-formal, academic tone with clear sentence structure and phrasing. Third person used throughout. No cliches, slang, or colloquialisms used.
8 points
Semi-formal, academic tone with clear sentence structure and phrasing. Third person used throughout.
6 points
Clear tone but may contain usage of first person, or occasional informal usage.
4 points
Too informal, usage of first person, and language usage does not reflect the academic reader.
0 points
Does not reflect the tone of academic writing.
Citations
25 points
Uses in-text citations accurately after examples from text. Provides Work Cited list with accurate citation(s).
22 points
Accurate in-text and Works Cited citation(s).
19 points
In-text and end citations may have errors, but show patterns given in our textbook.
17 points
Inadequate information to allow reader to find sources. Usage of URL as main citation. In-text citations missing or not accurate.
0 points
Missing or invalid.
Mechanics
10 points
Free of errors in punctuation, spelling, grammar, and sentence structure
8 points
Few errors in spelling, punctuation or grammar. Complete sentences with conventional phrasing.
7 points
Errors are too frequent, but few sentence construction problems--fragments, run on sentences or comma splices.
6 points
Too many errors. Problems with sentence constructions: fragments, fused senten.
Critical analysis of primary literature - PracticePurposeThis.docxwillcoxjanay
Critical analysis of primary literature - Practice
Purpose:
This purpose of this assignment is to critically analyze each section of one research paper, in order to gain experience dissecting, summarizing, and evaluating primary literature.
Skills:
As a result of completing this assignment, you will gain skills required to analyze and evaluate information from any source, and to apply the process of science to analyze and evaluate primary sources, including:
· Identifying and rewording hypotheses and predictions
· Evaluating experimental methods within the context of the hypotheses and predictions
· Analyzing statistical tests and describing their meaning
· Analyzing, interpreting, and summarizing Results and Interpretations, including the meaning and descriptive value of figures and tables
Tasks and Rubric:
· Select and read one of the provided papers that reports on original experimental research.
· Consider watching the Intro To Stats video lecture for help understanding the methods.
· Begin a Collaboration with me through our Canvas site (so that I may access and comment on it at any time), and complete the following analyses of the journal article:
Commentary Part 1
Focus on the Abstract and Introduction of the publication:
1. Explain in your own words why the researchers conducted this study; what is the value in studying their system? What background information is included to inform you of the relevance, importance or potential implications of the study?
2. Restate the researcher’s hypothesis and their predictions in your own words; Identify where they stated their hypothesis and predictions, and whether it was stated explicitly or implied. Did the researchers choose appropriate experiments or observations to test their hypothesis? Explain why you think so.
Commentary Part 2
Focus on the Materials and Methods:
1. In your own words, summarize the experimental methods (if there are multiple, summarize what you believe is the most important experiment).
2. Explainthe statistical method or test used to analyze their most important results: on what dataset is the statistical test applied? What is the test statistic measuring? What are the confidence limits, p-value, or R2 value, etc. and the significance level associated with the test statistic?
Commentary Part 3
Focus on the Results and Discussion:
1. Evaluate two figures or tables that visually explain the most important result: Explain what each one attempts to show. Explainhow the figures and tables do or do not help clarify the written results.
2. Evaluate the Results & Discussion: Do they match the predictions and therefore support the hypothesis, or do the results falsify the hypothesis...or do they suggest a way in which the hypothesis (or predictions) should be modified? Explain.
Additional criteria and tips. To receive 15 points, you must:
· Use no smaller than 11 point font, 0.75 inch borders.
· Use correct grammar and punctuation and adhere to Standard English sentence st.
Critical analysis of one relevant curriculum approach or model..docxwillcoxjanay
Critical analysis of one relevant curriculum approach or model.
Recommended Reading
Arce, E., & Ferguson, S. (2013). Curriculum for young children: An introduction (2n ed.). Wadsworth, CA: Cengage Learning.
Brady, L & Kennedy, K (2013). Curriculum construction (5th ed.). Australia: Pearson.
Cohen, L., & Waite-Stupiansky, S. (2013). Learning across the early childhood curriculum, UK: Emerald.
Curtis, C. (2011). Reflecting children's lives: a handbook for planning your child-centered curriculum (2nd ed.), St Paul, Minnesota: Redleaf Press.
