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July 01, 2012

Improving Oversight of Psychotropic Medication Use with Children in Foster Care

Eva J. Klain

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

Overuse of psychotropic medication with children in foster care presents challenges for child advocates. The Children’s Bureau, Administration on Children, Youth and Families, is boosting state oversight in this area. It recently issued an Information Memorandum, Promoting the Safe, Appropriate, and Effective Use of Psychotropic Medication for Children in Foster Care, that explains increased state oversight through state plans and monitoring (ACYF-CB-IM-12-03, found at

Planning and Oversight

The Child and Family Services Improvement and Innovation Act requires that states develop protocols for the appropriate use and monitoring of psychotropic medications. This requirement builds on the provisions of the Fostering Connections to Success and Increasing Adoptions Act of 2008 to develop a plan for oversight and coordination of health care. The state protocols now must be explicitly addressed in state Annual Progress and Services Reports (APSRs), which were due June 30, 2012.

States’ plans will be evaluated on whether they address five common elements:

  • Comprehensive and coordinated screening, assessment, and treatment evaluation mechanisms to identify foster children’s mental health and trauma treatment needs.
  • Informed and shared decision-making mechanisms to promote continuous communication among the prescriber, child, caregivers, caseworker, and others.
  • Adequate and effective medication monitoring at the client and agency level.
  • Availability of mental health expertise and consultation by board certified or board-eligible child and adolescent psychiatrists on consent and monitoring issues.
  • Ways to access and share accurate and up-to-date information and educational materials related to mental health and trauma-related inventions with clinicians, child welfare staff, and

The Children’s Bureau will work with states to develop quality plans. A summit scheduled for August 2012 titled “Because Minds Matter: Collaborating to Strengthen Management of Psychotropic Medication for Children and Youth in Foster Care” will bring together teams from all 50 states, the District of Columbia, and Puerto Rico. The teams will develop action plans to improve upon and implement their existing oversight protocols.

What Advocates Can Do

Advocates can provide input in several ways:

  • Review the state APSR (often posted on the child welfare agency’s website or provided on request) and provide feedback.
  • Identify members of the state teams attending the August summit, which consist of two representatives from child welfare, mental health, and Medicaid. Give them input on the oversight protocol.
  • Work with other stakeholders to identify mechanisms to address each of the five common elements required in the oversight plans.
  • Ask to participate in any pre-summit meetings or work groups to fine-tune the state’s APSR.

Eva J. Klain, JD, directs the Child and Adolescent Health Program at the ABA Center on Children and the Law, Washington, DC.


Psychotropic Medication and Children in Foster Care: Tips for Advocates and Judges, by JoAnne Solchany, PhD, ARNP

Child Welfare Information Gateway

“Joint Letter to State Child Welfare, Medicaid, and Mental Health Authorities on the Use of Psychotropic Medication for Children in Foster Care”

Use of Psychotropic Medication Among Children in Foster Care Webinar Series

HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions: GAO-12-270T (December 2011).