New guidance from the Florida Department of Health urges providers to take a more comprehensive approach before prescribing psychotropic medications to children.
The recommendations were released Friday in Orlando during a roundtable discussion on youth mental health hosted by state Surgeon General Dr. Joseph Ladapo.
Ladapo said the guidance is intended to encourage providers to spend more time evaluating the circumstances affecting a child’s mental health before turning to medication.
“But unfortunately, the structure of the system incentivizes fast prescriptions, patient throughput, and not delving into why people are actually having problems, and that's a huge problem,” Ladapo said.
The Florida guidance cautions providers about prescribing psychotropic medications to children ages 5 to 17, saying many young patients do not receive comprehensive evaluations or behavioral therapy before medication is started. It also notes that many psychotropic medications lack FDA-approved labeling for children and says their long-term effects are not well understood.
The department recommends that, except in emergencies, children receive a thorough medical, mental health and physical evaluation before treatment begins. Providers are encouraged to assess factors such as sleep, screen time, unstructured play, physical activity and diet, and consider laboratory testing for underlying medical conditions before prescribing medication.
The guidance also recommends psychotherapy before medication for children with mild symptoms and says providers should carefully evaluate whether children already taking psychotropic medications can gradually reduce or discontinue them rather than stopping abruptly.
The document cites national survey data showing that nearly 15% of children 5 to 17 received some form of mental health treatment during the previous year. About 8% reported taking medication as part of their treatment, while 11.5% received therapy or counseling.
Dr. Kristopher Kaliebe, a psychiatrist and professor at the USF Morsani College of Medicine who participated in the roundtable, said clinicians should first understand the circumstances surrounding a child's life before deciding on treatment.
"When you're assessing a child with any type of mental health or behavioral issue, you really want to get to know the child and know what's going on in their life because the circumstances of their life is going to be what determines for most kids most of the time what you're seeing," Kaliebe said.
He added that his approach is to address basic needs whenever possible and use medication "as needed" while recognizing that broader community supports are also necessary.
While the Florida guidance echoes recommendations from national medical organizations calling for comprehensive evaluations and psychotherapy as part of treatment, parts of it differ from guidance issued by the American Academy of Child and Adolescent Psychiatry.
The organization says psychiatric medications can be an effective treatment option for some children when used as part of a broader care plan that includes therapy and ongoing monitoring.
Laura Delano is founder of the Inner Compass Initiative, a nonprofit focused on psychiatric drug withdrawal and informed choice. During the roundtable, she said parents should resist viewing emotional struggles solely through a medical lens.
"I think what can happen in this very medicalized culture that we live in right now, where mental and emotional challenges are so often immediately translated into medical problems needing medical solutions, is that the way parents are taught to view their kids is around the question of what's wrong with my child, instead of saying what is happening to my child in my child's body, around my child in their environment," Delano said.
Also participating in the discussion were Brian Meyer, Florida’s deputy secretary of Medicaid, and Dr. Lisa Santos Specter, a developmental and behavioral pediatrician and co-director of the Central Florida Behavioral Health Hub, .
The group agreed that strengthening collaboration among physicians, educators, parents and community organizations can help ensure children and families have access to information about the benefits, risks and alternatives to treatment.
The health department said the guidance is intended to support informed decision-making and encourage treatment plans tailored to each child's individual needs.