Elias, C., & Jenkins, L. (2011). A practical guide to early childhood curriculum, 9th edn, NJ: Pearson Education.
Eliason, C., & Jenkins, L. (2012). A Practical Guide to Early Childhood Curriculum, 9th ed. New Jersey: Pearson Education
File N., Mueller, J., & Wisneski, D. (2012). Curriculum in early childhood education: re-examined, rediscovered, renewed New York: Routledge.
Fleer, M. (2013). Play in the early years, UK: Cambridge University.
Gronlund, G. (2010). Developmentally appropriate play: guiding young children to a higher level. St Paul, MN: Redleaf
Hunter, L., & Sonter, L. (2012). Progressing play: practicalities, intentions and possibilities in emerging co-constructed curriculum. Warner, QLD, Australia: Consultants at play.
Ingles, S. (2015). Developing critical skills: Interactive exercises for pre-service teachers. Kendall Hunt.
Irving, E., & Carter, C. (2018 in Press). The Child in Focus: Learning and Teaching in Early Childhood Education, Melbourne: Oxford University Press (particularly Chapter 4: Play and Play-based learning and Chapter 5: Curriculum and Pedagogy)
Kostelnik, M. J., Soderman, A. K., & Whiren, A. P. (2011). Developmentally appropriate curriculum: Best practices in early childhood education. Boston, MA: Pearson Education
Page, J.,& Taylor, C. (Eds). (2016). Learning & Teaching in the Early Years. Melbourne: Cambridge University Press.
Department of Education, Employment and Workplace Relations (DEEWR). (2009).
Belonging, being and becoming: The early years learning framework for Australia
. Australian Capital Territory, Australia: Commonwealth of Australia.
Pugh, G., & Duffy, B. (2014). Contemporary issues in the early years (6th ed.), Sage Publications, London.
Van Hoorn, J., Nourat, P.M., Scales, B., & Alward, K.R. (2015). Play at the center of curriculum (6th ed.). New Jersey, U.S.: Prentice Hall.
Wood, E. (2013). Play, learning and the early childhood curriculum (3rd ed.). London, England: Sage.
.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Trends in Psychotropic Medication Costsfor Children and Adol.docx
1. Trends in Psychotropic Medication Costs
for Children and Adolescents, 1997-2000
Andrés Martin, MD, MPH; Douglas Leslie, PhD
Objective: To examine trends in psychotropic medi-
cation utilization and costs for children and adolescents
between January 1, 1997, and December 31, 2000.
Methods: Pharmacy claims were analyzed for mental
health users 17 years and younger (N = 83 039) from a
national database covering 1.74 million privately in-
sured youths. Utilization rates and costs for dispensed
medications were compared across psychotropic drug cat-
egories and individual agents over time.
Results: Overall use of psychotropic drugs increased from
59.5% of mental health outpatients in 1997 (a 1-year
prevalence of 28.7 per 1000) to 62.3% in 2000 (33.7 per
1000), a 4.7% increase. The largest changes in utiliza-
tion were seen for atypical antipsychotics (138.4%), atypi-
cal antidepressants (42.8%), and selective serotonin re-
uptake inhibitors (18.8%). The average prescription price
increased by 17.6% ($7.90 per prescription), a change
in turn attributed to a shift toward costlier medications
within the same category (55.1% of the increase, or $4.35)
and to pure inflation (44.9% of the increase, or $3.55;
P for trend �.001 for all comparisons). Almost half
(46.7%) of the $2.7 million gross sales differential was
accounted for by only 3 of the 39 drugs identified (am-
phetamine compound, risperidone, and sertraline), and
75% was accounted for by 7 drugs (the previous 3 and
2. bupropion, paroxetine, venlafaxine, and citalopram).
Conclusions: Psychotropic drug expenditure increases
during the late 1990s resulted from more youths being
prescribed drugs, a preference for newer and costlier medi-
cations, and the net effects of inflation. The impact of man-
aged care and pharmaceutical marketing effects on these
trends warrants further study.
