1. Study Design & Population A retrospective cohort design was applied to the Medicaid administrative claims data of youth continuously enrolled in a Mid-Atlantic state from 2007 - 2012 (aged 4 – 17) with at least one nonpsychotic psychiatric condition (N = 48,087). Claims data were linked publicly available area health resource files for information on county level availability of CPs. Youth were required to have at least one non-psychotic psychiatric diagnosis (disruptive disorders, ADHD, depressive disorders, anxiety disorders, adjustment disorders or learning disorders) and no psychotic diagnosis (e.g. schizophrenia) County level CP availability was characterized as no CP, 1 CP to 6,954 youth or less, and 1 CP to >6,954 youth. Covariates include age, gender, race/ethnicity, and Medicaid eligibility groups Outcomes of Interest Percent prevalence of AAP use total and stratified by patient characteristics and CP availability across counties. Odds of AAP use by CP availability, adjusted for key characteristics Objective Methods Antipsychotic Medication Use in Conduct and Behavioral Disorders: The Role of Availability of Child Psychiatrists Dinci Pennap, M.P.H, 1 George Unick, Ph.D. 2 Conflict of Interest None Conflict of Interest None 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD 2 School of Social Work, University of Maryland, Baltimore, MD Conclusions AAP use for non-psychotic conditions varied significantly across counties. CP availability did not account for all the county level differences in AAP use. Medication data are dispensed medications. Actual consumption was not verified Data generalizes only to Medicaid youth population Availability of County level resources does not reflect person- level CP use. Limitations To assess the role of person-level and county-level characteristics in the use of atypical antipsychotics (AAPs) for the treatment of non-psychotic mental conditions among publicly insured children & adolescents in a Mid-Atlantic U.S. state Major findings Background Statistical Analyses Despite concerns about the dramatic increase in the use of atypical antipsychotics (AAP) for non-psychotic/behavioral conditions among publicly insured children and adolescents in the past two decades, little is known about role of the availability of trained child psychiatrists (CPs) in Medicaid enrollees’ county of residence in the use of AAPs in this population Youth diagnosed with nonpsychotic psychiatric conditions accounted for 36.0% of the continuously enrolled youth aged 4 – 17 in this U.S state (N = 48,087). 9.6% of them received at least 1 AAP prescription between 2010 - 2012 AAP use varied significantly across age groups, racial/ethnic groups, Medicaid eligibility groups, and availability of CPs Of the 24 counties in this Mid-Atlantic state, 7 had no CPs, 10 had a shortage of CPs, and 7 had a sufficient number of CPs from 2010-2012. Residents of counties with a sufficient number of CPs were significantly less likely to receive an AAP dispensing. Non-Hispanic Black residents of counties with no CPs were significantly more likely to receive ATPs compared to other racial/ethnic groups County variations accounted for 2.7% of AAP use in this population. AAP use was higher in youth with multiple psychiatric diagnoses The prevalence of AAP use and number of nonpsychotic diagnoses were assessed overall and by availability of CPs using bivariate analyses. A multivariable logistic regression model was used to assess the regression estimates and standard errors associated with AAP use without accounting for county-level clustering (i.e. availability of CPs). Using multilevel models, we assessed; the predicted probability of any AAP dispensing, the variability of AAP dispensing across counties, the association between person-level variables and the likelihood of an AAP dispensing, and the association between the county-level CP availability and the likelihood of AAP dispensing while controlling for person and county-level characteristics.