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First PCORI Grant to an Academic Institution in New Jersey Awarded to Stephen Crystal

Stephen Crystal was awarded a Patient-Centered Outcomes Research Institute (PCORI) Grant, “Comparative Effectiveness of State Psychotropic Oversight Systems for Children in Foster Care,” the first PCORI award at an academic institution in New Jersey. The comparative effectiveness of state plans and systems for oversight and monitoring of safe and effective use of psychotropic medications prescribed for children in foster care is poorly understood. Public and governmental concern has increased around high treatment rates, antipsychotic use as first-line treatments without non-pharmacological mental health interventions and practices such as polypharmacy, absence of metabolic monitoring, and other quality/appropriateness issues. States have implemented divergent systems ranging from consultative/educational to more-restrictive policies including prior authorization. This evidence gap adds to the difficulties faced by policymakers, patient advocates, and others in assessing and selecting oversight policies. Difficult trade-offs exist between consultative strategies that are more respective of prescriber autonomy, but may be less effective, and authoritative strategies that may have unintended consequences. Decisions about implementing oversight policies are difficult to make without better information on benefits, drawbacks and impact on the patient-centeredness of care and outcomes. These choices are often inadequately informed by the voices and perspectives of those closest to the treatment experience including foster care alumni and caregivers. To better inform state/stakeholder decision-making capacity, a multidisciplinary research team, incorporating consumer investigators, will examine the impact on patients and other stakeholders of differing, innovative oversight systems in four states: Texas, Wisconsin, Washington and Ohio.

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