Arch Pediatr Adolesc Med. 2003;157:997-1004
T
HE USE of psychotropic
medications in children has
become a highly visible is-
sue, receiving regular at-
tention from academics (for
a recent summary, see Jensen et al1), poli-
cymakers,2,3 and the lay press alike.4-6 In
contrast to the controversial and at times
charged reactions that the topic can en-
gender, reliable national estimates of the
extent of pediatric use of psychotropic
drugs have only recently started to be-
come available.7-9 Previous studies10,11 have
documented that most psychotropic medi-
cations are not prescribed by mental health
specialists but rather by general practi-
tioners, a pattern that is certainly appli-
cable to stimulants, the most widely used
psychotropic drug class for children: in
1995, pediatricians prescribed 50% of
stimulants, family practitioners 20%, and
psychiatrists only 13%.8
3. The financial implications of pediat-
ric pharmacotherapy have gone largely un-
examined, an important shortcoming given
that in the US expenditures for prescrip-
tion drugs have continued to be the fastest
growing component of health care across
all ages.12 The financial burden of medica-
tion-related expenditures is substantial:
whereas overall health costs increased by
7% in 2000, prescription drug spending
grew by 15%. For example, Medicaid spend-
ing on prescription drugs more than tripled
in the 1990s, from $4.8 billion (6.6% of total
Medicaid costs) in 1990 to $17.0 billion
(9.4% of total Medicaid costs) in 1999.13
The most recent national data on men-
tal health utilization and costs specific for
children and adolescents are from 1998,14
when overall national expenditures were es-
timated to be $11.7 billion ($172 per child).
Outpatient services accounted for 57% of
the total costs, inpatient services for 33%,
and psychotropic drugs for 9%. A study
based on privately insured youths15 showed
that during the same interval (1997 to 2000)
that outpatient and inpatient psychiatric
costs for American youths decreased (by
18.4% and 14.4%, respectively), medica-
tion-related expenditures increased by
12.1%. Although it is plausible that higher
psychotropic drug use may relate to cost
savings in overall mental health services (by
decreasing or obviating the need for other
5. Both of the cited studies14,15 analyzed aggregate psy-
chotropic medication expenditures and did not provide
information on the drug classes or specific agents re-
sponsible for driving cost changes. It is against this back-
drop that this study aims to describe the main drivers un-
derlying psychotropic medication cost changes at the level
of drug classes and specific agents involved.
METHODS
STUDY DESIGN
A cross-sectional design for each of 4 years (1997-2000) was
used to characterize psychotropic medication utilization and
cost trends for youths 17 years and younger.
DATA SOURCE
We used a research database (MarketScan; Medstat, Ann Arbor,
Mich) to describe patterns of health care utilization and costs.
The database, a publicly available fee-for-service medical and
pre-
scription claims resource, contains claims information for indi-
viduals nationwide who are insured through the benefit plans
of large employers and includes more than 200 different insur-
ance companies. The working sample consisted of all individu-
als in the database 17 years and younger who had a claim for
mental health services and possible pharmacy claims data avail-
able during the study (N = 83 039). We specifically did not ex-
clude children younger than 3 years, as there is epidemiologic
evidence for increasing rates of psychotropic medication use in
this age group.16,17 Demographic information on the entire en-
rolled population (N = 1 735 486) was also available. Individual
information was stripped of any personal identifiers, stored
anony-
6. mously, and exclusively referenced through study-specific
unique
identifiers following published guidelines.18
STUDY POPULATION AND PROCEDURES
The number and 1-year prevalence of enrolled children receiv-
ing mental health services and psychotropic medications were
calculated. Mental health claims were defined as those with a
di-
agnosis within the 290.00 to 319.99 range of International Clas-
sification of Diseases, Ninth Revision, codes. Potentially
relevant
codes (eg, 799.2 for “nervousness” or 780.5 for “sleep distur-
bance”) were not included, in keeping with earlier methods.15
In contrast to that earlier study,15 in which individual youths
were
the primary unit of analysis, this study focuses on prescrip-
tions. Thus, sociodemographic and diagnostic trends seen dur-
ing the study (such as an increase in the diagnosis of bipolar
dis-
order) are examined in detail in that complementary study.15
Psychotropic medications were identified on the basis of a
comprehensive National Drug Code registry and were assigned
to 1 of 6 drug classes: (1) �-agonists, (2) antidepressants, (3)
antipsychotics, (4) mood stabilizers, (5) stimulants, and (6) anx-
iolytics and sedative-hypnotics. Antihistamines (including hy-
droxyzine hydrochloride), �-blockers, and anticholinergic
agents
were specifically excluded from analysis given the potential for
ambiguity in determining their use as psychotropic agents.
