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Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP)

What is the APP — HEDIS® Measure?

Based on current NCQA HEDIS recommendations for best practices, children and adolescents from 1 to 17 years of age who had a new prescription for an antipsychotic medication must have documentation of psychosocial care as a first-line treatment.

The following will meet numerator compliance:

  • Psychosocial Care Encounter
    • Documentation of psychosocial care in the 121-day period from 90 days prior to the Index Prescription Start Date (IPSD) through 30 days after the IPSD (IPSD is the earliest prescription dispensing date)

NCQA HEDIS Population Definition for This Measure

Population: Members who are 1 to 17 years of age as of December 31 of the measurement year

Line of Business: Commercial, Medicaid

Antipsychotic Medications

  • Aripiprazole
  • Asenapine
  • Brexpiprazole
  • Cariprazine
  • Chlorpromazine
  • Clozapine
  • Fluphenazine
  • Haloperidol
  • Iloperidone
  • Loxapine
  • Lurisadone
  • Molindone
  • Olanzapine
  • Paliperidone
  • Perphenazine
  • Pimozide
  • Quetiapine
  • Risperidone
  • Thioridazine
  • Thiothixene
  • Trifluoperazine
  • Ziprasidone

Long-acting Injections

  • Aripiprazole
  • Aripiprazole lauroxil
  • Fluphenazine decanoate
  • Haloperidol decanoate
  • Olanzapine
  • Paliperidone palmitate
  • Risperidone

Antipsychotic Combination Medications

  • Fluoxetine-olanzapine
  • Perphenazine-amitriptyline

Reference: Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics (APP), NCQA HEDIS Tech Specifications

Best Practices

  • Psychosocial care, such as behavioral interventions and psychological therapies, is the recommended first-line treatment option for children and adolescents diagnosed with nonpsychotic conditions such as attention-deficit disorder and disruptive behaviors.
  • Periodically review the ongoing need for continued therapy with antipsychotic medications.
  • Establish a baseline and continuously monitor metabolic indices to ensure appropriate management of side effects of antipsychotic medication therapy.
  • For new child/adolescent patients taking antipsychotic medications, complete a thorough evaluation and coordination with the mental health professional to ensure that all medications are addressing current symptoms for the patient's ongoing stability and recovery.
  • Monitor children/adolescents prescribed antipsychotics closely as they are more at risk for serious health concerns, including weight gain, extrapyramidal side effects, hyperprolactinemia and some metabolic effects including glucose and cholesterol levels.
  • Monitor female children/adolescents treated with certain antipsychotics closely as they may also be at increased risk for gynecological problems.
  • Educate and inform parents/guardians of the increased side effect burden of multiple concurrent antipsychotics on children's health, which has implications for future physical health concerns including obesity and diabetes.

To learn more about your practice's current HEDIS performance, HEDIS Value sets for this or other measures, or for assistance in compliance with the HEDIS guidelines, please email or visit Provider Tips for Optimizing HEDIS Results Booklet.