NEW RESEARCH POSTERS 4.44 – 4.47 4.44 FACTORS ASSOCIATED WITH AGITATION IN A PEDIATRIC EMERGENCY ROOM Ayol Samuels, MD, Psychiatry (resident), Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467; Esther Rollhaus, MD; Yehuda Lerea, MD Objectives: With the closing of many comprehensive psychiatric emergency programs for children, the care for pediatric psychiatric emergencies is rapidly increasing within the confines of the general pediatric emergency room. The present study examines demographic and clinical correlates/ predictors of aggression in a pediatric emergency room at a major urban medical center over the course of 1 year. Methods: Data from 2014 to 2015 of patients in the psychiatric section of a pediatric emergency room in Bronx, New York were analyzed, focusing on the diagnoses, gender, chief complaint, time spent in the emergency room before escalation, and ages of patients who required pro re nata (PRN) or as needed medications for escalating behavior compared with those who did not require PRN medications. Furthermore, the rates of use of various psychotropic drugs for agitation were reviewed. Results: One-third of patients who received PRN medications were under the age 12 years, 38.8 percent had disruptive behavior disorders, and 15.7 percent had diagnoses of autism and/or intellectual disability. Medications (37.2 percent) were antipsychotic drugs, with Haldol being the preferred choice. Twenty percent of patients requiring PRN medications were “repeat offenders.” Escalating behavior most often occurred either within the first few hours or after 24 hours in the emergency room. Conclusions: Escalating aggression by patients is often treated with psychotropic medications, and little attention is paid to prevent these episodes. A better understanding of the demographic and clinical makeup of these patients can guide the creation of more effective approaches to dealing with them. AGG CON P http://dx.doi.org/10.1016/j.jaac.2016.09.239 4.45 PATHWAY TO DEPRESSION CARE IN CHILDREN AND ADOLESCENTS FIRST IDENTIFIED BY PRIMARY CARE PROVIDERS VERSUS PSYCHIATRISTS Aylin Yucel, BS, MBA, MS, College of Pharmacy, University of Houston, 2300 Old Spanish, Apt.1108, Houston, TX 77054; Ekere Essien, MD, DrPH; Rajender R. Aparasu, PhD; Osaro Mgbere, PhD; Vinod Bhatara, MD; Joy Alonzo, MBBS; Hua Chen, MD Objectives: The health professional contacted first for MDD diagnosis and treatment may determine the route of care-seeking pathway (CSP), as well as the receipt of care. This study evaluated CSP for pediatric patients identified by PCP or psychiatrists (PSY) for MDD with respect to follow-up visits, antidepressant medication (ADM) adherence, and mental health (MH)-related hospitalization. Methods: Data used for this study were obtained from 2006–2007 Medicaid Analytic eXtract (MAX) for New York State and comprised 850 children and adolescents aged 10–20 years, with a minimum of two consecutive MDD diagnoses (ICD-9-Clinical Modification: 296.2, 296.3, 300.4, 311) and administration of ADM. Patients with bipolar disorders were excluded. Patients identified by PCP [N ¼ 587 (69 percent)] or PSY [N ¼ 263 (31 percent)] were followed for 6 months to observe differences in the management pattern. ADM adherence was measured as having ADM 84 of the first 114 days of index prescription (HEDIS). The plurality approach was used to define the principal provider (PP) as either PCP or PSY, based on the number of visits (50 percent). Results: Pediatric MDD cases first identified by PSY were younger (10–13 years; PSY: 27 percent vs. PCP: 20 percent; P ¼ 0.02), mostly male (PSY: 44 percent vs. PSY: 22 percent, P < 0.001), white (PSY: 48 percent vs. PCP: 37 percent, P ¼ 0.02), and with preindex psychiatric comorbidities (PSY: 79 percent vs. PCP: 64 percent, P < 0.001). A small percentage of patients exclusively continued with the same specialty for MDD care (PCP-identified: 6 percent vs. PSY-identified: 12 percent, P < 0.01). Less than half (43 percent) of PCP-identified cases had PSY as their PPs, whereas only 