Charges associated with pharmacy claims were measured
as the actual paid amounts instead of the billed charges to pro-
7. vide a more accurate measure of cost. Paid amounts included
patient payments (deductibles or copayments) and payments
made by the patient’s insurance plan(s). Costs were adjusted for
inflation using the medical care component of the Consumer
Price
Index, with all amounts expressed as 1997 dollars.
After calculating costs for psychotropic medications as an
aggregate annual amount, costs were estimated across psycho-
tropic drug category and specific agent. Costs were estimated
as overall and per-prescription amounts. Each drug’s share of
utilization was then calculated by dividing the number of pre-
scriptions filled by (1) the number of all prescriptions in that
category and (2) the overall number of prescriptions filled in
that year. Each drug’s share of overall and class-specific utili-
zation, as well as mean prescription price, was compared across
the 4 years of study.
Next, the gross difference in psychotropic drug sales was
calculated between 2000 and 1997, and the proportion of the
total difference attributable to each medication category and
each individual agent was determined. Each drug’s attribut-
able proportion served as a weighting factor by which change
in price and change in category utilization was multiplied. By
summing the weighted price changes, an overall estimate of the
impact of medication inflation was obtained; a measure of medi-
cation shift (from one agent to another within the same cat-
egory) was similarly arrived at by summing the weighted uti-
lization changes. The fraction of overall psychotropic drug sales
that could be attributed to an increase in the number of pre-
scriptions filled was calculated by multiplying the difference
in the number of prescriptions by the mean prescription price
across the first and last study years. This amount, in turn, was
divided into portions attributable to (1) larger membership en-
rollment, (2) changing proportion of medicated enrollees, and
(3) enrollees continuing drug treatment for longer periods.
8. DATA ANALYSIS
Linear trends over time were assessed for categorical variables
by using the Cochran Mantel-Haenszel �2 test (df = 1) and for
continuous variables by using general linear models (df = 3).
Cost
trends were calculated based on log-transformed amounts.
RESULTS
POPULATION CHARACTERISTICS
Demographic and clinical characteristics of outpatient men-
tal health users in this study group have been described in
detail previously.15 Briefly, of 352 413 individuals 17 years
and younger with linked pharmacy data who were en-
rolled in 1997, 17 670 (5.0%) received outpatient mental
health services vs 26 677 (5.6%) of 473 954 in 2000, rep-
resenting a 34.5% increase in membership enrollment and
a 12.2% increase in outpatient mental health utilization rates.
PATTERNS OF PSYCHOTROPIC
MEDICATION USE
More than half of all outpatient users (60.1% across the 4
study years) were prescribed at least 1 psychotropic medi-
cation during any given year. Table 1 gives the 1-year
prevalence of psychotropic drug use across the various medi-
cation categories. In addition to giving the proportions of
outpatient mental health users dispensed psychotropic
agents, 1-year prevalence per 1000 enrollees are also given,
using the number of annual enrollees with pharmacy ben-
efits as the denominator. The overall use of psychotropic
drugs increased from 59.5% of mental health outpatients
in 1997 (a 1-year prevalence of 28.7 per 1000) to 62.3% in
10. ing that most additional prescriptions were for children
continuing psychotropic drug therapy for longer peri-
ods or for newly treated youngsters.
