“Drugs First, Ask Questions Later” Approach to Foster Youth Needs to Change

Recent reports by the Center for Health Care Strategies (CHCS) urge better, more cautious practices with respect to psychotropic medication of foster children. In 2005, nearly half of all foster children who were treated with psychotropic medications were prescribed anti-psychotic drugs, multiple medications, and/or medications without any other form of behavioral health service, according to CHCS.

Since 2005, these problems have steadily increased. The CHCS reports reveal:
• Almost half (48.7%) of children in foster care who were medicated with psychotropic drugs were dosed with two or more drugs at the same time (p. 66).
• Nearly half (42.1%) of foster children on psychotropic medications were prescribed one or multiple antipsychotic drugs (p. 17).

• Almost none (1% or fewer) of children in Medicaid (which includes foster children) who received behavioral health services were offered the best alternatives or adjuncts to drugs: wraparound, therapeutic foster care, Multisystemic Therapy (MST), peer support, or telehealth services (p. 15).
• Many (22%) foster children who received psychotropic medications received no treatment except drugs (p. 16).
• ADHD, mood disorder, and anxiety were the most common diagnoses. Psychotic disorders—the nominal target of “antipsychotic” drugs—were relatively rare (p. 28).

CHCS has identified a range of promising practices that offer safer treatment. In a CHIPRA webinar and overview, Kamala Allen noted several promising approaches:
• Non-pharmacological services first; consider pharmacology only later.
• Educate prescribers; drug manufacturers should not be physicians’ main source of current knowledge.
• Establish “red flag” systems with peer review and second opinion processes.
• Provide compulsory or optional second opinion support for primary care providers.
• Educate children, youth, and caretakers about psychotropic medications: their desired effects, adverse effects, and dangers.

We believe that more can be done to ensure that foster youth are connected to evidenced based behavioral and mental health treatments. Initiatives at the state and county level should include targeted goals to reduce medication-only treatment for foster youth.

Access to evidence-based interventions for behavior and mental health management should be tried first. Use of anti-psychotics should be limited and short-term. As always with psychotropic medications, the “start low, go slow, stabilize, begin to taper-off” approach should be accompanied by regular monitoring for adverse effects.

Anna Johnson is a policy analyst at Young Peoples Policy Solutions.

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About Child PsychDrug Safety Team 3 Articles
I am a trained advocate, teacher, and policy analyst focusing research efforts on safe, culturally and developmentally appropriate systems of education and health care for youth and families.

1 Comment

  1. Thank you for raising awareness and working toward better policies and practices on this important issue that effects children and youth. Please keep up the good work. It’s folks like you that really do make our world a better place; one issue, one thought change at a time.

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