16 percent of PSY- J OURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016 identified cases had PCP as their PPs (P < 0.0001). Compared with PCPidentified patients, PSY-identified patients received more follow-up visits [mean (SD): PSY: 9.57 (9.06) vs. PCP: 7.36 (7.67), P ¼ 0.007]; had better ADM adherence (PSY: 54 percent vs. PCP: 45 percent, P ¼ 0.01); and less hospitalization (PCP: 15 percent vs. PSY: 2 percent, P ¼ 0.002). Conclusions: The findings of this study provide evidence that disparities in quality and outcome exist between PCP- and PSY-initiated MDD diagnosis and treatment. Care coordination may be a solution to bridge the gap and eventually eliminate the disparities in the quality of MDD care and patients’ outcome. ADMIN ADP DDD http://dx.doi.org/10.1016/j.jaac.2016.09.240 4.46 THE IMPACT OF HIGH FIDELITY WRAPAROUND ON PENNSYLVANIA’S YOUTH AND FAMILIES WITH COMPLEX NEEDS Monica W. Payne, MA, Youth and Family Training Institute, Youth and Family Training Institute, 4055 Monroeville Blvd., Building One, Suite 438, Monroeville, PA 15146; Lauren H. Jones, BS, Youth and Family Training Institute, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, 4055 Monroeville Blvd., Building One, Suite 438, Monroeville, PA 15146; Ken C. Nash, MD Objectives: The study examined functional outcomes resulting from high fidelity wraparound (HFW), a youth-guided and family-driven planning process that follows a series of phases, principles, and activities to help youth with complex mental health issues and multisystem involvement. Methods: Eligible youth were between the ages of 8 and 21 years, enrolled in the HFW process in their county (13 counties participated), had a primary mental health diagnosis, were also involved in other child-serving systems, and were at risk for out of home placement. This poster will focus on the baseline to 12 months (n ¼ 40 families: youth and primary caregivers) in the following assessments: Child Behavior Checklist for youth ages 6 to 18 years (CBCL 6–18); Revised Children’s Sample Manifest Anxiety Scale, 2nd Edition (RCMAS–2); Reynold’s Adolescent Depression Scale (RADS–2); Caregiver Strain Questionnaire (CGSQ); Delinquency Survey, Revised (DS-R); and MultiSector Service Contacts (MSSC–R). Results: After 12 months of HFW, youth were shown to have a 22.8 percent improvement on the internalizing behavior scores and a 2.8 percent improvement on the externalizing behavior scores of the CBCL 6–18. Youth who scored in the clinical range on the RCMAS for anxiety decreased by 10.7 percent, and youth who scored in the clinical range on the RADS-2 for depression decreased by 16.7 percent. Caregivers experienced less stress and strain on the global strain score of the CGSQ. Youth experienced a 9.1 percent decrease in arrests and a 15.1 percent decrease in convictions. Better care coordination resulted in a 25.8 percent decrease in crisis stabilization services, a 9.1 percent decrease in medication monitoring, a 21.9 percent decrease in individual therapy, a 12.5 percent decrease in day treatment, a 21.9 percent decrease in psychiatric inpatient services, and a 15.6 percent decrease in residential treatment facilities, comparing the results from 6 months before baseline with results from 6–12 months. Conclusions: HFW is associated with significant improvement in mental health symptoms, problem behaviors, caregiver strain, delinquent behaviors, and less utilization of costly crisis stabilization, and outpatient, inpatient, and residential services after 12 months of participation. Findings indicate the importance of using the HFW process for youth and families who are the hardest to reach and who result in the highest cost to the child-serving systems. CC EBP LONG Supported by SAMHSA grant SM59056 http://dx.doi.org/10.1016/j.jaac.2016.09.241 4.47 COMMERCIALLY SEXUALLY EXPLOITED YOUTH VOICES: PERSPECTIVES ON HEALTH CARE NEEDS AND BARRIERS TO TREATMENT Shushanik Gaboian, MSW; Roya Ijadi-Maghsoodi, MD; Elizabeth Barnert, MD, MPH, MS; Mekeila Cook, PhD; www.jaacap.org S177