CATEGORY-SPECIFIC PSYCHOTROPIC
MEDICATION EXPENDITURES AND USE
Table 3 presents the costs and clinical share (overall and
by category) of all psychotropic medications identified. As
anticipated, stimulants were the most commonly pre-
scribed class, accounting for 45.6% of all psychotropic pre-
scriptions in 2000. Despite the large volume of stimulant
prescriptions filled, they represented a relative reduction
(–14.4%) from the 1997 total share, a reflection of the rapid
rise in the prescription of other nonstimulant medica-
tions to this age group, notably, antidepressants and mood
stabilizers. Indeed, antidepressants increased their share
of all psychotropic drug prescriptions by 16.5%, a mean
change that does not capture the wide variability seen across
subcategories: the atypical antidepressant and SSRI shares
increased by 61.4% and 27.9%, respectively, compared with
the large reduction (–51.4%) seen for TCAs. Mood stabi-
lizers had an increase in their share (13.7%) and ac-
counted for a larger volume of psychotropic prescrip-
tions (8.6% in 2000) than did antipsychotics (5.7%). The
latter experienced a radical shift from traditional to atypi-
Table 1. Psychotropic Medication Prevalence by Drug Category
Among MarketScan* Enrollees Aged 0 to 17 Years
Psychotropic Drug Category
No. (%) per 1000 Enrollees
Change in Proportion
13. In addition to TCAs and traditional antipsychotics,
several drugs had their category share eroded by newer
and generally more expensive agents. The clearest case is
that of stimulants, where methylphenidate hydrochlo-
ride decreased its category share by 23.4%. The stimulant
class balance was largely affected by the introduction in
1996 of amphetamine compound (Adderall; Shire Rich-
wood US Inc, Florence, Ky), whose share grew to 27.3%,
offsetting the declines in the use of dextroamphetamine
sulfate (–1.1%) and pemoline (–2.8%). In a similar man-
ner, the 7.7% decrease in fluoxetine’s share of the antide-
pressants was offset by increases in the use of newer SS-
RIs (including citalopram, introduced in 2000) and atypical
antidepressants. The price of fluoxetine did not change sub-
stantially (+5.3%), reflective of the fact that generic fluox-
etine, introduced after the patent exclusivity of Prozac (Eli
Lilly & Co, Indianapolis, Ind) expired on December 31,
2000, was not yet captured in the interval covered by this
data set. Older mood stabilizers, such as lithium carbon-
ate, carbamazepine, and valproate, in turn, had their class
shares eroded by newer-generation anticonvulsants, which
experienced the most turbulent prescription shifts of any
agents. For example, the number of topiramate, gabapen-
tin, and lamotrigine prescriptions increased by 13.6-, 6.4-
and 3.3-fold, respectively.
With few exceptions, most of the newly intro-
duced agents were more expensive—at times signifi-
cantly so—than those they were supplanting. For ex-
ample, atypical antipsychotic drug costs per prescription
were on average 3.8 times higher than those of their con-
ventional counterparts; SSRIs and atypical antidepres-
Table 3. Psychotropic Medication Expenditures and Use, by
14. Drug Category, 1997-2000*
Psychotropic
Drug Category
1997 2000
Change in Share, %‡
Prescriptions
Filled, No.
Prescription
Cost,
Mean, $†
Share, %
Prescriptions
Filled, No.
Prescription
Cost,
Mean, $†
Share, %
Of
Category
Of All
Prescriptions
Of
18. to atypical agents. Other antidepressants, stimulants, and
mood stabilizers accounted for a similar fraction each (ap-
proximately 15%). Almost half of the overall sales differ-
ential (46.7%) was accounted for by only 3 of the 39 drugs
identified (amphetamine compound, risperidone, and ser-
traline hydrochloride), and 75% by 7 drugs (the previous
3, together with bupropion hydrochloride, paroxetine, ven-
lafaxine hydrochloride, and citalopram). Five of the 7 agents
are antidepressants, and all of them are available only as
brand name preparations given their recent introduction
to the marketplace.
The seemingly low share of the overall sales differen-
tial accounted for by stimulants (14.5%) can be under-
stood on the basis of the cost shift seen within the cat-
Table 3. Psychotropic Medication Expenditures and Use, by
Drug Category, 1997-2000* (cont)
Psychotropic
Drug Category
1997 2000
Change in Share, %‡
Prescriptions
Filled, No.
Prescription
Cost,
Mean, $†
Share, %
22. line (–2.9%). Although these opposing trends provide an-
other line of evidence for the shift effect seen within this
drug category, it is not exclusive to stimulants. Indeed, the
shift toward newer and generally more expensive medica-
tions can be conceptualized as one of the two drivers to
prescription-related cost shifts over time. The other factor
is “pure” price inflation, reflective of higher costs for the
same medications due to cost increases at the manufac-
turer, wholesale, retail, pharmacy, or all levels combined.
Figure 2 depicts the various factors accounting for
the increase in psychotropic drug expenditures. The larg-
est component, responsible for 78.3% of the increment
seen, is the volume of prescriptions filled, a change that
can be attributed to a larger enrollment base (52.9%), to
more medicated enrollees (17.5%), and to enrollees con-
tinuing medication use for longer periods (8.7%). In ad-
dition, prescription price changes, through shifts to newer
medications and pure inflation, accounted for similar parts
of the remaining portion: 11.3% and 9.6%, respectively.
