In the third installment of our Best Practices for Children and Youth Behavioral Health series, we focus on how medication can support a child’s overall behavioral health.
Our three leading experts – ABHW board members Dr. Caroline Carney, President and CEO of Magellan Health; Dr. Deborah Fernandez-Turner, Deputy Chief Psychiatric Officer at Aetna, A CVS Health Company; and Dr. Doug Nemecek, Chief Medical Officer at Evernorth – discuss how they determine when medication is appropriate and safe, how it fits into a comprehensive behavioral health plan, and how they monitor and adjust treatment over time. Our experts offer practical insights for families and clinicians alike, showing how thoughtful, evidence-based prescribing can help support all aspects of a child’s wellbeing.
How do you decide if medication is truly the right option for a child or teen?
- DOUG: Our Evernorth Research Institute found that over the 5 years around and including the pandemic, the number of youth prescribed medications for behavioral health conditions increased 24%. Deciding whether medication is appropriate for a child or teen is always a careful, individualized process. It’s important to consider the severity and type of symptoms, the impact on daily functioning, and how the child has responded to therapy and other non-medication interventions. Family history, medical history, and potential side effects are also evaluated. Medication is typically part of a broader, evidence-based treatment plan that includes therapy, family involvement, and school supports. The goal is always to use the least invasive approach that effectively helps the child thrive.
What steps do you take to make sure prescribing is safe and appropriate for young people?
- CAROLINE: Ensuring safe and appropriate prescribing for young people involves several careful steps. We start with a thorough assessment of the child’s mental and physical health, family and medical history, and any prior treatments. We review evidence-based guidelines and consider therapy or other non-medication approaches first whenever possible. If medication is determined to be effective in the overall treatment plan, we choose the safest option at the lowest effective dose, monitor closely for side effects, and schedule regular follow-ups. Family and school input are also critical to track progress and make adjustments as needed. Safety and ongoing evaluation are at the heart of every prescribing decision.
Can you explain how medication works together with therapy, school support, and family involvement?
- DEBORAH: Medication works best when it’s part of a comprehensive, coordinated approach. Medication can help reduce symptoms like anxiety, depression, or impulsivity, which then allows the child to engage more fully in everything. When paired with school supports and active family involvement, medication becomes one tool in a larger plan. These components reinforce one another: therapy teaches skills, families provide skills practice and encouragement at home, schools support learning and social growth, and medication helps the child participate fully in all these areas.
What kind of monitoring do you do once a child starts a prescription, and how do you adjust if needed?
- CAROLINE: Once a child starts a prescription, we closely monitor their response through regular check-ins with both the child and family. We track symptom changes, side effects, and overall functioning. Communication with schools and other caregivers is often helpful. Based on these observations, we may adjust the dosage, switch medications, or integrate additional supports like therapy. The process is collaborative and ongoing, ensuring the child receives the most effective, safe, and individualized care.
How do you involve parents and caregivers in the prescribing decision-making process?
- DOUG: Parents and caregivers are central to every prescribing decision. Psychiatrists start by thoroughly explaining the child’s diagnosis, treatment options, potential benefits, and possible side effects. Parents and caregivers share observations about symptoms at home and school, their goals for their child, and any concerns they may have. Psychiatrists then weigh the risks and benefits with the parents and caregivers, and if the decision is made to start a medication, they develop a monitoring plan, and establish clear follow-ups. This collaborative approach ensures that the family feels informed, supported, and confident in the care plan. Every child is unique, and it’s important for parents and caregivers to work with their child’s clinician to ensure an evidence-based treatment plan, including consideration of both medication and therapy, is put in place.
What should families know about the differences between short-term use and long-term use of medication?
- DEBORAH: Families should understand that short-term and long-term use of medication serve different purposes. Short-term use may help a child manage acute symptoms during a stressful period. Long-term use may be recommended when symptoms are persistent or recurrent, and if ongoing use supports stability and daily functioning. In both cases, regular monitoring, follow-ups, and working with the parents are essential to ensure safety, assess effectiveness, and adjust the plan as the child grows and their needs change.
How do you ensure that medication isn’t being used as a “quick fix,” but as part of a comprehensive care plan for a child’s well-being?
- CAROLINE: Medication should never used as a quick fix. We ensure it’s only a piece of a larger care plan that can include therapy, family support, assessment and attention to social determinants, and school accommodations. Medication can help reduce symptoms that interfere with learning coping skills, and it works best alongside interventions that teach children strategies for managing emotions and stress. Regular monitoring, parental involvement, and coordination with schools keep treatment balanced and focused on the child’s overall wellbeing, not just symptom reduction.
You can read the first installment of this series, “How Experts Define Quality Care for Children and Youth Behavioral Health,” here and the second installment, “Putting Children First in Prescribing Decisions,” here.
