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The Center for Education and Research on Therapeutics (CERTs), directed by Stephen Crystal, is the only center within AHRQ’s CERTs program that has focused on mental health treatments. The CERTs has brought together outstanding research teams to provide the infrastructure necessary to address timely and important issues in mental health pharmacoepidemiology, safety and outcomes research. The set of core research projects addresses questions in the use of psychotropic medications in “real-world” settings. Significant partners are Columbia University’s Department of Psychiatry, the New York State Psychiatric Institute, and the Missouri Department of Social Services, along with state divisions of Medicaid and mental health.
The CERTs investigators have focused particularly on the therapeutic challenges with high population health impact; the apparent mismatch between evidenced-based recommendations and widespread practices; emerging safety concerns; the disparities and high variability in practices without apparent clinical rationale; off-label use of psychotropic medications; critical weaknesses in the knowledge base of psychotropic medications; the potential for significant impact in improving practices and outcomes; and the potential to leverage CERTs resources into outcomes improvement and sustainable studies and interventions. Through the CERTs consortium, Rutgers investigators have discussed therapeutic challenges with an outstanding group of experts, stakeholders, and federal and state agencies that have helped the CERTs evolve to meet the ever-changing challenges of the field. For education and translation it has been important to develop a sustained, multi-year effort to leverage CERTs funds to affect policies, practices and ultimately outcomes and to function as a resource that is trusted for its independence as well as its expertise. CERTs evidence development has been translated broadly through public/academic dissemination activities nationally.
Some examples of research in the CERTs include:
1. Database Development
A data use agreement supports merging Medicaid, Medicare and nursing home Minimum Data Set data for eight states. Analyses have been conducted on the use, management and outcomes associated with psychotropic medications across various population groups.
2. Use and Monitoring of Psychotropic Therapy among Youths
Analyses with Medicaid Analytic Extract data, private insurance data, and select state submitted Medicaid administrative data are conducted on the use and monitoring of psychotropic therapy and other care processes among Medicaid eligible youth.
3. Guideline Development and Prescriber Training to Improve Practices for Antidepressants and Atypical Antipsychotic Medications in Children
The CERTs convened a national consensus conference and conducted an expert survey on the treatment of aggression in youth. Treatment guidelines and toolkits for the management of aggression in youth in outpatient settings were developed based on these consensus activities.
4. Atypical Antipsychotic Drugs in Nursing Homes: Implementing Treatment Recommendations for Frail Elders
Exploratory work was conducted on antipsychotic drug use in nursing homes providing pilot data for the development of a multistate study of patterns of antipsychotic prescription use and management in nursing homes typically for the control of behavioral symptoms of dementia.
5. Impact of a CMHC-Based Health Home Model on Effective and Safe Use of Therapeutics
Working closely with partners in Missouri, this project will characterize program impact on treatment processes and outcomes; examine associations between organizational variations in implementation and patient-level impact, and translate lessons learned into program improvement in Missouri and other states.