COMMENT
In this study, data from a national group of privately in-
sured children and adolescents were used to examine
changes in psychotropic drug expenditures. We found that
relatively few drugs accounted for a large portion of the
change in psychotropic medication expenditures over time
and that a combination of more drugs being prescribed, a
preference for newer and costlier drugs, and the net effect
of inflation had a compounded effect on price trends.
Gross psychotropic drug expenditures for this sample
showed a $2.7 million (65.2%) increase between 1997 and
2000. Most of that change (78.3%) was due to the large in-
23. crease in the volume of prescriptions filled (46.7%). This
finding is in keeping with the observation that, particu-
larly after 1994, growth in utilization, rather than price, has
been the primary driver of increased pharmaceutical spend-
ing.19 In addition, a shift toward newer (and generally more
By Class
SSRIs
Atypical APs
Other ADs
Stimulants
Mood Stabilizers
Anxiolytics
α-Agonists
Typical APs
TCAs
By Agent
Amphetamine Compound
Risperidone
Sertraline Hydrochloride
Bupropion Hydrochloride
Paroxetine
Venlafaxine Hydrochloride
Citalopram
All Others
Olanzapine
Valproate
24. Quetiapine Fumarate
Fluvoxamine Maleate
Fluoxetine
Gabapentin
Topiramate
Buspirone Hydrochloride
Pemoline
Methylphenidate Hydrochloride
–10 – 5 2520151050 30 35
Attributed Proportion, %
Figure 1. Psychotropic medication overall sales differential,
1997-2000. Totals by class and by agent sum to 100% ($2.7
million) each. SSRI indicates selective
serotonin reuptake inhibitor; APs, antipsychotics; ADs,
antidepressants; and TCAs, tricyclic antidepressants.
9.6%
Price 2:
Pure Inflation
11.3%
Price 1:
Shift Effect
8.7%
Volume 3:
Longer Time
26. The fact that the large number of new prescriptions
did not lead to a parallel increase in the number of pre-
scriptions per treated youth (a number that in fact de-
creased slightly), combined with the constant rates of mul-
tiple psychotropic pharmacotherapy20 seen (approximately
7.5 per 100 outpatients,21 data not shown), indicate that
most of the additional prescriptions in 2000 were written
for newly treated children. Stated alternatively, more in-
dividual youths were initially given or continued taking for
longer periods of time psychotropic medications rather than
a growing number being medicated with multiple agents.
A few psychotropic agents accounted for a dispro-
portionate fraction of the observed cost shifts. Almost half
of the overall sales differential (46.7%) was accounted for
by only 3 individual drugs, and 25.3% was accounted for
by amphetamine compound (Adderall) alone. Although
the price ratio between amphetamine compound and meth-
ylphenidate was low (1.1), a series of new, nongeneric
stimulant preparations had only recently been intro-
duced to the marketplace. Thus, these may be conserva-
tive estimates of price differentials given that newer and
more expensive agents that have gained stimulant market
share since then (eg, Concerta [Alza Corp, Mountain View,
Calif]) had not yet been introduced to market in 2000.
