September 01, 2012

National Responses to Psychotropic Medication Use by Children in Child Welfare

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.

Are children in foster care being overmedicated? The question is receiving a lot of attention lately. Legal professionals should be aware of recent national efforts to ensure appropriate psychotropic medication use among children in the child welfare system.

The federal Administration on Children and Families (ACF) has released two Information Memoranda, one on promoting social and emotional well-being among children in the child welfare system, and the second on oversight of psychotropic medication use with children in foster care.

The federal Department of Health and Human Services convened an interagency working group to address emerging research and help states implement new statutory requirements addressing oversight of psychotropic medication in their Child and Family Service Plans through training and technical assistance.

ACF convened a summit, Because Minds Matter: Collaborating to Strengthen Management of Psychotropic Medications for Children and Youth in Foster Care in August 2012 to help states create and implement required oversight protocols.

The Children’s Bureau recently released “Making Healthy Choices: A Guide on Psychotropic Medications for Youth in Foster Care” to help youth understand when they need help, weigh options for medication use, ask questions about their diagnosis and treatment, and take medication safely.

To inform these efforts, researchers with ACF’s Office of Planning, Research and Evaluation have released a new research brief, Psychotropic Medication Use By Children in Child Welfare. The researchers examined data from the National Survey of Child and Adolescent Well-Being (NSCAW) to identify:

  • rates of psychotropic medication use by age among children in various placement settings;
  • rates of antipsychotic use by preschoolers, school-aged children, and adolescents in child welfare; and
  • types of behavioral services received by children in child

The findings show that children in out-of-home settings have higher rates of psychotropic medication use than children in in-home settings, and both are higher than rates in the general population. Factors associated with medication use include being male, race/ethnicity, and prior placement in an inpatient mental health setting. Four markers of potentially inappropriate medication use revealed:

  • 3.5% of children under age six were taking one or more psychotropic medication;
  • 3.1% of all children were taking three or more medications;
  • 4.3% of all children were taking one or more antipsychotics while 2-6% of children under age six, depending on their placement, were on antipsychotics; and
  • 9.4 % of children living out of home and 1.8% of children living at home used psychotropic medication without receiving any other mental health services.

The findings support the need to address children’s unmet mental health needs—more than half of children living in-home or informally with kin as well as a third of children in foster care met a clinical threshold for mental health needs. Yet many did not receive any behavioral health services, whether pharmaceutical or psychosocial. The researchers identified this underuse of mental health services to be just as important as the potential overuse of medications.

The findings suggest that entering foster care is a gateway for children to access specialty mental health services from various settings. Once in care, their needs should be brought to the attention of the many professionals and individuals engaged in their lives, including caregivers, teachers and school staff, primary care providers, social workers, lawyers, and court system staff. Coordinating care for this vulnerable population and encouraging collaboration among the many professionals and agencies involved is essential to ensure these children receive appropriate and effective treatments to address their mental health needs.

Eva J. Klain, JD, directs the health projects at the ABA Center on Children and the Law.

Source: Stambaugh, L.F. et al. Psychotropic Medication Use by Children in Child Welfare. OPRE Report #2012-33, Washington, DC: Office of Planning, Research and Evaluation, ACF, U.S. DHHS, 2012.