Several factors may help explain the observed trends:
1. Improved newer products and an expanding evi-
dence base. The virtual shifts from traditional to atypical
antipsychotics, or from TCAs to SSRIs, are supported by
a growing body of clinical trials specifically tailored to the
pediatric population.22 As pertinent examples, random-
ized controlled trials have documented the short-term
efficacy in children and adolescents of the SSRIs parox-
etine in major depression,23 sertraline in obsessive-
27. compulsive disorder,24 and fluvoxamine in generalized
anxiety disorder25 and of the atypical antipsychotic ris-
peridone in the treatment of disruptive behaviors in chil-
dren with subaverage intelligence26 or autism.27
2. Preference. Clinicians may have lower thresholds
to prescribe medication for conditions amenable to phar-
macologic treatment, especially when using newer agents
with more favorable safety and adverse effect profiles that
may not require as intense monitoring by specialists (eg,
serum levels with lithium or electrocardiographic moni-
toring with TCAs). Despite the steadily growing range of
effective pharmacologic treatments for psychiatrically ill
youths, a cautionary note is warranted, as clinicians may
use more psychotropic agents in the context of fewer in-
patient and outpatient resources to rely on; for example,
the increase in the use of mood stabilizers to target bipolar
and other externalizing disorders has limited underlying
supportive evidence, particularly for newer-generation an-
ticonvulsants.28 Moreover, there is a paucity of informa-
tion regarding long-term effects on the developing brain
of early and prolonged exposure to psychotropic drugs.29
3. Marketing pressures. Few truly new (ie, mecha-
nistically distinct) agents have been introduced to the mar-
ketplace during the past decade. Instead, variations of suc-
cessful compounds are crowding an existing repertoire,
a pattern that was most apparent for stimulants and SS-
RIs. Pharmaceutical industry marketing-sales and mar-
keting-research ratios have to be successively higher for
newer agents to overcome the advantages of early mov-
ers in the marketplace19: direct-to-consumer and direct-
to-prescriber advertising practices have been an increas-
ingly common mechanism for the pharmaceutical industry
to gain market share for their products.30 The effects of
28. these advertising practices on clinical practice are still
poorly understood but are likely to be substantial, as sug-
gested by the large shifts within category share occur-
ring during the relatively short interval of this study.
The public largely experiences (and pays for) the es-
calating costs of their pharmaceuticals indirectly—
through more expensive insurance premiums. Indeed, the
generous pharmacy benefits typically associated with pri-
vate insurance plans lead to increasing costs as consum-
ers become “price insensitive” and request and feel en-
titled to the latest (and more expensive) drugs.1 3
Conversely, the uninsured often pay the highest price for
drugs, as they are not covered by copayments and they lack
the bargaining clout that large insurers and pharmacies
have to obtain medications at a discount.13 As a result, those
who are insured take more medications and fill prescrip-
tions more often, and the uninsured often go without nec-
essary treatment. As a case in point, for the approxi-
mately 1 in 6 children in the United States without health
insurance, use of psychotropic agents remained far be-
low that for those covered under public or private plans
in 1996 (1.5%, 5.3%, and 4.1%, respectively).7
Such economic disparities, and the overall trends de-
scribed herein, need to be considered in the context of
potential cost savings, as it is plausible that effective phar-
macotherapy may be related to reduced expenditures in
other areas, such as hospitalization or outpatient costs.
Similar to our earlier study,15 this descriptive study can-
not provide the formal cost-benefit analyses that the field
of pediatric psychopharmacology is in need of.
This study has several shortcomings, including lim-
ited generalizability. The psychotropic utilization rates
30. In conclusion, despite its limitations, this study docu-
ments how a relatively few drugs accounted for a large por-
tion of the change in psychotropic drug expenditures seen
during this interval and how a combination of more youths
being prescribed drugs, a preference for newer and cost-
lier medications, and the net effect of inflation had a com-
pounded effect on price trends. These results expand on
earlier evidence of a shift toward medication-based men-
tal health treatment modalities in children and adoles-
cents. Future studies should further address the impact
of managed care and pharmaceutical marketing effects on
these trends of clinical care.
Accepted for publication April 24, 2003.
This study was supported in part by Scientist Career
Development Award K01 MH01792 (Dr Martin); by grants
M01 RR06022, 5P01 HD1DC35482, and 5P01 HD03008
from the Public Health Service; by Research Units on Pedi-
atric Psychopharmacology contract MH97 CR0001 to Yale
University; and by a grant from the Child Health and De-
velopment Institute of Connecticut, Farmington.
This work on the costs of child psychiatry is dedi-
cated to our teacher and mentor, the late Donald J. Cohen,
MD (1940-2001), who taught us so much about the values
at the very core of our field.
We thank Robert Rosenheck, MD, John Schowalter, MD,
and James F. Leckman, MD, for their helpful comments on
earlier drafts of this manuscript.
Corresponding author: Andrés Martin, MD, MPH, Child
Study Center, Yale University School of Medicine, 230 S
Frontage Rd, PO Box 207900, New Haven, CT 06520 (e-mail:
31. [email protected]).
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What This Study Adds
Psychotropic drug use prevalence among children and
adolescents has steadily increased during the past de-
cade, with most medications prescribed by pediatri-
cians and family practitioners.
Previous studies have shown increasing psycho-